The effect of cleft lip and palate, and the timing of lip repair on mother–infant interactions and infant development


Lynne Murray, Winnicott Research Unit, School of Psychology, University of Reading, Reading RG6 6AL, UK; Email:


Background:  Children with cleft lip and palate are at risk for psychological problems. Difficulties in mother–child interactions may be relevant, and could be affected by the timing of lip repair.

Method:  We assessed cognitive development, behaviour problems, and attachment in 94 infants with cleft lip (with and without cleft palate) and 96 non-affected control infants at 18 months; mother–infant interactions were assessed at two, six and 12 months. Index infants received either ‘early’, neonatal, lip repair, or ‘late’ repair (3–4 months).

Results:  Index infants did not differ from controls on measures of behaviour problems or attachment, regardless of timing of lip repair; however, infants having late lip repair performed worse on the Bayley Scales of Mental Development; the cognitive development of early repair infants was not impaired. Difficulties in early mother–infant interactions mediated the effects of late lip repair on infant cognitive outcome.

Conclusions:  Early interaction difficulties between mothers and infants having late repair of cleft lip are associated with poor cognitive functioning at 18 months. Interventions to facilitate mother–infant interactions prior to surgical lip repair should be explored.