(d) Source: (Hay et al, pp 1047-1048. Kliegman et al, pp 1252-1253. McMillan et al, pp 469-472, 2661-2662. Rudolph et al, pp 705- 710.) The infant pictured has bilateral cleft lip and palate. The incidence in the general population is about 1:1000 live births, but occurs in about 4% of the siblings of affected infants. Evaluation for other structural and chromosomal abnormalities is indicated. Although affected infants are likely to have feeding problems initially, these problems usually can be overcome by feeding in a propped-up position and using special nipples. Complications include recurrent otitis media and hearing loss as well as speech defects, which may be present despite good anatomic closure. Repair of a cleft lip usually is performed within the first 2 to 3 months of life; the palate is repaired later, usually between the ages of 6 months and 5 years.