These are deformities requiring the attention of the surgeon, and under ordinary circumstances his aid should, in case of simple harelip, be sought Within the first six months of the child's life, so that the operation may be well over before dentition begins. The fourth month is the period of election, but should there be difficulty in sucking and any evidences of inanition, the operation may be performed at an earlier age. The operation for cleft palate should not be undertaken before the end of the second year.

So far as the mother is concerned, the question of importance is whether or not there is any interference with the act of sucking. If harelip be trifling, the infant will be able to suck, provided the mother's nipple be large and the milk flow freely; when the reverse is the case, resort to a nipple shield. In grave cases, especially when harelip is associated with cleft palate, the child is unable to suck either from the breast or from the bottle, and must be fed from a spoon. Occasionally one can succeed in feeding a child so affected from a bottle, by resorting to a false palate. This consists of a bit of thin india rubber, cut the size and shape of the roof of the mouth and fastened by several firm stitches to an ordinary bottle tip (Fig. 24). In using this instrument, the nurse must insert it into the mouth in such a way that the rubber diaphragm will come uppermost and bridge over the imperfect portion of the palate.

Fig. 24. - Tip with False Palate.