Children with cleft lip and/or palate and their families have a range of emotional and psychological difficulties associated with this congenital anomaly. This article reviews the literature available on this subject and highlights the main difficulties as being those of social isolation, speech and language difficulties, specific and global learning difficulties and poor self-image. There is a description of the interventions a child with cleft may require, ranging from surgical and orthodontic procedures, long-term speech and language therapy and frequent clinic appointments. It then goes on to describe the current services provided by cleft teams and suggests ways to enhance the mental well-being of these children and adolescents. This includes better communication between professionals of the difficulties this population may encounter, early identification and intervention where problems exist, input from mental health professionals and social skills workshops.