Cleft lip and palate is a relatively common congenital condition presenting for surgical correction. Anaesthetic management has some specific considerations involving airway surgery in infants and young children who may have other associated anomalies. Surgical care pathway and approaches are discussed as relevant to anaesthesiologists. Perioperative management, including preassessment of the child, optimisation prior to surgery, intraoperative and postoperative care, is presented. The importance of a multidisciplinary approach, good communication, shared airway management and adequate multimodal analgesia with the avoidance of respiratory depression are highlighted. Anaesthesia for secondary speech surgery is also presented.