The decision to seek secondary treatment for facial clefts is often the result of concerns about the esthetic acceptability of appearance. There are no standard techniques to assess cleft impairment for esthetic acceptability. Therefore, it is not possible to evaluate objectively either the need for or the benefits of treatment. If it could be shown that people agree closely on how they rate the esthetic appearance of cleft impairments that vary in severity, then esthetic measures of cleft impairment could be developed with human judgment as the yardstick. The goals of this study were: (1) to examine the reliability with which children express their preferences for cleft impairments that vary in severity, (2) to determine if other facial characteristics influence the reliability of children's preferences for cleft impairments, and (3) to evaluate if age and gender of children influence preferences for cleft impairments. Based on preratings, eight types of photographic slides were created that varied in severity of cleft impairment and global facial attractiveness. A second sample of subjects then rated the slides on the esthetic acceptability of appearance. Children ranked the photographic types consistently. They least preferred the photographic types depicting severe impairment or low facial attractiveness, or both, and most preferred faces with no impairment or moderate attractiveness, or both. There were also developmental effects in that younger children tended to have less consensus in their ratings of appearance than older children. Finally, boys displayed greater consensus than girls.