Children with facial differences, such as repaired cleft lip and palate (CLP), may present with reduced capacity for sensorimotor simulation, particularly in the form of facial mimicry. This study examined whether facial mimicry, emotion recognition, and empathy skills are reduced in children with CLP when compared with sex/age-matched controls. A case-control design was utilized. Forty-five children between the ages of 8 and 12 with CLP, and 45 age/sex-matched controls were recruited. Participants completed a facial mimicry task, and facial movements were tracked and quantified using OpenFace. Participants also completed picture and context-based emotion recognition tasks. Picture-based assessment involved identifying emotions from the Dynamic FACES database. Context-based assessment consisted of identifying how a child might feel in various situations. Finally, participants and their parents completed the Empathy Questionnaire for Children and Adolescents (EmQue-CA). Children with CLP presented with significantly reduced facial mimicry (p = .017), picture-based (p < .001), and context-based emotion recognition scores (p < .001) when compared with controls. Better facial mimicry was associated with better picture-based emotion recognition scores in the control group only (r = .22, p < .01). Children with CLP also had significantly lower child and parent-proxy EmQue-CA scores (p < .001). Greater facial mimicry significantly predicted better parent-proxy EmQue-CA scores (p = .016) but did not predict child scores. Children with CLP presented with reduced facial mimicry, poorer emotion recognition, and empathy skills. These findings have a broader relevance as they suggest children with facial differences may present with reduced facial mimicry and/or deficits in emotion recognition. (PsycInfo Database Record (c) 2024 APA, all rights reserved).