As a parent, you want to give your child the best possible start in life. You work tirelessly to ensure they have everything they need to thrive.
But what happens if your child is born with a cleft palate (hole in the roof of the mouth) and/or cleft lip (a split in the upper lip)? These structural problems affect about 1 in every 700 babies born in the United States and can affect a child’s eating, speech and language.
While the holes and clefts in the lip and palate are often fixed with surgery, your child may need speech and language therapy too. According to the Cleft Lip and Palate Association, around half of all children with a cleft palate will need speech and language therapy.
Pediatric speech and language therapy is a type of treatment that focuses on improving a child’s ability to communicate effectively. It can be especially beneficial as it can help them overcome the unique challenges that come with a repaired cleft lip and palate.
Whether your child has recently been diagnosed with a cleft palate or lip, or has already undergone a repair, we share valuable information to help you support your child’s communication and language skills.
How cleft lip and palate affects speech
The soft palate (the back part of the roof of your mouth) plays an important role in speech production as it closes off the nose from the mouth during speech.
“It moves to make sure no air escapes through your nose when you make certain sounds,” said Jonathan Skirko, MD, a craniofacial plastic surgeon and pediatric otolaryngologist with Banner Children’s. “The palate moves up and back for sounds like p, b, t, sh and ch. It lowers to let air pass through the nose for letters like m, n and ng.”
Your child’s speech could be affected if their palate doesn’t work well. Children with cleft palates can also experience delays in developing proper speech patterns, making it difficult to understand them.
“There are several ways that orofacial clefts, like a cleft palate, can impact speech and communication,” said Robin Samlan, Ph.D., a speech and language pathologist with Banner–University Medicine. “The impact on speech depends on your child’s age, the type of cleft and the surgical repair they had.”
Some common speech problems in children with cleft palate include:
- Articulation disorder: Trouble making certain sounds clearly and correctly. This can be due to errors caused by structural issues, such as fistulas or velopharyngeal insufficiency (VPI), or because your child is not physically able to form the pressure needed to sound out certain letters. “VPI is when the soft palate does not close tightly against the back of the throat,” Dr. Skirko said. “This can cause air to come out the nose, making speech difficult to understand.”
- Resonance disorder: Abnormal balance of sound and voice quality. Your child might sound like they have too much sound in the nose (hypernasality) or like they have a cold, and no sound can get through the nose (hyponasality). VPI can also cause a resonance problem.
- Dysphonia: Abnormal voice or hoarseness. If your child is trying hard to produce speech sounds, but the air leaks out of their nose, they may push harder from the throat. This can cause their voice to sound raspy, hoarse or breathy.
Who provides speech and language therapy?
Speech and language pathologists, called SLPs or speech therapists, are critical to your child’s cleft palate care team.
“During their lifetime, children with cleft palate will be evaluated many times by SLPs for communication, feeding and swallowing, assessing the need for services,” Dr. Samlan said. “Each child will have different needs at different stages of life.”
Your child will be seen pre-palate repair, post-palate repair and every one to two years or more often, as needed until their speech is no longer a concern.
"The speech pathologists work with the rest of the team – which may include their surgeon, audiologist, otolaryngologist and dentist, among others – to determine how behavioral speech and language or feeding therapy could help in combination with surgical interventions to support optimizing your child’s communication,” Dr. Skirko said.
How speech and language therapy can help
There is no one-size-fits-most approach to speech and language therapy. Your child’s speech therapist will develop a treatment plan tailored to your child’s individual needs.
In general, speech and language therapy can help your child:
- Establish good articulation. This goal includes many skills to help the articulators (tongue, lips, etc.) do the right things to produce speech sounds. Your child will learn how to make all the speech sounds and improve the clarity of their speech.
- Maximize good oral pressure during speech sound production. This goal teaches children to build up the air pressure for speech sounds as best as possible based on their current structures and limitations. Your child may have developed issues from structural problems (like holes in the palate), or it may be due to habits they learned when there were problems that have since been fixed.
- Develop new motor speech patterns to replace speech sound errors. After cleft palates are repaired, many children still make errors in speech because of the habits they have formed. Speech therapists can help your child unlearn those habits or use facilitative contexts to “trick” them into making a correct sound.
“For example, we might use a well-produced ‘t’ or ‘th’ sound to achieve an ‘s’ sound,” Dr. Samlan said. “Once a target production is achieved, the speech and language pathologist will fade the supports that help the child produce the new sound and move toward automatic use in conversational speech.”
These types of sounds are often occurring along with hypernasality or VPI. Sometimes correcting these habits or errors can be difficult without first correcting the hypernasality, usually done with surgery.
What parents can do to help
- Don’t delay care. Speech therapy should begin as soon as possible. The earlier you start, the greater your child’s chance of success.
- Practice at home. Your support is also vital to your child’s progress in speech and language therapy.
The therapy sessions are short and infrequent compared to the amount of time your child is with you. Think of the sessions as treatment and training sessions to allow you to continue the work at home.
“Being able to practice with your child at home will help speed progress,” Dr. Samlan said. “If you are practicing with your child, you want it to be something where you know whether the production was correct and how to cue your child if they need help. Similar to how reading with your child at home will help their reading skills flourish.”
- Have patience. Overcoming speech or language issues can take some time and effort. It’s important to be patient and understanding.
- Speak up. Don’t be afraid to ask questions when you have them. You are your child’s advocate and will help ensure their care team is on the same page.
- Get a second opinion. If you’re uncomfortable with the answers you’re receiving or the progress you are seeing, seek a second opinion from another professional.
A child with a cleft lip and/or cleft palate can have feeding and speech problems. Speech and language therapy can help. It can play a huge part in helping your child become the clearest, most confident communicator they can be.
Your child’s cleft palate care team will have recommendations for speech therapists. But if you are looking for a speech therapist who specializes in cleft palate, check out the American Cleft Palate-Craniofacial Association to search for teams of specialists.
You can also find a Banner Health specialist near you by visiting bannerhealth.com.