speech problems with cleft palate

Cleft lip and cleft palate are among the most common congenital disabilities. This condition occurs due to abnormal development in the womb. These structural problems are often fixed with surgery, as early as possible. But even with surgery, speech therapy is still often needed to help the child produce speech sounds clearly

Speech-language therapy helps the kids improve speech, understand and use language, and communicate in non-verbal ways. Speech-language pathologists or speech therapists treat many types of communication and swallowing problems. This article will address issues related to speech in children with cleft palate and how to correct it.

What is a cleft palate?

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and the soft palate (the soft back portion of the roof of the mouth).

How does a cleft palate affect speech?

To speak, you build up air pressure in your mouth, and to create specific sounds, you touch your tongue to various oral structures- including the roof of the mouth or palate. In children with cleft palate, air escapes into the nasal passages, making it challenging to build up pressure. There also isn’t enough tissue in the palate for the tongue to touch.

Children born with a cleft palate may need speech-language therapy to help with problems such as –

Articulation and resonance disorders

An articulation disorder is when a child has trouble making specific sounds including-

  • Glottal stops-formed by a ”pop’ of air when the child forces his/her vocal folds together.
  • Nasal fricatives- It is formed by directing the stream of air through the nasal cavity, instead of the oral cavity, during the speech.
  • Pharyngeal fricatives- It is formed by pressing the base of the tongue against the back of the throat and releasing a stream of air for speech.
  • Mid-dorsum palatal stops-formed when the middle of the tongue contacts the middle of the roof of the mouth and used as a substitute for this sounds-T, D, K, and G.

A resonance disorder refers to an unusual amount of nasal sound energy when the child is talking, which can result in –

  • Hyper nasality (too much nasal sound energy)
  • Hypo nasality (too little nasal sound energy)
  • Mixed (a bit of both) resonance

What are the goals of speech therapy?

All children with a history of cleft palate are different and should be treated as such. No one treatment plan will adequately serve each child with this condition. The following are some general goals that should be considered: (1) (2)

  • Establish correct oral articulatory placement and airflow direction and pressure build-up at the target place, using behavioral and articulation (motor-phonetic) therapy.
  • Maximize the intra-oral air pressure build-up during speech sound production.
  • Teach new motor speech patterns to replace maladaptive articulation errors.

What is the timeline for cleft palate speech therapy?

This timeline chronicles the stages in which a child with cleft palate undergoes speech therapy.

Infants and toddlers (0-3 years)

During this age, Speech-Language Pathologists (SLP) should instruct parents how to be the ”therapist’ at home, as parents naturally become a child’s first language instructor. SLPs should teach parents how to encourage good speech habits and recognize the development of bad speech habits.

Most experts recommend cleft palate repair at 8-18 months.  Following surgery, it is not uncommon to see a decrease in both the frequency and variety of a child’s vocalizations for up to 6 weeks. Speech therapy can begin as early as two weeks following surgery if the patient feels well, and the surgeon agrees.

Young children (3 years and up)

In this age group, the patient should be evaluated by the SLP regarding a need for further speech therapy. Children in this age group are very receptive to learning new language skills, making this an ideal period for parents and SLPs to insure good language habits. After evaluation by an SLP, speech therapy should be initiated if multiple compensatory articulation errors are noted.

School-Age Children, Adolescents, and Adults (5 years and up)

In this age group, language skill development becomes more difficult, as the prime period of speech development has passed. While many patients will have corrected speech issues by this stage, others require on-going support, especially those who have had cleft palate repair at a later age. When therapy is required for school-age children, it is usually for correction of any articulation errors from velopharyngeal insufficiency or dental malocclusions.

What does speech and language therapy involve?

A speech and language therapist will usually carry out an initial assessment at around 18-24 months, followed by a further evaluation once the child is about three years old. Speech therapy for cleft palate can include the use of appliances, fun games, exercises, and drills. Some teams use a temporary speech appliance to guide a child’s speech. (3)

Another method of treatment may be to teach the child how to distinguish air passing through the nose from air passing through the mouth. Speech therapists also teach children articulation drills to practice making sounds correctly. (4) Here are some speech therapy techniques for the cleft palate –

Auditory feedback

It is a crucial first step toward correcting speech patterns. The child must first learn to distinguish between standard speech and nasalized sounds.

Articulation practice

Speech therapy techniques for children with a cleft palate emphasize on articulation practice.

Nasalized plosives

A plosive is a sound that is produced when a speech structure obstructs the vocal tract. Children with cleft palate produce nasalized plosives even after surgical treatment. It typically occurs when they improperly position the tongue. The SLP may have the child yawn to push the back of the tongue down.

Pharyngeal plosives

A pharyngeal plosive is produced when the base of the tongue moves backward against the pharynx. The SLP will encourage your child to make the ”ng’ sound. If they have trouble with this, a tongue blade may be used to press the tip of the tongue downward as the SLP pushes upward under the chin.

Pharyngeal fricatives

A pharyngeal fricative is produced when the tongue is retracted, but the base of the tongue doesn’t make contact with the pharyngeal wall. The SLP will first encourage your child to make a loud ”t’ sound, followed by a ”ts’ sound with his teeth closed.

Palatal Dorsal Productions

A dorsal palatal production may result in a lateral lisp. They can often occur due to malocclusion of the teeth. The SLP has the child bite down on a tongue blade, positioned in a way as to press down the tongue.

Over to you

A cleft palate is one of the most treatable conditions for newborns. Parents are naturally concerned about the long-term impact on their child’s appearance, speech, and dental health. Cleft palate speech therapy helps eliminate potential problems so that your child grows up speaking clearly and confidently. In partnership with parents, speech therapists help children with cleft palate express themselves in the same way as their peers. Cleft palate speech therapy offers a bright, confident future for children with this condition.