Cleft Lip and Palate Guide

Speech and Language

The person on the Children’s Healthcare of Atlanta Craniofacial team who works with your child’s speech and language is the speech/language pathologist (SLP). Your SLP will conduct regular checkups as your child grows to see how his speech is developing.

Based on these checkups, the SLP may advise treatment. Your child’s treatment may include speech therapy and surgery. Your child can be ready to speak at a normal level for his age by the first year in school.

  • How We Speak

      In English, we use about 46 sounds to speak. Some of these are vowel sounds like "a," "o" and "ow." Other sounds are consonant sounds like "p" and "d."

      - Of these consonant sounds, three—"m," "n" and "ng"—are spoken through the nose. These are the nasal sounds.

      - To make the remaining 43 sounds, the soft palate must seal off the nose and force sound out the mouth. This is important for the vowel sounds.

      - For the 16 pressure consonants sounds, such as "b," "d," "p" and "t," this is vital because air pressure is needed for enunciation (clear pronunciation of words).

      Children with a cleft lip and palate often develop other ways to attempt speech sounds that are hard to make. Once bad habits are learned, they are very hard to "un-learn." This is why it is important that early speech habits are learned correctly the first time.

  • Learning Speech and Language

      Children begin practicing for speech during the first year of life. Speech begins with sounds that are easy to make (vowels such as a, e, i, o and u) and progresses to sounds that are harder, such as "th," "st" and "str." For children, learning speech happens like this:

      - First they make general sounds, such as cooing and vowel sounds

      - Then they make sounds that are like speech sounds, such as babbling and consonant sounds

      - Then they make real speech sounds and words

      - After putting some speech sounds together to form words, they begin to make sentences

      For a child with a cleft lip and palate, it may be hard to move through these steps because of an opening into the nose, missing teeth or teeth that are out of line.

  • Requirements for Normal Speech Development

      1) Your child must hear spoken words clearly. We all must hear clearly before we can speak. The audiologist will test your child’s hearing and talk with you about any needed treatments.

      2) Your child must have a proper mouth structure. Most children with a cleft palate can speak normally once their palates are repaired. But some children still have very nasal voices because of air escaping from the nose. These children may need more surgery to close that opening in the future. Your SLP can perform many types of tests to check your child’s speech.

      4) Your child’s intelligence must grow for his or her speech to do the same. Not all children with speech problems have cognitive (mental) and learning problems. But some children with cleft lip or palate do have developmental delays and cognitive problems. The neuropsychologist on your Craniofacial team can help you monitor your child’s cognitive growth.

      5) Your child must have someone to teach him. Children learn to speak by listening to the voices of others. You can help your child begin to link spoken words to objects and actions. Talk often to your child about the objects and actions in his world. This includes people, toys, food, playing, bathing and feeding.

  • How does the Soft Palate Work?

      The soft palate is a muscular door attached behind the hard palate in the roof of the mouth.

      During speech, the soft palate opens and closes a doorway (the nasopharynx). This doorway is hidden and cannot be seen by looking in the mouth. It adjusts sounds and air flow from the throat to make speech sounds. If the soft palate doesn’t close the doorway when it should, a number of speech problems can result.

  • Speech and Language Modeling

      Your speech/language pathologist and the rest of the Children’s Healthcare of Atlanta Craniofacial team will do everything they can to make sure your child has the tools to build normal speech and language skills. But you and your family play the most vital roles in this process. Your child will pattern speech after the voices heard around him, so you and your family members are all models.

      Children who do not hear enough spoken language may have problems with speech and language skills. They may not learn certain skills (such as vocabulary and grammar) simply because they are not exposed to them. This is why your role as a model is so important.

      As a model, there are a few things you can do to help your child improve his skills:

      - Speak clearly and pronounce words well

      - Use short sentences when you speak to your child

      - Avoid "baby talk," as it does not help your child learn to speak properly

      Children learn "object" words first, so teach your child the names of objects. This includes the names of people, toys, food, utensils and furniture. Name and talk about new objects during shopping trips and visits.

      Between the first and second year, children often learn "action" (like walk, eat, and play) and "description" (like soft, wet and furry) words. When your child begins to show interest in books, begin by talking about the pictures. Take turns naming objects and talking about what is taking place in the pictures.

  • Speech Problems

      There are three main types of speech problems: hypernasality, hyponasality and articulation.

      - If the soft palate is too small (or the nasopharynx too big), speech may be hypernasal. This is when the soft palate allows sound to pass through the nose during words that should not be nasal. As a result, speech sounds too nasal.

      - If the doorway is too small, speech may be hyponasal. This is when sound can't pass into the nose when it should. As a result, it may be hard to make nasal speech sounds like "n" and "ing." A small doorway can also cause breathing problems and snoring.

      - Articulation means being able to make sounds correctly. Articulation problems are caused by air leaking out of the nose or by teeth that are out of line. Poor speech habits often result when a child tries to find other ways to make difficult sounds. Many consonant sounds are hard to make if the sound passes through the nose.

  • Surgery to Improve Speech

      Surgeries to repair a cleft lip and/or cleft palate are different for each child. Correcting a soft palate problem often involves the combined skills of your craniofacial surgeon, orthodontist and speech/language pathologist (SLP).

      Your Craniofacial team will study your child and perform many tests to decide how cleft lip and palate surgery will be done. The structure and function of the soft palate are tested by:

      - Visual exam

      - Videofluoroscopy (motion X-ray pictures)

      - Special fiber-optic scopes

      - Computerized instruments

      These studies help us decide how your child's cleft lip and palate will be treated. If these studies are needed, your SLP will teach you about the tests.

      Most children need only one surgery, but some need follow-up work as well. Your craniofacial surgeon, orthodontist and SLP will talk with you if your child needs further surgery.

      After surgery, your SLP may give your child a set of sounds to practice. These speech exercises will most likely become much easier as your child heals. Follow your SLP's advice to help your child improve his speech as quickly as possible.