Cleft Palate Related Speech Errors

Cleft lip and palate in one of the most common birth differences, impacting approximately one in 700 babies born each year.  A cleft lip alone doesn’t typically cause much of a problem for speech development, but all kids with cleft palate should be monitored by a speech pathologist to make sure that they develop good speech skills.  In fact, all kids with cleft lip and palate should be followed by an interdisciplinary cleft team from birth until they’ve finished growing and all of their surgeries have been completed.

A cleft palate impacts speech development because a baby isn’t able to seal the nose from the mouth during early babbling play, which creates problems for being able to experiment with oral pressure build up.  We don’t consciously think about the fact that our soft palate, the muscle connected to the roof of the mouth, is moving while we’re speaking.  But that little muscle actually plays a very important role in speech because it moves up and back to seal off the nose from the mouth.  This allows us to build up pressure and release it as a feature of our consonant production.  In English, there are 16 consonant sounds that require pressure build up and release.  Some examples of the earliest high pressure consonants are /p/, /b/, /t/, /d/, /k/, and /g/.  These sounds are also some of the earliest consonants babies experiment with when learning to babble.  Because the cleft palate makes these sounds challenging, babies will either start experimenting with sounds in their throat, which usually sounds like growling or grunting, or they’ll be limited to just a few sounds that don’t need oral pressure build up.  The only sounds that should come through the nose are the nasal consonants /m/, /n/, and “ng” (like in the word “sing”).

Luckily most kids will start producing pressure consonants soon after they have their palate repaired with surgery, which usually happens between 9 and 15 months of age.  The goal is to do the surgery around or before the baby’s first birthday, since that’s also when most babies will start to be ready to say his or her first word.  Having a functioning soft palate means that babies have the best chance to learn first words with oral pressure consonants, reducing the chance that some of that early growling or reliance on nasal sounds will become a habit, substituting throat sounds or nasal sounds for oral consonants.

If these habits do form, then speech therapy is needed to correct them.  Speech therapy for cleft palate substitution errors, like substituting a sound in the throat for a /p/ or /b/, is effective when the focus is on teaching the child to learn how to produce the sound in the mouth.  The therapist instructs the child about how to use their lips or tongue, depending on the sound they’re practicing, and then the child will practice this over and over again until it becomes easy and they start to use the sound in conversation.

A few kids with a repaired cleft palate will need another surgery to help their speech.  This is the case when the child has a condition called velopharyngeal insufficiency, meaning that the velum, or soft palate muscle, is not able to move enough to contact the pharynx, or walls of the throat.  As a result, air and sound leaks through their nose when they talk.  This makes their speech sound hypernasal, meaning it sounds too nasal compared to how it should sound for where they live.  This condition occurs in approximately 15 to 20% of kids who have their palate repaired as a baby and currently, best practice is to fix the physical problem with surgery.  This is why regular appointments with a cleft palate team are so important early in a child’s life.  Fortunately, an experienced surgeon has good success with correcting the problem, with great results for speech!  Often, a combination of speech therapy and surgery is needed to get the best results for speech.  The goal is that by the time a child enters school, his or her speech will sound like any other child’s—maybe they still have a few speech errors like /w/ for /r/ present, but so do tons of kids in the class.

Do you have questions about cleft palate related speech issues?  Reach out today for a consult!