Cleft Palette Repair on Hold? How to Help Promote Speech

The current ongoing spread of COVID-19 has led to recommendations to postpone non-life sustaining medical treatment—a recommendation that carries implications for speech and language development of infants and toddlers with unrepaired cleft palate. The American Cleft Palate and Craniofacial Association issued a statement from a panel of experts discussing considerations for cleft related surgeries (find it here) and suggested that cleft palate repair may be delayed.

While certainly a delay in treatment may cause additional worry for parents of a little one with an unrepaired cleft, there are so many great ways to help encourage language development and expand their consonant inventory before surgery! Here are a few to focus on in the upcoming time prior to when surgery can safely occur.

Continue to provide lots of language stimulation

One of the most important things a parent can do for an infant or toddler who is learning to speak is luckily an activity that parents naturally love to do—talk to baby! One way to help increase language stimulation is by adding an extra book per day or per week when reading (don’t worry about aiming high now, we all need to recognize that just getting by is enough—but, if you have it in you to read a new book, it could be a nice novelty to add to your day with your little one).

Narrate baby’s day! Talking to baby about what he or she is doing during activities can be a great way to help provide extra language stimulation. “Now we’re washing your hands with the soap” or “we’re pouring the doggy’s food into his bowl—look how he likes to eat!” are examples of things we can say to babies and toddlers to help give them extra opportunities to learn words.

On the listening/receptive language side, we can “test” babies to give them a chance to think about the words we’re saying without any extra clues. For example, if you tell your young child to go get their shoes for a walk, try to hold back from pointing to where the shoes are kept at first. Give them a chance to process the words you’re saying, and then if they need a little help, try repeating the instruction and adding extra help like pointing.

Expand their consonant inventory as much as possible

Many babies with an unrepaired cleft palate don’t experiment with as many sounds as they could be. Even before primary palatoplasty, babies are physically capable of producing sounds /m/, /n/, /w/, “y” and /l/. Very often, babies may rely heavily on the /m/ sound. That gives us a lot to focus on in the months leading up to palate repair. See if you can get your baby to imitate an /n/, /l/, /w/, or “y.” One of the best ways to try to get a baby to imitate an adult is by starting out with imitating them first. If your baby makes the /m/ sound, try a few turns back and forth and then, when your turn comes up, switch to an /n/, which is another nasal sound, or a /w/, which also uses both lips. See if your baby will try this as well. If not, don’t worry, just keep working at it! Get baby to watch your lips while you make the sounds.

If your baby is older and starting to say some words, remember that these are sounds you can expect them to make in the words they’re saying (unlike the high pressure early consonants /b/, /d/, and /g/, which are very unlikely to come until after surgery). So, if they’re not using the tip of the tongue to make the /n/ or /l/ sound, you can show them how you lift the tip of your tongue up to behind your teeth to make these sounds.

Ignore growling sounds to prevent habituating compensatory articulation errors

Very often, babies with unrepaired cleft palate will go through a growling phase as they’re trying to figure out how to build up pressure for speech production. This can be very adorable, but we don’t want to reinforce it because we don’t want kids to get stuck using their throat for speech sound production in place of oral consonants after surgery is accomplished.

So, how do you effectively ignore this? First of all, we need to remember that babies and toddlers talk to many people, not just moms or dads. So, siblings and grandparents and anyone else who regularly interacts with the child needs to agree that we’re not repeating these growls. If the baby uses a growl to try to communicate or get attention, pause a few seconds so as to not directly reinforce the undesirable production. Then, try to turn to your baby or toddler and see if you can get them to produce something that’s more in line with what you’d like them to say, like “mama” if trying to ask mom for something.

Don’t worry about trying to avoid words they won’t be able to say clearly till after surgery

Often, parents wonder if it’s a problem for their child to attempt to say words that have high pressure consonants like /b/, /d/, /g/, /p/, /t/, and /k/ before surgery occurs. If a baby is unable to produce these clearly, is it a concern for them to practice incorrect productions? The short answer is no—babies should be encouraged to expand their language skills to the fullest extent possible, and while we don’t anticipate that they’ll be able to produce these high pressure consonants until after surgery, we don’t want to prevent them from trying. I once knew a toddler who was able to push out her lips to occlude her own nostril while making the /p/ sound! All children are unique and will learn how they learn, and our job is to provide them with as much stimulation as we can to give them a lot of material to learn from!

Remember therapy is good at teaching correct articulation skills!

If a parent is feeling a lot of anxiety about a surgery being postponed—don’t! Speech therapy is very effective at creating changes in kids’ articulation skills. If your child is older and is waiting on a secondary surgery for velopharyngeal insufficiency because the palate is repaired but not working well enough, there are still so many things therapists can do in the meantime. Practicing correct placement of sounds with the tongue, lips, and teeth, are always worthwhile of time regardless of when surgery will take place. Some kids benefit from practicing with their nostrils covered in order to prevent air from leaking through the nose. Using pointer fingers on both hands, gently cover your child’s nostrils, or teach them how to do this on their own. Cutting out a nasal airflow leak in this way can help make practicing the correct placement for consonant sounds easier.

Make sure kids are followed by an interdisciplinary cleft palate team

The standard of care for kids born with a cleft lip or palate is to be followed by an interdisciplinary cleft palate team. Talking with the team about recommendations for an individual child while waiting on surgery is by far the best way to ensure that time is effectively spent for that child. If you don’t have a cleft palate team, check out the ACPA website to locate one near you. Even if clinics are not actively meeting at the moment, many professionals are available to answer questions!

Enjoy time with your baby or toddler!

Most importantly of all, remember that your baby has the ability to do great no matter what the timing of surgery ends up being. His or her sense of humor, intelligence, and curiosity all continue to thrive and develop and savoring these early years is by far the most important thing to put energy into!