Cleft lip and cleft palate are among the most common birth defects in the Western world.
It’s estimated by the Centers for Disease Control and Prevention (CDC) that nearly 2,650 babies are born with a cleft palate in the United States every year.
If your baby is diagnosed with a cleft palate at birth, your pediatrician will assess them and aid you in creating a treatment plan.
In most cases, your first step will be to physically correct the cleft palate with surgery, shortly after birth.
Timely surgery can reduce potential developmental difficulties in your child’s speech.
When surgery isn’t able to be performed right away, it may result in further complications, and additional surgeries as time progresses.
Whether your child’s surgery takes place earlier or later in their lives, we recommend you have them work alongside a speech language patholgist to help them either overcome or avoid developmental speech difficulties that may arise from their cleft palate.
Because the diagnosis of a cleft palate doesn’t happen until the third trimester, or in some cases until birth, guardians may feel unsure or even overwhelmed about how to deal with the condition.
You may find your mind racing through questions such as:
What is a cleft palate?
How will it affect my child’s speech development?
Once my child has had surgery, what exactly will they be doing in speech therapy for children?
We understand that often online resources about cleft palates and speech therapy can be heavy handed with medical jargon.
Read on to have your questions answered.
What Is Cleft Palate?
A cleft palate is when there’s a fissure or gap in the roof of a child’s mouth.
In a healthy pregnancy, a baby’s mouth tissues will fuse together in the first trimester.
When this doesn’t occur a child develops a cleft lip or a cleft palate.
The rift is discovered at birth and although they often appear on their own, they can also be associated with other health conditions, such as chromosomal irregularities.
Children with cleft palate are also more likely to be diagnosed with autism spectrum disorder, childhood apraxia of speech, or a learning disability or reading disability, according to a 2018 study by Tillman et al.
Often a cleft palate appears in tandem with a cleft lip.
While a cleft palate is a split in the roof of the mouth, a cleft lip refers to a split in your baby’s upper lip.
In both conditions, the tissues of your child’s mouth are unable to fuse together properly, on their own.
It can present itself as a subtle ridge on the upper lip, or it can be as dramatic as a gap that extends upwards into your child’s nostril.
How Does A Cleft Palate Make Speech Difficult?
Having a cleft palate can make it physically difficult for your child to articulate certain words and vocal noises.
The gap in the roof of your child’s mouth, as well as their nasal cavity, can alter the natural pathway for your child to vocalize.
In order for your body to properly generate speech, there has to be a synchrony of many moving parts.
Speech is first initiated by your body bringing air from your lungs to your larynx.
In the larynx, your vocal cords will either vibrate or hold themselves open.
If your vocal cords hold themselves open, you breathe.
If they vibrate, you start to generate a sound.
To articulate those sounds into words, your mouth and nose have to work together in shaping the vibrations.
In your mouth, the process is a complex dance between your lips, teeth, tongue, and palates.
If your child’s mouth and nose have physical irregularities it can make this dance difficult.
Within the roof of your mouth, there are two types of palates: hard and soft.
The hard palate sits in the front of your mouth and is made of bone.
The soft palate sits in the back and is made of tissues.
When your child has a cleft palate, they can’t close their nasal and oral openings properly.
This could mean a lack of control over their airflow while speaking.
When your child can’t close their mouth and nose properly it’s called velopharyngeal dysfunction (VPD).
While VPD can often be corrected with surgery, children will often need additional guidance from a speech language pathologist.
An additional challenge for children with hypernasality, caused by VPD, is their ability to recognize it.
A common condition that appears with a cleft palate is hearing loss.
Cleft Palate and Hearing Loss
Unfortunately, many children who are born with a cleft palate also suffer from hearing loss.
This loss is due to issues in the middle ear.
Since children gain language by hearing it from others, hearing loss can cause a speech delay.
It’s important to bring your child to both an audiologist and an ENT (ears, nose, and throat) specialist early on to prevent a speech delay that may be difficult to overcome.
A Quick Breakdown of Speech Pathology Terms
Before we continue with our next examples of speech therapy treatments for your child, we’d like to offer a breakdown of some common speech pathology terms that you will come across in our next few sections.
To someone who isn’t a speech language pathologist or familiar with the field, certain words may read a little like jargon.
If the following terms are known to you, feel free to skip ahead to the next section.
However, if you feel like you need a little more explanation, feel free to refer back to the terms and their definitions below.
Here is the breakdown of some terms you may come across.
Pharyngeal refers to the pharynx, which is the part of the throat behind the mouth and nasal cavity.
It ends before the esophagus and trachea.
The rear end of the roof of your mouth.
A “hissing” noise made in the mouth when air escapes a narrow passage.
Think of how your mouth moves when you start to say the word “chair”.
If you are someone with properly developed speech, you will notice that you’ve narrowed your mouth to create the “ch” sound at the beginning of the word.
That narrowing of the mouth and the hissing noise of “ch” is you creating a fricative.
A plosive sound is created when you obstruct your speech structure using your lips or tongue.
Examples of a plosive would be the letter “n” or “b”.
In this article, we will cover pharyngeal plosives and nasal plosives.
One deals with plosives associated with the pharynx, and the other incorporates the nasal cavity.
Speech Therapy Treatments For Cleft Palate
Finding out that your child has a cleft palate can be overwhelming.
There are a lot of resources out there, but how do you know you’re choosing the right path for your child?
If corrective surgery for your baby is your first step, where do you go from there?
Since cleft lips and cleft palates are among one of the most common birth defects in the world, there are options to aid your child further.
Working with a speech language pathologist (SLP) is a wonderful way to help your child face the vocal challenges associated with cleft palates.
They can assist you by first assessing your child’s needs.
For example, your speech therapist will carefully determine your child’s needs by examining things such as their:
- Nasal consonant sounds: sounds that are made by blocking air in the mouth and releasing sound through the nose. Of which there are three: bilabial (involving both lips), alveolar (using tongue and alveolar ridge), and velar (using tongue and vellum – the soft palate)
- Vocalic consonant sounds: ability to create consonant sounds that form syllables on their own (such as m or n)
- High Pressure consonants: speech sounds that need the palate to close to the back of the throat.
- Fricatives: a constant sound that is produced by moving the mouth to partially block the airstream and create audible friction. Such as a “hissing” sound.
- Affricates: A consonant sound that begins as a stop and then releases as a fricative. For example the “ch” at the beginning of the word chair.
- Stops: momentary blocking off part of the oral cavity
- Vowel sounds: such as a, e, i, o, u, and sometimes y
Once you meet with your SLP for an assessment they may suggest a treatment plan that involves multiple speech therapy treatments.
These speech therapy sessions often involve different stepping stones that are catered to your individual child.
Depending on the severity of the speech impediment, an SLP may begin by helping your child gain the skills to identify varying speech patterns and then continue by guiding your child in replicating them.
These can be through listening to recordings, displaying proper speech techniques, and creating muscle memory within the mouth.
Involving multiple specialists and corrective speech therapies can seem excessive at times, but in combining these resources your child is ensured the best care possible.
Through surgery and therapy, the majority of children with cleft palates go on to live very healthy and normal lives.
1. Using Auditory Feedback Techniques
Auditory feedback is a crucial first step in mending and guiding speech patterns.
Helping your child to identify the difference between normal and nasalized sounds will make it easier for them to replicate them on their own.
Your SLP may use various techniques to help your child become familiar with both types of sounds.
Depending on your child’s needs, the SLP may play recordings of normal and nasalized speech, or they may simulate the two types of speech themselves.
Once they have heard the two types they will be asked to identify which type of speech is which.
Sometimes your child may use a listening tube while speaking, to help them notice their own levels of nasality while speaking.
By placing one end of the listening tube in the nasal passage, and holding the other end up to their ear, your child can better hear their own nasality while speaking.
This is particularly helpful to children with cleft palates who have also suffered from hearing loss.
2. Practicing Pharyngeal Fricatives
Your child may also be advised to practice their pharyngeal fricatives with a specialist.
Pharyngeal fricatives are sounds such as “sh” or “ch”.
They are created when the tongue is pulled back but its base doesn’t make contact with the roof of the mouth, also known as the pharyngeal wall.
To begin the practice, the SLP will work with your child on creating loud “t” sounds, followed shortly after by a “ts” sound with their teeth closed.
From there your child can round their lips and begin practicing sounds such as “ch” or “sh”.
An SLP will work with your child and give tactile feedback within their mouth.
This feedback will help them recognize what position their tongue should be in to properly articulate difficult pharyngeal fricatives.
3. Practicing Pharyngeal Plosives
Pharyngeal plosives are created when pronouncing letters such as k, b, d, g, and t in the English language.
When creating a pharyngeal plosive you stop vocalizing and then suddenly release air between the pharynx and the base of the tongue.
The base of your tongue will move backward against the pharynx.
When a child has difficulties creating these noises, an SLP will coach them.
Often this coaching will begin by asking your child to create an “ng” sound.
If your child finds creating an “ng” sound difficult, the SLP may step in and guide them with a tongue depressor.
The SLP will use the tongue depressor to push the tip of the tongue downwards as the SLP simultaneously presses upward under the chin.
Once your child is able to properly articulate the “ng” sound, they will be guided to transition it into a “k” sound by dropping their tongue.
4. Practicing Nasal Plosives
Children with cleft palates have a tendency to produce nasalized plosives.
This is the result of placing the tongue in improper positions during speech.
Even after your child has had corrective surgery, they may need speech therapy to help them develop the muscle memory of proper pronunciation.
In their speech therapy sessions, your SLP may have your child yawn as a way to give them access to pushing the back of their tongue down.
As they practice pushing the back of the tongue down, your SLP will ask your child to acknowledge how the stretching feels.
As your child continues to yawn, they will be asked to practice producing a sound.
If needed they may also incorporate the listening tube to help them hear their own level of nasality.
5. Practicing Palatal-Dorsal Productions
Palatal-dorsal productions are when the dorsum, or the upper surface of the tongue, touches the palate where the tip of the tongue was supposed to.
This is often the result of the tongue’s path being obscured by misaligned teeth, or an anterior crossbite.
When the path is obscured the tongue compensates and a palatal-dorsal production is created in the speech pattern.
This misplacement of the tongue against the palate may result in a lateral lisp.
To work on correcting your child’s pattern of creating palatal-dorsal productions, your SLP may position a tongue depressor on the middle of your child’s tongue and ask them to bite down.
Once the tongue depressor is pushed onto the middle of the tongue, the SLP will have your child run through creating sounds such as “d”, “t”, and “p”.
From there they may move on to practicing “k”, “g” and “ng” sounds.
Book An Appointment With District Speech
District speech can aid you and your child in their speech development progress.
We’d be happy to pair you with a speech language pathologist to help you assess, address, and overcome the speech difficulties that may arise from your child’s cleft palate.
If you’re curious to learn more about this subject or would like to consult with one of our speech and language therapists, feel free to contact us.
Until next time,
District Speech and Language Therapy
1331 H St NW, #200,
Washington, DC 20005
District Speech & Language Therapy specializes in speech and language solutions from children to adults in the Washington D.C and Northern Virginia area.