What is cleft palate/lip?
Cleft means “divide”. Children with a cleft lip or a palate have a lip or a palate where both sides are not joined together. This means that there is a hole in their lip, palate or both of these structures.
A cleft lip can usually be detected via an ultrasound before the child is born. However, because the palate is inside the mouth, it is very difficult to detect any cleft in the palate prior to birth and even after birth. Some signs of a cleft palate can be observed during feeding: a weak suck, long feeding time or milk flowing out from the nose.
Sometimes, a cleft palate can not be seen with our naked eye. This is usually in the case of a sub-mucous cleft where the hole is hidden by the skin in our mouth. In some cases, this sub mucous cleft is accompanied by a bifid uvula. The uvula is the piece of flesh that hangs at the back of your throat and is visible when you open your mouth. A bifid uvula will be divided into two. This is a sign of a possible cleft and it is best to talk to your doctor to find out more.
How a cleft lip or palate disrupts your child’s speech?
Children with a cleft lip do not usually have any speech issues. However, children with a cleft palate may have speech issues and may need help so that they can produce the sounds accurately and be understood by people around them.
This is because during speech, the soft palate will need to move in order to contact the back of the throat. This separates the space between the mouth and the nose which creates pressure for some sounds to come out of our mouth. For example, the “p” sound requires us to build up pressure in our mouth in order for it to be produced.
However, there are some sounds like “m” and “n” which are emitted from our nose. In order to do so, the soft palate must be opened to allow the air to pass through.
A child with velopharyngeal insufficiency (VPI) is unable to create a seal between the mouth and nose using his soft palate. This may be because his soft palate is too short or is unable to move in the right way. This results in air escaping though his nose when he is speaking.
The crania-facial team may recommend surgery to fix VPI. Alternatively, the child may need to wear a device in his mouth to close up the gap in his soft palate.
In addition, speech therapy may be needed to help him make sounds accurately.
Speech issues commonly associated with cleft palate
Because of oral structural differences in children with cleft palates, there are some speech sound errors that these children commonly present with. This may be due to underlying structural differences, compensation strategies, or simply misarticulation by these children. These speech differences are known as an “articulation disorder”.
Glottal stops: Stops are sounds which are formed with a burst of air. Some children with cleft palates replace front stop sounds with sounds that are made in the throat. This means that their vocal folds comes together forcefully when they are making these sounds. This may make it sound like they have missed out the starting consonants in these words. For example, “paint” —> “aint”.
Nasal fricatives: Fricatives are sounds that are formed with a continuous stream of air. Normally fricatives involves the air stream flowing through the mouth. But in some children with cleft palate, the air stream is directed through their nose instead. This makes them sound like they are “talking through their nose” for these sounds. An example is the “f” in “fun”.
Pharyngeal fricatives: The pharynx is the back part of the mouth that is connected to our food pipe. In some cases, children with cleft palate may push the base of their tongue against the pharynx, as they try to generate the flow of air for speech. In such cases, the sound produced sounds like a rough “h” for certain sounds, for example, “s” in “sun”.
Mid dorsum palatal stops: This sound results when the middle of the tongue touches the middle of the roof of the mouth resulting in a sound that sounds like something in between a T and K. This sound is usually substituted for sounds like T, D, K and G.
Resonance disorder
Another kind of articulation differences is known as a resonance disorder. This means that the sound is emitted from the nose when it is normally done so from the mouth.
Hypernasality results when too much sound is emitted nasally. Hyponasality is the opposite. We all sound a little hyponasal when we have a cold. Some children may exhibit both hypernasality and hyponasality.
Hypernasality often results when the soft palate is too short to form an effective seal between the mouth and the nose. This results in air escaping from the nose as the child speaks.
How can speech therapy help the speech of children with a cleft palate?
The goal of speech therapy for children with a cleft palate is to help them to learn to speak clearly and be understood by others by the age of 5-6 years old. This is so that children are able to participate in school and communicate with their fellow students when they enter school.
A speech therapist can help by teaching the child how to produce sounds correctly using articulation therapy techniques. In the case where the child is unable to achieve the sound due to structural differences or physical limitations, the speech therapist can help the child to find the next best approximation of the sound.
Because every cleft patient is different, a program tailored to the needs of each individual child works best. This means that speech therapy that is conducted one-on-one is the most ideal. However, in the case where this is not possible due to lack of funding or availability, group therapy can help as well.
If you are a parent of an infant with cleft lip or palate, it helps to constantly model speech sounds, especially those produced in the front of the mouth like “p”, “b”, “f”, “v”, “s” and “z”. This exposes your child to the correct posture in order to articulate these sounds. Encourage your child to produce these sounds in his babbling by repeating these sounds back to him.
How Parents can Help
Since hypernasality is common in children with cleft palate, it is important to teach him to let the air flow through his mouth. Engage in games or sing songs with your child that give him many opportunities to blow air through his mouth instead of through his nose.
Also, model language that is appropriate for your child’s developmental level. This means speaking at a level just above what your child is capable of. For example if your child is speaking in two-word phrases, model three-word phrases.
In addition, give your child an opportunity to talk. Try not to interrupt him or to complete his sentence. When he has finished, try to expand on what he has just said to show him a more advanced way of talking.
For parents of older children, speak to a speech therapist if you have concerns about your child’s speech clarity. Children who received early intervention usually have better outcomes. Even though older children can also benefit from therapy, their progress is not as rapid because their previous motor patterns are more ingrained.
During therapy, it is also important to carry out the homework. Speech therapy is like learning the piano: one session a week is not enough to help your child to learn new motor plans. Therefore, homework will provide more practice so that your child can cement his learning.
Also, if your child make a mistake with his pronunciation, try not to correct him. Instead, provide a correct model. For example, if your child says “The hun is shining”, you can say “The sun. The sun is shining!”
Lastly, be patient. All children need time to learn their sounds, not just children with cleft palate. With your help, your child may learn to speak clearly even if he has a cleft palate.