Speech and language therapy

The development of speech in the child with a cleft lip

Children whose cleft does not affect the palate generally have no cleft-related speech problems. However, all children will still be contacted by one of the speech and language therapists in the cleft team at two and three years old to check how his or her speech and language skills are developing.

Speech development in children born with a cleft palate

Many children born with a cleft palate need no additional input with their speech development. Some children will need extra help.

Around half of all children with a cleft palate will benefit from speech therapy. This can often be due to the structural differences a child born with a cleft palate has. Such differences may cause difficulties with articulation and with the use of the soft palate.

For information about cleft palate and how the palate works please follow this link.

In a small number of children there may be a lot of air coming down the nose when speaking after palate repair. Speech therapy alone may not be enough to stop this. Further surgery on the soft palate may be necessary to resolve this problem. About 20% of children with a cleft palate require this. The cleft surgeon and specialist speech therapist will decide whether any further surgery is needed. Following surgery, speech therapy may still be needed in order to eradicate any unhelpful speech habits that remain.

Speech Therapy

Speech and language therapy can be offered to adults and children. The speech and language therapist will aim to tailor therapy to individual needs. A community speech and language therapist may also be involved and providing therapy. For more information on therapy including ideas for activities please click here. 

Speech Therapy Assessment for children born with a cleft palate

A specialist speech and language therapist from the cleft team will see your child for an assessment at age two and three years and then in a multi-disciplinary clinic at age 5, 10, 15, and 20. Any speech and language therapy will be arranged, where necessary.

If you are a speech and language therapist you can request a second opinion for a child or adult you are seeing by downloading and completing this  form.

Babble advice for babies

The speech and language therapy team have put together advice on what you can do to help your child babble while they are waiting to have cleft palate repair surgery. The advice, activities, handouts that you may have already received are still useful. Please refer to them and if you have any questions please ring the speech and language therapists.

If your baby is age 6-9 months:

Your baby will be able to do nearly everything a baby without a cleft palate can do. They may be able to make sounds like "m", "n" "w" and "l" as well as vowel like sounds. Copy these sounds to encourage your baby to continue making them

Continue to babble with your baby face to face. Don't ask your baby to repeat sounds, all they need to do is watch and listen even if it is a brief glance.

Babble using "m" "n" sounds, they are sounds that do not require the palate to move so your child may be able to copy you.

Babble using "p","b","t","d" sounds, they are sounds that require the palate to work so your baby will most likely not be able to copy you. They can still watch and listen to these sounds. Try not to copy any 'growly' sounds your baby makes as ideally we want to avoid them making sounds purely from their throats. Instead, if you hear those sounds, simply repeat one of the other sounds above.

There are additional ideas at:  

https://www.bbc.co.uk/tiny-happy-people/6-9-month-old-baby-development-activities

https://www.bbc.co.uk/tiny-happy-people/making-language-fun/znyxmfr

https://www.bbc.co.uk/tiny-happy-people/helpful-advice-from-a-speech-and-language-therapist/zfh3xyc

9-12 months:

A baby with a cleft can still be developing in most areas of communication despite the fact that their palate is not yet repaired.

In addition to the sounds at 6-9 months (see above) you can try gently holding your baby's nose when they make sounds. This may help your baby make new sounds as you are stopping air escaping out of the nose. Continue to talk to your baby about everyday events. You can make a sound 'wow' bag with objects beginning with p, b, t,d e.g.  teddy, baby, ball. There will be a lot of value in your baby hearing and watching you even if they do not make the sounds. If your baby does not like his/her nose being held try again in a few weeks. There is no benefit from forcing this though if your baby really doesn't like it!

There are additional ideas at  https://www.bbc.co.uk/tiny-happy-people/9-12-month-old-baby-development-activities

https://www.bbc.co.uk/tiny-happy-people/five-baby-talk-tips-from-a-speech-and-language-therapist/zhdx92p

https://www.bbc.co.uk/tiny-happy-people/slt-advice-2-12-18-months/z6hjd6f

Older children:

You can continue to draw your child's attention to sounds by making a 'wow' sound bag. You can talk about the sounds in words e.g. the word 'baby' has a b sound in it, you can say "did you hear the b, I put my lips together for a b". Your child may not copy you, and may only look briefly, but they will still be learning about how the sounds are made.

You could try gently holding your child's nose when they attempt sounds to stop air escaping out of their nose. If your child does not like his/her nose being held try again in a few weeks.

Please watch our therapy videos for further ideas.

Hearing

Children with a cleft palate are at greater risk of having a hearing loss which might come and go. We always advise parents to be face to face when talking and reduce background noise such as the TV, radio.

This video has been created to give babble advice to parents and carers of babies born with a cleft palate. There are some quick and simple ways that may help prevent your child from developing bad speech habits, decreasing the need for speech therapy later on.

Submucous cleft palate

A submucous cleft palate is where the muscles inside the soft palate are not positioned correctly. Having a submucous cleft palate may mean the soft palate cannot close off the back of the throat properly causing air escape through the nose during speech. Children with a submucous cleft palate may require surgery to reposition the muscles and speech therapy to target any speech sound differences.

Download our patient leaflet on submucous cleft palate.

Velopharyngeal Dysfunction

Some children do not have a cleft palate, but their soft palate may not close off the back of their throat properly which means air can escape through their nose. This is called velopharyngeal dysfunction.

Velopharyngeal dysfunction may lead to:

• Air escaping down the nose causing a nasal tone.
• unusual speech patterns- for example using lots of nasal sounds (e.g. m, n) or sounds right at the back of their mouth (e.g. h, or a uh sound).
• Food and drink coming down the nose when eating and drinking.
• Hearing difficulties or glue ear.

If you are concerned about your or your child's speech, please discuss this with your GP, speech and language therapist or ring one of the speech and language therapists in the cleft team.

Speech investigation 

If there are any concerns about your or your child's palate function, you or your child may need to have an x-ray of the palate during speech so that we can visualise the palate in order to make a treatment plan. We call this a speech investigation or SPIN clinic. We have made the videos below to describe what will happen during the SPIN clinic. Please note that in the video there are some minor differences in how we run the SPIN clinics at present.  

Child patients:

 

Adult patients: