SPEECH AND CLEFTS

You are probably wondering if cleft lip and palate will affect your baby' s ability to speak. Speech is so important in our lives. Almost everything everyone does requires the ability to speak. If there are no other developmental problems, your child will develop vocabulary and learn to speak just like other children. Research findings, however, indicate that many children with clefts begin talking several months later than children without clefts of the palate. This seems to be in part related to the increased number of ear infections and thus, frequent episodes of hearing loss. Difficulty with speech has been one of the most serious results of cleft palate. Cleft of the lip alone rarely produces a noticeable speech problem, but palatal clefts, especially in the area of the soft palate, may make production of many speech sounds difficult.
Speaking takes place on the air we breathe out. Ordinarily we breathe in and out at a regular rate. When we talk, however, we inhale in a slow, controlled way. The outgoing air stream passes through the larynx, where for the production of sound, a tone is added to the air stream by the vibration of the vocal cords. From the larynx the air is directed into the throat. If the soft palate and the pharyngeal walls (throat walls) are not pulled together, the sound from the throat will enter the nose and the mouth. More than 97% of the speech sounds are produced and formed in the mouth. For these sounds, the soft palate (velum) and the throat walls work together to block off the nose so that the air and sounds will be directed into the mouth.
During the first period, from the time of birth to the time of surgical closure of the palate, your child will produce all sounds through the nose. He or she may develop, in his attempt to speak like you, different habits of articulation. Usually he will try to move the back part of the tongue to the pharyngeal wall, in an effort to block the air stream. This attempt may lead to sound substitution. So instead of "pa-pa", it may sound like "ga-ga", etc. Early closure of the soft palate is very essential for speech. Nevertheless, these compensatory articulatory habits are the basis of defective speech, even if the cleft is surgically closed in an ideal way. Speech is usually not established at the earliest until towards the end of the second year of life, but the actual sounds used in speech are acquired very much earlier. Therefore you should work closely with the team speech pathologist who will guide you through all the necessary steps. The best general advice for parents of children with clefts of the palate is to encourage and stimulate speech just like with any child, but not to expect the same precision in the sounds and not to press their child to make the sounds more clearly. They should talk with their child, name things, share experiences and be pleased with their child' s attempts to talk. Children with cleft palates, like any other children, do not know they cannot be understood clearly unless they are constantly reminded.
Another question you may have is whether speech therapy will be necessary after repair of the cleft palate. It is impossible to determine this beforehand. The cleft palate team speech pathologist will be able to make this determination more accurately after seeing your child many times. Some children require little therapy, while others may need several months or years and some (luckily very few) may require a special surgical intervention (pharyngoplasty).