Some children are born with a cleft palate which affects their speech.
What is a Cleft Palate?
A cleft palate occurs when the roof of the mouth does not join together properly. It happens during early pregnancy but we do not know why. It may occur on its own or with a cleft lip.
The cleft can range from a small hole at the back of the throat (in the soft palate) to a complete separation of the roof of the mouth (soft and hard palate). The lip may also be split.
Most cleft palates are picked up during antenatal scans and the child will be referred to the specialist Cleft team at Addenbrookes hospital (East of England Cleft Lip and Palate Network). Families are given advice on feeding and surgical procedures.
Sometimes a submucous cleft can occur which may not be discovered until the child is older. This is when the skin grows over the cleft and it’s more difficult to detect.
How does a Cleft Palate affect speech?
When we speak the soft palate moves up and down to create different sounds. For example when we make sounds like p and b the palate moves up and closes the nasal passageways to ensure air flows through the mouth. However when we make sounds like m and n the palate stays down so that the air flows through the nose.
If the palate does not work properly then it may be difficult to make particular sounds which require a build up of pressure in the mouth or it may be difficult to direct the air through the mouth when necessary.
There may also be a problem with the way speech sounds – it may sound nasal and you may hear air escaping from the nose.
The speech and language therapist will carry out a detailed speech assessment to listen to exactly how words and phrases are pronounced.
Any other problems?
Babies born with a cleft palate may have difficulties with feeding. They may have reduced sucking strength and there may also be some nasal regurgitation. The specialist cleft team can provide advice and equipment to help with this.
Children with a cleft palate may also have hearing difficulties associated with glue ear. This is because for these children the muscles which open the tube to allow liquid to drain from the middle ear do not work efficiently. Please see the section on glue ear for more information.
What happens at speech and language therapy?
If a child is born with a cleft palate they are referred to the Specialist Cleft Team immediately. The speech and language therapists in this team can provide advice and therapy on babble, speech and language development. The child’s case will be primarily managed and monitored by this team.
If the Specialist Team feels the child requires more regular therapy or if the child starts to attend school they may become part of the community speech and language therapy caseload. There is good collaboration between the two teams and the specialist therapists will provide and advice and suggest targets for the community therapist to work on with the child and their family.
Sometimes children may have nasal speech when they are older. This may be a learned habit or there may be a structural problem which was previously undetected (submucous cleft palate – see above). Sometimes speech can sound nasal after tonsils and/or adenoids have been removed but this usually goes away after a few weeks. If the community therapist is concerned about a child with nasal speech, she may refer them to the Specialist Cleft Team.
If your child is a preschooler and you are concerned that they have nasal speech, please come along to one of our
drop-ins.
External Websites
Cleft Lip and Palate Association
East of England Cleft Network