Cleft Palate and Speech Disorders

Cleft lips or palates, which happen before birth, is the most common birth defect in the United States. A baby can have a cleft lip, cleft palate, or both. A cleft lip may be on one or both sides of the upper lip. The split may also be in the upper jaw and gum.

A cleft palate is an opening in the roof of the mouth. The front part is the bony hard palate. The back part is the soft palate, made of muscle. A cleft palate can be on one side or both sides of the mouth. 

Most of the time, a doctor will see a cleft lip or palate at birth. However, it is not always easy to see a cleft palate. If your child has a weak suck and takes a long time to feed or if milk comes out of your child's nose, it may be a possible sign of a cleft.

In some cases, cleft may not show up until your child starts talking. His speech may sound like it comes out of his nose. This may be a clue that there is a cleft palate.

Children who have a cleft lip have fewer speech problems than those with a cleft palate. About one in five children with cleft palate have speech problems after surgical repair. Most often, this means that a child's voice is hypernasal (sounding like the child is talking through the nose). This happens because the palate doesn't move well enough to prevent air from leaking out of the nose.

If your child’s teeth do not “line up” correctly, speech may be understandable, but some sounds (like “s” or “sh”) may sound distorted. Some children, with a cleft palate, may simply develop speech more slowly than others. Children with clefts also can have other types of speech problems for example, age-related errors such as saying, "wed" instead of "red."

Many children will only need speech-language therapy when they are younger, but some will need support into their teenage years. A speech-language pathologist (SLP) will usually carry out an initial assessment at around 18-24 months, followed by a further assessment once the child is around three years old. The assessments will look at how well your child understands words as well as how they sound when they speak.

If the assessments show a child has difficulties with speech, the SLP will advise on further treatment which, as well as direct therapy, could include teaching you exercises to help your child’s development at home. The SLP will work with your child for as long as they need help. The aim is for children to have good quality, understandable speech by age five or six so they can enter school able to participate fully in class and communicate with their peers.

The Speech-Language Institute (SLI) offers assessments and individualized treatment plans that can help children overcome these obstacles and improve their communication. For more information on SLI’s services or to schedule an appointment, call 215.780.3150.