After proper surgical repair of the palate, approximately 80% of children with cleft palate will develop normal speech. Parents have a crucial role to play in their child’s speech development. After palate repair, children are advised to follow up regularly with the speech therapist until they develop normal speech, or speech defect are detected and surgically treated if necessary. Children with clefts of the palate tend to develop speech and language a bit more slowly than other children. These children are also at increased risk for some kind of language disorder.
The effect of a cleft lip and palate on speech is very variable and not always related to the type or extent of the original problem. Generally however, a cleft lip without a cleft palate rarely has any effect on speech. Sometimes if the cleft lip involves both sides, or if the gum is also affected, there may be some minor speech difficulties.
During speech, the palate is important for sealing the nose so that sufficient air flows through the mouth to produce consonants and vowel sounds. If the palate is not able to close off the nose adequately nasal sounding speech (hyper-nasal speech) may result.
Once the palate has been repaired at around six months, the majority of children go on to develop clear speech. However some continue to have difficulties which may require speech therapy, or in some cases, further palatal surgery.
There are many causes of speech difficulties in children with a repaired cleft palate, some related to the structure and function of the palate, others to recurrent hearing problems or to the arrangement of their jaws and teeth.
You will probably first meet a speech therapist when you attend a cleft palate clinic, usually just before the cleft lip or palate repair. She will be able to answer any questions you may have about the effect of a cleft lip and palate on speech production and the early development of speech skills. There are some things that you can do to encourage your child’s speech development from quite an early age.
When your child is around eighteen months of age, arrangements will be made for a more formal assessment of their speech and language development by the speech therapist at the cleft palate clinic. This will be undertaken again at least annually until they are five or six years old.
If your child requires speech therapy treatment you may be referred to the speech therapist at your local health centre for regular sessions. Some children continue to have difficulty with speech production and further surgery may be necessary (possibly a pharyngoplasty) if the palate is not closing the nose adequately. Before decisions are made about the need for further surgery are made, your child’s speech will be carefully assessed with the help of some special tests e.g. video-fluoroscopy, which is a special x-ray, and nasoendoscopy, which involves putting a tiny telescope into the nose to look at the palate during speech.
Sound Acquisition: Generally, children should make the following sounds correctly by the ages indicated
3-4 years - m, b, n, t, d, k, g, w, h, and vowels
5-6 years - sh, ch, l, l-blends
7 years - v, j, th, s, z, r, s-blends, r-blends
Vocabulary and sentence development:
12-18 months first words
2 years 2-word sentences
3 years 3-4 word sentences; 400-900 word vocabulary
5 years 5-6 word sentences; 1500-2500 word vocabulary
Remember that every child is different and none of them actually go by the book. As long as you see consistent development you probably have nothing to worry about. If you have some concerns, talk to a speech pathologist, and you should have your child screened annually anyway.
Sometimes we get all worried due to an articulation problem which is not a problem at all, but a normal age-appropriate substitution.
Every cleft-affected young child should see a pathologist at least once per year for screening.
For more information and worked Cited: please refer to www.cleftcare.org