Text supplied by Maeve Morrision, Speech Language Therapist, South Auckland Health and Marilyn Heine, Speech Language Therapist, Hutt Hospital
If your child has a cleft of the lip only this should not interfere with speech. A cleft of the palate can however cause speech problems.
Before surgical repair of the palate, the nasal and oral cavities (nose and mouth) are not adequately separated and the quality of speech is often nasal. The primary aim of surgery is to produce a normal instrument for speech with a long and mobile soft palate to ensure good speech develops.
Following surgery to repair the palate the majority of children go on to develop good speech. Some children can however have persistent hypernasality (nasal quality to speech). This hypernasality can be accompanied by nasal emission of air on certain sounds. The child may replace certain speech sounds with abnormal sounds.
For most speech sounds air has to be directed out through the mouth. For nasal sounds such as ‘m’ and ‘n’ the air is directed through the nose. This is why words such as ‘Mummy’ ‘no’ and ‘Nana’ are easy for a child with a cleft. Words such as ‘puppy’ ‘baby’ ‘ta ta’ ‘daddy’ and ’see-saw’ that require air to be directed through the mouth and also require a build up of pressure may be difficult for the child to produce.
Your child’s speech will be monitored regularly by the speech-language therapist on your Cleft Team. If speech therapy is recommended a referral will be made to the child’s local Speech-language Therapist who will maintain close liaison with the Team Speech-language Therapist. For some children Speech Therapy alone may not correct the problem associated with hypernasality and nasal emission and surgery may be necessary. Further investigations by nasendoscopy or videofluoroscopy may be useful to help make this decision.
Nasendoscopy is a procedure where after numbing the inside of the nose, a fibreoptic tube with a tiny telescope is inserted into the child’s nostril to view the nasal passages and the back of the throat. It is not painful but the child needs to be mature enough to cooperate. The movements in the back of the throat and the palate can be observed during speech. This is usually carried out by the Plastic Surgeon together with the Speech-language Therapist.
Videofluoroscopy is also an investigation that assesses palate movement in speech using x-rays. The child must be able to speak some words and sit very still. Swallowing can also be assessed. The Radiologist will carry out this procedure in the x-ray department together with the Speech-language Therapist. Information from nasendoscopy and videofluoroscopy studies can help the cleft team determine whether further surgery is necessary to improve speech. If further surgery is planned speech therapy after surgery is very important.
As well as monitoring speech sounds your Speech-language Therapist will be checking your child’s language development for levels of understanding and age-appropriate speaking. Children usually babble around 6 to 9 months of age. First words occur about 12 to 14 months and by 2 years your child should be starting to put words together to make 2 word sentences.
If there is a delay of more than 3 months in any of these milestones consult your speech-language therapist.
As speech and language development are dependent on hearing speech sounds, it is important to ensure your child has good hearing by having ears checked and hearing tested.
More Complex Problems
In some instances the child’s cleft may be part of a more complex problem involving difficulties with learning. For some children a further consequence of the cleft palate may be voice problems or hoarseness. Your Speech-Language Therapist and Ear Nose and Throat Specialist will offer appropriate investigations and treatment for persistent voice disorders.
The Speech-Language Therapist will aim to work closely with you to help your child achieve optimum communication skills. Speech and communication should be fun so try to avoid criticising your child’s speech and help build up self-esteem with plenty of praise and encouragement.