Your child’s speech
While speech difficulties are associated with cleft palate, it is important to realize that not every child with a cleft palate will experience such difficulties. However, because of the nature of the problem, your child is more at risk of having a speech and/or language problem. Both you and the professionals will need to keep a close eye on your child’s speech development. Most problems can, however, be resolved with speech and language therapy. Children with cleft lip only rarely have any speech difficulty associated with the cleft.
Nature of the difficulties
Speech and/or language problems in children with cleft palate are usually associated with:
- deficits in hearing,
- wrong patterns of tongue movement,
- problems of palate function, or
- a combination of these factors.
The resulting problems are ones of language development, articulation and nasality.
Children with a cleft palate tend to use the back of their tongue too much. This results in many sounds being made far back in the mouth. With a cleft palate the normal closing action of the soft palate does not take place, resulting in air escaping into the nasal passages causing nasal sounding speech.
The Speech and Language Therapist
First contact with a speech and language therapist should be as early as 6 months of age if your child is experiencing feeding difficulties. You may even find that contact with the speech and language therapist begins earlier than this. This seems the practice favored by cleft teams in their overall care approach. The therapist can learn much at the early stages from listening to your child’s babbling pattern and observing his or her interaction with you. The therapist can also advise you on important aspects of speech and language development. Once in the system regular reviews can occur to ensure everything is developing along normal lines.
If your child is experiencing difficulties with their speech, a detailed assessment will determine a course of action, which may consist of:
- a course of speech therapy,
- a course in therapy and an appliance in the mouth (SEE Electropalatography below),
- corrective surgery followed by therapy, or
- a combination of the above.
A small percentage of children present with significant speech problems despite ongoing therapy and require specialized assessment of palatal movement during speech. Two special investigations are available:
- Videofluoroscopy involves the use of continuous x-ray during speech, assessing the movement of the palate while the child is producing speech samples. The study is recorded on videotape. In order to see the palate, a liquid material called barium is put through the nose either with a syringe or via a small tube that is put into the nose.
- Nasendoscopy involves inserting a small scope (nasendoscope) into the child’s nose to observe palatal movement during speech.
Information from these specialized assessments can help decide on future management for speech.
The majority of children with cleft lip and palate who have initial speech problems will grow up to have normal speech if they are attended to at the appropriate time and have all the necessary speech therapy and surgical and orthodontic treatment. Approximately 10% of children with cleft palates will have nasal sounding speech which will require surgical intercession. This procedure, called a pharyngoplasty, involves a small operation to the muscles at the back of the throat, and is usually carried out between the ages of 3 to 5 years.
Electropalatography (EPG) is a technique used for recording and analysing the contact of the tongue with the hard palate during continuous speech. A central component of EPG is an artificial plate which is moulded to fit against the individual’s hard palate. The plate must be custom-made for each individual. This plate consists of electrodes, and when the tongue comes into contact with the plate, signals are conducted to a processing unit and displayed on a computer screen. The plate is constructed from a plaster cast taken of the roof of the individual’s mouth.
EPG has been found to be useful in correcting speech disorders by identifying spatial distortions which should not occur in normal speech. It therefore facilitates the speech and language therapist in the assessment of speech disorders and the individual in helping them to modify abnormal lingual gestures.
Related Post: Speech and Language Therapy Services – A crisis in Need of Resolution. Position Paper, May 2002.