Speech-Language Therapy for Children With Cleft Palate

What Is Speech-Language Therapy?

Speech-language therapy is care that helps kids:

• improve speech
• understand and use language
• communicate in nonverbal ways (listening, taking turns, etc.)

Who Does Speech-Language Therapy?

Speech-language pathologists (SLPs) — also called speech therapists — treat many types of communication and swallowing problems. They have at least a master's degree and state certification/licensure in the field, and a certificate of clinical competency from the American Speech-Language-Hearing Association (ASHA).

Speech-language pathologists help kids with speech disorders (like stuttering), hearing problems, feeding problems, and other medical conditions, including cleft palate.

How Does Speech-Language Therapy Help Kids With Cleft Palate?

SLPs who work with children with cleft palate have extra training to recognize and treat specific problems caused by a cleft palate. Children born with a cleft palate may need speech-language therapy to help with problems such as:

Articulation and Resonance Disorders

An articulation disorder is when a child has trouble making specific sounds. "Cleft palate speech" refers to speech sound errors that are more common in kids with a cleft palate. These include:

• Glottal stops: formed by a "pop" of air when the child forces their vocal folds (located in the voice box) together. The release of air can make it sound like a child is omitting a consonant (like saying "–all" for "ball").
• Nasal fricatives: formed by directing the stream of air through the nasal cavity, instead of the oral cavity, during speech. It sounds like the child is "talking through the nose" for particular sounds, like S in the word "sun."
• Pharyngeal (fair-en-JEE-ul) fricatives: formed by pressing the base of the tongue against the back of the throat and releasing a stream of air for speech. It can sound like the child is using a "raspy H" for particular sounds, like SH in the word "shoe."
• Mid-dorsum palatal stops: formed when the middle of the tongue contacts the middle of the roof of the mouth and used as a substitute for these sounds: T, D, K, and G. When the child produces a mid-dorsum palatal stop, it often sounds "in between" a T and a K, or a D and a G.

A resonance disorder refers to an unusual amount of nasal sound energy when the child is talking, which can result in:

• hypernasality (too much nasal sound energy): This makes a child sound "nasally."
• hyponasality (too little nasal sound energy): This makes a child sound like they have a cold.
• mixed (a bit of both) resonance

Hypernasality may mean that the child's palate is not working properly, called velopharyngeal dysfunction. This can make it hard for others to understand the child's speech, and might need further evaluation and treatment.

What Are the Goals of Speech Therapy for Children With Cleft Palate?

Speech therapy works best when a speech-language pathologist works one-on-one with a child. Sometimes, though, therapy is done in small groups. 

The main goals to help children with "cleft palate speech" are to:

• Establish correct articulation (placement, manner, and voicing) using articulation therapy techniques.
• Ensure there is good oral pressure during speech sound production.
• Establish new motor speech patterns that replace speech sound errors.

How Can Parents Help?

Speech therapy should begin as soon as possible. Children who start speech therapy early tend to have greater success. Therapy also can help older kids, but their progress can be slower because their motor patterns are more ingrained.

Support from parents is key to the success of a child's progress in speech therapy. Kids who complete the speech program quickest and with the longest-lasting results are those whose parents are involved.

Your therapist should give homework for you and your child to do after each session. Helping your child complete these activities will ensure continued progress and carryover of new skills. For example, practicing the P sound for 30 minutes a week in therapy is much more effective when it's also done for 10 minutes a day at home.

The process of overcoming a speech or language disorder can take some time and effort. So it's important that all family members be patient and understanding.

How Can We Find a Speech Therapist?

The American Cleft Palate-Craniofacial Association (ACPA) lists cleft teams by state on their website. To be accredited by the ACPA, each team must have a speech-language pathologist on staff. Your team SLP can recommend other cleft-trained SLPs in your area if you want to use school-based and/or private services. Ask the local SLPs:

• if they have worked with children with these specific speech sound errors
• how many children with cleft palate they have worked with

The SLP should be certified by ASHA.

Sometimes, speech assistants (who usually have a 2-year associate's or 4-year bachelor's degree) may help with speech-language services under the supervision of ASHA-certified SLPs. Your child's SLP should be licensed in your state and have experience working with kids and your child's specific disorder.