A Cleft Palate is where there is a hole in the roof of the child's mouth so that there is a connection between the nasal cavity and the mouth. A Cleft Lip is where the top lips do not join together and a gap occurs in the lips.
A cleft lip and/or palate occurs when the tissues of the mouth and/or lip do not form properly during early foetal development. Cleft lip and palate can occur together or separately within a newborn baby. A cleft lip only, generally does not cause any feeding or speech difficulties. However, a baby with a cleft palate will have difficulties with early feeding if the cleft is not surgically repaired. Often a child with a cleft palate - even if it has been repaired - will have some difficulties with speech production.
What are the features of it?
- Babies with cleft palate will generally have difficulty with sucking and swallowing (feeding) because they are unable to form a seal around the teat and produce the pressure and suck needed to extract the milk from the bottle or teat.
- A baby with cleft lip will often need the mother to block the cleft with a finger or breast tissue to allow a seal around the teat or nipple so that sucking can occur efficiently.
- Children with cleft palate are more prone to ear infections which may affect hearing.
- Cleft lips affect the appearance of a child and when repaired, the child will still have a scar. This can affect confidence and self esteem in some children.
- Some children with cleft palate will have speech difficulties due to the structure and functioning of the palate. This often improves with surgical repair of the cleft. However, some children will need ongoing Speech Therapy.
- Children with a cleft palate may need orthodontic and dental treatment for teeth in the area of the cleft.
Common challenges experienced by children who have a Cleft Lip and/or Palate:
A Child with Cleft Palate may have difficulties with hypernasality (i.e. too much air resonating in the nose) or nasal emission (i.e. air being pushed through the nose) during speech affecting how well they are understood and socialisation.
A child with cleft Palate may present with compensatory articulation errors such as replacing many sounds with “back sounds” (i.e. where the tongue hits the back of the mouth and include sounds such as “k”, ”g” and non-speech glottal sounds). These errors will affect intelligibility of speech.
A mother of a child with cleft lip and palate may have difficulties with bonding and is more at risk of post-natal depression. This can affect how the child and parent interacts and may lead to speech and language delay.
A child with cleft lip may have difficulties with socialising due concern over facial appearance.
Management strategies for children with Cleft Palate:
- Children with cleft lip and /or palate and their families will be seen by a member of a Cleft Lip and Palate Team shortly after a diagnosis has been made pre or post the birth of the baby. This will usually consist of a number of specialists and may include a Speech Pathologist, Ears Nose and Throat specialist, Respiratory Physician, Plastic Surgeon, Maxillofacial Surgeon, Orthodontist, Dentist, Geneticist, and Paediatrician.
- A Speech Pathologist's role will be to help with any feeding issues before and after the cleft repair and to monitor speech production during the first years of life.
- If a child requires ongoing Speech Pathology, they may continue to be seen by the Specialist Speech Pathologist in their hospital or their care may be transferred to a Speech Pathologist within the community.
- The role of the treating Speech Pathologist is to develop therapy goals specific to cleft speech errors.
- Provide specific strategies to help reduce speech errors occurring to be practiced at home.
Speech Pathology approaches and activities that can support the individual or their carer's include:
Activities and strategies to help reduce hypernasality (too much air resonanting or being projected through the nose): children with a repaired cleft palate will often still have difficulty with hypernasality during speech
Strategies to eliminate the over use of “back sounds” such as “k”, “g’: children with cleft palate often present with backing (i.e. where the tongue hits the back of the mouth) such that their speech contains lots of ‘k’, “g” and other back sound affecting speech intelligibility.