Cleft lip and cleft palate are among the most frequent birth defects in the US. Cleft lip and palate occurs in 1 in 940 births in the United States according to ASHA. It is usually diagnosed at birth or within the first year and is treatable with surgical intervention. The following information will define cleft lip/palate, describe health problems associated with cleft palate, and provide appropriate treatment options.
Cleft lip and/or palate defined
A child may present with a cleft lip, cleft palate, or both. Cleft lip and/or palate are caused by a combination of genetic and environmental factors. Cleft lip is defined as the separation of the sides of the upper lip on one side or both. It often includes bones of the upper jaw and/or gum. Cleft palate is an opening in the roof of the mouth caused by an underdeveloped joining of the palate in utero. In some cases, the cleft on the palate is covered by mucous membrane defined as a submucous cleft. A submucous cleft is harder to detect but common symptoms include bifid uvula, midline groove of the hard palate, and/or nasal sounding speech.
Children with only a cleft lip usually do not experience feeding problems. On the other hand, children with a cleft palate may have difficulty with breastfeeding or bottle-feeding. Some difficulties include,
• Poor suction
• Prolonged feeding times with decreased intake
• Milk/formula escaping through nose
• Excessive air intake
• Choking or gagging during feedings
A speech-language pathologist may provide specialty nipples and bottles to assist with bottle-feeding.
Children with a cleft palate may be at a higher risk for middle ear infections. The Eustachian tube is the canal that connects the middle ear to the throat and the back of the nose. Children with cleft palates often have poor function of the Eustachian tube leading to frequent infections. Over time, excess infection may lead to temporary or permanent hearing loss affecting speech and language in young children.
Depending on the severity of the cleft, speech sound disorders may present. To produce most speech sounds (with the exception of nasal sounds such as ‘m’ and ‘n’) the soft palate elevates and moves to the back of the throat. This movement stops air from escaping into the nose. Cleft palates affect the movement and efficiency of the soft palate causing more air to escape through the nose. The speech may sound hypernasal like the child is talking through their nose. Cleft lip and palate may also affect dental alignment affecting certain speech sounds such as ‘s’, ‘sh’, ‘ch’, and ‘j’.
A Multidisciplinary team determines the most appropriate treatment for your child. The core team typically consists of a plastic surgeon, orthodontist, and speech-language pathologist. Additional professionals include pediatricians, nurses, ear-nose and throat doctors, audiologists, psychologist, social workers and nutritionists. Surgery to repair the cleft lip and/or palate is usually completed in the first year. The speech-language pathologist will assist with feeding during infancy. As the child develops speech and language, the speech-language pathologist may provide articulation therapy. If speech problems are related to structural deficiency, speech therapy is only appropriate after surgical or orthodontic intervention.
If your child demonstrates difficulty with speech and language after a cleft lip and/or palate repair, please contact Lumiere Children’s Therapy for a speech-language evaluation.
“Cleft Lip and Cleft Palate.” American Speech-Language-Hearing Association, ASHA, www.asha.org/public/speech/disorders/CleftLip/.
“Cleft Lip and Palate.” Edited by Rupal Christine Gupta, KidsHealth, The Nemours Foundation, Oct. 2014, kidshealth.org/en/parents/cleft-lip-palate.html#.
Meredith, Amy Skinder. “Speech Sounds Affected by VPI Amy Skinder Meredith.” SpeechPathology.com, www.speechpathology.com/ask-the-experts/speech-sounds-affected-by-vpi-1103.
Vissing, Amy. “Cleft Lip and Palate: The Role of the SLP