Abby Barnes, M.S., CCC-SLP
A cleft lip or cleft palate is one of the more common birth defects in the U.S. This article provides an overview of these conditions, as well as how speech therapy can help children with a cleft lip or cleft palate speak more clearly. Around half of all children with a cleft palate will need speech therapy at some point.
What is cleft lip and palate?
A cleft refers to a split or hole. There are a variety of types of cleft lips and palates.
A cleft lip means a divide in the formation of the lip. A cleft lip can be on one or both sides of the upper lip. The split may also be in the jaw and gums, aligned with the split in the lips.
Now let’s discuss a cleft palate. The palate is essentially the roof of the mouth. The hard palate refers to the front of the roof of the mouth, which has bone underneath. The soft palate is the back of the palate, which consists of muscle. A cleft palate can be on one side of the roof of the mouth, or it can go across both sides of the roof of the mouth.
Some cleft palates aren’t obvious. This is often referred to as a submucous cleft. In a submucous cleft, the hole is still present in the palate, but the pink tissue in the mouth covers the hole, so it’s hard to see. Submucous clefts can go undiagnosed for longer because they are much harder to spot.
What causes cleft lip and palate?
Cleft lip and palate are types of birth defects. A cleft palate typically forms between the fourth and seventh weeks of pregnancy. There are pieces of the palate that should join together during this window of time. When the pieces do not join together, or only partly join, a cleft palate is present.
A child may have a cleft lip or palate on its own. However, the cleft is often present along with genetic diagnoses such as 22q11 deletion syndrome or Stickler syndrome.
Possible risk factors for a cleft lip or palate include the following:
Smoking during pregnancy
Diabetes before/during pregnancy
Use of certain medicines during the first trimester
Drug or alcohol use in pregnancy
Inadequate prenatal health care
Genetics
How common is cleft lip and cleft palate?
The CDC reports the following facts about the prevalence of cleft lip and cleft palate:
About 1 in every 1,600 babies is born with cleft lip with cleft palate in the United States.
About 1 in every 2,800 babies is born with cleft lip without cleft palate in the United States.
About 1 in every 1,700 babies is born with cleft palate in the United States.
What are the signs of a cleft palate?
A cleft lip is typically identified by an ultrasound during pregnancy. A cleft palate is more challenging for a sonographer to spot on an ultrasound. Both cleft lip and cleft palate can be assessed and diagnosed after birth.
Before a cleft palate is diagnosed, feeding issues or a poor latch could be a signal that something is going on. In these cases it’s possible that a submucous cleft is present, as it is harder to see.
If a child’s speech sounds very nasal, this could be a sign of a cleft palate.
If your child is having trouble feeding and you notice that they have a bifid uvula, this could be a sign of a hidden cleft palate. The uvula is the piece of tissue that hangs in the back of the throat. A split in the uvula is called a bifid uvula, and it’s a sign of a submucous cleft. It’s as if the tissue is a zipper, and it didn’t get “zipped” all the way up. A bifid uvula means there could be a hidden hole in the palate where the palate did not join all the way. Talk with your doctor if you suspect your child has a submucous cleft.
There can be other symptoms of a cleft palate. If a child’s speech sounds very nasal, this could be a sign to look for a cleft palate. A cleft palate does not block off the oral cavity from the nasal cavity enough to prevent air from going into the nose during speech. So a sound like /s/ may sound odd, as if the air production isn’t quite right. Issues with this kind of hypernasality are referred to as a resonance disorder.
What is the treatment for cleft lip and cleft palate?
There are many doctors and professionals involved in treating cleft lip and palate. This “cleft team” usually consists of:
Plastic surgeon
Dentist
Orthodontist
ENT (ear, nose, and throat doctor)
Nurses
Dietitian
Speech-language pathologist (also known as a speech therapist)
Audiologist
Social worker
A cleft lip or cleft palate requires surgery to correct. Typically the cleft lip is corrected within the first few months of an infant's life. The cleft palate is corrected within the first 18 months or earlier. It’s common for kids with these conditions to need more surgery as they get older, along with special dental or orthodontic follow-up and intervention.
How does speech therapy help kids with cleft lip or palate?
According to the Cleft Lip and Palate Association, around half of all children with a cleft palate will need speech therapy at some point. Children with a cleft lip may not have many speech problems. Children with cleft palate will typically have an articulation disorder and/or a resonance disorder.
An articulation disorder is when a child has difficulty saying speech sounds correctly and clearly. For kids with cleft palate, this is due to their oral anatomy. They’ve learned to compensate for that anatomy by pronouncing speech in a different way.
As mentioned above, a child with a cleft palate may have hypernasality, which is a resonance disorder. A resonance disorder refers to an unusual amount of sound energy in the oral or nasal cavities.
For children with a cleft palate, a speech therapist will teach them the correct articulation speech patterns for sounds. The therapist will also help them improve their resonance abilities as much as possible given their current oral and palatal structures.
Kids with cleft palate may need a longer amount of time in speech therapy than kids who do not have structural abnormalities. Or they may receive speech therapy in phases.
Kids with cleft lip and palate may have various surgeries and orthodontic gear. Their speech therapist will work with them to achieve the most clear sounding speech possible at each stage in their treatment process.
It’s possible that kids with cleft palate may need a longer amount of time in speech therapy than kids who do not have structural abnormalities. Or they may need to receive speech therapy in phases. For example, they may receive speech therapy, take a break, then return after surgical corrections have been made.
Even though a child’s oral structures are improved after surgery, they still may need to learn correct speech patterns and appropriate resonance. That’s because they’ve been used to speaking one way for a long time and need help learning the correct speech patterns. A speech therapist can work with a child for as long as they need therapy.
How to find a speech therapist for cleft lip or palate
It’s likely that your child’s doctor will have recommendations for speech therapists. There may also be a speech therapist involved on your child’s cleft team from birth. But if you’re looking for a speech therapist who specializes in cleft palate, check out the American Cleft Palate-Craniofacial Association (ACPA), where you can search for teams of specialists. To have ACPA accreditation, each team must have a speech-language pathologist on their staff. The team speech therapist can recommend other cleft-trained speech therapists in your area if you are looking for school-based and/or private services.
It’s important to find a speech therapist who has experience with cleft lip and palate and who can communicate well with your family, as you’ll likely be partnering with them for awhile. Speech therapy plays a huge part in helping children with cleft lip or palate become the clearest, most confident communicators they can be.
Sources: Cleft Lip and Cleft Palate, The American Speech-Language-Hearing Association. Facts about Cleft Lip and Cleft Palate, Centers for Disease Control and Prevention. Pediatric Cleft Palate, Children’s Health. Speech, Cleft Lip and Palate Association. Speech-Language Therapy for Children With Cleft Palate, Nemours KidsHealth.
