How does Cleft Lip and Palate affect your speech?
A cleft is a gap or split which can affect one or both sides of the upper lip and/or the roof of the mouth that connects the mouth directly with the nose cavity.
A child with cleft lip only should not develop cleft related speech difficulties.
The soft palate closes off the nose from the mouth during speech. Most speech sounds produced in the English language are made with the palate raised and the nose cavity closed off. Such sounds are called ‘oral’ sounds (p, b, t, d, k, g, f, v, s, z, sh, ch, j). In addition there are three sounds, (m, n, and ‘ing’) that are produced with the palate lowered allowing air into the nose. These sounds are called nasals.
Soft palate moves up against the back of the throat to close off the nose allowing all air to pass into the mouth for oral sounds.
Soft palate remains level allowing air to pass into the nose for nasal sounds.
When do Speech and Language Therapists see Children?
Ward Visit
All children born with a cleft lip and/or palate are seen on the ward following surgery by a member of the Speech and Language Therapy team. You will be provided with information on how to encourage speech and language development at an early age.
Babble Therapy Workshop
All children who have a cleft palate will be invited to attend a ‘babble’ workshop session between the ages of 9-12 months. This is a preventative measure to reduce the risk of babies developing speech difficulties related to cleft palate. The session aims to:
•Provide parents with ideas and activities to encourage early speech and language development
•Allow parents the opportunity to meet other families who have a baby born with a cleft palate
•Provide early advice on dental hygiene from a Dental Hygienist
You will find ideas on encouraging babble by watching the video linked in the picture or here . Also here is a leaflet to help you use your Babble Bag
Assessment and Monitoring
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Your child’s first speech assessment will be when they are 18 months of age. This is very informal and carried out through play.
Following this, children are assessed again at 3 years of age. (Though some children may require more frequent monitoring). The 3 year assessment is a more detailed speech assessment to check that your child’s palate is working properly and to monitor the sounds they are using.
Children born with a cleft palate are also routinely seen at the ages of 5, 10, 15 and 20 by the Speech and Language Therapists as part of the cleft team’s monitoring process and in line with national recommendations. The results of these assessments are fed back to the Cleft Surgeon, which helps to assess the success of the surgery and will help the Team to know whether further intervention is required. Some children may need additional monitoring or help with their speech and this will be arranged locally.
If there is concern that your child’s palate is not working as well as it should, your child may be seen for a palatal investigation which involves a ‘talking x-ray’ (Videofluoroscopy). Some older children may also require an assessment using a ‘magic eye’ (Nasendoscopy).
The Speech and Language Therapists will monitor your child’s speech while they are attending cleft clinics and also if they require further treatment at a later stage such as orthognathic (jaw) surgery.
A child born with a cleft lip only does not routinely attend these assessments, as it is rare that a cleft lip will cause them to have any speech difficulties.
Therapy
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Speech therapy aims to teach your child how to make theirs sounds correctly in order to produce clear intelligible speech. Parents have an important role to play in their child’s speech development and we will demonstrate activities and provide ideas that can be used at home for this purpose.
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50% of children born with a cleft palate will need speech and language therapy input to help them learn how to use speech sounds.
If it is felt at any stage that your child may require further help with their speech and/or language development, arrangements will be made for them to be referred to their local Speech and Language Therapy Service. The therapy will be carried out by local community based Speech and Language Therapists, supported by a Link Speech and Language Therapist who coordinates the local care for children with a cleft palate.
The Link Speech and Language Therapists are specialist therapists in cleft lip and palate who are based at the Welsh Centre for Cleft Lip and Palate but who also spend time working closely with local community based therapists to ensure that children receive the most appropriate therapy.
In addition, your child may be offered therapy sessions at the cleft palate unit in Morriston Hospital or locally with the link Speech and Language Therapists, depending on their individual needs. Children may be seen for therapy on their own or as part of a small group if appropriate. Additional specialised therapy using electropalatography (EPG) and nasometry can be offered in a small number of cases where required.
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National Theoretical Standards for Speech
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Audit of our speech results shows that The Welsh Centre for Cleft Lip and Palate are more than meeting these standards.
Children not born with a Cleft Palate
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The Welsh Centre for Cleft Lip and palate also sees children without a cleft, but whose palate still may not be working as it should. The speech and language therapists will assess your child’s speech and determine whether your child would benefit from therapy and/or a joint consultation with the cleft surgeon.
Approximately 69% of patients who have a diagnosis of 22q11 deletion syndrome have problems with their palate. We therefore routinely assess and monitor patients who have a diagnosis of 22q11 and make referrals to local Speech and Language Therapy Services as appropriate. A member of the cleft team attends a multidisciplinary 22q11.2 deletion clinic in Cardiff which is run 3 or 4 times a year to offer further advice. Surgery to help improve the functioning of the palate may be offered where appropriate
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For help of support on 22q11 please click the link below.
Max Appeal
Information Leaflets
The Speech and Language Therapy Department has developed a number of advice leaflets which you may find helpful. These can be downloaded from the documentation page.
If you require further information or would like to ask us a question regarding your child’s speech, please email us on abm.cleftslt@wales.nhs.uk and a member of our team will get back to you shortly.
Parent Feedback
Some of your comments are posted below. We value your feedback (whether positive or suggestions for how we can continue to improve our Service). Please do get in touch on with your comments on abm.cleftslt@wales.nhs.uk
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