Updates

Clefts and Speech Development at North Austin Campus

Conditions

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Children with clefts may develop speech differently. This varies from child to child, and varies depending on the type of cleft. We recommend annual speech evaluations with a speech-language pathologist affiliated with the Cleft Palate Team until your child shows functional speech. We may recommend speech therapy if your child’s speech and language skills are delayed. Some families will choose to come to speech therapy at Texas Children’s, while other families may prefer to be seen for therapy closer to their home. If speech therapy closer to home is easier for your family, our speech-language pathologists can work closely with your treating speech therapist to ensure your child’s speech develops appropriately. 

Our goal is that your child will enter school with speech that is as close to normal as possible. Importantly, not all children with clefts will require speech therapy or speech surgery. 

  • If your child’s cleft is limited to their lip, speech will likely develop normally, although sometimes there are distortions on sounds produced with the tongue right behind the teeth, like when saying “T” of “S”.
  • Our speech language pathologists will meet with your child as their speech develops and determine if their speech is age-appropriate or if they would benefit from speech therapy. 
  • A cleft palate affects the muscles of speech in the back of the palate. Our surgeons reposition these muscles at the time of the cleft palate repair. 
  • At Texas Children’s North Austin, we repair the cleft palate before most children begin using words meaningfully, which helps them learn to say their sounds correctly with the muscles in the correct position. 
  • We will arrange for our speech language pathologist to meet your child for their first speech-language evaluation several months after the cleft palate repair. During that visit, they will monitor early language development and listen closely to how your child produces sounds. We will arrange annual speech evaluations with a speech-language pathologist affiliated with the Cleft Palate Team until your child shows functional speech. 
  • Children with cleft palate are more prone to have speech difficulties. Some of those difficulties may result in air leaking from the mouth into the nose during speech.
  • This air leak is known as velopharyngeal insufficiency (Vee-Low-Fa-Rin-Gee-El In-Suff-E-Shin-See) or “VPI”. In this condition, the palate is not able to fully touch the pharynx (back of the throat) during speech.
  • Children with VPI may have difficulty pronouncing sounds like “b” and “p”, and these sounds may come out muffled, or they may sound like ‘m’ or ‘n’.

Velopharyngeal insufficiency

  1. Speech with normal palate function. During speech, the soft palate can touch the back of the throat, allowing the air to go into the mouth and allowing air pressure to build up in the mouth
  2. Speech with velopharyngeal insufficiency. The palate is unable to touch the back of the throat during speech. Therefore, air rushes into both the mouth and the nose during speech, and the child is unable to build up adequate air pressure inside their mouth

 

  • If VPI persists, the speech language pathologist will order some extra tests and discuss with the plastic surgeon and determine if secondary speech surgery is needed.
  • Secondary speech surgery is needed in less than 10% of all cleft palate repairs.
  • The speech surgery will either lengthen the soft palate some more (Furlow palatoplasty), narrow the air passage between the nose and mouth (sphincter pharyngoplasty), or create a bridge of tissue between the palate and back of the throat (pharyngeal flap). 
  • If needed we try to perform secondary speech surgery before your child goes to kindergarten, but in milder cases we may do the surgery at an older age. 
  • The surgery lasts around 2 hours. Your child will stay one night in hospital before going home. They will need to follow a soft food diet for two weeks to allow healing. Our speech team will then reassess your child’s speech 2 to 3 months after the surgery.