Speech development is a major concern regarding children born with a cleft lip and/or palate. Even though corrective surgery of the lip and palate and therapy does help many children develop their speech to normal levels, some children can face significant speech impairments. By the age of five, “normal” speech has developed. In some children born with cleft lip and or palate, there are higher chances of speech delays. Children born with a cleft palate are have a more increased chance of speech problems because of the tongue not being able to hit the roof of the mouth correctly in order to pronounce specific sounds and words correctly.
Speech impairments can persist because if the child’s teeth do not form correctly, their speech cannot be understood. The nasal cavity and soft palate are connected and for proper speech they must work together to produce proper air flow. Many sound, ba, fl, s, sh for example will sound distorted. With the help of speech therapy, it can be helped depending on the severity of the speech impairment. There are many speech impairment that effect cleft children more often, hyperacidity, speech articulation disorder, nasal emission, velpharyngeal inadequacy to name a few. When therapy alone does not help, corrected surgery is needed.
What is Velopharyngeal Insufficiency (VPI)?
In order to produce speech, the soft portion of the palate (called “soft palate”) needs to elevate and make contact to the back of the throat. This closes off the mouth (the oral cavity) from the nasal cavity so that sounds can come out of your mouth and not your nose. When we produce nasal sounds, such as “m” and “n,” the soft palate stays down so sound can travel out the nose to produce the nasal sound. Velopharyngeal Insufficiency (VPI) is when the soft portion of the palate does not reach the back of the throat to produce normal sounding speech. This results in unwanted escape of air or sound through the nose during speech. A child who has VPI may have nasal sounding speech. Even after surgery to close the cleft in the palate, approximately 20% of children will continue to have VPI and may require another surgery and/or speech therapy. The team speech-language pathologist will determine if VPI is present and recommend appropriate management for your child. There are several other terms that are used synonymously with VPI. These include velopharyngeal inadequacy and velopharyngeal incompetency. Some teams use the term velopharyngeal dysfunction (VPD) to include any problem with velopharyngeal function for speech.
If my child does have speech problems, how are they treated?
If your child’s speech problems are due to incorrect articulation (how sounds are formed by correct placement of the tongue and lips during speech) speech therapy is the appropriate treatment. Speech therapy can help your child learn how to use the “articulators” (tongue or lips) to make speech sounds correctly. If the speech-language pathologist determines that your child’s speech problems are related to VPI or other problems with oral structures (e.g., teeth, how the teeth come together, or a “fistula”), speech therapy may not be an appropriate treatment. Surgical or orthodontic intervention is generally required to correct these anatomical differences. Often, children may need both speech therapy and additional surgery to create normal sounding speech. It is important to discuss treatment of your child’s speech problems with the cleft palate/craniofacial team speech-language pathologist (SLP) who has special knowledge and skills to accurately diagnose and treat or monitor treatment of your child’s speech problems. The team SLP can also work collaboratively with the school-based SLP or other community SLP who may be treating your child to provide coordinated speech care.