Early speech development in babies with cleft lip and/or palate

This page explains about early speech development in babies with cleft lip and/or palate and what to expect when your child comes to Great Ormond Street Hospital (GOSH).

Children born with cleft lip and/or palate vary in their speech development. The severity of the cleft does not always indicate the level of difficulty a child will have in developing speech. Many children with cleft lip and/or palate develop normal speech with no need for help from the speech and language therapist.

However, others may develop speech problems recognised by the speech and language therapist as being related to the cleft. Many of these ‘cleft-type’ speech problems can be corrected with speech therapy.

It is important not to confuse these abnormal speech patterns with the normal immature sounds many children produce. Children generally tend to grow out of these without any therapy. The therapist often works with the parents to sort out these differences and aims to correct any residual speech difficulties.

We produce speech by air coming from the lungs, through the vocal folds (voice box) and out of the mouth. We shape the sound with our tongue, lips and teeth in order to say sounds and words. The diagrams below show the main parts of the speech mechanism and where sounds are made.

The palate plays an important role in speech production as it closes off the nose from the mouth during speech.

Most sounds produced in English are made with the palate raised (with the nose cavity closed off) and these sounds are called ‘oral’ (p, b, t, d, k, g, f, v, s, z, sh, ch, ge).

In addition to this there are three sounds (m, n and ng) where the palate is lowered (the connection between the mouth and the nose is open) and these are called ‘nasals’.

In our centre we aim to prevent the development of abnormal speech patterns. We do this by observing and discussing your baby’s babble sounds with you. If necessary, we advise on how best to encourage the movements and sounds needed for speech. We will also discuss which sounds to discourage.

Children with cleft lip and/or palate are seen by a speech and language therapist at Great Ormond Street Hospital/St Andrews Centre for a formal speech and language assessment at the age of 18 months and around three years of age, in addition to the routine Cleft Lip and Palate clinic appointments.

In addition to normal “chatting” with your baby, which is a vital part of language development, parents can play an important role in shaping early sounds. We hope the following ideas are useful. The aim is to develop what your baby is already doing and to encourage further speech sound development.

These ideas are for developing the skills your baby needs before they can start talking. It is important for your baby to look, listen and experience sounds and speech before they can produce them.

You can play sound games at any time. It is generally best to try to cut down on background noise so that your baby can hear your voice and the quieter speech sounds such as p, t and k. Try to sit facing your baby so they can clearly see your face and mouth.

By doing this throughout the day, you are providing a clear model of speech for your baby. You don’t even need to use real words: have some fun with sounds! Your baby may not copy these sounds straight away but will enjoy watching your mouth and face and hearing the sounds you make.

For example:

• make silly sounds

• change the loudness and pitch of your voice

• pull funny faces and make exaggerated facial expressions for your baby to watch

Even at this early age it is important to begin to take turns in conversation. Turn-taking is an important skill in the development of speech and language, so after your baby has had a turn at ‘talking’, you can say something and then allow a gap for baby to take a turn again.

It is important for babies to become ‘tuned in’ to the speech sounds and everyday noises that they may hear.

For example, when at home draw your baby’s attention to everyday sounds such as a vacuum cleaner or the telephone by asking “what’s that noise?”, then show them what made the noise. You could also do this with toys that make a noise, such as musical instruments.

When you make sounds, vary the pitch and tune in your voice so that your baby can listen and copy. This is also an important skill for your baby to develop so try to include this in play.

For example, when you swing or bounce your baby up and down, vary the tune in your voice to match the word, so your voice goes up when you say “up” and down with “down”.

Listen to the sounds your baby makes and repeat these back to them. This will allow your baby to hear and see the sounds they are making and let you tune into his or her speech sounds. Let your baby see and feel your mouth moving either with his or her hands or on his or her skin.

For example, blow raspberries and let your baby touch your lips to feel the vibration. Try to avoid repeating back to your baby any sounds that are made deep in the throat, as these are the ones we aim to discourage.

Encourage your baby to make sounds. Babies at this early age usually won’t be able to copy sounds perfectly. It is more important for you to provide a clear model of the sound and this will encourage your baby to join in.

Encourage early speech sounds, particularly gentle lip sounds such as “muh, buh, puh”. Use words like “peep-o”, “pop!” and “mummy” or imitate animal sounds, for example, “moo”, “baa” and “miaow”.

You can also make up nonsense strings of sounds, for example mumumum or boobooboo. If you make the sounds, your baby will want to join in.

Pop bubbles while saying “pop, pop, pop” and play hiding games, saying “peep-o”.