Speech and language ideas while waiting for your baby’s cleft palate surgery

If you are waiting for your child’s palate to be repaired, you might be wondering if this will affect their speech. The good news is there are plenty of things you can do at home to help with speech and language development during this time as you wait for surgery – this information sheet from the North Thames Cleft Lip and Palate team at Great Ormond Street Hospital and Broomfield Hospital gives you a few suggestions.

You may have read or been advised that it is best to have surgery in time for when most children start talking, which in many cases is about one year of age. While this age is a general guideline for the timing of palate repair, there are a number of health reasons why many children have to have their palate repair delayed. In some cases, this does not seem to have any effect on their speech development, while other children might need more help with this.

Speech – the way in which we pronounce our words – is a very small part of communicating.

We can imagine communication as a tower. Speech can be seen as the brick at the very top of the tower. Long before they start talking, babies are learning the skills they need that form the foundations of the tower. These include being able to pay attention and listening to others, playing and socialising, understanding what is being said to them, starting to use words themselves and then finally learning how to pronounce words.

Here are some things you can do at home, starting with skills in the lower levels of the tower.

• Play face to face with your baby every day. Games like peek-a-boo help develop play and social skills. Here is an example: www.bbc.co.uk/tiny-happy-people/playing-with-peekaboo/zb8f7nb 

Limit how much you let your baby watch screens and play on phones and tablets. At this age they need lots of playing with people to help their social interaction and play skills.

As your baby grows, encourage them to play with toys they can pretend with, such as tea-sets. Here is an example of this

Help your toddler start to take turns and sharing in very simple ways, like waiting for ‘ready, steady, go’ before knocking a tower down or rolling a ball back and forth to each other.

• Sing nursery rhymes with your baby, using the actions. 
• Read books with your baby every day. This is a lovely bonding activity and helps their language development, linking with every level of the tower. 

Research shows that this benefit carries on into school days! There are also lots of online books available. including books in over 50 languages

• Watch out for signs that you toddler is communicating before using words. They might lift their arms to be picked up. Respond to these attempts as this can help reduce frustration. 
• Label these attempts at communicating. For example, you could say: “Up? Up, you come.” as you pick up your toddler.

• Talk to your baby about what they can see using simple words. Try to be face to face so he/she can easily see you. Keep background noise down while you are doing this.
• Copy the sounds your baby makes as long as they are sounds you hear in your own language. Do not copy sounds made in the throat like “eh” “huh” or harsh sounds unless these are sounds used in your language.
• Expand on what your baby is saying. They might say “mama”. You can say back: “mama moomoo”. See this example
• Easier sounds for your baby to say before surgery will be those that do not need the palate to separate the mouth from the nose, which is not possible until after the cleft has been repaired. These sounds include vowels (like ‘aa’ ‘ee’ ‘oo’), sounds made in the nose (like ‘m’ and ‘n’) and sounds like ‘w’ ‘l’ and ‘j’. Examples of easier words include: Mummy, more, Nanny, lolly.
• Harder sounds will be those sounds that need the palate to separate the nose from the mouth. They include sounds like ‘b’ ‘d’ ‘g’. You might find that your toddler either says these sounds using a nose sound (‘m’ ‘n’) or leaves them out. For example a word like ball might sound like ‘mall’ or ‘all’. Don’t correct these types of mistakes but just say the word back clearly in a natural way. For example, you can say: “Yes, ball. You rolled the ball. Big ball”.
• Show your baby how sounds are made by playing face to face with sounds. You can say something like: “mmmmm ….. with my lips”. You can poke your tongue out a little and make a gentle ‘n’ sound, saying something like “nnnnnn…. with my tongue”, showing your toddler your tongue. Don’t worry at this stage if they do not copy you. 

You can show your toddler how some of the harder sounds are made too but do not expect them to copy these yet. It is best to start with quiet sounds like ‘p’ and ‘t’. Make sure you say the sound really gently and quietly. This link shows good examples of how to do this for toddlers with a cleft.