Information for new parents

Speech and Language Therapy Information

The Northern and Yorkshire Regional Cleft Lip and Palate Service

Introduction This information booklet has been produced to provide you with information about your child’s early speech and language development and to tell you how the Speech and Language Therapist will be working to help support this.

What is your palate – why is it important in speech? The palate is very important in speech production. It forms the roof of the mouth and is made up of two parts, the hard palate and the soft palate. The soft palate, towards the back, is made up of muscles. When we speak, air from the lungs passes up through the vocal folds (voice box) and into our mouth. To talk clearly, it is necessary to be able to shut the nose off from the mouth. To do this, the muscles of the soft palate move upwards and backwards towards the throat. At the same time, muscles in the back and side walls of the throat move towards the soft palate to close the nose off. We use our tongue, teeth and lips to shape the air to make different sounds. Most of the sounds that we use in speech are made with the palate raised up, closing off the nose. Sounds made in this way include p, b, t, d, k, g, s, z, ch, j. Some sounds, such as m, n and ng, are produced with the palate lowered (relaxed) allowing air to flow up through the nose.



Diagram of soft palate Soft palate raised to make oral sounds, e.g. ‘p, b, t, d, k, g, s, f’

Soft palate at rest, for nasal sounds, e.g. ‘m, n, ng’

Will my child have speech problems? Many children born with a cleft palate will develop normal speech. However, because the structures used for speech are affected by the cleft, those children are at a higher risk of developing speech and language difficulties. If difficulties do occur the speech and language therapist will offer your child therapy and advice as appropriate. A small number of children may go on to need further surgery to help them with their speech. It is also possible for children to develop speech and language difficulties that are not related to their cleft palate. The Speech and Language Therapist with the cleft team will monitor all areas of your child’s speech and language development and provide support as required. Children born with a cleft palate are more likely to suffer from a build up of fluid in the middle ear, sometimes called glue ear, which can make it difficult to hear and distinguish between sounds. This can have an effect on your child’s speech and language development. Hearing will be routinely monitored as part of the cleft service. 

What difficulties can occur? Even if we do all the right things, some children with a cleft palate may find talking difficult. If the palate doesn’t work efficiently, and is unable to close off the mouth from the nose, air may escape through the nose. This may result in: • a nasal quality/tone to speech • a difficulty making certain sounds • sounds that are weakened and/or replaced by incorrect or unusual sounds eg using only nasal sounds ‘m’ and ‘n’, baby → ‘mamy’, daddy →‘nanny’ Some children born with a cleft palate find it easier to make sounds at the back of the mouth or in the throat e.g. daddy → ‘gaggy’. They often need to be encouraged to make sounds at the front of the mouth using their lips and tip of their tongue.

Speech and language development in your child’s first year Before palate repair During the first few months you will probably be busy sorting out feeding and focusing on your child’s forthcoming surgery. Your child, even in these early days, will be busy learning important communication skills including listening, turn taking, eye contact and using his/her voice. Up to 4 months of age, your baby will develop different cries and pleasure sounds. There is little difference in these sounds for babies with or without clefts. They make mainly vowel and nasal sounds eg ‘uh’ ‘ah’ ‘muh muh’. Between 4-6 months babies begin to use a range of speech like sounds. If a baby has a cleft palate they are unable to close off the nose and find it difficult to make sounds such as ‘b’ and ‘d’. However they are able to make sounds such as ‘m, n, w, y, ng’. 

From around 6 months of age your baby will start to babble and make an increasing range of noises. They will begin to let you know what they want by pointing and making body movements and gestures. By approximately 6 months, babies born without a cleft palate begin to make an increasing number of sounds with air coming out of the mouth, e.g. ‘bah’ ‘dee’ ‘guh’ etc. For the baby born with a cleft palate it is important to encourage them, even in these early stages, to play with sounds at the front of their mouth and so develop their range of tongue and lip movements before their surgery.

Things to do with your baby…….

• Talk to your baby about the world around them – who can you see, what are they doing, name objects and people around them • Watch and listen for your baby’s attempts to communicate. This may simply be a smile or a giggle. Give your baby time to communicate - wait for a response and then copy what they have just done. • Listen together to noises around you. • Have quiet 1:1 time each day. Sit face to face with your baby and spend time playing with sounds. Listen to sounds your baby makes and have pretend conversations. Copy the sounds your baby makes such as ‘mah, nee na’ and add in some others eg ‘paa tee’. Use times of the day when you are close together such as feeding, washing or changing times. • Make your own sounds very gently and close to your baby’s face so they can feel the sound/breath on their face. • Before your baby has surgery to repair their palate they will find vowels and nasal sounds ‘m’ and ‘n’ easier to make. Make sounds on their body, watch and wait 

e.g. say ‘bbb’ on their tummy, ‘www’ on their foot, ‘hhh’ on their face. If they like it, do it again. Encourage sounds such as ‘m, n, w, h’ and vowels. Things to avoid • Avoid growling like a lion or making grunts like a dog during play • Avoid making throaty sounds your baby may copy, e.g. monstertype noises

After palate repair Your baby’s palate is usually repaired at around 9 months of age. After this operation your baby will need to explore what their new mouth can do. They will probably begin to make some new sounds like ‘b, d’ and ‘g’.

When does the Speech and Language Therapist see your child and what will they do? The Cleft Specialist Speech and Language Therapist (SLT) will monitor your child’s speech and language development regularly. Advice and help will be given as required. These checks will take place at the following intervals until your child is 20 years of age: 0-6 weeks old – The SLT will see you and your child when you attend the multi-disciplinary clinic appointment. You will have the chance to talk about any concerns you may have and the therapist will discuss with you ways to encourage your child’s speech and language development. 9-12 months old – The SLT will see you and your child again when you attend the multi-disciplinary clinic appointment. We may also see you and your child at home if you feel this would be helpful. If you are concerned and would like a 1 to 1 appointment with a SLT to discuss your child’s early speech and language development we can come and see you at home. This can be requested via your Specialist Cleft Nurse, or through the SLT in clinic. 

18 months old – The SLT will see you and your child at home and will assess your child’s early speech and language development through play activities. They will listen to what your child is saying and what sort of sounds they are making. If there are any concerns at this stage advice/therapy will be offered as is appropriate. 3 years old - The SLT will see you and your child at a local clinic to carry out a detailed speech and language assessment. If your child needs any regular speech and language therapy for speech difficulties related to their cleft palate we have Cleft Specialist Speech and Language Therapists based locally who will offer you support. If your child has speech and language difficulties that are not related to their cleft palate we will refer your child to the nearest local speech and language therapy service. We also monitor your child’s speech when they are 5, 10 and 15 and 20 years of age. As well as these specific points, speech and language therapy input can be offered at any stage, if speech difficulties occur or if you have any concerns. If you have any questions you would like to ask us please do not hesitate to contact any one of the Speech and Language Therapists in the Regional Cleft Service at: Northern Area: Speech and Language Therapy Newcastle Cleft Team Royal Victoria Infirmary Queen Victoria Road Newcastle NE1 4LP Tel: 0191 282 4660

Yorkshire Area: Speech and Language Therapy Leeds Cleft Team Clarendon Wing The General Infirmary at Leeds Great George Street Leeds LS1 3EX Tel: 0113 392 8558 

Compliments & Complaints We would welcome any feedback on our service, which could be given directly to your Specialist Speech and Language Therapist or to our team coordinator. Alternatively, problems can be raised with a member of PALS. Pals aims to give advice and assistance to sort out your problems as quickly as possible. The service is led by matrons and managers. To contact PALS ask a member of staff or ring the general PALS number on 0113 206 7168 and we will arrange for a matron or the relevant manager to speak to you. If you remain unhappy, you can contact the Patient Relations department to make a formal complaint. Telephone: 0113 206 6261

Additional Source of Information Cleft Lip and Palate Association (CLAPA) Head Office – Green Man Tower, 332 Goswell Road, London, EC1V 7LQ Phone 020 7833 4883 Email: [email protected] Web: www.clapa.com

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