Cleft lip and palate
A cleft lip and / or palate is a split or a space in the upper lip, or the palate (roof of the mouth), or in some cases both.
A cleft lip and / or palate can impact upon a child’s speech skills and feeding skills as children may have difficulties producing certain sounds, having the correct resonance or phonation as well as difficulties with eating and drinking.
Speech and language therapy can help reduce the level of difficulty your child is experiencing. A speech and language therapist can help ensure your child a safe experience during eating and drinking as well as creating an individualised programme to work on your child's speech difficulties.
What exactly is cleft lip and palate?
Cleft lip and / or palate is a facial defect that exists at birth. It is the result of the lip and / or the plate not properly fusing together during the early stages of pregnancy. This results in an opening, space or hole that usually wouldn’t exist.
A cleft lip can occur only to the upper lip or the upper lip as well as the gum ridge and / or the alveolar ridge.
A cleft palate is an opening in either the hard palate or the soft palate (velum) or both. This leaves a continuous passage between the mouth and the nose. This is because the palate acts as a barrier between the nose and mouth.
The severity and type of cleft can vary. A cleft can differ in:
Unilateral vs bilateral
- Unilateral cleft only occurs on one side of the lip or palate.
- Bilateral cleft occurs on both sides of the lip and or palate.
Complete vs incomplete
- Complete cleft refers to a gap in the lip and / or palate that follows through to the nose.
- Incomplete cleft refers to a gap in the lip and / or palate that doesn’t follow through to the nose.
Severity can be severe vs mild
- Mild cleft can be a notch in the lip or palate.
- Severe cleft is a complete bilateral cleft lip and palate.
What causes cleft lip and palate?
A cleft lip and palate occurs in the early stages of pregnancy when the structures that form the upper lip and palate do not join properly. The cause of cleft lip and / or palate is currently unknown; however researchers suggest there are certain genetic and environmental factors during pregnancy that can increase the chances of having a child with a cleft lip and / or palate. Factors include:
- Inherited genes.
- Lack of folic acid during pregnancy.
- Smoking during pregnancy.
- Alcohol consumption during pregnancy.
- Obesity and poor nutrition during pregnancy.
- Certain medications taken during pregnancy.
- Pierre robin syndrome.
- Stickler syndrome.
Research shows that cleft lip and / or palate is the most common facial defect in the United Kingdom, with 1 in 700 children being born with some form of a cleft. 50% of those children have a cleft palate, 25% have cleft lip and a further 25% have both cleft lip and palate. A unilateral cleft lip and / or palate is more common than a bilateral cleft lip / or palate, only 10% of those born with a cleft lip and / or palate have a bilateral cleft lip and / or palate.
Symptoms associated with cleft lip and palate
The symptoms associated with cleft lip and / or palate will differ according to the type of cleft and its severity. Not all children will demonstrate these symptoms and the severity of symptoms will vary between children depending on their abilities.
- Difficulty with feeding.
- Difficulty with eating, drinking and swallowing, potential chance of food coming out of the nose.
- Hyper-nasal speech or hypo-nasal speech.
- Chronic ear infections.
- Impaired speech development.
- Inaccurate production of sounds.
- Reduced speech intelligibility.
- Difficult to make distinctions in the child’s speech.
- Difficulties with voice including breathiness and hoarseness.
- Difficulties with communication.
How does cleft lip and palate impact upon function?
Cleft lip and / or palate can impact a child’s speech, language and communication skills. Thus having an impact on their daily activities and participation in daily life. If a child is aware of their difficulties with speech, language and communication, it can often impact the child’s social and emotional wellbeing.
Cleft lip and / or palate can impact a child’s quality of life in the following way:
- Difficulty in being understood by others.
- Difficulty expressing their thoughts and feeling in a way that can be understood by others.
- Difficulty taking part in activities in school or at home that require them to use their voice and speech skills.
- Embarrassment around eating or drinking in public.
- Difficulty making and maintaining friendships.
- Reduced self confidence.
- At risk of bullying due to speech sound abnormalities such as nasal turbulence or nasal snort and appearance.
Speech and language therapy can help children with cleft lip and / or palate by providing them with therapy that concentrates on the correct production of speech sounds the child is physically able to make. This in turn will increase their intelligibility making it easier for others to understand them.
Speech and language therapy assessments suitable for cleft lip and palate
Speech and language therapists can carry out assessments of speech and language to determine the level of difficulty your child is experiencing. The assessments may differ according to your child’s ability and age. Speech and language therapists carry out a variety of formal and informal assessments including:
Speech and language therapy treatment available for cleft lip and palate
Speech and language therapy can be beneficial for children with cleft lip and / or palate. Developing children’s speech sounds can increase their ability to establish the production of different speech sounds. After surgery, speech and language therapists can help children to develop their speech sounds to make it easier for them to be understood by others.
Our speech and language therapists will use the information from the assessments, as well as collaborate with you, your child and their school to create an individualised therapy programme that works on your child’s needs and includes their motivators and goals.
A child with cleft lip and / or plate may experience difficulty with producing certain sounds that require you to build up air pressure in your mouth such as /p/ /b/ /t/. After surgery on the cleft, the child may still choose to produce the sound in an incorrect manner making words that contain the sound difficult to recognise. Our speech and language therapists work with children to eliminate this habit and work on producing the sounds in the correct manner.
Therapy available from our speech and language therapists include:
- Speech sound therapy.
- Communication skills therapy.
- Advice and strategies for eating, drinking and swallowing difficulties.
- Voice therapy.
- Individual therapy.
- Group therapy.
- Advice, training and support for parents, carers, teachers and other professionals.
- Augmentative and Alternative Communication.