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This one is about: Early Speech Stimulation in the Cleft Lip/Palate Child

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     Birth to 12 Months

by Kelly Mabry Downing MS, CCC-SLP

All parents look forward to the day their child says his first word! Whether it's "mama", "dada", or "ball", the groundwork for speech is laid long before you hear meaningful words. Parents with children who have cleft lip or palate need to be aware that the structural deviations associated with cleft affect speech in two major ways: First, the way your child says certain sounds may be different due to his unique mouth structure, and second, his voice may have a nasal quality if the cleft affects the soft palate or if the hard palate is unrepaired. Sometimes after surgery a child may have a small hole, or fistula, that allows air to "leak" into the nose. This usually affects speech only slightly.

When stimulating early speech development families of cleft-affected children should do what comes naturally, while keeping in mind these two goals: 1) Imitation is an important learning and social tool, and especially important in speech development. As a family you want to encourage correct PLACEMENT (not necessarily production) of sounds. Imitation is a valuable skill your child will need in "copying" you. 2) your cleft affected child may have special difficulty in producing non-nasal sounds (everything except m,n and ng) if the hard and/or soft palate is involved. For this reason you will want to encourage him to learn to direct airflow through the mouth rather than the nose.

Since speech is a social act, there is no better way to encourage speech development than through play. The following are suggested games that are specific to the cleft-born child's unique needs:


This is a great time to start teaching your baby imitation skills. At this age he will begin to make sounds in the back of his mouth. He will also love to look at his favorite thing - your face! While your baby is looking at you, talk to him often while making your voice interesting by varying your pitch and loudness. Also, imitate the sounds your baby makes at you.


Your baby will now begin to put sounds together and play at making sounds. During daily activities such as feeding, talk often to your baby using vowels and early consonant combinations such as "mama", "deedee" and "baba". Nursery rhymes and songs are great tools to teach your baby to listen. While facing baby, try singing a song and then stopping; wait for your baby to vocalize, then continue singing. He has just asked you for "more"! Encourage him to imitate your lip and tongue movements by making silly sounds such as raspberries or "popping" sounds with your lips.


Your baby will begin to babble several syllables at a time. Encourage him to produce different combinations by saying those sounds to him in a playful voice with varied intonations. While playing this speech game, give him several seconds to make sounds back to you. Then reward him with a smile, hug or tickle. Don't forget those nursery rhymes! Think of all the great sounds you are stimulating while singing, "Pat a cake, pat a cake, Baker's man."

The most important thing to remember is to have fun and enjoy the act of communicating with your child. If you are concerned about your child's speech skills, contact your Speech/Language Pathologist through your cleft team, public school system or privately, for an evaluation.

------------------------------------------Kelley Mabry Downing, MS, CCC-SLP, is a Speech and Language Pathologist for University of Connecticut Health Science Centre, Cleft Palate Craniofacial Team. She is also the Speech/Language Consultant for WIDE SMILES Magazine.

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