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Sometimes children have to wait to have cleft palate surgery. This document explains what to do before the child is able to receive surgery to help develop their speech.

Download Link: Strategies Before the Cleft Palate is Repaired

What to do Before the Cleft Palate is Repaired to Improve Speech Outcomes After Surgery

Where possible cleft palates are generally closed for the first time when the baby is between 9 and 14 months old. Sometimes it takes longer when the baby is not healthy or big enough, or the family is waiting for a surgery. Here are strategies parents and professionals can do before the cleft palate is repaired to make sure the baby has correct articulation placement—that is so the speech sounds are created with the correct tongue and lip placement.

The point of all these strategies is to ensure that the child’s speech is the best it can be once the cleft palate is closed in surgery. Babies and children with open cleft palates cannot make certain sounds, including the b, p, t, d, k, g, and s. The goal is for the child to have correct placement of the sounds so that once the cleft palate is closed, the child will have good placement for speech. If they have good placement before surgery, the child will likely need much less speech therapy after the palate is closed.

  1. Reinforce babbling using sounds the baby can make correctly: Even with an open cleft palate, the baby can make the m, n, and ng sounds and the w, l, y sounds, and the vowels. So we use those sounds and play back and forth with the baby using those sounds. E.g. If the baby babbles with sounds that are not part of language, such as glottal stops or sounds made at back of the throat, smile and babble back with the sounds the baby can make like “nanananana” or yi yi ya ya yee” or “nane nane nane” or “wa wa woo woo woo”. Eventually, the baby will respond with the sounds the parent makes.
  2. Reinforce language: Use language to have fun with your baby as you would with any other child. They are not more delicate than any other child. Sometimes children with cleft palate need more communication interactions with the parents to make sure that their language develops well.
  3. Use functional vocabulary: words that have the sounds the child can make like mommy, me, my, more, man, mine, no, nana, ear, hair, eye, arm, knee. on, in, moon, ring, new, moon, noon, moo, meow, wow, wow wow (dog bark), roar (lion or truck sound), maa (lamb sound), mini, you, yay, yeah, yoyo, yo, lamb, etc.
    • Fathers will have to wait to hear “Daddy” until after the cleft palate is repaired. A child with a cleft cannot say the D sound but they can make the M sounds. So they can say, “Mommy” but not “Daddy.” The best approach is to call Daddy, “Nanny”. The N and D are made in the same place in the mouth with the tongue. After the cleft is repaired the child will much more easily say “Daddy”. Be patient, fathers (or “Nanny”), and after the surgery you will hear “Daddy.”
  4. Focus on placement: Reinforce the correct placement to make the sound. Like “Cookie” or “NGooNGEE,” or “I want a cookie” “I wanN a NGooNee.” (the NG is like the last sound on “ring” and “sing”).  Even for children with a cleft palate who will have to wait a long time for a surgery it is better to help them make the sounds in the correct place because it is easier to understand.