Cleft lip and palate

Also called Cleft palate speech, Velopharyngeal insufficiency, VPI, Submucous cleft

How a cleft affects speech (nasal air, missing pressure sounds, glue ear), the surgery and therapy that follow, and what parents can do between appointments.

What it is

A cleft is a gap in the lip, the palate or both, present from birth, and the Health A-Z carries it as cleft lip and palate. This entry is about speech, which a cleft lip alone rarely affects and a cleft palate often does, because the palate is what seals the nose off from the mouth when we make most speech sounds.

The lip is usually repaired at around three months and the palate at around six to twelve months, before most speech develops. Many children then speak entirely typically. A significant minority need speech therapy, further surgery or both, and the cleft team follows every child until adulthood to catch it.

Who it can help

Families of babies and children born with a cleft palate, and the nurseries, schools and therapists around them. Adults who had a cleft repaired years ago and still have nasal or unclear speech; treatment is available at any age.

It isn't a guide to feeding, hearing or the surgery itself, though all three touch speech. And the nasal speech of a cleft is different from dysarthria, where the palate is intact but weak.

How it works

Two things go wrong when the palate doesn't seal. Air escapes down the nose during speech, so the voice sounds nasal and consonants such as "p", "b", "t", "d", "s" and "k", which need pressure built up in the mouth, come out weak or with a snort. And a child who can't build pressure often learns to make the sounds further back, in the throat, a compensatory pattern that persists after the palate is fixed and is what therapy mostly treats.

Glue ear is very common with a cleft palate because the same muscles open the ear's drainage tube, and muffled hearing during the speech-learning years adds a speech sound layer on top. Hearing is checked regularly and grommets are common.

The cleft team's speech and language therapist assesses at around eighteen months, three years and five years and at intervals after. If air escape continues after repair, a further operation to improve the seal may be offered. Therapy targets the compensatory patterns with play-based sound work and is often intensive over a short period.

Getting started

Keep every cleft team appointment and every hearing test; the pattern across them is what drives decisions. Ask the team's therapist what to listen for at home and which sounds to model.

Play with the pressure sounds: blowing bubbles, "p-p-p" games, popping sounds in stories. Don't correct; model and carry on. Read aloud daily, close and face to face.

Tell nursery or school about the cleft and the hearing, and ask them to seat the child near the front and check they've heard. If speech is affecting confidence, say so to the team; psychology is part of every cleft service.

Where to get help

CLAPA, the Cleft Lip and Palate Association, supports families from diagnosis and adults born with a cleft, with a helpline, parent contacts and feeding equipment. NHS cleft care in the UK runs through regional specialist cleft teams, and every child is referred at birth; the team's speech and language therapist is your contact for speech. The RCSLT explains the profession more widely.