Common Speech Sound Errors in Children with Cleft Palate and How Therapy Helps

Children born with a cleft palate often experience speech sound errors due to their different anatomical structures which can affect early speech development. Even after surgical repair, some children may continue to have errors that are the result of mislearning or residual compensatory errors (errors that developed due to anatomical differences but may no longer be functional after surgical intervention). Speech therapy plays a crucial role in resolving these error patterns and helping improve speech intelligibility.

Common Speech Sound Errors in Cleft Palate

Children with cleft palate may exhibit the following speech sound errors:

• Compensatory articulation errors – When a child learns to produce sounds incorrectly due to structural differences, even after surgery. These include:
  
  • Glottal stops - using the vocal cords instead of the mouth to produce sounds
    
    • This often sounds like grunting or an “uh” sound and replaces sounds like /p, b, t, d, k, g/
  • Pharyngeal fricatives - producing sounds in the throat instead of the mouth
    
    • This is often seen in airflow sounds like /s/ and /sh/
  • Nasal fricatives - pushing air through the nose when making certain sounds
    
    • This is also often seen in airflow sounds
  • Mid-dorsum palatal stops - contacting the roof of the mouth with the middle of the tongue rather than the tip of the tongue leading to distortion
    
    • This is often seen in sounds like /t, d, k, g/

Other Considerations

There are other errors that exist in children with cleft palate that are not corrected through speech therapy and require surgical intervention. These include:

• Nasal air emission – Unintentional air leakage through the nose while speaking, especially on high pressure consonants like /p/ and /t/
• Resonance differences – This includes hypernasality, hyponasality, and cul-de-sac resonance which change the quality of speech production
• Weak oral pressure – Difficulty building up enough airflow in the mouth for certain sounds, leading to distorted speech
  
  • This can also lead to nasal realization, where sounds like /p/ are completely nasalized and become another sound, in this case /m/

Why Speech Therapy?

Early speech therapy interventions work with young children (as early as children start babbling) to move sounds from their throat to their mouth. As children get older, speech therapy can help address compensatory errors to improve speech intelligibility. If you have any concerns about your child’s speech development, it is always a good idea to have them evaluated by a speech-language pathologist with a background in cleft lip and palate to answer any questions and provide additional support.

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