The Facts on Orofacial Clefts

The term “orofacial clefts” comprises “cleft lip” and “cleft palate”—congenital abnormalities in facial tissue that leave gaps in the upper lip and/or roof of the mouth. Most clefts can be closed surgically, but even after treatment, the child is often left with speech disabilities. Fortunately, these are often rooted in habit, so they can be unlearned.

Today’s post is contributed by Abby Freking of Lake Jackson, a professional speech pathologist and mother of two children with orofacial clefts.

young child with speech therapist

The Voice of Professional Experience

Children with cleft palate tend to have pronunciation difficulties, especially with plosive sounds such as p and d. Air pressure has to be built up in the mouth to produce plosives, and if there’s a cleft in the roof of the mouth, the air escapes through the nose—creating a nasal sound such as m or n. Early surgical intervention—closing the cleft to create effective division between nose and mouth—is imperative to preventing and resolving speech errors.

Young children with clefts usually catch on very quickly that the sounds they are making do not sound like what mommy or daddy says, and they instinctively try to compensate by manipulating their tongues, nasal airflow, and vocal folds [aka vocal cords]. For example, a one-year-old may realize that when they try to say “dada,” it comes out as “nana.” If the position of a cleft makes it impossible to produce an actual d sound, the child may experiment and teach themselves the alternate plosive g, producing a “gaga” which sounds a little more like “dada.”

The trouble is, a child who implements such “compensatory errors” may start using them habitually, even after surgery makes them unnecessary. If surgery is completed prior to the child acquiring all their speech sounds, it can prevent some compensatory errors from emerging; however, intense speech therapy is still essential in most cases. The child needs to learn articulation placement for some sounds, and also how to control oral airflow with the palate. 

If a child has surgery and no other comorbidities, we generally expect them to communicate effectively through speech by the early elementary grades (some researchers suggest a goal of age four). So far, I have not met anyone who developed a permanent impairment, and needed a text-to-speech app or other assistive technology. 

The Voice of Personal Experience

In my own family, our son was born with a cleft soft palate, and our daughter with a complete bilateral cleft lip and palate. My son’s cleft was never visible, so we have not faced reactions concerning him.

With my daughter, her cleft was completely visible prior to surgery, and when I share her baby pictures, I’ve had several people appear shocked at her very different face. The best responses have been from the people who don’t try to avoid looking at her. They display a healthy curiosity: “That’s interesting, how does it happen? Does it hurt?”

The surgeries on her lip and palate were done over two years ago, and her craniofacial surgeon is truly an artist. Many people can’t even tell she has a scar. 

Thankfully, we haven’t met with any nasty or awkward reactions. I think that is because I always try to approach the topic as if I’m educating and not defending. My hope is that the kids will grow up able to respond to questions in ways that build awareness. They’re still little—seven and three—but we are already laying the groundwork for them to handle future interactions. I have told my son that he might have a curious friend asking about his sister someday soon, and that he should just answer with the simple facts: “she was born with a cleft lip, she had surgeries, and now she’s fine.”

Every morning, we tell both kids that they are kind, they are important, they are loved, and God has big plans for their lives. It’s important for every child to know that their worth does not come from appearances.

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