Understanding cleft palate and lip: How speech therapy can support your child

How are clefts detected and why do they occur?

Medical teams frequently identify cleft lips during routine 20-week prenatal ultrasound scans ⁵. However, cleft palates occurring without a cleft lip are harder to spot on an ultrasound. As a result, doctors typically diagnose them during a physical examination at birth ⁵. Milder forms, such as submucous cleft palates, might only be identified later in childhood when speech differences appear ⁵.

Parents receiving a diagnosis often wonder what caused the condition. However, experts do not know the exact cause of orofacial clefts ⁶, ⁷. Evidence suggests a genetic component because a family history increases overall likelihood ⁶, ⁷.

Additionally, environmental risk factors like smoking and folate deficiency play a role. However, many children are born with clefts even without these risk factors present ⁶, ⁷.

How are clefts managed?

A cleft diagnosis involves long-term management tailored to your child’s growth. Specialized multidisciplinary teams care for children from birth through young adulthood in hospital clinics ⁸. These teams typically include:

• Audiologists

• Dentists

• Ear, nose, and throat (ENT) surgeons

• Oral and maxillofacial surgeons

• Pediatricians

• Plastic surgeons

• Speech-language pathologists ⁸

Surgeons usually repair a cleft lip within the first 3 to 6 months of life. Later, they repair a cleft palate between 6 and 12 months of age ⁵. Families attend regular cleft clinic reviews—often annually—to evaluate growth and speech development ⁴, ⁸.

Hospital-based speech-language pathologists evaluate feeding during infancy. Additionally, they monitor speech development as the child grows ⁴. When a child needs ongoing support, community-based speech-language pathologists provide direct therapy ¹.

How do speech pathologists support children with clefts?

Infants born with clefts in the hard palate cannot create the suction needed for typical breastfeeding ⁴. Therefore, hospital speech-language pathologists visit families within 24 hours of birth. They introduce specialized feeding bottles that rely on gentle biting motions instead of suction ⁴. Families can use expressed breast milk or formula in these bottles to ensure proper nutrition ⁴.

As speech develops, cleft team speech-language pathologists evaluate sound production. Specifically, they listen for three types of speech features:

• Obligatory errors: Structural anatomical differences directly cause these speech alterations. For example, air escapes through the nose during speech ², ⁴. Speech therapy alone cannot resolve obligatory errors, so children may need surgery ², ⁴.

• Compensatory errors: Children develop these learned speech habits to work around palate gaps ¹, 2, ⁴. Fortunately, targeted speech therapy can successfully correct these patterns ², ⁴.

• Developmental speech errors: Typical speech errors that non-cleft children also experience during development ⁴.

Research shows that roughly 80% of children with cleft lip and palate will require speech therapy at some point ².

How Speech Therapy Helps

When a child needs ongoing support, hospital and community speech-language pathologists work together ¹. Your local community speech pathologist helps in several key ways:

• Assessment: They review reports from your hospital cleft team. Then, they evaluate voice resonance and sound accuracy to build a custom therapy plan ¹,⁴.

• Correcting compensatory patterns: They retrain tongue placement and airflow habits. As a result, your child learns to make clear sounds even if structural differences remain ¹, ².

• Post-surgical rehabilitation: Surgery changes the physical structure of the mouth. However, old speech habits do not disappear automatically. Therapy helps children use their new palate function effectively ¹, ².

• General speech milestones: They address broader communication goals alongside cleft-specific needs. Consequently, your child stays on track with their peers ¹, ⁴.

Getting the Right Support

Multidisciplinary teams monitor children on a cleft pathway at key developmental steps ⁸. Outside of these routine visits, you should contact your team if you notice persistent nasal-sounding speech. Similarly, reach out if your child’s speech clarity falls behind their peers ¹, ⁴.

Overall, coordination between hospital cleft teams and local speech pathologists gives your child continuous care. This team approach supports clear, confident communication as your child grows ¹, ⁸.

References:

1. American Speech-Language-Hearing Association. (n.d.-a). Childhood apraxia of speech [Practice portal]. Retrieved August 18, 2026, from https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/
2. American Speech-Language-Hearing Association. (n.d.-b). Evidence-based practice (EBP). Retrieved August 18, 2026, from https://www.asha.org/research/ebp/
3. American Speech-Language-Hearing Association. (n.d.-c). Orofacial myofunctional disorders [Practice portal]. Retrieved August 18, 2026, from https://www.asha.org/practice-portal/clinical-topics/orofacial-myofunctional-disorders/
4. American Speech-Language-Hearing Association. (n.d.-d). Speech sound disorders: Articulation and phonology [Practice portal]. Retrieved August 18, 2026, from https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/
5. American Speech-Language-Hearing Association. (2022). Optimizing outcomes for children with phonological impairment: A systematic search and review of outcome and experience measures reported in intervention research. Language, Speech, and Hearing Services in Schools. https://pubs.asha.org/doi/10.1044/2022_LSHSS-21-00132
6. Evidence base for oral motor treatment. (2019). The ASHA Leader. https://leader.pubs.asha.org/doi/10.1044/leader.IN6.24092019.8
7. Homem, M. A., Veira-Andrade, R. G., Falci, S. G. M., Ramos-Jorge, M. L., & Marques, L. S. (2020). Orofacial myofunctional therapy and myofunctional devices used in speech pathology treatment: A systematic quantitative review of the literature. American Journal of Speech-Language Pathology. https://pubs.asha.org/doi/10.1044/2020_AJSLP-20-00245
8. Sundberg, J., et al. (2025). Effectiveness of orofacial myofunctional therapy for speech sound disorders in children: A systematic review. International Journal of Orofacial Myology and Myofunctional Therapy, 51(1), 4. https://www.mdpi.com/2694-2526/51/1/4