Speech advice following palate repair

This leaflet is for parents/guardians of babies born with a cleft palate (with or without cleft lip) after their baby’s palate has been repaired.

What this leaflet contains:

• A recap of the palate's role in speech following palate repair.
• Activities that will support babble and speech development.
• Language development and encouraging first words.
• The importance of hearing and managing the listening environment.
• Useful links.
• Next appointment

A recap of the palate's role in speech

When we speak and swallow, the soft palate lifts and stretches to close the nose off from the mouth:

Most speech sounds are oral (made through the mouth), for example ‘p, b, t, d, k, g, f, v, s, z, sh’. These sounds all need the palate to lift and close, so that air does not leak inappropriately through the nose. Now that your baby's palate is repaired, it is hoped that they will start to be able to explore some of these sounds.

From now on, at your baby's speech therapy appointments, we will be monitoring the sounds we can hear, both in terms of how well the palate is functioning for speech, and how they are forming the sounds.

Activities that will support babble and speech development

• Continue to make sounds visual, by using a ‘floppy tongue’ for sounds made at the front of your mouth. Show tongue tip for the front sounds ‘n’, ‘t’ and ‘d’.
• Continue to listen to the sounds that your baby makes and repeat and extend these to continue having early conversations with them.
• Continue making the most of face-to-face times to model sounds (for example nappy changing, bath time, cuddling, and so on). Make sure you are close to your baby’s face to allow them to feel the air from your mouth as you speak. This is particularly important if you know your baby has previously had reduced hearing. Being close to your baby makes it easier for sounds to be heard clearly.
• Continue making the most of face-to-face times to model sounds (for example nappy changing, bath time, cuddling, and so on). Make sure you are close to your baby’s face to allow them to feel the air from your mouth as you speak. This is particularly important if you know your baby has previously had reduced hearing. Being close to your baby makes it easier for sounds to be heard clearly.
• Stretch out words as you say them, for example when doing up your zip: “zzzzzzzzziiiiiiiiiiiiiiip”. Your baby’s gaze will naturally be brought to your face as you reach the top of the zip, so they will see the shape your mouth makes for the ‘p’ at the end. Also use this when you pick them up, so that they are level with your face when you finish the word “up”.
• Try patterning back your baby’s vocalisations and making them into words, for example - Baby: “babababa”, Adult “babababa…baby!”, “bababababa…ball!”.

Language development and encouraging first words

• Continue to expand what your baby says, for example by adding another word to his/her word or babble string, for example “bear” … “bear gone”.
• Model single words in an everyday, functional context , for example labelling toys, pointing out interesting things when out on a walk, pointing at things in favourite books. The more your baby hears a word, the quicker they will remember it.
• Use repetitive phrases in play to show your baby what they could say, for example “up (and down)”; “open….and shut”, “again”, “more”, “ta”, “bed”, “bye bye”, “where’s…..?” “there it is!”
• Use choice making as a way of giving repeated models of a word, for example give baby a choice of two foods and ask: ”do you want……banana (show them banana)…or yoghurt? (show them yoghurt)”. This also works with toys and clothes (what to put on first).
• Sing nursery rhymes with actions like ‘incey-wincey-spider’ and ‘I hear thunder’. Play games like ‘pat-a-cake’, ‘round-and-round the garden’ and ‘peep-bo’. These connect words to actions and help your baby to understand and remember words.
• Talk to your baby about what you are doing, such as 'Mummy’s putting shoes on'. This will help them to connect words to the world around them.
• If your baby is pointing at something, tell them what it is. If they try to say the word, say it back to them.
• Follow your child’s lead. When your child is playing, talk about what they are playing with. If they are looking at something, tell them what they can see. Comment on, rather than ask about, what your child is doing.

The importance of hearing and managing the listening environment

• We will continue to ask you about your baby's hearing as it is crucial for speech development, and children with a cleft are at increased risk of fluctuations in hearing associated with ‘glue ear’.
• Glue ear can affect how clearly sounds are heard, for example by making speech sounds seem ‘muffled’ or ‘fuzzy".
• Glue ear can come and go which means that hearing levels can go up and down over time. If sounds are not heard clearly, this may affect speech sound development.
• It can be difficult to judge whether your baby is hearing well at home. They may well be responding to sounds, and appear to hear you when you speak to them, but they may not be hearing sounds and words crisply.

Useful tips:

1. Make sounds closer rather than louder
2. Reduce background noise at certain times during the day (for example by turning TV/radio off)
3. Prioritise face-to-face times during babble play (for example nappy changing)
4. Be aware of noisy surfaces, for example tables or hard floors, and consider playing with toys on a mat.
5. Regardless of how well your baby is hearing, it is helpful to ensure you are holding toys and objects up to your face as you model sounds and words. This strategy will naturally encourage your baby’s attention to your mouth as you speak.

What happens next?

At your baby’s next appointment we will continue to assess the sounds they are making. It is not uncommon for babies to be less chatty in the clinic environment, so if possible, it can be helpful to bring a video on your phone of them babbling or “chatting” at home. This is a useful way of enabling us to hear the typical sounds your baby makes when they are relaxed and confident.

You may also want to keep a note of when new sounds and words appear to share with your speech and language therapy (SLT) team at the next appointment – this can be a really helpful way of tracking progress.

Your baby’s next speech and language review with the SLT team will be when they are around 18 months old. Wherever possible, we try to arrange this at Addenbrooke’s hospital when your appointment can be combined with seeing a clinical psychologist and paediatric dentist.

Please do not hesitate to contact us should you have any questions before your next appointment.

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Useful links

• The South Wales Cleft Team has also produced a useful video (opens in a new tab).
• The following website is also a useful resource, with tips and ideas to help support language development: I Can Charity (opens in a new tab)

Contacts/further information

Speech and Language Therapy Team
Cleft.NET.East
Box 46
Addenbrooke’s Hospital
Cambridge University Hospitals NHS Foundation Trust
Cambridge Biomedical Campus
Hills Road
Cambridge CB2 0QQ

Tel: 01223 596272