Better Speech for Children with Cleft Lip and/or Palate

posted in: MUSC Women’s Health

In 1927, the American Speech-Language-Hearing Association designated May as Better Hearing & Speech Month. The month serves as a good reminder to everyone that there are many organizations and resources available for those in need of improving their speech and/or hearing throughout the year.

One very special group of children that often require the assistance of a speech language pathologist is infants who are born with cleft lip and/or palate. The MUSC Children's Health Craniofacial Anomalies and Cleft Lip and Cleft Palate team is listed as an ACPA Approved Team by the American Cleft Palate-Craniofacial Association (ACPA). The team of specialists is dedicated to treating and caring for children who have cleft lip and/or palate.

Clefting of the lip and/or palate occurs in the first trimester of pregnancy. It results in the incomplete closure of the lip or palate of the baby. While cleft lips are visible on the face, one must examine the roof of the mouth to see the cleft palate.

Clefting can involve either the lip, palate or both. It can also occur on one side or both sides. The degree of severity can vary from a very subtle notch at the lip to a widely open cleft extending from the nose to the throat. Cleft lip/palate is the most common congenital anomaly of the head and neck region. It occurs in approximately one in 700 births and always requires surgery.

Melissa Montiel, an MUSC Children’s Health speech language pathologist, said that the MUSC team helps children with cleft lip and/or palate to speak, eat and communicate. The help often begins before the child is born.

“We meet with both parents to explain what the condition is and begin to prepare them for what lies ahead for their child. Many parents have already been doing their own research, and we also like to help them separate the misconceptions from the facts,” she said.

One of the most common misunderstandings is a fear that the infant cannot eat after birth.

“This is not the case,” she said. “Children who are born with only a cleft lip will likely not have feeding problems. Children born with cleft lip and palate typically don’t need a feeding tube, but they do have trouble sucking. They are unable to breast feed for nutrition since they cannot create a seal. Many mothers pump their milk for a special bottle used in feeding and then bring the child to the breast for bonding after they pump.”

The cleft lip is often repaired at around three months of age with a follow up repair occurring when the child is about 10-12 months old. In some cases, more surgery will be required.

Speech therapy, depending on the child, begins when the child is around one year of age or sooner if feeding therapy is required, as weight gain is closely monitored during the first year. As with all care of children with cleft lip and/or palate, treatment is individualized. Montiel said the length of speech therapy can vary but typically averages around one year long, depending of their age, parental involvement and how receptive the child is to therapy.

“I encourage parents, when their child is learning to talk, and this a good thing for parents to do in general, to do a lot of visual and tactile cues with their children. So if they are trying to make a “P” sound, take the child’s hands up to their lips and let them feel the sound or look at their mouths when they talk,” said Montiel.

She encourages a little bit of practice time multiple times a day at home as opposed to one or two longer sessions. More repetition for speech therapy is beneficial.

Hearing is monitored beginning when the child is born, and ear tubes may be inserted if necessary. As the child gets older, hearing will be regularly checked.

Montiel urges all parents searching for care for their child with cleft lip and/or palate to find a team that is approved by the American Cleft Lip Palate-Craniofacial Association.

She said it is important to choose a surgeon who is board-certified and is accustomed to repairing pediatric patients with specific training and experience with cleft. The MUSC team includes pediatric specialists in plastic surgery, ENT (ear, nose and throat), speech pathology, dentistry, oral surgery, orthodontics, audiology and social work. Currently the team meets with patients monthly in Rutledge Tower in Charleston.

When the new MUSC Shawn Jenkins Children’s Hospital opens in October, the team will see patients there. “I can hardly wait for the new children’s hospital to open,” she said.

To learn more about the Cleft Lip & Palate team at MUSC Children’s Health, visit or call 843-792-1414.