July 30, 2001 Surgeons, dentists and speech therapists should intervene much earlier to help children avoid speech problems associated with cleft palate, a University of Wyoming research says.
Mary Hardin-Jones, head of the Division of Communication Disorders in the UW College of Health Sciences, is co-investigator in a research project to examine the impact of cleft palate on speech sound development and to determine the best age at which to perform palatal surgery.
Approximately one in every 700 children in the United States is born with cleft lip and/or cleft palate, making it the country's fourth-most common birth defect.
If the cleft extends through a child's lip, surgery to repair the lip is usually performed when the child is between eight and 12 weeks of age, while bone grafting to repair clefts in the gum ridge usually is not done until the child is eight years or older.
Surgery to repair palatal clefts is routinely performed when the child is between nine and 18 months old, with the average age being 12 months. But Hardin-Jones and project director Kathy Chapman of the University of Utah suspected that there was not much scientific basis for that timetable.
"We've known for a long time that waiting until after a child has begun to talk to repair a cleft palate will have a pretty dramatic effect on that child's speech-sound development," says Hardin-Jones. "That has been interpreted to mean that surgery should be performed before the child begins to produce words, which typically happens at about 12 months of age. But we are finding that the cleft can have an impact on speech development long before the child produces its first word."
Preliminary findings suggest that differences in speech development are evident in babies with clefts as early as six months of age.
Hardin-Jones says this suggests that surgeons, dentists and speech therapists need to think about intervening much earlier to help avoid the speech problems a child typically develops to compensate for the effects of the cleft. "The child's safety is always the most important issue, but if possible, we would like to see surgeonsintervene earlier than 12 months of age. Earlier surgery and speech therapy might accelerate speech development for babies with cleft lip and palate and minimize the amount of speech therapy they're going to need later."
Babies begin learning to produce various consonant sounds by engaging in what speech pathologists call canonical babbling, which precedes their first spoken words. In children with clefts, some of those babbling sounds may be distorted, Hardin-Jones explains, and the child may not attempt to make some sounds. This deficiency must be corrected with speech therapy following surgery to repair the mechanical problems brought on by the cleft.
"Babies with cleft palate are producing only one-half the number of consonants (before surgery) as babies without clefts," Hardin-Jones says."We used to think that the 12-month average age for surgery was sufficient. Now we see that it's not," she says. "Surgery must occur earlier than that to avoid the negative impact of cleft palate on speech-sound development."
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