Speech and language development before cleft palate repair surgery

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Parents and caregivers play an important role in supporting their baby’s speech and language development. Learn how to help your baby develop their speech and language before their cleft palate repair.

Key points

  • Learn how to help your baby develop early receptive and expressive language.
  • Learn how to help your baby develop early speech sounds that can be made before cleft palate repair surgery.

One of the most important aspects of a baby’s early development is the ability to communicate. In order to learn to communicate, a baby needs to:

  • Hear the speech of other people
  • Have opportunities to repeat or imitate sounds and words they hear
  • Have different experiences within their environment
  • Have a need or desire to communicate

There are speech and language skills you can help your baby develop before their cleft palate repair surgery. Children learn best during positive interactions, so make communicating with your baby a fun experience.

Help your baby develop early language skills

Language development involves what your baby can understand (receptive language) and what your baby can express to you using eye contact, gestures, pointing, vocalizations and words (expressive language).

To help develop your baby's receptive language:

  • Be face-to-face: Physically get down to your baby's level. This may mean you sit on a small chair, sit on the floor, or lift your baby up to your level.
  • Make eye contact: Hold a toy or object by your face to encourage your baby to look at you. Try to keep their attention while talking to them.
  • Use gestures: When talking to your baby use gestures to help them understand what you are saying. For example, wave while saying "bye", lift your arms for "up", or shake your head for "no".
  • Follow your baby's lead: Talk about the toy that your baby is looking at or showing interest in. Talk about your baby’s actions using sounds and/or words that match what your baby is doing.
  • Use simple language: Try to use language that is one step ahead of your baby's language level when talking to them. For example, if your baby uses vocalizations, you can use single words (e.g., "milk").
  • Repetition: You will need to repeat important words many times in different situations so your baby learns what they mean. You can use facial expression or tone of voice to emphasize what you are saying.
  • Routine activities: Talk to your baby about what you are doing during routine activities. Some examples of daily routines are bath-time, mealtime, bedtime and playtime. Talk about objects and actions during each step in the routine, for example "all-done", "away", "more", "wash hair" and "night-night."
  • Pair sounds and words with actions: A good time to do this is during play. For example, when playing with toy farm animals, say "moo, moo" while making the cow move across the table. When pretending to feed a baby doll, say "mmm…yum."
  • Play turn-taking games: Play games such as peek-a-boo and pat-a-cake. Keep repeating the activity so your baby learns the routine. Teaching turn-taking is a first step to having conversations with your baby.

To help your baby develop expressive language:

  • Wait for a response: Give your baby time to respond using eye contact, gestures and/or vocalizations. Model the sounds and early words that your baby is trying to say. For example, say "On. Put block on" while giving your baby a block to put on top of a block tower.
  • Give choices: Give your baby choices so they can tell you what they want. For example, show and name each item while asking "Do you want car or ball?". Then wait and watch as your baby looks, reaches, vocalizes or attempts the word in response.
  • Gestures: Teach your baby gestures to give them a way of expressing themselves before they are able to "talk." Say the word and use the gesture at the same time. Examples of gestures to show your baby include lifting arms for "pick me up"; waving for "hi, bye"; head shake for "no"; and clapping for "good job, hooray."
  • Sing a song: Pause during or at the end of a song to allow your baby a chance to vocalize or imitate an action. When you repeat a song many times, your baby may start to anticipate their turn in the song or try to fill in the sound, word or action. Songs and finger plays you could use with your baby include The Wheels on the Bus; Twinkle, Twinkle, Little Star; Itsy Bitsy Spider; Row, Row, Row Your Boat; Head, Shoulders, Knees and Toes; Pat-a-Cake; Old MacDonald Had a Farm.
  • Motivation: You may need to motivate your baby to communicate. For example, pour only a little milk into your baby's cup so they have to "ask" for more during mealtime. Your baby may ask for more by using a gesture, looking, vocalizing and/or trying to say a word.
  • Imitate, interpret and expand: Imitating your baby’s sounds, gestures or words will motivate them to interact and communicate with you. During everyday activities, repeat what your baby is saying and/or doing, and add another piece of information. For example, if your baby says "more" and holds up an object, repeat the word "more" and add the name of the object (e.g., "more banana"). When your baby reaches for a toy cow and says "uh", you can interpret that your baby wants the toy and say “cow moo”.
  • Read to your baby: Choose sturdy board-books, soft cloth or vinyl books with bright colors and repetitive or rhyming text. While reading to your baby, imitate the sounds they make, label the pictures and encourage turn-taking by waiting after you take your turn to give your baby a chance to make another sound or to look at or touch a picture in the book.

Suggested books for babies

Peek-A Who? by Nina Laden

Where’s Spot? by Eric Hill

Moo, Baa, La-La-La! by Sandra Boynton

Goodbye Moon by Margaret Wise Brown

Brown Bear, Brown Bear, What Do You See? by Eric Carle

Mr. Brown Can Moo! Can You? by Dr. Seuss

Indestructible: Baby Faces by Kate Merritt

Where is Baby’s Belly Button? by Karen Katz

Pat the Bunny by Dorothy Kunhardt

Ten Little Fingers and Ten Little Toes by Mem Fox

Websites with language-building tips:

City of Toronto: Early Language Stimulation Strategies for Parents/Caregivers
*available in multiple languages

The Hanen Centre: Tips for Parents

Reading Rockets: Tips for Parents of Babies

Help your baby develop early speech skills

Even before cleft palate repair surgery, your baby should be able to make a variety of sounds. There are many things you as a parent can do to support speech development.

Encourage your baby to be more vocal

Babies love to look at faces. To make your baby aware of lip and tongue movements make funny faces, stick out your tongue, open and close your lips, and blow kisses. This gets your baby to concentrate on your face, which will be important later when you try to get your baby to imitate specific speech sounds.

Use non-speech noises with your baby. Practice making "raspberries" using your lips and when sticking out your tongue. This gets your baby to focus on your face, and it allows your baby to see and hear an oral airflow activity. To keep your baby’s interest, you can make these sounds with different pitches and loudness levels. Raspberry sounds may be difficult for your baby to imitate before cleft palate repair but it is still important for your baby to listen, focus on your face and learn about sounds.

Avoid using grunting and growling sounds.

Babies who are having trouble producing consonants may overuse these sounds and this pattern can be difficult to get rid of. Parents should not reinforce these types of sounds. If your baby babbles with grunting and growling sounds, smile and babble back with more easy and relaxed vocalizations such as "ahh", "ohh" or "oww" and combinations such as "nanana", "yayaya" or "wawawa". Eventually, your baby will respond with the sounds that you make.

Stimulate early speech sounds

Use different vowel sounds. Practice by vocalizing vowels and vowel combinations (e.g., "ahh", "aawee", "oowaa", "oowee"). You can do this by either saying them or singing them. Using exaggerated tones and varied loudness levels will capture your baby's attention. It is fun to use pictures or toys when encouraging different vowel combinations.

Different vowel sounds

Some speech sounds will be easier for your baby to produce before their cleft palate is repaired. These include nose sounds (m, n) and speech sounds that do not need air pressure to build up in the mouth (h, w, y). The ability to produce other early developing mouth sounds (e.g., p, b, t, d) is limited before cleft palate repair surgery as having a cleft palate makes it difficult for pressure to build up in the mouth.

A baby with an unrepaired cleft palate can make the "m" sound so they can say "mommy", but they cannot make the "d" sound. This is why fathers have to wait to hear “daddy” until after the cleft palate is repaired.

Encourage consonant and vowel combinations during babbling using sounds your baby can make correctly (e.g., "mama", "nana", "haha", "wawa", "yaya"). Also encourage your baby to copy or imitate sounds while playing with you. This is an important early step in speech development as children imitate sounds more easily than words. Some examples of sound imitation using m, n, h, w, y are:

Consonant and vowel combinations

Model easy first words that have the sounds your baby can make (e.g., "mama", "more", "moon", "nana", "no", "hi", "home", "yeah", "wow", "ow" for 'ouch', "one"). Remember your child may not repeat what you have said. Just keep practicing.

Last updated: October 21st 2022