Each diagnosed case is carefully evaluated, with babble and speech development being monitored by a speech and language therapist. In infants, an operation may be undertaken when there is a history of significant feeding difficulties, persisting ear problems, and delayed development of babbling. Speech and language therapists will listen in particular for sounds which require pressure in the mouth, e.g. d , b , and g . For these children, a range of investigations may be carried out. In some cases there may be a period of diagnostic speech and language therapy to determine if the child can achieve an improvement in speech without having to undergo an operation.
Some children achieve good palate function alongside an improvement in articulation skills.
When surgery is necessary, a detailed speech assessment should be carried out 6 to 8 weeks post-operatively. Children who already had good speech and language skills prior to an operation may not need formal therapy. Others, with less good articulatory skills, require therapy to help them learn to use their improved palatal musculature and to overcome bad habits in their speech patterns. Case One Tania is a little girl whose submucous cleft was found two days after birth, during a routine paediatric examination. She was referred to the surgeon and speech and language therapist from the Cleft Team.