Speech Therapy Guidelines for Emily

Emily’s speech therapist gave us a list of goals for Emily that I thought may be useful to parents who are dealing with similar speech issues in babies and toddlers who have a repaired cleft palate.

Goals for Post-op Cleft-Repaired Children

1. Increase frequency and diversity of sound production
2. Increase use of consonant-vowel production (“Dada”, Mama” etc.)
3. Increase communicative opportunities

– Arrange the environment so that the child needs to ask for what s/he wants
– Create consistency in the household schedule so the child can predict what’s happening next and comment on it.
– Take advantage of every opportunity to lavel, describe, etc. (bath time, cleaning up toys, etc.)

4. Create play “temptations” (put toys in containers, offer novel toys)
5. Imitate the child’s productions to encourage turn-taking
6. “Balance” the communicative terms. Don’t talk or vocalize too much more than your child.
7. Engage in face-to-face vocalizations/verbalizations as much as possible
8. Encourage imitations of large and small motor movements. Use songs with gestures and large motor movements to accompany actions in play.
9. Keep a running list of consonant sounds produced spontaneously.
10. Model words with initial pressure consontants (/p/b/)
11. Expand on your child’s productions. For instance, the child says, “Cat”. You say, “Cat. Yes, the cat jumped”. Use gestures to accompany your explanations and expansions.
12. Increase your child’s awareness of airflow with vocalizations. Start with a whispered “Paaa” with lots of airflow (in a play context. Try having a puppet make this sound to call another puppet, etc.) You can blow bubbles using this sound or gently blow pieces of cotton balls across a table using the sound. Gradually introduce some voicing. Whisper the “Paaa” then add a voiced “aaa” (Paaa-aaa). This technique can be expanded on by your speech pathologist to eliminate glottal substitutions which reduce intelligibility of speech.

Emily is now 20 months old and her speech is improving every day. She still has glottal substitutions for certain consontant sounds (e.g., she substitutes the “g” for the “d” and also the “g” for the “n”), but she’s getting much better with her “d” sounds. She still says “Gaga” instead of “Ana.” I think I’m going to cry the day I hear her clearly say sister’s name!