Challenges Of Speech Development

Many parents reminisce on the memories of the speech development journey of their child. How their toddler go from mumbling their first word to one that is ready to fire endless questions to fulfil their growing curiosity. Most parents would find this journey an exciting phrase and one of the earlier milestones of parenthood. Unfortunately, there are parents among us that will have to endure a rougher journey in the development of their child's speech abilities.

One of the main reason for these challenges are due to the condition of oral clefts such as clefts of the lip and palate and they are considered to be one of the most common birth defects in Singapore. They occur approximately in 2.07 per 1000 live births. (Local incidence varies according to ethnicity, with the highest incidence seen among the Chinese at 1.64, followed by Malays at 0.29, Indians at 0.10 and other ethnic at 0.04 per 1000 live births respectively.) Within these stats, approximately 45% of individuals are diagnose with a cleft lip and palate, 40% with a cleft palate only and 15% with a cleft lip.

So What Is A Cleft Palate?

A cleft palate is a birth defect in which a baby is born with a gap in the roof of the mouth.

The palate separates the mouth from the nose, and is made up of two parts:

1. Hard palate: The bony hard palate, towards the top row of teeth.

2. Soft palate: Also known as the velum, towards the throat; which is made up of muscles which move when a person talks or swallows.

A cleft palate occurs when the right and left halves of the palate fail to fuse into a single palate.

This may result in a gap, i.e. the cleft, in the soft palate or in both the soft and hard palate (Figure 2). In addition, the cleft can be incomplete or so mild that the only visible sign is a split in the uvula – the lowermost part of the soft palate that hangs down in the midline in front of the pharynx. This is called a bifid uvula (Figure 3).

Common Signs and Symptoms To Look Out For:

  • Difficulty in feeding, nasal regurgitation of milk through the nose, slow feeding, poor sucking.

  • Hearing difficulties, typically due to Otitis Media (middle ear effusion) and poor ventilation of the Eustachian Tube, associated with the cleft palate

  • Disordered speech patterns (eg. butterfly says as “uh-er-eye”, or sounds like “s, sh, ch, t, p” which require adequate oral pressure

  • Hypernasality (excessive air from the nose when speaking) due to velopharyngeal inadequacy

  • Hoarseness of voice


It can be heartbreaking for parents in such diagnosis, but a good understanding of the condition, procedures, and looking for the right support from parents who went through the same journey of recovery will aid greatly and keep things in perspective.

Procedures can be done in hospital for clip lip and palate treatment. After the procedure, it would then be followed by a series of speech therapy aimed to improve speech and feeding. Medical devices are usually also required to aid in the recovery phrase after this. Thankfully, cost of such procedures are not overly expensive and usually are within the range of a few thousands. (Pricing would also depends on the hospital and ward chosen.) However, do note that expenses may scale after the procedure as numerous session of follow-ups and medical assistance devices are required to aid in recovery.

While the road to recovery may not be immediate, there are plenty of successful recovery cases in Singapore. And to ensure the parents are not weight down by the medical cost, we highly recommend expecting parents to explore financial plans that provide coverage for such congenital abnormalities. It is only when the finances are being taken care, that parents can focus on helping the little one to a quick road of recovery

The journey ahead may be tough, but always remember that you are not alone, and support would be there if you were to ask for it.

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