On a consistent basis, a child is born somewhere around the world with either a cleft lip or cleft palate, thus making this one of the most common birth defects globally. Also known as oral-facial clefts, these blemishes affect the mouth and lip. Worth noting is that during conception a normal fetus usually has a split lip and palate. However, in the early stages of pregnancy, the roof of the mouth and the sides of the lip should fuse. Children with cleft lip and palate are born so due to the failure of fusion of these two parts (Dixon, Marazita, Beaty, & Murray, 2011). A cleft lip is identified as a condition in which the lip fails to develop during the growth of the fetus and may be a mild notch or a large opening from the lip through to the nose. On the other hand, a cleft palate is a birth defect occurring as a result of the failure of the roof of the mouth to close completely during the fetal development, thus leaving an opening that stretches to the nasal cavity (Dixon et al. 2011). Mostly, a cleft palate is usually a genetic disorder.
Phonological and Articulatory Systems
Proper speech in the development of children is dependent on several factors. However, the most common challenges that are associated with children with cleft lip and palate are articulation and phonological complications due to nasal escape as they try to speak. Due to the opening of the lip and the roof of the mouth, muscle functions are usually decreased and can result in the abnormality or delay or speech (Grunwell, & Russell, 1988). These phonological speech problems are associated with functional variations such as velopharyngeal inadequacy. In this case, the soft palate is unable to close the opening stretching from the throat through to the nasal cavity. Consequently, the child has problems in the pronunciation of many sounds especially consonants.
The effect of the Velopharyngeal inadequacy on the articulation systems of children with cleft lip and palate results in obligatory and compensatory errors in characteristics of kids with this disorder (Grunwell, & Russell, 1988). Obligatory errors are those that occur due to the abnormalities in the structures of the palate and lip. Markedly, such kids may experience hyper-nasality on vowel and consonants. Additionally, articulation errors may be associated with dental malocclusion that is brought about by the defect in the formation of the palate and lip (Grunwell, & Russell, 1988). On the other hand, compensatory errors are those that occur due to the complications in the direction of airflow. Notably, these may be caused by the inability of the kid to produce sufficient intraoral air pressure that is necessary for consonant production.
Assessment and Treatment Principles for Children with Cleft Lip and Palate
Assessment Principles
There are two key principles in the assessment of children with cleft lip and palate birth defects. These include screening and comprehensive evaluation. Speech screening for children who are suspected of having a velopharyngeal dysfunction is completed by speech-language pathologists and can take place in a variety of settings. The main tasks of the pathologist in this assessment technique include attending to signs associated with anatomical or structural differences, nasal airflow complications, and articulation errors (Haque, Khursheed, & Arshad, 2015). The screening protocol involved in these operations may also include the evaluation of hearing, receptive and expressive language aptitudes. The speech-language pathologist can, therefore, come up with recommendations that necessitate additional assessments or comprehensive speech and language evaluation.
The comprehensive assessment principles involve the use of both standardized and non-standardized measures. This may entail the evaluation by a pathologist during the early stages of child development for the identification of language delays before they are even observable to the fully integrated multidisciplinary team (Haque, Khursheed, & Arshad, 2015). Vocalization diversity, complexity, and rate are also important considerations for the pathologist to make in case a child has not yet started talking. Finally, due to the likelihood of the development of hearing loss in children with cleft lip and palate, it is essential that an audiologist performs an audiology evaluation.
Treatment Principles
The treatment of the birth defects of cleft lip and palate entails several principles. First, the provision of cleft care should be made in a coordinated manner. Consequently, fully integrated multidisciplinary teams are necessary. Notably, all the members of this group should be competent in the provision of cleft care (Haque, Khursheed, & Arshad, 2015). Additionally, the management of the cleft lip and palate disorders should be based on evidence-based practices. It is, therefore, necessary to standardize the records that encompass all the aspects of this kind of care to evaluate and compare treatments.
Conclusion
Significant advancements have been made regarding the assessment and treatment of children with cleft lip and palate. For instance, research is still underway for the utilization of prosthetics technology in the management of these birth defects. However, there is the need to conduct more clinical trials for children with this disorder through the formation of a nationally funded programme for the auditing of the outcomes of cleft care. This will play a significant role in the establishment of the real origin of the defects since currently there is no sufficient knowledge about this.
References
Dixon, M. J., Marazita, M. L., Beaty, T. H., & Murray, J. C. (2011). Cleft lip and palate: understanding genetic and environmental influences. Nature Reviews Genetics, 12(3), 167-178.
Grunwell, P., & Russell, J. (1988). Phonological development in children with cleft lip and palate. Clinical linguistics & Phonetics, 2(2), 75-95.
Haque, S., Mohammad Khursheed, A. L. A. M., & Arshad, A. I. (2015). An overview of indices used to measure treatment effectiveness in patients with cleft lip and palate. The Malaysian journal of medical sciences: MJMS, 22(1), 4-17.
