Cleft Palate and Speech: Nasal Speech, Compensatory Errors, and Therapy
About 1 in 1,600 US babies is born with cleft palate alone, and about 1 in 1,050 with cleft lip with or without cleft palate. Even after repair, speech may sound nasal or include learned compensatory errors such as glottal stops. Structural problems need physical management; learned errors respond to speech therapy.
How common clefts are
| Type | United States | Worldwide |
|---|---|---|
| Cleft lip with or without cleft palate | About 1 in 1,050 births | — |
| Cleft palate alone | About 1 in 1,600 births | About 1 in 1,500–3,000 births |
| Any oral cleft | — | About 1 in 1,000–1,500 live births |
Cleft estimates (US figures from CDC via NIDCR; worldwide from ASHA).2,1
NIDCR explains that early in pregnancy there is normally a split between the right and left sides of the lip and palate that joins between the 6th and 11th weeks; if the tissue does not join, a cleft results. Children with a cleft lip or palate may have speech and language delays and are more likely to have ear infections, hearing loss, and dental problems.2
How a cleft affects speech
During most speech sounds, the soft palate and throat walls close off the nose — velopharyngeal closure — so that vowels resonate in the mouth and pressure can build for stops, fricatives, and affricates. ASHA names cleft palate, including submucous cleft palate, as the most common cause of velopharyngeal dysfunction, which can cause hypernasality, nasal air emission, or both.1
| Error type | What it is | What treats it |
|---|---|---|
| Obligatory errors | Placement is correct, but the structure (velopharyngeal insufficiency, a fistula, dental or bite differences) distorts the sound | Physical management — surgery, orthodontics, or a prosthesis |
| Compensatory errors | Learned articulations that make up for lost pressure, such as glottal stops or pharyngeal fricatives | Speech therapy |
| Learned nasal emission | Air directed through the nose on specific sounds (phoneme-specific nasal emission) | Speech therapy |
| Unrelated speech errors | Ordinary articulation or phonological errors that any child might have | Speech therapy |
Kinds of cleft-related speech errors (ASHA Practice Portal).1
Hearing and ear fluid
Children with cleft palate are at risk for middle ear fluid because of eustachian tube dysfunction. ASHA notes the fluid typically fluctuates and can cause conductive hearing loss, and calls fluctuating and long-standing conductive hearing loss a primary concern for children with cleft palate.1
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Treatment: surgery, the team, and therapy
NIDCR says surgery is often used to close the lip and palate — cleft lip surgery usually before the first birthday and cleft palate surgery before 18 months — and that with treatment, most children with cleft lip or palate do well.2
ASHA says treatment is best done through a cleft palate–craniofacial team; under American Cleft Palate-Craniofacial Association standards, a team must include at least a surgeon, an orthodontist, and a speech-language pathologist. Treatment aims to normalize structure through surgery or orthodontics and function through therapy.1
Skip the blowing exercises. ASHA describes nonspeech oral motor therapy — oral-motor training used before or alongside teaching sounds — as controversial in cleft care, and an ASHA Leader evidence summary reports that nonspeech oral motor exercises for children with cleft palate are not effective. Therapy works on the speech sounds themselves.1,3
In medical coding, cleft palate and cleft lip are classified under Q35–Q37, separate from the F80.0 code for developmental speech sound disorders.4
About SpeechStep
SpeechStep was not designed for resonance or cleft-related errors, and its practice does not judge nasality. Follow your cleft team’s SLP; general home practice should only be added on their advice.
Frequently asked questions
How does a cleft palate affect speech?＋
The soft palate normally closes off the nose during most speech sounds. If it cannot close fully (velopharyngeal dysfunction), speech can sound hypernasal, air can escape through the nose on sounds like p, b, s, and children may learn compensatory errors — such as glottal stops — to make up for the lost air pressure.
Can speech therapy fix cleft palate speech?＋
It depends on the error. ASHA explains that obligatory errors come from the structure itself and need physical management such as surgery, orthodontics, or a prosthesis, while compensatory errors are learned and are treated with speech therapy.
When is cleft palate surgery done?＋
NIDCR says cleft lip surgery is usually done before a baby’s first birthday and cleft palate surgery before 18 months, with some children needing further surgeries, dental and orthodontic care, and speech therapy as they grow.
Do oral-motor exercises help cleft palate speech?＋
The evidence says no. ASHA describes nonspeech oral motor therapy as controversial for cleft lip and palate, and an ASHA Leader summary of the evidence reports that nonspeech oral motor exercises for children with cleft palate are not effective.
Put this into practice today
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References
4 sources from authoritative bodies. Last reviewed October 2026.
- 1.ASHACleft Lip and Palate — Practice Portal page.
- 2.National Institute of Dental and Craniofacial Research (NIH)Cleft Lip and Palate — Health information page.
- 3.ASHAEvidence Indicates Nonspeech Oral Motor Exercises for Children With Cleft Palate Are Not Effective — ASHA Leader article, 2022.
- 4.ASHA2027 ICD-10-CM Diagnosis Codes Related to Speech, Language, and Swallowing Disorders — Coding resource (PDF), 2026.