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Bureau for Handicapped Children 
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Afo\se/y7Q£-/R /944- A Teacher-Parent Guide 
to 
Speech Training for Cleft Palate Children 
Charlotte G. Welle, Ph. D, FOREWORD 
This pamphlet is intended to be of universal 
appeal and value to all parents who have a child bom 
with a cleft palate or cleft lip, or both. When we 
consider that one out of every thousand babies born 
comes to the family with this accident of nature, one 
realizes the importance of rehabilitating these child- 
ren when they are young, if they are to have an equal 
opportunity with others. 
The pamphlet was written by Dr. Charlotte G.Wells, 
assistant professor of speech at Mount Holyoke College. 
Massachusetts. During the summers of 1943 and 1944, 
Miss Wells directed the cleft palate speech training 
center and prepared this material in collaboration with 
Gretchen Mueller and Irma Stockwell, teachers in the 
training center. Illustrations are by Winifred Balsley 
and the arrangement is by Gretchen Blanke. 
The cleft palate speech training center is a part 
of Wisconsin’s program for crippled children and has 
been financed entirely through federal and University 
of Wisconsin funds. The aims and purposes of the pro- 
gram were given in a pamphlet published in January 
1944 with the title "Speech Therapy—A New Chapter in 
Wisconsin’s Care for Handicapped Children". Early in 
the summer of 1943 and in the months following, many 
parents requested more help than could be provided in 
a two-months* program.. Hence, this pamphlet, so that 
the parents might continue the work begun. During the 
school years of 1944-46 and 1945-46, Miss Mueller will 
be employed by the state with federal funds made avail- 
able for the purpose, to study the state speech situ- 
ation pertaining to cleft palate and cerebral palsy 
children. 
We wish to take this opportunity of expressing our 
appreciation to Dr. H. M. Coon, and the staff of the 
state hospital. Dr. John Guy Fowlkes and Dr .Robert West 
of the University of Wisconsin, and the members of the 
Children’s Bureau who have helped in making this program 
possible. 
Frank V. Powell, Director 
Bureau for Handicapped Children TABLE 0? CONTENTS 
Introduction 
Part I The Problem of Cleft Palate 1 
Part II How Parents and Teachers Can Help the 
Cleft Palate Child 17 
Part III Suggestions for Speech Training for 
the Cleft Palate Child 23 INTRODUCTION 
Parents and teachers have many responsibili- 
ties for children in their homes and classrooms. 
They must care for the child, guide him, teach 
him, provide opportunities for his best growth 
and development. Theirs is not an easy task even 
when the childrens problems are those we expect 
of the child who is average in growth, development, 
school progress, and social adjustment. 
When children have special problems, parents 
and teachers assume additional responsibilities. 
A child who cannot see, one who cannot hear, one 
who cannot walk or run as others can, one who has 
difficulty in learning or using speech may bring 
to family and school the responsibility of special 
care, but may also bring the satisfaction of ser- 
vice to those who help the child become a better 
member of the society in which he will live. 
This bulletin is designed to help parents and 
teachers of children born with cleft lips and cleft 
palates. It recognizes the need for suggestions 
to those who are responsible for the child*s health, 
growth, development, and education. It sees the 
many problems Involved in teaching speech to the 
cleft palate child. It discusses the functions of 
those speech organs that are incomplete because of 
a cleft in lip or palate. It answers some of the 
questions often asked about lip and palate clefts. 
It suggests procedures for speech training at home 
and at school. 
The reader is urged to study the entire bulletin 
before he tries to use it. The material is presented 
in sequential form, each part supplementing, but 
depending on, the part preceding. PART I 
THE PROBLEM OF CLEFT PALATE 
If we are to understand the failure of growth 
that results in a cleft or opening in the roof of 
the mouth, we should first consider "briefly the 
structures of the mouth, throat, «md palate as they 
serve in the fundamental processes of eating and 
drinking and in the important process of speaking. 
An understanding of the average structure will help 
us to appreciate more the problems faced by the 
child with a cleft palate and by the surgeon, the 
parent, and the teacher who are interested in help- 
ing the child. 
The lips, teeth (after their growth), tongue, 
roof of the mouth, and the upper part of the throat 
are among the parts used in the eating process. As 
the food or drink enters the mouth cavity, it is 
moved about by the tongue, chewed by the teeth if 
such chewing is necessary, and pushed to the back 
of the mouth. The swallowing process then carries 
the food into the esophagus and thence to the stom- 
ach. The lips aid the child in nursing and in taking 
food into the mouth. The tongue pushes the food in- 
to position to be chewed by the teeth or helps move 
the liquid toward the back of the mouth to be swallow- 
ed, The teeth break the larger particles of food 
into smaller and more easily swallowed pieces. The 
roof of the mouth serves as a top boundary to keep 
the food in the mouth and to prevent its entering 
the nose cavities, which lie just above the mouth 
and are separated from it by this palate structure. 
At the front of the mouth, the palate is quite hard, 
being composed of bone covered over with skin, while 
at the back of the mouth, the roof becomes soft and 
flexible, 
If you place your tongue behind the upper teeth 
you will feel first the rotgh solid surface of the 
1 hard palate and then, as you move the tongue back, 
you will notice a change in the surface from hard 
to soft. The soft palate goes on back to hang like 
a veil or covering above the mouth cavity, and ends 
in a pendulous extension called the uvula. Tour 
tongue will probably not be able to explore as far 
as the uvula, but you can easily observe it by look- 
ing in a mirror. 
As you look, say "ah", as your doctor has you 
say when he wishes to look at your throat, and you 
will see the movement of the soft palate and uvula 
at the back part of the top of the mouth. 
Not only is the palate an essential part of the 
apparatus used for eating, but, like the lips,teeth, 
tongue, and other throat and mouth structures, it 
is used also for speech. When we speak, we send a 
stream of air from the lungs through either the mouth 
cavity or the nose cavity. This stream of air may be 
sent out as air only or it may be "voiced”—set into 
vibration by the action of the vocal cords in the 
throat. The sound or air is then formed into the 
many different sounds we use for speech. However,all 
but three of the sounds of American speech, be they 
voiced by the vocal cords or voiceless, are directed 
through the mouth passage and do not reach the open 
air through the nose passage. The soft palate is 
used to control the direction of these speech sounds. 
When it is lowered, the sounds m, n, and n& go through 
the nasal passages. When the soft palate is elevated 
to meet the forward-moving walls of the throat, the 
other sounds are sent through the mouth. If the soft 
palate is not complete, if it has failed to grow or to 
develop, it will not be able to assist in making the 
adjustments necessary to control the direction of the 
sound or air in speech. 
Let us see now how the average palate works to 
direct the sounds of speech through the mouth or 
through the nasal passages, as we wish. Suppose that 
you are going to say "Hello" in greeting to someone 
2 you meet. You donH have to think very hard about 
saying that word, because you have become so accus- 
tomed to saying it. However, you do make, uncon- 
sciously, many adjustmentr 
in your speaking apparatui 
as you form the sounds. 
You open your mouth and 
say the word, forming the 
stream of air and tone 
into the sounds that are 
in the greeting. All of 
the sounds in the word 
"Hello11 are sent through 
the mouth passage. None 
of them reaches the open 
air through the nasal 
cavities. And so, quite 
unconscidusly, you close 
off the passage into the 
nose and direct the air and sound through the mouth. 
But the closing of the passage-way is not just a 
matter of moving the soft palate. The back wall of 
the throat must come forward and the sides of the 
throat move in a little to help the rising soft palate 
to block the passage into the nose cavities. Once the 
closure has been made, no sound can get into the nose 
and all sounds must go out through the mouth. 
With the passage into 
the nasal cavities closed, you 
say "Hello" and you sound like 
the average speaker because 
the sounds in the word "Hello" 
are supposed to come through 
the mouth and not through the 
nose. 
If you had been walking 
along the street, breathing 
quietly and normally through 
your nose before you met the 
person to whom you wished to 
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3 say "Hello" , you would 
have had the passage 
from the nose open so 
that you could take 
breath in through the 
nose and have it go 
down the throat to the 
windpipe and the lungs. 
When you wished to 
speak you had to close 
the doorway into the 
nose passages, and kee| 
it closed during the 
time you said the word 
"Hello". The whole performance might sound quite com- 
plicated, but it would be quite easy for you if you had 
average mouth, nose, and throat structures. 
Now suppose that you add a name to the greeting 
and say "Hello, Mary". The "Hello" is Just like it 
was before, but you suddenly find yourself faced with 
the need of making the sound of the letter "m", to be- 
gin the word "Mary". The sound of the letter "m" is 
one of the three sounds in American speech which are 
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directed through the nose passage—the others being 
the sounds of the letter "n" as in "now" and "man" 
4 And the letter-combination "ng", as in "sung", "king", 
and "rang". If you wish to make the sound of the 
letter "m" correctly, you must open the passage into 
the nose and send the sound through the nasal passages 
to the open air. Then, at once, you must again close 
the passage and direct the rest of the sounds that 
make up Mary’s name through the mouth. In these sudden 
adjustments from nasal to mouth sounds, the soft pal- 
ate plays a very important part. If you could not move 
it, or if you had no soft palate to move, or if the 
soft palate were incomplete, you could not close the 
passage into the nose and all the sounds you used 
would come out through both the mouth and nose. And 
we have seen that only three American sounds (m, n, 
and ng) should come through the nose passages. 
Throughout the day, whenever you speak, you make 
the many, many adjustments necessary to direct sounds 
correctly and you make them quite unconsciously. If 
you were to read aloud the foregoing sentence, the 
first one in this paragraph, you would make no less 
than 31 soft palate and throat-wall adjustments if 
you directed the various sounds properly. All these 
movements would be easy for you if you had a normal 
soft palate. The cleft-palate speaker finds such 
movements difficult and perhaps impossible. 
We have considered the soft palate. Now let us 
look briefly at the role of the hard palate in speech. 
Many of the sounds we produce, whether they properly 
come through nose or mouth, must be shaped and made 
different from one another by the movement of the 
tongue against the hard palate as well as against the 
soft palate. In such a word as "tell", the tongue 
comes to the hard palate just behind the upper teeth 
for the sound of the letter "t", goes away to form the 
vowel sound, and returns to a slightly different posi- 
tion against the hard palate for the "1" sound. These 
are only two of the sounds making use of the hard pal- 
ate. The hard palate plays an important part in the 
production of many speech sounds. 
All of the things we have said thus far about 
5 the functions of the hard and soft palates in eat- 
ing and speaking have referred to the average mouth 
structure. With that as a background, we are now 
ready to answer directly some of the questions of- 
ten asked about palates that are not average in struc- 
ture or function. 
The first of these questions usually is: What 
is cleft palate? 
Cleft palate is the result 
of a failure of growth before a 
child is bom, the parts of the 
roof of the mouth failing to 
join at the midline. The opening 
may be complete from front to 
back, the gap extending from the 
teeth through the entire length 
of the palate, or it may be a 
partial cleft, involving only the 
back part of the soft palate. 
Occasionally an opening appears 
behind the gum ridge, the remain- 
der of the palate being intact. 
The Joining of the two parts of 
the roof of the mouth should occur quite early in 
the development of the child after conception, and, 
when this growing together does not take place, an 
opening or cleft appears in the roof of the mouth. 
The cleft palate condition is noted by the physician 
when he examines the child shortly after it is bom, 
but, unless a cleft in the lip 
accompanies the palate cleft, the 
child’s appearance does not indi- 
cate to the ordinary observer the 
lack of growth and development of 
the roof of the mouth. 
Palate clefts vary greatly 
in size and in their effect on the 
total mouth structure of the child. 
The normal palate is shown above. 
Some babies are born with a shor- 
tened uvula; some have a short and 
insufficient soft palate. 
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6 Some babies are bom with a 
Y-shaped opening which splits the 
soft palate, leaving a double uvula, 
half on each side of the cleft. 
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Some have a 
cleft that ex- 
tends through 
both the hard 
and soft palates 
and penetrates the gum ridge in some instances. 
Most clefts are on the midline, although some- 
times the split is slightly to the left or right. 
When the gum is divided, that division usually comes 
on one side at about the position of the eye tooth, 
or may come on both sides, particularly if the cleft 
in the palate is accompanied by a double cleft in the 
lip. 
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7 Because cleft palate is sometimes accompanied 
by an opening in the lip, a second question often 
asked is: What is MharelipM? 
In the first place, the term "harelip11 is not 
quite accurate to describe the cleft lip condition. 
The rabbit, or hare, does have an opening or cleft 
in his upper lip, but that split is in the center 
of the lip, while in the human the cleft is almost 
always on one side or the other, or even on both 
sides, of the upper lip. 
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The lip cleft, which often accompanies cleft 
palate, hut which may occur separately from it, is 
also the result of the failure of Joining In growth 
during an early stage in the development of the 
child before he is horn. The lip ordinarily grows 
in three sections, one directly under the nose and 
one on either side. There are, then, two points of 
Juncture in the upper lip, one under each nostril. 
When, for some reason, the closing of those seams is 
not complete, the result is 
a cleft in the lip. Such 
clefts may he small or large 
single or double. They fre- 
quently extend above the lip 
area into the nostril. 
■ 
The occurrence of cleft 
lip is immediately observ- 
able after birth, and further 
investigation may reveal the 
presence of a palate cleft. 
The diagrams on this page show some of the types of 
lip clefts. 
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8 Because mere description of the lip and palate 
openings does not help us understand the causes of 
these deviations from normal, a third question of- 
ten posed is; What causes cleft palate? 
To this question there can be no specific 
answer at present. Research in the cause of cleft 
palate and cleft lip is going on all the time, but 
so far no one has succeeded in finding a satisfactory- 
explanation for this failure of growth. We have no 
evidence to make us believe that any stigma should 
be attached to the presence of cleft palate in a 
family. Many parents have had several children whose 
mouth structures are quite complete and then have a 
child whose palate or lip is incomplete. Some parents 
with clefts in palate or lip have children with aver- 
age palates and lips; other mothers or fathers with 
cleft palates have cleft palate children. 
Pre-natal care, attention to the mother's diet 
and her glandular adjustment, and other methods of 
preventing the occurrence of cleft palate are being 
tried now in an attempt to control the incidence of 
this condition, but thus far no conclusive evidence 
is available on the cause of cleft palate and cleft 
lip. That it occurs, we do know; why it occurs, we 
do not know. 
Those who are concerned with the problem of 
cleft palate frequently wish to know more about the 
relationship between the actual cleft in lip or roof 
of mouth and the deviations in speaking, eating, and 
breathing noted in cleft palate children. They ask; 
What are the effects of cleft palate and cleft lip? 
To answer this question, we must return to the 
chief uses made of the mouth and throat region, as 
we discussed them earlier. We breathe through nose 
or mouth and the air goes down the throat and wind- 
pipe to the lungs. We take in food or liquid and it 
passes through the mouth to the throat and down the 
esophagus to the stomach. We speak and air comes 
9 from the lungs to the throat and voice-box and out 
of the mouth or nose, as air or as sound, to carry 
our thoughts in words to others. If there is a 
cleft in the palate or in the lip, all three of. 
these fundamental uses of the mouth region may be 
disturbed, some more than others. 
Cleft palate and cleft lip may interfere with 
normal breathing habits, since the usual procedure 
in quiet breathing is to take air in through the 
nose and have it, to some extent, warmed and fil- 
tered in the nasal passages before it goes to the 
lungs. The cleft lip child may be a mouth breather 
and may, as a result, miss some of the stimulation 
that comes from the passage of cool air through the 
nasal cavities. The child with cleft palate may 
find that the constant passage of air through both 
nose and mouth chambers, since they are not separat- 
ed by a palate, may dry and irritate the mouth. 
The lip cleft will interfere, at first, with 
the child*s ability to nurse. Later, if the lip is 
still unrepaired, it will interfere with his ability 
to sip from a cup or to use the lips for grasping 
and sucking food. The gap in the palate will permit 
food particles to go into the nose passage, where 
they may be a source of Irritation or infection for 
both nasal said ear areas. Liquids taken into the 
mouth may issue from the nose and not be swallowed. 
Chewing will be difficult or Impossible because there 
will be no mouth roof against which the food may be 
moved by the tongue to get it into position to be 
masticated and because teeth may be out of line or 
fail to grow if the palate cleft has extended through 
the gum ridge and damaged the tooth buds. 
In speech, sounds will be sent through the nasal 
passages as well as through the mouth. The child, 
as he learns to speak, will produce all sounds some- 
what defectively, with the probable exception of the 
three which should go through the nose—the m, n, and 
ng—and even those may be somewhat distorted if the 
lip is imperfectly formed or if the gum ridge has 
10 suffered damage because of the palate cleft. The 
child will try, to the best of his ability, to talk 
like those around him, for he learns to speak by 
hearing others speak. He will make any substitu- 
tions he can for speech sounds. He may form the 
habit of making the little explosion needed for 
such sounds as those of the letters MtH , Hkw, "g", 
MdM, and others in his throat or may fail to use 
the sounds indicated by those letters. He may use 
only the sounds he can produce with some degree of 
accuracy and change most of the consonant sounds to 
m, n, and ng. All of the vowel sounds, which are 
directed almost entirely through the mouth passage, 
will be MnasalizedM—that is, sent out through the 
nasal passage as well as through the mouth. In 
addition, the child may be slow in learning to speak 
if speech is difficult for him and if he meets with 
little success in making himself understood. This 
is particularly true if undue attention is called to 
his problem either before or after repair has been 
made. If his hearing is somewhat defective--and 
that is frequently the case with cleft palate child- 
ren—he will have added difficulty in learning speech, 
since he will have trouble hearing those around him, 
who are his models for speech. 
Surgical repair alone is not enough to assure 
good speech if the child has already learned to speak 
before surgery is completed. Habits formed using the 
incomplete structure may be retained, and the child 
may continue to speak incorrectly even after he has 
a fairly normal palate. 
An incomplete upper lip will affect speech,since 
both lips are needed for the production of certain 
speech sounds, such as those represented by the letters 
MpH, «bM, "m", and "w". Again, the child will do the 
best he can with his limited equipment and will build 
up habits of poor speech which will persist even after 
the repair is made, if that repair is delayed until 
after speech develops. 
The above discussion has given us an answer to 
11 the next question usually presented; Can lip and 
palate clefts he repaired? 
It is evident that repair of cleft lips and 
palates is not only possible hut essential to the 
well-being and development of the child. 
Through the skill of the physician, the plastic 
surgeon, and the dental specialist, the child horn 
with a cleft lip or a cleft palate has an opportuni- 
ty to obtain excellent repair and to have a mouth 
structure which he can manage well in eating and in 
speaking. 
Having recognized the need for repair of cleft 
lip and palate, we are now ready to consider the 
next query; How can these repairs he made? 
The kind of repair needed for cleft palate and 
cleft lip will depend on the nature and extent of 
the openings present in lip and roof of mouth. The 
lip opening is given surgical treatment, the cleft 
being closed by a plastic surgeon, a specialist in 
his field, who tries to provide the best possible 
appearance and to arrange for the best use of muscles 
in the lip. If the lip cleft is a double one, the 
task of the surgeon is more difficult, but he can 
usually provide a movable and usable upper lip through 
plastic surgery. More than one operation may be nec- 
essary to complete the task, and follow-up surgery 
to improve appearance will often be recommended. 
If the palate cleft is operable, the surgeon will 
use one of several accepted methods of closing it. He 
will use the material present in the mouth, actually 
moving that part of the roof of the mouth which has 
developed to replace that which is lacking. If the 
opening is too large to permit surgical repair, a 
special device, called an obturator, may be provided 
to cover the top of the mouth as does the plate which 
holds false teeth. The obturator gives the child an 
artificial palate which can be used as a division 
between mouth and nose passage. 
12 In any case, the advice of the family physician 
will be of help to you. He may not provide the 
surgical repair, but he will probably refer you to a 
plastic surgeon who will be the judge of the need for 
surgery or for an artificial palate. 
Your state and local child welfare agencies can 
be of help to you if you need advice about surgical 
attention for your child or if you need assistance in 
providing this needed palate and lip repair. 
If surgery is the solution for the lip or palate 
cleft, it should be done at the discretion of the 
surgeon. However, the present trend is to provide 
immediate surgical repair for cleft lip, so that the 
child can nurse properly and not suffer needlessly 
froBj lack of nourishment. Tube feeding, which is some- 
times necessary for cleft lip children, is a difficult 
and unsatisfactory substitute for nursing. Many sur- 
geons now recommend lip repair as early as a few days 
or weeks after the child1 s birth. The physical con- 
dition of the child will be a determining factor in 
the surgeon’s decision, but he will probably wish to 
repair the lip as soon as possible. 
Repair of the palate may be delayed, although the 
palate opening, too, makes feeding a problem. However, 
because of the difficulties in the palate operation, 
it is frequently postponed until the child is nine 
months old or even older. Several palate operations 
may be needed to complete the repair; hence, it is well 
to begin them early so that as much of the work as 
possible can be finished before the child begins to 
speak. Only through early palate repair can we be sure 
that the child has an opportunity to develop speech 
that is reasonably normal, and even then we cannot be 
absolutely sure that the palate provided by the surgeon 
will function properly without some special training. 
Primary palate repair usually involves the closure of 
the soft palate area, and a cleft that extends into the 
hard palate region may need several operations before 
it can be completely closed. 
13 In all such problems, the advice of the compe- 
tent plastic surgeon will he the best, since he will 
know, through examination or through consultation 
with the physician, the physical condition of the 
child, the need for immediate operation, or the ad- 
visability of postponing operative repair. 
Once a reasonably normal structure has been pro- 
vided through surgery or by other means, further 
operative work may be needed to improve appearance, 
to make for better use of the palate for eating and 
speaking, to make the lip more flexible and usable, 
to straighten the nose, or to assure the normal growth 
of teeth. 
The contribution of the orthodontist—the dental 
specialist—must not be neglected. He can serve the 
child by providing correction for crooked teeth, by 
widening the mouth arch, by adjusting the alignment 
of the upper teeth with the lower, and by fitting 
artificial teeth to replace any which may have failed 
to grow because of destruction of tooth buds by the 
cleft itself or by necessary operative procedures. 
Attention should be paid to the hearing of the 
child with a cleft palate. If he cannot hear well, 
he will not develop speech that is suited to his needs. 
The same failure of growth that was responsible for 
the cleft in his palate may have been responsible for 
some deviation in the Important connection between 
the nose and the ear—the Eustachian tube going from 
the nasal cavity to the fiddle ear. This tube helps 
to keep the ear working normally by balancing the 
pressure between the air on the outside and the air 
within the middle ear itself. However, this tub© may 
carry infection from nos© or throat to the middle ear. 
Frequent check on the hearing of the cleft palate 
child will assure prompt attention if a loss exists 
or develops. 
No possible aid should be denied to the cleft 
palate or cleft lip child if that aid will help him 
to have a better mechanism for eating and speaking. 
14 a better appearance, or a better adjustment to his 
special problem. 
In our attempts to provide every possible assis- 
tance for the cleft palate child, we must not over- 
look his special needs beyond surgery, dental care, 
and attention to hearing. Our final question, then, 
might bej What are the additional special needs of 
the cleft palate child? 
The child with cleft lip or cleft palate will un- 
doubtedly have problems other than those of a physical 
nature. He will need to make adjustments to his prob- 
lem and will need the sympathetic understanding, not 
the pity, of his parents, brothers and sisters, teach- 
ers, and playmates. He is not an abnormal child. He 
needs to be treated as if he were an average person, 
no different from anyone else. His frequent visits 
to physician or hospital may upset his ordinary house- 
hold routine to some extent, but he should not be 
considered Mdifferenttt or "unusual” or "handicapped” 
Just because he needs special help in some ways to 
assure the development of good speech and the mainte- 
nance of good health. 
With a few exceptions, children born with cleft 
lips and cleft palates will develop physically Just 
as they would have developed if they had not had the 
lip and palate openings. It is true that early feed- 
ing problems, the possibility of bad breathing habits 
and of nasal infections, frequent hospitalization 
and operations, and difficulties in personality ad- 
justment may make the cleft palate child slow in 
growth, a little thinner, a little smaller, a little 
paler than his brothers and sisters or friends, but 
he will not necessarily continue to be small and to 
seem undernourished. He may be subject to colds, 
earaches, infections of the nose and throat; he may 
be small for his age; ho may need special physical 
care and supervision. These needs are probably the 
indirect result of the cleft palate. 
Neither is there any reason for the child with 
15 a cleft palate to toe mentally retarded toy the palate 
opening. If he is slow to learn and If he does not 
lead his class in school, this slowness may toe due 
to many factors tout not necessarily to the palate 
cleft. It is true that his difficulty in making him- 
self understood may make some people, who cannot un- 
derstand him, consider him a "dull" child. It is 
also true that he may toe late in starting school or 
may have to miss some schooling if he is sent to the 
hospital for operations, tout most of the operative 
repair for children of school age is done during the 
summer months and most childrens hospitals provide 
"toedside schools" for their patients during the win- 
ter. We should expect average school work and at 
least average mental development from the average 
cleft palate child. We must realise his needs for 
attention, affection, responsibility, and understand- 
ing and meet those needs to the toest of our ability. 
16 PART II 
HOW PARENTS AND TEACHERS CAN HELP 
THE GLEET PALATE CHILD 
Parents of children horn with cleft palates 
or cleft lips, wishing to do all they can to he of 
service to those children, must continue to provide 
care and attention after surgical repair of the 
conditions has been secured. In the case of the 
lip cleft, surgery done early hy a competent plastic 
surgeon will generally he sufficient, since the re- 
paired lip usually assumes its functions quite well. 
Exercise of the lip in indirect ways, such as the 
playing of a musical wind instrument that requires 
lip pressure will he helpful. Drill for lip agility 
will help to insure better articulation in speech 
and better facial expression. 
Following even the earliest repair of the pal- 
ate, parents can begin to encourage the child to use 
speech sounds carefully, can provide good examples 
of speech for him to observe, and can procure for 
him the assistance of a specialist in speech through 
the city school system or upon recommendation of the 
physician. They can supervise home drill on mater- 
ials presented by the speech therapist and can give, 
at all times, understanding attention to the child 
and his problems of adjustment to a world in which 
he may, unfortunately, sometimes be made to feel out 
of place* 
The first consideration in the speech training 
of children with cleft palates is to attempt to se- 
cure operative repair of the cleft palate condition 
before the child has had an opportunity to learn 
speech, or, if this is not possible, before the child 
has had too long a time to practice speech habits 
with an incomplete or partially-repaired structure. 
Early surgery performed by a specialist, followed by 
speech training, if it is needed, will make for 
better speech for cleft palate children. 
1? Speech needs more training than do chewing and 
swallowing, since the speech habits are learned later 
and at a much slower rate than are the eating hahlts. 
Hence, speech training may he essential to a child 
who, as soon as the repaired tissue has healed, is 
able to chew or swallow with relative ease. 
There are a few basic speech habits and skills, 
which parents can help their children to develop, that 
will enable the child to learn improved speech more 
quickly and easily. First, the child with a repaired 
palate must learn to use that palate for speech and 
must be able to move and control it as he speaks. 
Blowing drills of any kind are excellent to help him 
establish movement of the soft palate after the stur- 
geon is satisfied that exercise of the palate will not 
be injurious. These blowing drills serve to provide 
a natural impulse for the movement of the soft palate 
up and back to meet the wall of the throat as it closes 
in to shut the passage into the nasal cavities. 
Second, after some control of the palate has 
been learned, the child can begin to use the closure 
of the port into the nasal cavities in speech, learn- 
ing to direct vowel sounds and all consonant sounds 
other than m, n, and through the mouth instead of 
through the nasal passage. 
Third, the child can be taught, directly as well 
as by example, how to form the various sounds of 
speech correctly and how to use them in words, phrases, 
and sentences. The parents must provide good example 
in the production and use of sounds and can frequently 
show the child how a certain sound is formed so that 
he can imitate not only the sound itself but also the 
movements or position for its production. 
It will be necessary to wipe out old, bad habits 
as well as to build new, correct ones. Parents can 
encourage the child to use the sounds he is now able 
to produce and can remind him, under certain condi- 
tions to be discussed later, of his mistakes. 
18 The same drill materials that are suggested for 
teachers should he used by parents at home, although 
the most valuable contributions to the child’s speech 
training that parents can make are to give him good 
example in speech and to supervise practice material 
assigned to him. 
No one in the family should be permitted to 
anticipate the child’s requests, but all should in- 
sist that he use speech to the best of his ability 
for the expression of his needs and wants. He must 
realize the value of speech if he is to use it well. 
If he is excused from using speech to make known his 
needs and wants, he will fail to recognize the im- 
port ance of clear self-expression at home, at school, 
and in other social situations. 
Parents should not consider that the operative 
correction of cleft palate, or of cleft lip, is the 
final step to be taken. We have mentioned before 
that further operative procedures may improve appear- 
ance, make for better mouth and tooth structures, 
and provide an improved mechanism for use in speak- 
ing and eating. Attention to dental problems, con- 
sideration of the advisability of orthodontia, care 
of hearing difficulties, and opportunity for the 
best possible physical condition will prove worth- 
while in terms of better social, school, and home 
adjustment for the child. 
And when the best possible repairs of palate 
and lip have been followed by attention to appear- 
ance, hearing, tooth alignment, and physical condi- 
tion, the parent will find that he has given the 
child a basis for good personality development. Un- 
derstanding and a fair share of attention, opportun- 
ity for self-expression and a normal part in the 
family conversation, playmates who accept him and 
brothers and sisters who consider him a perfectly 
normal individual—all these factors will help the 
child with a cleft palate to make the most of his 
home and school opportunities. 
All of these desirable situations have their 
19 foundation in the necessity for acceptable speech, 
which can be assured only if early operative repair 
is followed by speech training, if such training is 
deemed necessary. 
In any program designed to aid the child, co- 
operation between home and school is essential. Par- 
ents and teachers, working together, can provide for 
the child endless opportunities for growth and de- 
velopment in speech as well as in education, health, 
personality, and social adjustment. 
The child enters kindergarten or first grade 
with a whole new world of opportunity before him. To 
take advantage of this new world, he needs certain 
qualities, chief among which is the ability to ex- 
press his ideas, his needs, his wants, his opinions, 
and his enthusiasms by means of speech suited to his 
age and his grade level. The school system will 
undoubtedly wish to give the child special assistance 
if his speech is unsuited to his age, his mental a- 
bllities, and his grade in school. 
Many school systems have set up methods of def- 
inite training in speech for all children whose speech 
is not within normal limits for age and grade, and in- 
clude the cleft palate child in their speech programs. 
The speech correctionist, working with the child alone 
or in a group, tries to build up those desirable ha- 
bits of palate movement and control, production and 
use of correct sounds, and elimination of faulty sounds 
which we cited previously. However, some school sys- 
tems have not as yet established a program of special 
speech training for children in the grades or high 
school. If such training is not available through a 
regular school program, it must be provided by the 
classroom teacher and the parents. 
Teachers and classmates must be willing to ac- 
cept the cleft palate child as a normal individual, 
and should not consider him "defectiveH or "abnormal", 
or "underprivileged" in any way. In spite of any handi- 
20 cap in his speech, he may he a leader in his class 
and a popular member of his social group. All he 
needs is an opportunity to do his work and have his 
fun with the others, since he can he, and frequently 
is, a normal, healthy, well-adjusted individual. 
The classroom teacher should insist upon slow, 
clear speech at all times. Every opportunity for 
speaking should he used hy the child as a practice 
Provide for the cleft palate 
child every opportunity to 
observe his ovn speech. 
Encourage him to exercise the 
palate muscles by bloving. 
21 period for good speech. The cleft palate child 
should not be excused from participation in oral dis- 
cussion simply because his speech is not up to the 
standard of the other members of his class. Instead, 
he should be given full opportunity to do his share 
of the speaking under conditions which are favorable 
for his growth in speech, in poise, and in social 
adjustment. 
At all times and in all places, an understand- 
ing evaluation of the child's speech must be made. 
Other children must not be allowed to mock or criti- 
cize his speech, nor to tease him about it. They 
should be given an explanation of his problem and 
should be encouraged to help him by attentive listen- 
ing, sympathetic understanding, and kindly reminders 
to express himself to the best of his ability. Ex- 
amples of good speech should be provided constantly 
by the teacher and the other members of the class. 
If it is at all possible, the teacher should devote 
a few minutes each day to individual work with the 
cleft palate child, after surgery is completed. Such 
a period could be used for drill in the correct pro- 
duction of sounds, words, and sentences and in 
establishing good habits in the direction of sounds 
through the mouth passage. 
If it is not possible to give the child indi- 
vidual attention, the teacher may be able to incor- 
porate in her language, reading, or spelling class 
some drill material and exercises that would be 
beneficial to all the class and particularly helpful 
to the cleft palate child. Such group training may 
help to prevent the child1s feeling self-conscious 
about his special work, and may give the other child- 
ren a better understanding of how to assist him. 
In any event, the teacher, as well as the 
parents, must have an understanding of the child's 
problem, a concept of her role in his Improvement, 
and the desire to assist him in making any adjust- 
ments necessary to assure for him the best possible 
school and social life. 
22 PART III 
SUGGESTIONS FOR SPEECH TRAINING 
FOR THE CLEFT PALATE CHILD 
We have been speaking, in a general way, of 
speech training for the cleft palate child. We have 
considered the basic problem brought about by the 
lip and palate clefts and the general contributions 
that can be made by the parents and teacher to the 
personality development and speech improvement of the 
child. We are ready now to look at specific drills 
and methods that can be used in providing the speech 
training so often needed after surgery has been com- 
pleted. 
Our basic premise in all speech training—for 
the cleft palate child or for any other—is that 
drill, explanation, and practice must fit the indi- 
vidual child and his individual needs. Our suggestions 
must therefore be quite general, but they can be 
Htailored” to each situation. Parents and teachers 
can learn to know the child*s particular problems so 
well that they will be in a position to understand 
his needs and to help him in overcoming many of his 
deviations in speech. 
Having recognized the essential need for con- 
sideration of each child as an individual, we may 
turn to a general plan of speech training procedure 
designed to fit the majority of cases. Such a plan 
involves the recognition of the child*s problems and 
provision for special drill, ear-training, and daily 
practice of newly-acquired speech skills. 
If we are to help any speech-handicapped child, 
we must first determine his speech deviations. This 
involves, of course, a consideration of so-called 
%ormal” speech. 
23 Speech within the normal range may he described 
as being speech that is easy to hear, easy to under- 
stand, suitable to the age and grade level of the 
child, reasonably pleasant to watch and to listen to, 
and sufficient for the expression of the child*s 
needs, wants, ideas, and opinions. ’'Normal" speech 
is speech that is usable and serviceable, that is an 
adequate means of self-expression for the speaker. 
It is speech that enables him to keep in touch with 
those around him and to make a reasonably favorable 
impression upon those with whom he talks. 
If we are trying to evaluate the speech of a 
child whose cleft palate has been surgically repaired, 
we may have, as a basis for comparison, only our own 
speech, the speech of other adults, and that of child- 
ren of the same age and grade as the one we are hop- 
ing to help. We must, then, sharpen our own sense 
of discrimination by listening attentively to the 
speech of children of a certain age and grade level, 
to the speech of adults with whom we talk, and, inso- 
far as possible, to our own speech. 
We should pay attention to the voice used. Is 
it "nasal"? Would we say of the individual, "He talks 
through his nose?" Is it too high in pitch to be 
pleasant? Is it "squeaky" or "breathy" or "thin"? 
Does it seem to be a voice unsulted to the individual 
using it? 
We should pay attention to the pronunciation of 
the sounds used. Does the child say " fum" instead 
of "come"? Does he say "moy" instead of "boy"? Does 
he say "nail" instead of "tall"7 Does he say "ngat" 
instead of "cat"? Does he omit or distort sounds in 
the words he uses? 
We need to consider, also, the use of sounds in 
words, phrases, and sentences. Does the child use 
the sound of the letter "b" in the single word "Bob", 
but fail to put it into the phrase, "Let*s bob for 
apples"? Does he say the word "Dad" clearly, but 
fail to use that word well in a sentence such as, 
2 4 "My Dad is in town today”? 
There are three things to keep in mind as we try 
to evaluate the child1s speech in terms of the speech 
sounds he uses or fails to use. They ares the use 
of sounds in relation to the child’s age, the use of 
sounds in various positions within a word, and the 
differentiation "between the letters of the alphabet 
and the sounds of the American language. 
By the time a child is five years old, or by the 
time he enters school, he should be able to produce, 
and use in words and sentences, certain of the speech 
sounds used by all American speakers. These are the 
vowel sounds and the consonant sounds £, b, m, d, 
n, k, £, ng, (as in ”rlng”) h, y (as in "yes”). 
TThese sounds are not the names of the letters used 
most frequently to spell them, but are the sounds 
themselves. They are not pee, bee, em, tee, dee, en, 
kay, Jee, en-jee, aitch, and wy; they are the simple 
sounds indicated by those letters—the sound of the 
letter ”p” in the word ”£i£©H, the sound of the 
letter MbH in the word ’’book”, the sound of the let- 
ter “m” in the word "home”, and so on.) 
During his first year in school, or by the time 
he is six, the child will add to his list of usable 
sounds that of the letter "f” as in "fish” and "waffle” 
and "half". He may, of course,use all of the speech 
sounds before he enters school, but he does not have 
to do so to be within normal limits in speech develop- 
ment. 
The sounds of "v", as in "very”, "waving”, and 
"have", of the voiced "th”, as in "this",~and "mother", 
of as in "measure" and "pleasure", of "sh", as 
in "show", "bashful”, and "wish", and of "1", as in 
"looFT, and "call" should be added to the 
foregoing sounds by the time the child is seven years 
of age. 
• 
The use of the remaining American speech sounds 
should be established by the time the child is eight. 
25 These sounds are: "z”, as in ”£ebra”, Mhazard” and 
"was" (the final sound in the word being pronounced 
as £ even though the letter "s" is used in spelling), 
MsMf as in "jjing", "listen", and "mijss", "r", as in 
"run”, "borrow”, and "father”, the voiceless ”th”, 
as in "think”, "birthday”, and "both”, and ”wh”, as 
"when” and "somewhere”. 
For your convenience in checking the sounds the 
child can produce correctly, a list of sentences is 
given on the following page. In these sentences, 
most of the sounds are used at the beginning, in the 
middle, and at the end of words. The vowel as well 
as the consonant sounds are given in this list of sen- 
tences. 
When we know the errors a child is making in 
speech, we are better able to determine the best way 
in which to help him. If he misuses or omits the "t". 
”sh”, and ”s" sounds and is only six years of age, we 
should teach him the "t" sound and, giving him good 
example in speech always, wait until he is seven be- 
fore we teach him the "sh" sound. By that time, he 
may have learned it by himself. If he has not, then 
it may bo taught to him. If ”s” is still poorly 
produced when the child is eight, and if he has a 
tooth and mouth structure that will permit him to 
learn the sound under direction and supervision, then 
we should show him how to produce the sound usually 
indicated by the letter ”s” and give him an opportun- 
ity to practice, with our ear and his as his guide, 
the use of that sound in words and everyday speech. 
In presenting to the child a sound he has never used 
or a sound he uses incorrectly, do not say simply, 
"Johnny, don*t say 1 ’ing1, say •king1.” Such a pro- 
cedure will not help the child a great deal, since 
” *ing” jl£ "king" to him. Instead, show him first 
how the k (the sound of the letter "k") is produced. 
Have him imitate the tongue position you use. Demon- 
strate the way in which the back of the tongue goes 
up to the soft palate in k and how it snaps away a- 
gain as a puff of air comes out through the mouth. 
26 Test sentences may be read by the child or repeated after 
the parent or teacher. 
1. e Bach of the people saw me. 
2. ¥ In summer my work is easy. 
3. e Sid with the letter that you think bpst. 
4. £ Am I the man who ran back of him? 
5. a Are your hands as large as your father’s? 
6. o Always call for the~man you saw. 
7. oo Would you read as many books as you could? 
8. oo Who will do our work when we are through? 
9. u Upland away* the best is above us. 
10. co About half of the boys saw another girl with Anna. 
11. a Play hard and stay all day. 
12. jo Ohl How I hope to go! 
13. T always like to know whg. 
14. ou Our house is very old now. 
15. oi The point is that he is only a boy. 
16. b Be ajbove such things. Bob. 
17. p Please open the book and stand up. 
18. m May I remain if they go home? 
19. w fe will go that way if you wish. 
20. h He had hoped to be here. 
21. d Do you see him standing there in the cold? 
22. t Tell the little girl what you wanib. 
23. n Hot once did he run. 
24. g Give him the book again when he gets big. 
25. k Keep working on the "book. 
26. ng Think of~things to bring. 
27. y Tears went by with nothing new to try. 
28. f For a long time after that, he bad a happy life. 
29. v Very often he thought over the things he wanted 
to have. 
30. Ah That boy»s father and mother are the ones he is with. 
31. zh He finds pleasure in his work. 
32. sh Show them the dishes if you wish. 
33. 1 Little did they think that help would come later. 
34. ch Change the word "speeches” to "speech". 
35. j Just tell him that the soldier is too large. 
36. s It is, Sgsy to hear what he sayis. 
37. s See them soon if you want the best house. 
38. r Run from here to there. 
39. th Think of nothing but what pleases you both. 
40. hw Where were you when we saw you? 
27 The uae of a mirror for both 
ohlld and teacher is recommended. 
Present the sound to the child through many of 
his senses. Be sure that he hears it, that he sees 
how it is produced, and that he notices in a mirror 
the movements of tongue, lips, Jaw, and soft palate 
as he says the sound correctly. Have him use k with 
28 other sounds, not in words he already knows, but in 
sound-combi nations such as kee, kay, kie, koh, koo, 
eek, ayk, okay, ookec, and so on. This procedure 
will help the child learn the many muscle adjustments 
necessary in the production of k and will avoid his 
old word-habit of using £ for k or of leaving out the 
"k" sound altogether. 
Even if we provide the most careful and persis- 
tent help for the child who is learning speech sounds, 
we cannot be sure that he will retain the newly- 
acquired sound skills unless he can listen to his own 
speech critically. Hence, it is important for us to 
know, first, that the child1s hearing is within normal 
limits and, second, that the child is listening care- 
fully to his own speech and to that of others. We 
must make him conscious of speech sounds through ear- 
training. Have the child listen to you as you pro- 
nounce a certain word—"fan", for example, for the 
11 fM sound. Pronounce the word coVrectly and incor- 
rectly ("fan", "pan", "than", "fan", "man", and so on) 
and ask the child to tell you each time you say 
correctly the name of the object we wave back and 
forth in summer to keep us cool. Have him tell you 
other words in which he hears the MfH sound, such as 
“fish", "face", "left", "if", "after", and "knife". 
Give his ears the opportunity to help his speech by 
becoming "good listeners". 
Correction of the child’s errors in the produc- 
tion of speech sounds will not guarantee good speech 
for him. He may be able to form the sounds clearly, 
but he may still direct them through the nasal 
passage instead of through the mouth. In the case 
of m, n, and ng, this direction of sound through the 
nasal chambers will be correct, but if other sounds 
are sent out through the nasal cavities they will 
seem "nasalized" and will not be accurately produced. 
For example, the child with a repaired cleft palate 
may know that the sound of the letter "p" in the word 
"pay" is one for which the two lips come together, 
then open to emit the puff of air we have come to 
recognize as the p sound. He may put his lips 
29 together in the proper manner, then open them, but 
send the puff of air out through the nasal passages 
because he has failed to close the HgateM, the portal 
at the back of the mouth described and illustrated on 
pages 3 and 4. In such an instance, the nasally 
directed £ may be similar in appearance to the £ used 
by most people, but it will not sound like the normal 
£ sound. 
In the case of a voiced sound—b, for example,— 
the distortion will be even greater if the sound is 
directed through the nasal passages instead of through 
the mouth. The vocal tone, which is part of the 
"■voiced” sounds such as b, d, £, £, v, and so on, is 
greatly changed in quality if it goes through the nasal 
cavities. It is important to the child*s speech for 
him to direct the tone through its proper channel; 
hence, control of the soft palate and back wall of the 
throat is essential. 
This control of what we have termed the "gate**, 
for ease in discussion, may be acquired by the child 
if he understands wjiat is wanted of him and if he has 
many opportunities for practicing this skill. Blowing 
exercises of any kind will be of value to the child 
who needs to learn "gate** closure, since the palate 
and throat-wall make an almost involuntary adjustment 
in blowing. The child should blow soap bubbles, should 
blow any simple musical wind instrument, should direct 
little puffs of air between rounded lips onto his 
finger tips or against the palm of his hand, or should 
do any one of a number of other blowing drills sugges- 
ted in more detail in the following pages. 
In addition to the skills described, which are 
important parts of the speech training of the cleft 
palate child, certain basic speech skills will be of 
value to him. He should have an agile tongue, flex- 
ible lips, and a relaxed Jaw. He will find that con- 
trol of all of the parts of the body used in speech 
will aid him in overcoming the particular speech 
deviations which result from lip and palate clefts. 
Because these general drills seem to be essential 
30 Blowing soap bubbles. 
parts of the entire speech program, they are given 
first in the following sequence. 
31 The following suggested exercises provide a guide 
to speech training for the cleft palate child. These 
drills, done with care and with regularity, should 
make it possible for the cleft palate child to improve 
his speech, provided he understands his problem, works 
under supervision, and moves forward as he masters each 
defective sound and each bad speedh habit. 
Each practice period might well begin with some 
of the following general exercises, designed to provide 
mobility and control of the jaw, the lips, the tongue, 
and the soft palate (the "gate"): 
Jaw exercises 
1. Chewing in rhythm (beginning slowly and in- 
creasing the speed) . 
2. Chewing like a camel (moving the jaw from 
side to side), 
3. Stretching the mouth as wide open as possible. 
4. Clicking the teeth lightly together (build- 
ing up speed to as rapid a rate as possible). 
Lip exercises 
1. "Beaming’1—stretching the lips in a broad 
grin. 
2. Tucking the lips in (until none of the red 
border can be seen)• 
3. Moving the lips from side to side as far as 
they will go. 
4. Pushing lips forward as far as possible and 
then pulling them back into a smile as the 
child thinks "oo-ee, oo-ee M 
5. Puckering and opening the lips several times 
in succession in the production of ”wah.., 
wah,.,wah,..M 
6. Compressing and releasing the lips rapidly, 
with the sounds Mmee...mee,..mee...mee,.,” 
7. Adjusting the lips for the prolonged vowel 
sounds "ah,..11, Moh,..M, Moo...n, Bee M 
8. Massaging the lip by placing the tongue 
between the upper lip and the teeth and mov- 
ing it from side to side, stretching the 
upper lip (This exercise is especially bene- 
ficial for the child who has a short or taut 
upper lip). 
32 10. Massaging the lips by placing the finger 
tips on the upper lip and moving the lip 
against the finger pressure. 
Tongue exercises 
1. Touching the nose with the tongue tip. 
2. Touching the chin with the tongue tip. 
3. Extending the tongue as far as possible 
and pulling it quickly back into the mouth. 
4. Touching the comers of the mouth with the 
tongue, moving from the right side to the 
left and back again in quick succession. 
5. Licking "honey” from the lips, the tongue 
circling the upper and lower lip edges. 
6. Moving the tongue In a circle between the 
teeth and the closed lips. 
7. "Cleaning house" 
a. Sweeping the tongue along the roof of 
the mouth from back to front—" Cleaning 
the attic". 
b. Sweeping the tongue upward from behind 
the lower teeth—"Cleaning the basement". 
c. Pushing the tongue against the right 
cheek wall—"Tapping in a loose brick". 
d. Pushing the tongue against the left 
cheek wall—"Tacking on a loose shingle". 
e. Running the tongue along the outside of 
the upper teeth behind the lips—"Clean- 
ing the upper porch railing". 
f. Running the tongue along the outside of 
the lower teeth behind the lips—"Clean- 
ing the lower porch railing". 
g. Flapping the tongue rapidly—"Shaking 
out the rug". 
When the child has done some preliminary "limbering 
up" drills, he should go on to the particular consider- 
ation of the day—the proper position and direction of 
air for the sound of the letter "t", the proper position 
and direction of sound for b, the incorporation of k and 
g into words in phrases and short sentences, or any other 
33 individual and special problem with which he needs to 
be concerned at the time. 
Since each speech problem will need to be 
approached in terms of the individual need and the 
individual situation, let us consider how to teach 
the sounds of American speech to the child, and how 
to help him overcome nasality. After that, we may 
look at specific examples in teaching procedure. 
One of the chief points to keep in mind as you 
begin to help the cleft palate child to overcome his 
specific speech deviations is the distinction be- 
tween •’nasal" and "non-nasal" sounds. If we consider 
the sounds in American speech, we will recall that 
only three of them—the m, n, and ng as in man, now 
and sing—are directed through the nasal passages. 
All of the other sounds are sent through the mouth. 
Although this hard-and-fast division between m, n, 
ng and the other sounds Is not maintained by all 
American speakers. It Is a very Important distinction 
for the cleft palate child to learn. 
The cleft palate child has not used his soft 
palate to close off the passage Into the nasal cavi- 
ties in speech. First, he has not used It before 
surgical repair because it has not been complete and 
could not work in conjunction with the walls of the 
throat to make a "gate" closure. Secondly, he has 
not used the repaired soft palate because, particular- 
ly if he has learned speech before surgery is com- 
pleted, he does not know how to use the new, complete 
palate that he has and he continues to speak as he 
did before surgery. 
If we help the child to control this soft palate- 
throat wall "gate"—we are helping him In two ways: 
First, In learning muscle adjustments which will en- 
able him to produce consonant sounds correctly and, 
second, in using this closure in the formation of 
vowel sounds. Both of these skills are needed if he 
is to overcome nasality. 
It may help the child to understand the importance 
34 of palate movement to speak of the palate as a "gate" 
and of the adjustments of the palate and throat wall 
as "opening the gate" and "closing the gate". A refer- 
ence to the diagrams on page 3 will provide graphic 
illustration of the process of closure. We can tell 
the child that he closes the gate when he says "ah". 
We can have him look into his mouth with a mirror and 
say the sound "ah" and let him observe for himself the 
action of the soft palate and of the hack wall of the 
throat as they come together to close off the passage 
into the nasal cavities. He can then say "ng - ah" t 
still watching his palate in the mirror, and can see 
how the changes in palate position change the direc- 
tion of the sound. If he places his fingers lightly 
on the bridge of his nose, looks into the mirror, 
opens his mouth wide, and says "ng" and "ah", he will 
feel the "ng" sound come through the nasal passage as 
he watches the soft palate move down and will feel 
that "ah" may cause less vibration in the nasal cavity 
as the soft palate moves back and the wall of the 
throat moves forward to "close the gate". 
The following drills will help the child learn 
control of the soft palate and will aid him in open- 
ing and closing the "gate". 
1. Saying "ah,holding the mouth well open. 
2. Thinking "ah,..", without making a sound. 
3. Opening the mouth wide, then breathing in 
through the mouth • 
4. Yawning . 
5. Breathing in through the nose and out through 
the mouth with the mouth held open • 
6. Breathing in through the mouth and out through 
the nose with the mouth held open • 
7. Repeating syllables—ung-ah, ung-ah, ung-ah— 
with the mouth open and no movement of the 
jaws . 
8. Repeating syllables—ing-ick, ing-ick, ing-lck 
—with the mouth open and no movement of the 
jaws. 
9. Panting like a dog with the mouth open and the 
tongue in a relaxed position • 
10, Breathing in through the mouth and expelling 
35 air 'between puckered lips. 
11. Breathing in through the nose and whistling, 
being sure that the breath goes out during 
the whistle. 
12. Massaging the soft palate by puffing out the 
cheeks and pressing the fingers repeatedly 
against one cheek without allowing the air 
to escape through mouth or nose. 
13. Blowing (See page 31) 
a. through straws 
b. soap bubbles 
c. pin-wheels 
d. balloons 
e. wind Instruments 
14. Whistling tunes (blowing the air out, not draw- 
ing it in). 
15. Saying the word wpapaH or the word "so" with the 
fingers held lightly on the bridge of the nose. 
(Notice that no vibrations are felt in the nasal 
passages. Instead, the sounds are directed 
through the mouth.) 
16. Letting the child feel the difference between 
nasal and mouth sounds by placing his fingers 
on the bridge of your nose. (Be sure that you 
have experimented for yourself before you demon- 
strate for the child, and that you are producing 
these sounds correctly and directing them 
through the proper passages.) 
As you work with the child, at home or at school, 
do the following things: 
1. Have brief periods of general drill (See pages 
32 and 33) and drill for "gate" movement and 
control (See page 35). 
2. Show the child how a defective sound should be 
pronounced, 
3. Make the sound yourself, having the child watch 
you carefully. 
4. Have him imitate you, watching himself in a mirror. 
5. Insist that he say the sound correctly by itself 
before he tries to use it in words and sentences. 
6. If he cannot make a certain sound correctly, 
36 show him again exactly where your tongue goes, 
how your lips move, what occurs at the soft 
palate wgateM, and whether the throat "buzzes” 
or is silent. 
7. If the child still makes a mistake in the 
production of a sound, you may need to review 
some of the palate exercises to help him use 
the palate closure in making the sound. Usually 
the HahH sound, prolonged, with the mouth wide 
open, will get .the "gate" closed. So, such 
drill as: ah-d-ah, ah-d-ay, ah-d-ee, ah-d-oo, 
may enable the child to make a better d sound 
than just dah, day, dee, doo. 
8. At all times, use your own ear as a guide, re- 
mind the child to listen carefully, and use a 
mirror to help both yourself and him. The illus- 
tration on page 28 shows a teacher and pupil, 
sharing a mirror, working on the sound £. The 
child is watching both the teacher and herself 
as she tries to get the position for the sound. 
9. Follow the sequence of sounds given earlier in 
this discussion (page 26), teaching b before f , 
and k before s, for example, if the child makes 
errors on those sounds. 
10. Keep in mind the fact that the child need not 
be able to produce and use all the speech 
sounds until he is eight years old. 
11. Be sure that he is using all of the sounds that 
are expected of him at his age, but do not in- 
sist that he use sounds beyond his age level. 
(See pages 25 and 26 for this "developmental” 
list.) 
12. In some instances, sounds will be formed correct- 
ly—that is, the position or movement for the 
sounds will be correct—but the child will con- 
tinue to direct the sounds through the nasal 
passages instead of through the mouth. Constant 
drill on "gate” movement and control will help 
overcome these faults. If b is still like m, 
have the child go from one sound to another, using 
a drill such as m-b-m-b-m-b, reminding him to 
Hclose the gate” for b each time he says it. Hav- 
ing him touch his nose as he says m and hold his 
37 hand in front of his lips to feel the h sound 
come out will help him in directing these 
sounds properly. 
13. One of the greatest helps in learning to send 
sounds through the mouth is blowing. Let the 
child blow against your hand and on his own. 
Have him hold the first finger of one hand in 
front of his lips and place the first finger 
of his other hand under his nostrils. As he 
blows between pursed lips, he should feel breath 
only on the finger in front of his mouth. If 
air escapes from his nostrils, he does not have 
the "gate" closed. Blowing a whistle, or 
musical instrument, blowing through a straw, 
puffing on a piece of paper, or whistling (as 
long as he does not whistle on an indrawn breath) 
will provide excellent exercise for the palate. 
14. Teach the child to think of all speech sounds— 
except m, n, and ng—as coming through the mouth. 
Have him make a "basket11 of his hands and pre- 
tend that he puts words into it. This helps him 
to concentrate on directing the sounds through 
the mouth. Have him "push" the words out from 
his mouth toward a real or imaginary target. 
Suggest that he try to blow a small piece of 
paper across a desk or table with the jo, b, t, 
d, or wh sound. 
15. Begin at once to encourage the child to use, 
in his everyday speech, the sounds he is learn- 
ing in drill periods. Set aside one week, or 
several if more time is needed, as d week or k 
and £ week or s week and hold the child to 
accurate use of the particular sound or sounds 
during that time. At the supper table at home, 
during reading and spelling and language lessons 
at school, insist that ho use correctly the one 
or two sounds he is trying to master. Do not 
hurry him. Do not have him work on more than 
two sounds at a time. When one problem seems 
to have been solved, go on to the next. 
16. Once you start to help the cleft palate child with 
his speech, make the lessons a regular part of 
his daily routine. Work with the child each 
38 day at a specified time. Make it his responsi- 
bility to maintain the schedule that he, the 
parent, and the teacher, agree on. 
17. Provide frequent short periods of drill rather 
than few long ones. The child gains far more 
from three ten-minute speech lessons during the 
day than from one lesson lasting thirty minutes. 
18. Parents and teachers must cooperate in present- 
ing a "united front" in this speech work. It 
will not do for the teacher to insist on atten- 
tion to a specific problem and for the parents 
to ignore that problem. If both parent and 
teacher attempt to assist the child, the sequence 
of work should be decided in conference and 
followed carefully. 
19. Encourage the child by pointing out his success- 
es. End each lesson with some drill that the 
child can do well. Try to make him feel the 
importance of good speech so that he will try 
hard to improve. 
20. Check your own speech. Be sure that it serves 
as a good example for the child. Learn to 
listen to yourself and to others as you wish 
the child to listen. 
21. Make the speech lessons pleasant periods for the 
child. Help him to have fun as he works. Hold 
him to good standards of attention and response, 
but do not make this work "Just another lesson". 
22. Help the child to learn first the words and 
phrases he needs to use every day—"Hello", "How 
are you?", "I am fine", "May I have.*.", "Please 
give me,..", "How do you do?", his name and 
address, and his age. If his speech is service- 
able and if he obtains a favorable response 
from his better speech, he will try all the 
harder to improve. 
23. Do not be concerned because you are not an 
"eapert" in speech. You cannot expect to do as 
much in training the speech of your child or 
your pupil as the trained speech correctlonist 
might do, but you have the advantage of being 
with the child daily and of being able to work 
with him regularly over a long period of time. 
39 You can do him no harm by giving him these 
speech drills. You can, in all probability, do 
him some good. However, a good rule to observe 
is this: If you are not sure of your procedures 
do nothing until you ask the advice of a spec- 
ialist in the field. If possible, check with 
the plastic surgeon to be sure that the child 
is ready for speech training. If possible, check 
with a speech correctlonist to be sure you cure 
using the most helpful procedure. Do not hesi- 
tate to ask advice. Ask it, then determine your 
course of speech training and follow it to the 
best of your ability. 
Consideration of a typical situation may be of 
value. Do not think of the following procedures as 
the only approach to speech help for the cleft palate 
child. Indeed, there is no "only approach". This is 
simply an example which may help you to see more 
clearly some of the things you might do to help your 
child or your pupil. It is present in "diary" form 
so that the time element may be included. It is 
written from the point of view of the teacher, but the 
parents' contribution is considered, also, 
September 5. Today Mary Jane Doe entered my 
first grade class. She is 6 years old, a seemingly 
bright youngster, but her speech is very poor. The 
children who know her understand her fairly well, I 
must admit, I don't. I'll see her family at once, 
September 8. Mrs. Doe and I discussed Mary 
Jane's speech problem today. Mrs. Doe tells me that 
Mary Jane was born with a severe lip and palate 
cleft, that the lip was repaired when she was only 
two weeks old, and that surgery on the palate was 
consisted two years ago when Mary Jane was four. 
She learned to speak at an average age (about 16 
months) but couldn't be understood, except by the 
family, even after the palate was completely repaired. 
I do hope I can help the child. At least I can keep 
the other children in the room from teasing or mock- 
ing her. 
40 September 15. The Bureau for Handicapped Child- 
ren in Maaieon has a bulletin for Mrs. Doe and me 
to use in helping Mary Jane. It is called ”A Teacher- 
Parent Guide to Speech Training for Cleft Palate 
Children”. Wefll read it carefully. Both Mrs. Doe 
and I have sent for copies. 
September 20. This afternoon Mrs. Doe, Mary Jane, 
and I met to begin work on Mary Janefs speech. We 
wonft have to have many of these three-way meetings 
after we get started, because Mrs. Doe and I will 
make our plan and each will do her share—she at 
home, I during phonic drill and at any other time I 
can find at school. Well, we listened to Mary Jane 
and, although we*re not speech experts, we found, 
as she repeated sentences from that bulletin (they*re 
on page 27) that she made the following noticeable 
mistakes: She said m for b; she said n for d and t; 
she said th for £ and ss; she left out k and £; she 
the vowel sounds. Heally, the child 
spoke far better when she was being careful than I've 
ever heard her speak before, and she seemed to enjoy 
the ”game” of repeating things for us. We probably 
missed a lot of little mistakes—and maybe some big 
ones—but if she learns those sounds I've listed, 
her speech will be much clearer. We decided to start 
with just two things—teaching her to blow, which she 
does poorly, and teaching her to say b, Mrs. Doe 
will help her every day as soon as she gets home from 
school and I'll work with her during phonics class. 
(Lucky I have only three first graders in this rural 
school.) 
September 50. Mary Jane can say b. And it 
makes me feel good to hear her say it! Now if I can 
get her to use that sound in words— Guess I'll 
have her cut out some pictures of things with the 
b sound in them—a baby, a book, a ball, a basket, a 
ribbon, a rabbit, and a crib—and paste them on a 
sheet of paper. (Note to myself: remember to take 
that old reader and last year's mail-order catalogue 
for her to cut up.) She can take the pictures home, 
too, and "show off” to her family! 
41 October 5. Today Mary Jane showed me how well 
she could blow a crumpled piece of paper across her 
desk. She's beginning to get the idea of blowing 
through her mouth. And I noticed that she said "boys’* 
and not nmoysn. She still makes eome mistakes on b, 
but it’s coming. David and Ellen, the other first 
graders, know all about b, too, 
October 10. Mrs. Doe and I decided it's time to 
try another sound for Mary Jane, Better not tackle 
s and t yet—the bulletin said they weren't absolutely 
essential until a child was eight. (Note to myself: 
Ernest, who is ten, says th for js. Better check up on 
him.) Perhaps it and d might be the next sounds. Since 
they're formed the same except that £ is whispered and 
d has voice with it, we can probably do them together. 
Mary Jane's blowing does seem to be making her voice 
less nasal. It's hard to tell, of course, since I'm 
getting so used to her speech. Maybe I'd better lis- 
ten a little harder. Mary Jane reminded Ellen today 
to make b clearer. Quite the little teacher! 
October 31. Maybe we're not experts, but Mrs. Do© 
and I have decided we can do a great deal to help 
Mary Jane. Her speech is really much better and she 
seems to be more sure of herself on th© playground 
and in conversation at school. Mrs. Doe says she 
talks more at home and that Mr. Doe, who was sometimes 
cross with Mary Jan© when he couldn't understand her, 
is very pleased. I'm glad we've been able to help 
her. We needed the suggestions about exercises and 
procedure, of course, but our attitude toward Mary 
Jane and her speech has been a great factor in her 
improvement. She's a bright child. She loves atten- 
tion and affection. She wants to be Just like the 
other children. And her speech Ijs better. There's 
still a long way to go, with orthodontia and probably 
more surgery to improve appearance, but it's worth 
every minute and every dollar spent on her if we can 
help her to become a better speaker, a more effective 
person, and a better member of society now and in the 
future. 
42 These few excerpts from the imaginary diary of 
an entirely imaginary teacher may serve to illustrate 
one approach to the speech problems of one cleft palate 
child. The teacher and the parents are working to- 
gether. That's fine. They are working for the child. 
That's even better. They are planning and then follow- 
ing their plan. That way lies success, and that success 
moans better speech, better adjustment, better living 
for the cleft palate child. 
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