Health and social problems of children with cleft palate

Children with cleft palate are more prone than other children to certain health or social problems.

Speech problems

Children with cleft palate may have speech problems, even after surgery to correct the cleft. These problems differ, depending on how severe the cleft is and whether other facial defects are present. Children who have problems with speech and hearing may have reading difficulties in school. Common speech problems include:

  • Incorrect pronunciation of certain consonants, such as p, b, t, g, f, v, s, and z.
  • A lower tone of speech (hypernasal speech). In most children with cleft palate, their missing soft palate cannot make contact with the back of the throat during speech. This causes a constant escape of air into the nose, resulting in hypernasal speech. About 20% to 30% of children who have had only one surgical procedure to repair cleft palate have hypernasal speech.1 Additional surgeries may help children with this or other speech-related problems.
  • Unusual noises made during speech because of air movement through the nose. This occurs when a small opening still exists between the nose and mouth.
  • Unclear speech.

Hearing problems and ear infections

Children with cleft palate are prone to fluid buildup behind their eardrums and to middle ear infections. These ear problems can cause trouble with hearing. Middle ear infections occur most often in children younger than 3 years of age. Children's ears are not fully developed before age 3, and the immature structures allow fluid to easily build up behind the eardrum. This problem is worse for babies born with cleft palate, because the muscles of the palate are not properly formed. The irregularly formed muscles prevent the eustachian tubes, which connect the inside of the ears to the back of the throat, from functioning normally during swallowing. Also, hearing defects not caused by fluid buildup or ear infections may occur along with cleft palate.

Dental problems

Children with cleft palate often have problems when their permanent teeth erupt. Problems may include missing teeth, excess teeth, or a misshapen or small jaw. Treatment for dental problems usually begins when children are between ages 9 and 11 and continues through the teen years.

Social problems

Some children with cleft palate require surgery during the school year, resulting in long absences. This can interfere with academic performance and friendships. Problems with self-esteem can also develop from feeling self-conscious because of unclear or hypernasal speech or visible scars (usually because of a cleft lip).


  1. Kuehn DP, Henne LJ (2003). Speech evaluation and treatment for patients with cleft palate. American Journal of Speech-Language Pathology, 12(1): 103–109.

Last Updated: January 21, 2010

Author: Debby Golonka, MPH

Medical Review: John Pope, MD - Pediatrics & Donald R. Mintz, MD - Otolaryngology

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