Communicative abilities in toddlers and in early school age children with cleft palate.

OBJECTIVES: Evaluation of improvement in communicative abilities in children with nonsyndromic cleft palate.

METHODS: Longitudinal retrospective case history study. Out of 117 children with cleft lip and/or cleft palate born in 1998, 1999 and 2000 and enrolled in the cleft palate team of the University Medical Centre Groningen (UMCG), 63 children were included in the study; 29 (46%) boys and 34 (54%) girls. From these 63 Dutch speaking children communicative abilities were measured when toddlers and at early school age. Cleft types were cleft lip with or without cleft alveolus (CL+/-A; n=10, 5%), unilateral cleft lip and palate (UCLP; n=23, 37%), bilateral cleft lip and palate (BCLP; n=9, 14%) and isolated cleft palate (CP; n=21, 33%). The percentage of problems in language comprehension, language production, articulation, hearing and hypernasality, present when toddlers, were compared with the percentage of problems found at early school age. The treatments executed were also analysed.

RESULTS: Except for hearing problems, problems in all other communicative fields improved significantly. In the total group language comprehension problems decreased from 23% to 2% (p=0.00), language production problems from 21% to 6% (p=0.01), articulation problems from 57% to 25% (p=0.00) and hypernasality from 38% to 10% (p=0.04). Hearing problems appeared more difficult to treat effectively, they decreased from 42% to 31% (p=0.29). Children with BCLP appeared to have the most problems, followed by children with UCLP and then children with CP. Children with CL+/-A show the least problems. In the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be very successful in treating hypernasality, with a success rate of 86%.

CONCLUSIONS: At early school age, in children with clefts, speech and language problems were significantly improved following a multidisciplinary approach to treatment and resemble their peers without clefts. Hearing problems were more difficult to treat.