Emergence of Prevocalic Stop Consonants in Children With Repaired Cleft Palate

Feeding Management and Palate Repair Timing in Infants with Cleft Palate with and without Pierre Robin Sequence: A Multisite Study

OBJECTIVES

Compare the feeding management practices in infants with cleft palate with and without Pierre Robin sequence (PRS) and determine if specific feeding difficulties or interventions predict delayed palate repair.

DESIGN

Retrospective cross-sectional study.

SETTING

Seventeen cleft palate teams contributed data.

PATIENTS

414 infants were included in this study: 268 infants with cleft palate only and 146 infants with cleft palate and PRS.

PROCEDURES

Data were collected via parent interview and electronic health records.

MAIN OUTCOME MEASURES

Outcomes for the primary objective included categorical data for: history of poor growth, feeding therapy, milk fortification, use of enteral feeding, and feeding difficulties. The outcome for the secondary objective was age in months at primary palate repair.

RESULTS

Infants with PRS had a significantly higher prevalence of feeding difficulties (81% versus 61%) and poor growth (29% versus 15%) compared to infants with cleft palate only. Infants with PRS received all feeding interventions-including feeding therapy, milk fortification, and enteral feeding-at a significantly higher frequency. Infants with PRS underwent primary palate repair at a mean age of 13.55 months (SD = 3.29) which was significantly (P < .00001) later than infants with cleft palate only who underwent palate repair at a mean age of 12.05 months (SD = 2.36). Predictors of delayed palate repair included diagnosis of PRS as well as Hispanic ethnicity and a history of poor growth.

CONCLUSIONS

These findings can be used to establish clinical directives focused on providing early, multimodal feeding interventions to promote optimal growth and timely palate repair for infants with PRS.

Stop Consonant Production in Children with Cleft Palate After Palatoplasty

The current study examined stop consonant production in children with cleft lip and/or palate (CP ± L) 2-6 months following palatal surgery.

Prospective comparative study.

Multisite institutional.

Participants included 113 children with repaired CP ± L (mean age = 16 months) who were participating in the multicenter CORNET study.

Parents of participants were asked to record approximately two hours of their child's vocalizations/words at home using a Language ENvironmental Analysis (LENATM) recorder. Four ten-minute audio-recorded samples of vocalizations were extracted from the original recording for each participant and analyzed for presence of oral stop consonants. A minimum of 100 vocalizations were required for analysis.

Preliminary findings indicate that at least one oral stop was evident in the consonant inventory for 95 of the 113 children (84%) at the time of their post-surgery 16-month recording, and 80 of these children (71%) were producing two or more different stops. Approximately 50% of the children (57/113) produced the three voiced stops, and eight of the children (7%) were producing all six stop consonants.

The findings of this study suggest that the majority of children with repaired CP ± L from English-speaking homes are producing oral stops within six months following palatal surgery. Similar to same-age children without CL ± P, voiced stops were more frequently evident in the children's inventories than voiceless stops. In contrast to findings of previous reports suggesting place of articulation differences, a somewhat comparable percentage of children in this study produced voiced bilabial, alveolar, and velar stops.

Lexicogrammatical skills in 2-year-old children with and without repaired cleft palate

The purpose of the current research was to compare the lexical-grammatical skills of two-year-old children with and without repaired cleft palate (CP), accounting for the effect of variables such as vocabulary size at 18 months of age, maternal education level, and gender. Participants included 52 children with CP and 25 typically developing (TD) children. The CDI-WS was employed to measure vocabulary and grammatical skills. Significant differences were observed between the CP and TD groups with respect to the number of words, word forms (irregular nouns and verbs), word endings (overuse of plural (-s) and past tense (-ed) markers), the mean number of morphemes in their three longest utterances (M3L), and sentence complexity. In addition, compared to TD children, significantly smaller proportions of children with CP were observed to use words to talk about past and future events or use words to talk about an absent object. The difference between the CP and TD groups in terms of the size of vocabulary at 24 months of age remained statistically significant in the multivariable model. Among all predictors, the size of vocabulary at 18 months of age was identified as the most robust precursor of lexical and grammatical skills at 24 months of age. Gender was identified as a predictor of the M3L measure as an index for syntactic ability.

Alveolar Backing in 3-Year-Old Children with and without Repaired Cleft Palate: Preliminary Findings Related to Cleft Type and History of Otitis Media

OBJECTIVE

The purpose of this preliminary study was to determine if cleft type and/or history of otitis media with effusion (OM) contribute to backing of /t/ and/or /s/ in young children with and without repaired cleft palate.

METHOD

Participants were 39 children (mean age=36 months, range 34 to 41). Ten children had repaired unilateral cleft lip and palate (CLP), nine had repaired cleft palate only (CP), twelve had no clefts but histories of OM, and eight were typically-developing (TD) without clefts or OM history. All children were video and audio recorded during administration of the Goldman-Fristoe Test of Articulation-3 (GFTA-3). Standard scores of articulation, frequency of alveolar backing, and first spectral moments of the /t/-/k/ and /s/-/ʃ/ phonetic contrasts were obtained.

RESULTS

Children with CLP had lower GFTA-3 scores than both TD (p=.012) and OM (p=.001) groups. Fisher's Exact test showed that significantly more children with CLP backed alveolar targets, mostly /s/, than children with CP (p=.020). Children with CLP also had (a) reduced /t/-/k/ spectral difference compared to TD children (p=.016) and (b) reduced /s/-/ʃ/ spectral difference compared to both children with CP (p=.010) and children with OM (p=.018). Children with OM had reduced /t/-/k/ spectral difference compared to TD children (p=.009).

CONCLUSIONS

Cleft type contributes to alveolar backing and reduced spectral contrast of /s/-/ʃ/ in 3-year-old children with repaired cleft palate. History of OM affects spectral contrast of /t/-/k/ in non-cleft children. Etiology and clinical implications of alveolar backing are discussed.

Longitudinal Study of Vocal Development and Language Environments in Infants With Cleft Palate

OBJECTIVE

This study investigated vocalization and language environment longitudinally in infants with cleft palate (CP) based on day-long audio recordings collected in their natural environments.

DESIGN

Language Environment Analysis (LENA) data from all-day recordings at home were collected at 3-month intervals for infants from 4-6 to 16-18 months of age. The recordings were analyzed using experimentally blinded human coding as well as LENA automated analysis.

PARTICIPANTS

Ten infants with CP (± cleft lip) and 10 age-matched infants without CP.

MAIN OUTCOME MEASURES

Several measurements were obtained from the LENA automated analysis software. In addition, human coded measurements of vocalization and language environment, including the true canonical babbling ratio and the infant-directed speech ratio, were analyzed for each time point of data collection for each infant. Statistical analyses were performed to conduct group and age comparisons for each measure of vocalization and language environment.

RESULTS

No group differences emerged in number of syllables produced. Infants with CP exhibited late onset and fewer productions of canonical syllables compared to infants without CP. Infants with CP did not show significant differences from infants without CP in measures related to language environment across ages.

CONCLUSION

This study provides detailed information through naturalistic all-day home recordings about vocal development and early language environments in infants with CP before and after palatal repair. Clinical implications for early intervention are discussed.