A 5-year-old with repaired cleft palate continues to use compensatory articulations; what is the most appropriate next step for the SLP?

• A. Recommending that the child be examined by a cleft palate team to determine the cause of the persistent articular errors
• B. Referring the child back to the surgeon to determine the need for a revision of the pharyngeal flap
• C. Initiating articulation treatment to teach the correct placement for the stops and fricatives
• D. Initiating articulation treatment to teach correct production of nonpressure consonant sounds

Answer: (C)

When a child with repaired cleft palate continues to use compensatory articulations, the best next step is articulation therapy focused on teaching the correct place and manner for high-pressure consonants, such as stops and fricatives. These sounds require oral pressure and precise velopharyngeal closure to avoid nasal emission, so retraining placement and production of these sounds helps establish proper oral airflow and realigns the speech system toward typical articulation.

Starting with stops and fricatives gives the child a concrete, high-impact goal. By guiding where the tongue and lips should be for these consonants and providing cues to ensure closure and correct airflow, the therapist addresses the core difficulty behind compensatory patterns. This approach often reduces hypernasality and nasal air escape and can generalize to other sounds once stable oral-closure patterns are established.

Referral to a surgeon or cleft palate team for revision is not the immediate step. Surgical decisions are typically considered if velopharyngeal insufficiency persists after substantial articulation therapy or if objective assessments show a structural limitation that therapy cannot overcome. Focusing therapy first aligns with helping the child relearn speech production before pursuing medical interventions.

Treating nonpressure consonants alone would not address the main issue driving compensatory errors, since they don’t demand the same level of oral pressure or velopharyngeal coordination as high-pressure sounds. Prioritizing articulation of stops and fricatives builds the foundation for normal speech more effectively.