Child’s high palette and speech issues

[exhaustedandoverit]

Does anyone have any experience with this?
DC is 7 and has always had unclear speech, his vocab is brilliant and he has no learning issues but he still speaks in an almost babble and can’t say ‘r’ or ‘sh’.

he's been referred to SALT before when in reception but was signed off after one video call. He’s been re-referred and we’re now waiting on an appointment.

when we last went to the dentist I noticed his palette looks really high, his tongue won’t reach the top of his mouth, the dentist seemed bemused and didn’t know whether anything needed to be done (NHS).

does anyone know if SALT will be able to do anything to help us with this? Or should I be looking to the GP or a private dentist? his confidence is really starting to take a hit when he has to keep repeating himself.

A cranial osteopath could help as our facial bones aren’t fixed in place. My DD had to have upper jaw expansion for her underbite and when it stopped working/was moving unevenly the CO massively helped.

The shape and size of the palate make no difference r or sh sounds as in neither does the tongue make contact. However lip and tongue position and movement can make these sounds challenging .

There are many reasons why certain sounds may be difficult and SALT is definitely the way to approach this, also worthwhile checking on hearing as well as undiagnosed hearing problems can often cause speech problems. . As waiting lists can be long for SALT going down the private route for this may be a better use of money .

Cranial osteopathy in children particularly is controversial to say the least and there is no evidence that this would help the speech problems.

NHS dentists don't do anything more than the basics. I would make an appointment to see a private early intervention orthodontist.

How is his teeth spacing?
Does he breathe through his mouth or nose?

There is absolutely no evidence to show that r and sh sounds are affected by tooth spacing or mouth breathing and most children will find speaking with an orthodontic appliance is more difficult.

The babbling , unclear speech and difficulty with certain sounds all point towards investigating hearing and having a SALT assesment . There are multiple reasons there might be a problem , an orthodontist is not the right person to investigate .https://oxfordhealth.nhs.uk/cit/resources/articulation-difficulties/

The high palette can absolutely affect tooth spacing and mouth breathing though so I would want an orthodontist to investigate if those are issues.

But it is babbling , r and sh sounds that are the issue here and hearing and SALT are the appropriate pathways to follow. The shape of the palate is not material to these .

Ah, thanks all. He had a hearing test after his last SALT meeting which didn’t pick up on any issues, he got a clean bill of health. We’ve also taken him to the GP to rule out any tonsil, ear, or adenoid issues and other than a small bit of skin which apparently will resolve in time they were happy too.

His jaw IMO as a non expert is too small, he’s lost all 8 front teeth and so far hasn’t got his incisors on the top as there is no space and the bottom is crowded. He never had gaps as a toddler. The dentist said to just wait and see if he needs braces as he gets older.

He's a mouth breather and has been very snotty/dribbly since he was tiny. When he talks now he very noticeably slurps to try to dry his mouth out. He was also prone to tonsillitis but seem to have grown out of that now happily.

I'm happy to wait for SALT although I know it may take a while, it was a battle to get them to take him back on despite me and the school pushing for it. I just wasn’t sure if there was something I could do myself in the meantime to help him. Modelling the sounds isn’t helping. I think there is a part of it that is behavioural (he’s a mile a minute and speaks so fast), but he just can’t help the lack of sounds which makes him hard to understand.

He also had a tongue tie as a baby which apparently isn’t now an issue

NHS dentists won't do any preventative work, they will just wait until the teeth crowding is causing functional issues and then remove teeth.

I'd get the small jaw/teeth crowding evaluated now by a private orthodontist as they can do things now like palette expansion which can help with facial growth - you do need to look into this before the jaw bones fuse at puberty though.
The high palette probably also means his airway is restricted hence the mouth breathing and dribbling.

The speech issues clearly aren't the only things going on.

There is no widely accepted evidence to suggest that early orthodontic intervention will improve a child’s airway or breathing and indeed the guidance suggests most problems will resolve in adolescence and that early orthodontic intervention for breathing in children has no evidence to recommend it. There are some practitioners who disagree with this and there has been cases brought before the GDC about this hence the new guidance L

There is definitely no evidence to suggest the height of the palate is associated with problems in sounding r , sh or speeding through speech .

There is plenty of evidence to show that wearing a brace , particularly early and particularly of the palate expansion type , will cause or make worse speech problems.

OP is worried about speech and communication , orthodontics are not an appropriate pathway.

If crowding continues to be a problem the appropriate time for palatal expansion is just before the pubertal growth spurt , 10,11, 12 ish not 7.

I would get another hearing test , things can change quickly at that age .

Find out how long wait is for SALT appointment and see if sooner out of area . If not , perhaps, consider starting private SALT sessions to get the ball rolling and perhaps point you in direction of things to help with the speech you can start on now . https://www.rcslt.org/speech-and-language-therapy/how-to-find-a-speech-and-language-therapist/#section-2

DD1 has a very high palate, overbite, mouth breather / snorer and is seeing SALT for various speech issues. We've been advised to see a myofunctional dentist by our usual NHS dentist. I think the idea that something myo based will help ease the way for further orthodontic work when she's a teen. We are in South London so will book an appointment at Toothbeary in Richmond, who we've heard recommended locally by lots in similar positions. But we havent been yet so I cant personally recommend. Maybe worth seeing if there is a myofunctional dentist near you?

Has he been checked for a submucous cleft palate. They often aren’t spotted until speech issues occur.

DD was a mouth breather until the sorted her jaw out which sorted her high palette out. She also stopped have continuous sore throats and regular tonsillitis out. Sadly ENT had discharged her years early saying she would grow into her tonsils and adenoids 🙄

The a different child kept passing all her NHS hearing tests had severe speech delay and it turned out she had a completed distorted hearing curve and was down to nearly 40 decibels for high frequency sounds whereas in a young child they should be high teens 🤬

Sorted her hearing out and it sorted her speech out.

Undiagnosed palate issues sounds worth exploring.

Unfortunately the NHS seems to take a very short term, one issue at a time approach and will only deal with exactly what is in front of them rather than looking at the bigger picture.

So you'll get children with tongue tie, high palate, crowded teeth, enlarged adenoids/tonsils, glue hear, speech delay - but each issue is dealt with separately, on a separate waiting list and only at the point where in causes a problem. There won't be any consideration for how they are linked or what can be done to prevent problems.

@marcyhermitexactly there is zero holistic approach, they each come under separate categories despite all being ENT. Beyond frustrating.

It really is frustrating. It’s an issue that has been picked up since nursery and we’re no further forward. Sadly I don’t have money to throw at it otherwise I’d be looking into seeing someone privately which I imagine would speed things along and give me more options. School have expressed that they’re concerned about him but can’t help 🤷‍♀️

I just don’t want this to carry on and him lose all confidence, he’s the loveliest boy but is now saying that his friends at school aren’t listening to him. I don’t want to wait until he needs however many teeth extracted and braces when potentially something could have been done sooner either to make his life a little bit better