Parental Perception of Speech Intelligibility Among Children with Repaired Cleft Lip and/or Palate: A Cross-Sectional Study

Abstract

Background: Cleft lip and palate (CLP) are common congenital anomalies that significantly impact speech development. While surgical repair is foundational, optimal speech intelligibility often requires sustained therapeutic intervention. Parental perceptions are crucial for understanding functional communication outcomes and shaping family-centered care Objective: To find out the parental perspectives on the speech intelligibility of their children (aged 3-6 years) with repaired cleft palate. Methods: A cross-sectional study was conducted with 100 parents/caregivers of children with cleft lip and/or palate (CLP). Participants were recruited via convenience sampling from three cleft care hospitals in Lahore. Data were collected using a structured Speech Questionnaire Parent Form, capturing demographics, surgical/therapy history, and parental ratings of intelligibility across eight communicative contexts. Analysis was performed using SPSS version 26, employing descriptive statistics. Results: Parental understanding was higher for single words (88% reported "always" understanding) than for conversational speech (44% "always"). Intelligibility was rated lower by unfamiliar listeners, especially in challenging contexts: over the phone (majority "rarely/sometimes"), with unfamiliar topics (78% "never/rarely/sometimes"), and in noisy environments. Access to speech-language therapy was limited; only 52% of children had received therapy, with merely 17.3% attending weekly sessions. Children with bilateral or complete clefts were perceived to have poorer intelligibility compared to those with unilateral or incomplete clefts. Conclusion: Surgical repair alone is insufficient for optimal speech outcomes. Parental perspectives highlight significant gaps in the intensity and accessibility of essential speech-language therapy. The findings advocate for a comprehensive, family-centered care model that integrates early and intensive therapy, parental education, and psychosocial support to address both functional communication and the child's socio-emotional well-being.