Longitudinal Speech Outcomes in Foreign-Born and Native-Born Children in Sweden with Cleft Palate, and Influence of Palatal Surgery Timing

Objective To compare longitudinal speech outcomes at ages 5 and 10 years in foreign-born and Swedish-born children with cleft palate with or without cleft lip (CP ± L), and assess impact of cleft type, additional diagnosed conditions, sex, and age at completed primary palatal surgery.DesignLongitudinal, registry-based cohort study.SettingRegional public care university hospitals in Sweden.Participants 723 children (143 foreign-born, 580 Swedish-born) with CP ± L.Interventions Primary and secondary palatal surgery, and speech-language therapy.Main outcome measures Dichotomized outcomes of velopharyngeal competence (VPC), percentage of consonants correct (PCC), and non-oral speech errors, and received secondary palatal surgery and speech-language therapy.Results A significantly lower proportion of foreign-born than Swedish-born 5-year-olds had VPC (75% vs. 85%, p = .007), age-appropriate consonant production (25% vs. 57% p < .001), and no non-oral speech errors (67% vs. 84%, p < .001). Speech improved longitudinally, yet a significantly lower proportion of foreign-born children had VPC (86% vs. 94%, p = .002), age-appropriate consonant production (52% vs. 76%, p < .001), and no non-oral errors (82% vs. 93%, p < .001) at 10 years. The difference in VPC at age 5 and in all speech outcomes at age 10 was associated with higher age at primary surgery in foreign-born children. They also had higher rates of secondary palatal surgery (p < .001) and speech-language therapy (p < .001) than Swedish-born peers.Conclusions Later primary palatal surgery in foreign-born children was associated with poorer speech outcomes at 10 years. Early primary palatal surgery and continued follow-up are essential to optimize speech development.