Velopharyngeal Dysfunction

VPD in children can happen for several reasons. The most common causes include:

• Cleft palate (whether repaired or unrepaired), which affects how the soft palate closes against the throat
• Structural differences in the palate or throat, such as a short soft palate or mismatch between palate length and throat depth
• Neurological conditions, which can lead to muscle weakness or poor coordination
• Post-surgical changes, for example after adenoid removal

These issues can make it hard for the soft palate to seal properly during speech or swallowing, causing air or food to escape through the nose and affecting speech clarity.

Common symptoms of VPD in children include: 

• Speech that sounds very nasal
• Air escaping through the nose while talking
• Trouble making certain speech sounds 
• Speech that is hard to understand
• Food or liquid coming out of the nose when eating (in some cases)

Diagnosis usually starts with a physical examination from your child's provider, who listens for nasal speech and checks how the palate works. Tests such as nasopharyngoscopy (a small camera to view the throat) or videofluoroscopy (X-ray video during speech) help doctors see how the palate moves and confirm VPD.

Treatment depends on the cause and severity. Most children benefit from speech therapy to improve sound production. If the palate doesn’t close properly, surgery such as pharyngeal flap or sphincter pharyngoplasty may be recommended. Sometimes, a speech prosthesis is used to help seal the palate. Your child’s care team will create a plan tailored to their needs.