Velopharyngeal dysfunction (VPD) is a condition that affects how air moves through the mouth and nose during speech. Children with VPD often sound nasal when they speak and have trouble making sounds correctly. Their speech may also be hard for others to understand.
To make most speech sounds, the soft palate (the back part of the roof of the mouth) and the walls of the throat work together to close off and separate the nose from the mouth. This closure is called velopharyngeal closure. It helps creates pressure in the mouth needed to make clear speech.
Velopharyngeal dysfunction happens when this closure does not happen completely. The nose cannot be closed off from the mouth. This causes sound and air to escape through the nose during speech. This affects speech accuracy, quality and clarity.
You may hear doctors use different terms when talking about VPD. These terms describe different reasons for the palate dysfunction.
Velopharyngeal closure includes:
Together, these structures form the velopharyngeal valve. At rest and when breathing, the valve is open. When a child speaks, the opening and closing of the soft palate directs sound and airflow through either the mouth or the nose. Most speech sounds are oral sounds that need the valve to close to send the sound and air into the mouth. Only a few English sounds are nasal sounds, including /m/, /n/ and /ng/, which need the valve to be open to send the sound and air into the nose.
When the valve opens and closes properly, speech sounds can be made clearly and are easy to understand.
In children with VPD, the velopharyngeal valve does not close completely during speech. This allows air and sound to escape through the nose instead of staying in the mouth. As a result, children may have:
Children with VPD may become frustrated when people have trouble understanding them. These speech differences can affect social interactions at home, school and in the community, if not appropriately managed through treatment.
The most common cause of VPD in children is a history of cleft palate. A cleft palate is when there is an opening in the roof of the mouth because the palate did not fully come together before birth. The cleft palate is typically repaired around 1 year of age. Ongoing monitoring of speech and language development is needed for the next several years. VPD after cleft palate repair can happen if the repaired palate is too short or does not move well enough to completely seal off the nose from the mouth during speech.
Other causes of VPD include:
Signs of VPD can become more noticeable as speech develops and a child begins talking in sentences. Parents may notice:
Early evaluation can help identify the cause of speech differences and guide treatment recommendations.
Diagnosing VPD usually involves several specialists working together. Speech-language pathologists (SLPs) and plastic surgeons work together to confirm the diagnosis, identify the severity of VPD, and recommend the most appropriate treatment. Otolaryngologists (ear, nose and throat doctors or ENT doctors) with specialty training can also treat VPD.
The evaluation often starts with an SLP who has experience working with cleft and craniofacial patients. A child needs to be imitating speech and speaking in sentences for VPD to be confirmed.
The evaluation to confirm VPD may include:
Nasometry: a non-invasive technique of measuring the difference between the sound and air that leaves through the nose compared to what leaves through the mouth, using an electronic device.
When VPD is confirmed, additional imaging may be needed to see how the velopharyngeal valve works during speech. This may include:
Nasopharyngoscopy: A small flexible camera is passed through the nose to view the palate and pharynx while talking. This allows for the size and location of the opening to be examined.
Treatment depends on the cause and severity of VPD. Many children need a combination of treatments to have the best speech outcomes.
Velopharyngeal insufficiency can range from mild to severe. When velopharyngeal insufficiency is impacting speech skills and overall clarity, surgery is needed to help improve the function of the palate. This is because velopharyngeal insufficiency is a structural problem. The symptoms of velopharyngeal insufficiency (nasal speech quality, air escaping through the nose) cannot be treated with speech therapy.
Treatment options may include:
Velopharyngeal incompetency can also range from mild to severe. This problem is due to a movement problem caused by weakness or muscle difficulty that limits the soft palate from closing against the back wall of the throat.
Treatment options may include:
Nasopharyngoscopy helps the child’s surgeon determine which treatment is best. Decisions are based on the size of the velopharyngeal gap, location of the gap, the length of the palate, and the amount of palate movement during speech. Surgical options may include:
Speech therapy plays an important role in treatment. Speech therapy may be recommended before VPD is confirmed and after the VPD has been surgically addressed. Speech therapy helps children learn correct speech patterns and stop habits that developed while their structures were not working correctly. A speech-language pathologist who is experienced in working with VPD can help determine timing of speech therapy and sounds to work on in treatment.
Recovery depends on the type of surgery a child receives. After surgery, children return for a follow-up with their surgeon to ensure they are healing appropriately and to get approval to return to speech therapy if applicable. Children will then follow up with a speech-language pathologist to evaluate the success of surgery. The evaluation also helps decide whether speech therapy is needed. Many children will need intensive speech therapy after surgery to learn to use their new structures and new speech sounds.
Follow-up care may include:
Most children improve significantly with appropriate treatment and team management.
Some children need ongoing speech therapy or additional procedures as they grow. Others have normal or near-normal speech after the initial surgery.
A speech delay generally refers to a child not meeting developmental milestones related to speech skills or language skills. This can happen without a known cause. VPD is a structural problem that affects how sound and air moves through the mouth during speech. Some children with VPD may also have delayed speech and language skills. Others may have met all speech and language developmental milestones on time.
Speech therapy alone cannot correct VPD. Speech therapy can improve speech sound errors caused by VPD. A speech-language pathologist can help determine timing for when it is appropriate to participate in therapy.
Not every child needs surgery for VPD. Treatment depends on the severity and how much the VPD is impacting overall speech clarity. In cases where the VPD is only inconsistent or mild, the decision may be to simply monitor speech over time as the child continues to grow.
Children with cleft palate are at increased risk for VPD because the repaired palate may not be able to fully close against the back of the throat during speech. This is due to short length of the palate or inadequate muscle positioning.
The goal is for surgery to eliminate VPD. Some children may still have some degree of VPD after surgery. Many children improve significantly with surgery and speech therapy. Some children achieve normal speech, while others may need ongoing therapy or additional procedures as they grow.
Children need to be able to follow a variety of directions, imitate a variety of words and phrases on command, and be speaking in sentences to be able to fully participate in the evaluation. If a craniofacial team actively follows your child, the team providers will help guide and determine readiness for the evaluation.
No. VPD impacts speech accuracy, quality and clarity. VPD never prevents a child from speaking verbally. Children with VPD can imitate all words and sentences, but the accuracy of the sounds they produce may be altered. VPD is never considered a cause of a language delay.
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Last Updated 09/2026
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