In this video, speech-language pathologist Carrie Clark explains how to do speech therapy for a child who has nasal emission (or air coming out through the nose when speaking).
Make the Referral:
When these characteristics are noted, a referral should be made to a regional craniofacial or cleft palate team (even if there is no history of cleft) for further assessment and management.
When We Can do Therapy:
- Phoneme-specific nasality or nasal emission due to faulty articulation
- Children who use compensatory articulation productions due to a history of velopharyngeal dysfunction
- After surgical management of velopharyngeal dysfunction to help the child to learn to make the best use of the new structures
How ‘Bout Some Blowing and Sucking Exercises?
No.
ASHA advises against use of non-speech oral motor exercises like blowing and sucking for improving velopharyngeal function. The parts of the brain that control blowing and sucking are not the same as those that control speech production so benefits will not carry over to speech.
How DO we do therapy?
- If there is nasal emission on sibilants only, have the child produce a /t/ sound with the teeth closed. Next, have the child prolong that sound. If the child has a normal velopharyngeal valve, this should result in a normal /s/ without nasal emission. This skill can then be transferred to the other sibilant sounds.
- If the child co-articulates /ng/ for /l/ or /r/, or if the child has a high tongue position for vowels, it is often helpful to have the child co-articulate a yawn with the sounds. With a yawn, the back of the tongue goes down and the velum goes up.
What if it’s Not Working?
If the child continues to demonstrate hypernasality or nasal emission after a few months of treatment, that child should be referred to a specialist for further assessment and consideration of physical management.
For More Info about hypernasality: https://www.speechandlanguagekids.com/speech-therapy-children-hypernasality/
Source: http://leader.pubs.asha.org/article.aspx?articleid=2288234
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Hi
I am working with a child who has nasal emission on sh, ch and dg only? No nasal emission on the s
Do you have any suggestions on where to start.
I would probably try starting with the /s/ and see if they could transition from that to the sh without losing the oral airflow
I have the other problem. No nasal emission on any sound except /s/ and /z/. Cannot make /s/ without nasal emission.
I suggest that you seek help from a speech-language pathologist near you who can evaluate your specific problem and determine what the best course of action is.
I have a child that has nasal air emission on s (lateralized), z, ch, sh, d3. any tips !??
Hi! Thanks for these tips they are great! I have a kiddo who’s /l/ sounds like /ng/, how common is this? does is suggest that he should get a further eval to rule out anything serious? any other tips or tricks besides the yawn for proper placement?
It’s hard for me to say what needs further evaluation without seeing it myself. Generally, I say that if you try some therapy for 4-6 weeks and don’t see any improvement, it’s always good to get a more thorough eval to make sure
I am working with a child who has significant nasal emissions with the /k/ and /g/ sounds. He had his adenoids removed at age 3 (he’s now 6), has a high arched hard palate, and his uvula is very far back- it’s difficult to see and is actually attached to his left tonsil it appears. Not bifid though. Do you think I should try some attic therapy first, before referring to an OMF team? Thank you.
Since I haven’t worked with the child in question, I cannot say what would be best for him specifically. However, in the absence of any major issues or physical concerns, 6 weeks of therapy should give you a good idea of if a child will make progress without further evaluation.
Please Guide me, I want to know about the real reasons for the NASAL SOUNDS.Can it be cured with some therapy or there is any other treatment in medicament like Surgery.
Trouble with nasal sounds can be helped with speech therapy!
I have a student who produces /n/ for /l/. When her nose is held closed, it sounds correct /l/. When you leave her nose open, it comes out as /n/. Her tongue and lip placement is intact. Have you heard of anything else to try aside from the yawn method?
I’m not sure what to do about that one! My only thought would be to try working on helping the child hear the difference between the two sounds (with the nose plugged and unplugged) and see if she could hear the difference and feel the difference enough to eventually be able to produce them differently. That’s just a thought though, no idea if it would help!
I have a student that has nasal emission only on /r/. I have used a see scape to no avail. I have also tried starting with the ah sound and moving into raising the tip of the tongue to the hard palate and he is unable to produce it without nasality. I’m thinking of recommending he be seen by an ENT just to make sure nothing structural is causing it. What are your thoughts?
Generally speaking, if you’ve been doing therapy for about 6 weeks and haven’t seen improvement, it’s always a good idea to get the physical structures checked out, just in case!
I have a 6 year old boy who has received speech therapy since preschool specific to the /r/ production. The previous therapist indicated that he was making great progress and may be dismissed from services in kindergarten. She also mentioned that he had used abnormal mouth posture while practicing this sound for a brief period of time. When therapy was initiated in kindergarten he began producing a nasal /r/. We worked on achieving accurate tongue placement, which he was occasionally able to achieve. A few weeks ago, his parent emailed and asked what I was doing different in therapy, were there new sounds we were working on, because she can’t understand a thing he says. After receiving her email, I pulled him out from class to listen to his speech, since I had just seen him earlier that week and had not noticed any additional nasality on other speech sounds or difficulty understanding his spontaneous speech. When I listened to him, I was completely taken back by how his speech had changed so drastically over just a period of three days. The nasal emission had generalized to other speech sounds such as ‘f, s, z, sh, ch, j, l’ and significantly impacted his intelligibility. I had made a video of his spontaneous conversation, which I had another Speech Therapist view. She recommended that he be referred to the school nurse. After the nurse had an opportunity to meet with him, she called his mother and recommended that she take the boy to the doctor. The boy’s Pediatrician felt it was related to allergies and told mom to put him on over -the -counter allergy medication. He has been on the medication for approximately 12 days with minimal change in the degree of his nasal emission. His annual IEP comes due soon, which will now reflect reducing nasal emission, but I am still concerned about the ‘why’ of how quickly the nasality generalized to other speech sounds which he ihad no difficulty with and is able to produce without nasality in isolation and at the syllable level. This occurs I words containing these sounds that do not include the /r/. Do you have any thoughts and recommendations regarding this?
Hey there! Unfortunately, our licensing board says that we are not allowed to “treat via correspondence”, which basically means that since I haven’t worked with your child directly, I can’t state my opinion on what’s going on with him. A speech-language pathologist who can work with him directly may be able to help! Sorry!!
Hi, I am late to the conversation but I have an almost identical case that I am trying to figure out. Whatever came of this? Did you figure out the cause?
I just started working with a child with phoneme specific nasal emission on ch, sh, and “j”. I tried to have him transition from an /s/ to a sh but as soon as he switches the nasal emission starts again. Any suggestions? I had him prolong the /s/ but still no change.
That can be so tricky. Since I haven’t worked with the child directly, I don’t have any specific strategies to recommend. But I can say that sometimes it takes a while for these strategies to work. Sometimes you have to keep working on the sounds in isolation for a few weeks before the student starts to get it. Though, if the child has been working on that specific skill for 6 weeks or more with no progress, an evaluation by an ENT may be in order.
Hi, thanks for this info. My son has hyponasal speech with s and z sounds only. He has been through four rounds of speech therapy over the past year (unfortunately with four different speech therapists). Progress was very slow, and, at some point, a speech therapist noted that he also had problems with sh and ch sounds. I could be wrong, but I think that this developed over the course of therapy – maybe because he was concentrating so hard on s and z. By the end of his last therapy session, his speech therapist thought his speech was mostly good and he was fine to stop therapy and just practice at home. Two months later and his speech is terrible again. He needs constant reminders and when he tries to correct the same sounds, he messes up other things. Is it normal for this to take so long to resolve? Is it possible that there is something structural going on even though it is only certain sounds? He was referred to a vpi clinic and they refused to do a scope – I think because it is only certain sounds and he can make a good s sounds when he really concentrates.
Sorry, I meant hypernasal speech.
Does anyone know how to transcribe in a way that denotes nasal air emission? My student has NAE on /s/.
Hi, Karen-
Have you reviewed this link: https://www.speechandlanguagekids.com/how-to-treat-nasal-emission-in-speech-therapy/?
Hi, thanks for the tips! I have a 5yo patient with nasal emissions on all stridents /f, v, s, z, ʃ, ʒ, tʃ, dʒ/, except sometimes he stops /v/ with or without co-occuring emissions (I’m guessing to compensate for air out of his nose). He produces tʃ & dʒ in the initial position of words and he also produced “lunch” correctly today. I tried having him imitate “munch” to see if the /n/ facilitated this for him but it did not work. We tried plugging the nose today but he could not seem to get any sounds out of his mouth, even at a whisper, air was being forced to his nose which caused him discomfort. I already sent him to ENT and the ENT basically just did another oral mech exam, stating that the soft palate seemed slightly high and short. Any other interpretations or therapy recommendations? I have only seen him once but will try the t->s strategy next week.
Hi
I have a student who has nasal emission and it is extremely difficult to understand her. Her sister is pretty much the same. She went to ENT appointment and then was referred to an SLP for further evaluation. She watched her sister go through some testing and then refused to do it after watching her sister scream and cry. I have set up 3 different appointments and have an interpreter to help her mom at the appointment. Mom has not gone to any of the appointments. She keeps saying she will and then does not follow through. I really don’t know what to do at this point. She is in 4th grade in a self contained classroom and just struggles with everything. I want to help her and just don’t know what else to do. Do you have any ideas?
Hi. I am SLP and working with nasal emission on sibilants. Have achieved proficiency at sound level using the /t/ behind teeth but unable to move onto CV level. Any tips?? The child reverts back to emission when combining with a vowel
Hi,
I have a student that has nasal air emission on /s, sh, z, j, ch, and t/. I thought he may demonstrate PSNE, but then I’ve been noticing that the /t/ he also demonstrates nasal air emission on too. I’ve tried the nose plug strategy and he absolutely hates it and always says that it feels uncomfortable. I’ve tried focusing on placement only which made minimal progress. I’ve also tried to produce the /s/ from a /t/ sound, but with nasal air emission with the /t/ as well that hasn’t made much progress.
Any suggestions?
Thank you!
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