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Objective: To compare speech outcomes in 4 groups of 5-year-olds with cleft of the hard and soft palate: with Robin sequence without additional conditions (RS−), with Robin sequence with additional conditions (RS+), without Robin sequence with additional conditions (CP+), and without Robin sequence without additional conditions (CP−).

Design: Registry-based cohort study.

Setting: Regional public care university hospitals in Sweden.

Participants: A total of 433 children with cleft of the hard and soft palate: 72 with RS−, 28 with RS+, 61 with CP+, and 272 with CP−.

Interventions: Primary cleft palate repair in 1 or 2 stages.

Main outcome measures: Dichotomized outcomes of percentage of consonants correct, percentage of nonoral speech errors, and velopharyngeal competence. Logistic regression was used for statistical analysis.

Results: Children with RS+ had significantly lower odds of age-appropriate consonant production (OR 0.17, 95% CI 0.08-0.40), no nonoral speech errors (OR 0.17, 95% CI 0.07-0.39), and velopharyngeal competence (OR 0.24, 95% CI 0.10-0.56) than those with CP−. Significantly lower odds of age-appropriate consonant production were found for children with RS− (OR 0.50, 95% CI 0.29-0.88) and CP+ (OR 0.45, 95% CI 0.24-0.84) than children with CP−.

Conclusions: Both Robin sequence and additional conditions were associated with decreased odds of age-appropriate consonant production at 5 years of age. For children with RS+, the odds were further reduced, and they also had decreased odds of no nonoral speech errors and of velopharyngeal competence. The results can form the basis for informing parents and planning intervention.