Purpose: This study investigates early anatomic determinants influencing the likelihood of cleft speech characteristics (CSCs) in children with cleft palate with or without lip involvement (CP+/-L). The primary objective was to identify critical anatomic factors within the first year of life that impact the presence of CSCs at Age 3. Methods: The Cleft Collective Longitudinal Cohort Study of children born with a CP+/-L was utilized. Data from 293 children were included in the analyses. Anatomic variables, including cleft type, pre-operative cleft width and fistula status, were assessed in relation to CSCs. Logistic regression analyses were adjusted for confounding variables such as age, sex and hearing status. Results: At 36 months, 64.9% of children with cleft palate exhibited CSCs. Anterior CSCs were most common (36.2%), while passive CSCs were least common (16.0%). Cleft type strongly influenced CSC prevalence, with UCLP and BCLP associated with higher odds of any CSC. Wider clefts were associated with passive, non-oral and posterior CSCs. Fistula presence markedly increased the odds of CSCs, especially passive and posterior CSCs. Logistic regression analyses revealed strong associations between cleft type, cleft width, fistula and specific CSCs outcomes. Conclusions: The multifactorial nature of CSC production in children with CP+/-L is underscored by distinct impacts of cleft type, pre-operative cleft width and fistula status. Early, individualized interventions are paramount, emphasizing the need for proactive measures, including effective fistula management and speech therapy. Prioritizing prevention strategies for children with anatomic risk factors may reduce the likelihood of producing CSCs, contributing to more typical speech development and optimizing long-term speech outcomes for affected children.