Healthy Living

Your child is 2 years old and still isn't talking. He says a few words, but compared to his peers you think he's way behind. You remember that his sibling could put whole sentences together at the same age. Hoping he will catch up, you postpone seeking professional advice. Some kids are early walkers and some are early talkers, you tell yourself. Nothing to worry about.

I encounter this scenario among parents of kids who are slow to speak. Unless they observe other areas of "slowness" during early development, parents may hesitate to seek advice. Some may excuse the lack of talking by reassuring themselves that “he'll outgrow it.”

What is normal?

Knowing what is “normal” and what is not in speech and language development can help you figure out if you should be concerned. Babies start communicating by cooing and babbling. They go on to making sounds of “mama” or “dada” that initially does not refer to mom or dad, but as they become toddlers it becomes more specific. By 18 months your child should have a vocabulary of about 20 words. By age 2, most children should be learning to combine words. A two-year-old should also be able to follow two-step commands (such as “bring me a ball”). Later by 2-3 years, a child should be routinely combining three or more worded sentences.

Whether you have an older sibling makes a difference in speech development. Older siblings routinely speak for their younger ones, such as “Johnny wants his bottle.” Therefore the younger ones may not talk as much.

Whether you are a boy or a girl also matters. Boys tend to be slower than girls. If parents speak a language different than what a child is learning at daycare or other places, it could affect the child’s language development. I encounter this situation in many families that speak Spanish or other foreign languages at home and their children are exposed to English everywhere else.

Warning signs

If you are concerned about your child’s speech and language development, here are some things to watch for.

• An infant who is not vocalizing or responding to sounds
• Is not pointing or waving bye-bye by 12 months
• At 18 months still prefers gestures over voice to communicate or has trouble imitating sounds or following simple requests.
• Seek an evaluation if your child is two years old and:
• Can only imitate speech and does not say words or phrases spontaneously
• Says only certain sounds or words repeatedly
• Can’t follow simple directions
• Has his own routines and keeps to himself and does not show emotional interactions

Causes of speech delay

There are many things that cause delays in speech development. A child may encounter problem in effectively using lips, tongue and jaw to make sounds. These children may have other associated problems such as eating certain foods. Speech delay could be a part of what we refer to as a “global” meaning general developmental delay. However having speech delay does not always mean developmental delay. Hearing problems can also commonly be related to speech problems.

What can I do?

Always talk to your child’s pediatrician. Assessment of speech and language is a routine part of physicals during early childhood. Hearing evaluations are usually a first step in the evaluation process. Specialists trained in Speech and Language Pathology are available to further assess your child’s skills and difficulties and make treatment plans.

Backus Hospital's Rehabilitation Services Department offers a wide range of services for children in the community with speech and developmental issues or disabilities.

Paula Signora, a speech therapist at the Backus Outpatient Care Center, said there are services available for infants, toddlers and school-age children, which may supplement services from birth to age 3 or through schools. A referral from a doctor, such as a pediatrician, is needed.

“We have speech therapists, occupational therapists and physical therapists all trained to work with children,” said Ms. Signora. Several of the speech therapists also are trained in PROMPT, a program that involves the use of touch cues to improve a child's speech.

Here are a few tips you can do at home:

• Spend a lot of time communicating with your child. Encourage him to repeat after you.
• Read to your child
• Discourage older siblings from speaking for the younger ones
• Use everyday situations to reinforce your child’s speech
• Explain what you are doing as you cook a meal, point to objects at home, on TV and as you drive
• Point to sounds you hear
• Repeat and reinforce the same sounds and routines.
• Whatever your child’s age, recognizing and treating problems early on is the best approach to help with speech and language delays. With proper therapy and time, your child will likely be better able to communicate well.

For more information, go to www.backushospital.org/rehab and click on “pediatric services.”

Ravi Prakash, MD, is a pediatrician on the Backus Hospital Medical Staff with a private practice in Norwich. This column should not replace advice or instruction from your physician. E-mail Dr. Prakash or any of the Healthy Living columnists at healthyliving@wwbh.org. To comment on this or other Healthy Living columns, click below or go to the Healthy Living blog at www.backushospital.org/backus-blogs.