My Little One Isn’t Talking—Should I Be Worried?

Dr. Gellner: Your child's speech development is something your pediatrician checks at toddler and preschool well visits, so how do you know if you should be concerned or not about your late talker? I'm Dr. Cindy Gellner and today we are talking about delayed speech and language development on The Scope.

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Dr. Gellner: Some kids are early walkers and some are early talkers. Some are late walkers and some are late talkers. Unless a parent observes other areas of slowness during early development, they may be hesitant to seek advice. Knowing what's normal and what's not in speech and language development can help you figure out if you should be concerned or if your child is right on schedule.

So what are developmental normals for speech and language development? Before age 12 months, kids should be watched to see if they are using their voice to relate to their environment. Cooing and babbling are the early stages of speech development. As babies get older, usually around 9 months, they begin to string sounds together, incorporate different tones of speech, and say words like "Momma" and "Dadda" even though, until they are about 12-15 months old, they sometimes don't realize what “Momma" and "Dadda" really are. Before 12 months old, babies should also be attentive to sound and begin to recognize names of common objects like bottle, binky, and especially their name, by 9 months old. Babies who watch intently, but don't react to sound, may be showing signs of hearing loss.

By 12-15 months, kids should have a wide range of speech sounds in their babbling, like the p, b, m, d, or n sounds. They should begin to imitate sounds and words modeled by family members, and typically say one or more words other than just "Momma" and "Dadda." Nouns usually come first, like "baby" and "ball." Other things would be things like "uh-oh" or "wow" or "no," which is a very popular first word.

From 18-24 months, there's a lot of variability. This is when we talk about the language explosion. Most toddlers are saying about 20 words by 18 months and 50 or more words by the time they turn two. By age two, kids are starting to combine words together to make two word sentences such as "baby crying" or "come help." A two year old should be able to identify common objects as well. If you point to a picture in a book of an object that they know, like a baby, they should be able to tell you that. They should also be able to point to their facial features when asked, and follow two step commands like "please pick up the toy and give it to me."

From ages two to three, parents also see a huge gain in their speech. Your toddler's vocabulary should increase to too many words to count, and he or she should routinely combine three or more words like "please come here" or "mommy I want." Comprehension should also increase. By three years old, a child should begin to understand what it means to put something on the table or put it under the bed and they should start to be able to identify simple colors and comprehend descriptive concepts such as big versus little.

What is the difference between speech and language? They're often confused but there is a distinction between the two. Speech is the verbal expression of language and it includes articulation, which is the way sounds and words are formed. Language refers to the entire system of expressing and receiving information in a way that's meaningful. That's why sometimes your child may have receptive language skills that are good, they understand what you're saying, but they have expressive language problems, meaning they cannot get the words out that they are trying to say. A child with a language problem may be able to pronounce words well, but unable to put more than two words together. A child's speech may be difficult to understand, but he or she may still use words and phrases to express ideas.

If you're concerned about your child's speech and language development, there are some things to watch for. An infant who isn't responding to a sound or who isn't vocalizing by six to nine months of age is a particular concern. Between 12 and 24 months, other reasons for concern include children who are not using gestures, such as pointing or waving "bye, bye," by 12 months, prefers gestures over making words and vocalization to communicate by 18 months, has trouble imitating sounds by 18 months, and has difficulty understanding simple verbal requests.

If your child is over two years old, you should have your pediatrician evaluate them and refer them for speech therapy and a hearing exam if they can only imitate speech or actions but don't produce words or phrases by themselves, they say only certain words and only those words repeatedly, they cannot follow simple directions, they have an unusual tone to their voice such as sounding very nasally, they're more difficult to understand than expected for their age. And here's an easy way to understand how a child's speech should be understood. At two they should understand half of what their child is saying. At three, they should understand three quarters of what they're saying, and by four they should understand 100% of what a child is saying.

So what can you do to help with your child's speech development and also try to help them if you notice that they have a speech problem? First you can spend a lot of time communicating with child, even during infancy. Talking, singing, and encouraging imitation of sounds and gestures with your child goes a long way.

One of the most researched ways of improving speech and language skills is reading. You should start reading to your child as early as six months old. Start with an age appropriate soft or board books or picture books that you can point out what the pictures are and have your child feel the pictures. You can use books with textures that they can touch and learn the difference between soft or fuzzy or rough. Later let your child point to recognizable pictures and try to name them.

Finally, you can progress to books that are more age appropriate for toddlers, like the Hungry Caterpillar, where kids can actually predict what's going to happen. Dr. Seuss is also wonderful for children to learn speech patterns because of the rhyming that's in there. So your child is also able to start predicting what types of words come next. As your child gets older they will love reading on their own and will have their own favorite stories as well.

You can also use everyday situations to reinforce your child's speech and language. In other words, talk your way through the day. Point out objects around the house. If you're driving, point out the things you see along the road. Keep things simple, but never use baby talk. Always use good pronunciation so your child learns that as well. Whatever your child's age, recognizing and treating problems early is the best approach to help with any speech and language delay.

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