Speech delay: When to worry

HEALTH mattersA

few years ago I was at a children’s birthday party where a mother of a 2-year-old worried aloud because her daughter hadn’t started talking yet. In fact, the child hadn’t uttered a single word. Many of the mothers in the group looked nervously at one another, then one said,"Don’t worry. Einstein didn’t start talking until he was 3.”I’ve heard this Einstein story repeated through the years and there was even a book written about children who talk late, The Einstein Syndrome. It is true that children acquire speech at different rates. Some talk earlier, some later, but parents should understand the basics of how children learn to communicate and when to seek help. In the case of the mother at the party, her concern was probably appropriate.

Parents await the first words with great anticipation, but talking is only one aspect of communication, which also involves listening and understanding. Among health care professionals, talking is called"expressive language” while listening and understanding is called"receptive language.” Many parents notice that their child understands what they are saying (receptive language) long before they can talk (expressive language). Babies respond to sounds and voices and will typically alert to their own name as early as 2 to 6 months old. Most children between ages 1 and 2 will demonstrate understanding a question like"where is your nose?” by pointing to their nose. They will also follow simple directions.

One of the most critical parts of speech development is the ability to hear. Hearing is so important that it’s often the first thing professionals will test for in any child who isn’t talking. A formal audiology evaluation can be done at a very young age and is the first step in making sure that a child hears well.

Most children begin to develop expressive language (talking) between 10 and 14 months of age when they utter their first word. They will repeat or imitate words by 16 months and a typical child will say 15 words spontaneously by 18 months old. By age 2 a vocabulary of 50 words is expected and by that time most children are putting two words together like"want more” and"go out.”

Children who grow up in a home where two languages are spoken will often develop a particular vocabulary in one language and a different vocabulary in the other language. Parents should consider the total number of words in the child’s vocabulary, not just in one language.

As children learn to talk they are often difficult to understand, but by age 3 a child’s speech should be easily understood by strangers. It is normal for children to have trouble pronouncing the sounds"L”"R” and"S” and many children between ages 2 and 5 will stutter as they work hard to put thoughts into words, but this should last less than six months and then go away.

Children commonly mispronounce words, such as psghetti for spaghetti and aminal for animal. One of my children said hosipoo (hospital) for the longest time and another said absoloopy (absolutely), but these were eventually replaced by the proper pronunciations and are now charming memories of their younger years. Lisps (where"s” sounds like"th”) are also common, but should resolve by age 7.

There are a lot of things parents can do to help boost their child’s speech development. Perhaps the most obvious and important thing is to talk to your child and encourage your child to talk to you. Conversations can begin in infancy and can be as simple as asking your child,"what do you see?” while looking at a book or out the car window. Be patient while your child tries to express the thoughts that often come too fast for little mouths. Have a lot of books and magazines in your home to show your child how important and fun language can be. And if you’re in a house full of talkers let your child sit in on conversations. Children who live in homes where there is a lot of talking tend to develop speech more easily.

If you think your child has speech delay ask your pediatrician for a referral to a speech pathologist. To find a qualified professional, visit the American Speech-Language-Hearing Association (www.asha.org) or call your local school district or hospital. Depending on the severity of the speech delay a child may be entitled to free speech and language services through federally mandated public school programs that are available in all school districts.

I would like to thank Lauren Kobritz Krause, chief of Speech-Language Pathology at LaRabida Children’s Hospital (www.larabida.org) for her help in preparing this article.

When to consider an evaluation

n Immediately if you think your child isn’t hearing normally

n At age 2 if your child doesn’t speak 50 words and doesn’t understand language

n At age 2½ if your child doesn’t have 50 words, but does understand language

n At age 3 if your child’s speech is difficult to understand

n At age 7 if your child lisps

n If your child stutters for more than 6 months

Dr. Lisa Thornton, a mother of three, is director of pediatric rehabilitation at Schwab Rehabilitation Hospital and LaRabida Children’s Hospital. She also is assistant professor of pediatrics at the University of Chicago. E-mail her at drlisathornton@gmail.com.

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