We eagerly await our children’s first words, so it can be disappointing—and worrisome—if they’re slow to come. But the good news is that most kids who seem to talk “late” catch up without any problems by the time they’re around 2. About one in four children is a late talker—and most don’t need special help to get them on track. Here’s what to expect with your child’s speech development, and how to tell if you need to see a specialist.

Kids Health : What Causes Speech Delay In Children
Kids Health : What Causes Speech Delay In Children

What’s normal

Though speech develops pretty much the same way for all children, the pace can vary considerably from child to child. As a rule of thumb, children should be able to say one word at about 1, two-word combinations at 18 months to 2 years and three-word sentences before turning 3. When speech specialists evaluate delayed speech, they care as much about a child’s understanding as they do about how much he speaks. For instance, although a typical 18-month-old can say 50 to 100 words, he can understand far more. Making gestures and following directions indicate that your child is understanding and communicating, and there’s likely little reason to worry. The American Speech-Language-Hearing Association offers a detailed chart of language development. Find out how you can gauge your child’s progress.

Reasons behind speech delays

Heredity and temperament can make for a linguistic late bloomer, as can a parent’s anticipating a child’s every need (“Do you want your bottle?”) rather than letting her speak for herself. Some kids who tend to be late talkers include:

Boys:

They often develop speech later than girls, though there’s usually only about a one- to two-month lag. At 16 months, boys use an average of 30 words, while girls tend to use around 50.

Preemies:

Babies born early often take longer than others to reach milestones, but by age 2 they usually catch up to their peers. Pediatricians say that when gauging a preemie’s development, parents should begin counting from the child’s due date, not her birth date. A child born three months early can seem like a later talker but might be progressing just fine.

Multiples:

Speech pathologists estimate that as many as 50 percent of all multiples have some language delay. Prematurity, low birth weight and medical intervention at birth—all of which occur more often among multiples—can contribute to language delays.

Children with chronic ear infections:

If fluid in the ear persists for months at a time—especially during the first year, when a child is starting to process language—it can result in poor hearing, and thus delayed speech.

Kids who are focused on other skills:

If a child is late to talk but her overall development is progressing on schedule, she may just be trying to perfect one skill, like walking, at the expense of speaking.

Signs your child might have a delay

Before your child reaches age 2, there’s wide variation in what’s considered normal. But some signs that may indicate he needs help:

At 1 year:

He isn’t babbling or speaking in mock sentences at all. He doesn’t seem to understand or respond when you talk.

At 18 months:

He hasn’t said at least one word.

At 2 years:

He says only a few words and communicates mostly through grunting and pointing, or he’s losing language skills—either his vocabulary has shrunk or he no longer talks very much.

At 2 1/2 years:

He’s still speaking in single syllables, drops final consonants or doesn’t have a vocabulary of 50 words.

At 3 years:

Strangers can’t understand his pronunciation, or he speaks using only simple two-word phrases.

What to do

The best time to get professional help is when your child is around 2 1/2—the age when late bloomers usually catch up. Language problems are addressed with speech therapy or by treating undiagnosed ear infections or hearing problems. Your pediatrician can recommend a speech-language pathologist; the American Speech-Language-Hearing Association, in Rockville, Maryland (800-638-8255), can also provide a referral.

Before age 2 1/2, listening to your voice is a great way for your child to learn to talk, so read aloud, sing songs and ask open-ended questions to invite conversation. Blowing bubbles can develop oral muscles, and toy phones and pretend play encourage talking.

Famous late talkers

When you’re tired of being asked when your child is going to talk, remember that these successful people didn’t begin talking until they were at least 2—and, in some cases, 4!

Gary Becker, Nobel Prize-winning economist
Albert Einstein, theoretical physicist
Julia Robinson, the first woman president of the American Mathematical Society
Arthur Rubinstein, piano virtuoso
Edward Teller, physicist and nuclear power pioneer

Summary

Kids acquire speech, like all the other developmental skills, at their own pace. Most children who talk late eventually catch up. But if you have concerns about your child, don’t hesitate to discuss them with your pediatrician, who can guide you to a specialist if necessary.

Evaluation and Management of the Child with Speech Delay

A delay in speech development may be a symptom of many disorders, including mental retardation, hearing loss, an expressive language disorder, psychosocial deprivation, autism, elective mutism, receptive aphasia and cerebral palsy. Speech delay may be secondary to maturation delay or bilingualism. Being familiar with the factors to look for when taking the history and performing the physical examination allows physicians to make a prompt diagnosis. Timely detection and early intervention may mitigate the emotional, social and cognitive deficits of this disability and improve the outcome.

Speech is the motor act of communicating by articulating verbal expression, whereas language is the knowledge of a symbol system used for interpersonal communication.1 In general, a child is considered to have speech delay if the child’s speech development is significantly below the norm for children of the same age. A child with speech delay has speech development that is typical of a normally developing child of a younger chronologic age; the speech-delayed child’s skills are acquired in a normal sequence, but at a slower-than-normal rate.

Speech delay has long been a concern of physicians who care for children. The concern is well founded, because a number of developmental problems accompany delayed onset of speech. In addition, speech delay may have a significant impact on personal, social, academic and, later on, vocational life. Early identification and appropriate intervention may mitigate the emotional, social and cognitive deficits of this disability and may improve the outcome.

Kids Health : What Causes Speech Delay In Children
Kids Health : What Causes Speech Delay In Children

Normal Speech Development

To determine whether a child has speech delay, the physician must have a basic knowledge of speech milestones. Normal speech progresses through stages of cooing, babbling, echolalia, jargon, words and word combinations, and sentence formation. The normal pattern of speech development is shown in Table .

Kids Health : What Causes Speech Delay In Children
Kids Health : What Causes Speech Delay In Children

Normal Pattern of Speech Development

 

AGE                                 ACHIEVEMENT

 

1 to 6 months

Coos in response to voice

6 to 9 months

Babbling

10 to 11 months

Imitation of sounds; says “mama/dada” without meaning

12 months

Says “mama/dada” with meaning; often imitates two- and three-syllable words

13 to 15 months

Vocabulary of four to seven words in addition to jargon; < 20% of speech understood by strangers

16 to 18 months

Vocabulary of 10 words; some echolalia and extensive jargon; 20% to 25% of speech understood by strangers

19 to 21 months

Vocabulary of 20 words; 50% of speech understood by strangers

22 to 24 months

Vocabulary > 50 words; two-word phrases; dropping out of jargon; 60% to 70% of speech understood by strangers

2 to 2 ½ years

Vocabulary of 400 words, including names; two- to three-word phrases; use of pronouns; diminishing echolalia; 75% of speech understood by strangers

2½ to 3 years

Use of plurals and past tense; knows age and sex; counts three objects correctly; three to five words per sentence; 80% to 90% of speech understood by strangers

3 to 4 years

Three to six words per sentence; asks questions, converses, relates experiences, tells stories; almost all speech understood by strangers

4 to 5 years

Six to eight words per sentence; names four colors; counts 10 pennies correctly

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