Speech delay is a topic that is on my mind constantly. My own 21 month-old is hardly talking and it is causing her mother great stress. Even pediatricians have kids with issues. Despite knowing what to do (and implementing it), my daughter is making slow progress. Her problem isn’t unusual. Every day in clinic I see at least one child with speech problems. It is one of the most common problems I see. Usually the parents know in their heart that there are problems, but sometimes they didn’t realize that how their child is speaking is not developmentally appropriate.

Is there a difference between speech and language disorders?

Technically speaking there is a difference:

Speech disorders happen when a person is unable to produce speech sounds correctly or fluently (examples are problems pronouncing certain sounds and stuttering)

Language disorders happen when a person has trouble with one of 2 types of language:

• Receptive language—your ability to understand (receive) language
• Expressive language—your ability to share/speak (express) language

How to improve your child’s language:

1. Talk to your child. I know this sounds like a no-brainer, but many parents don’t realize how quiet they are during the day with their nonverbal child. Even if your child doesn’t talk back, narrate the whole day. As you are making lunch, point out the items to be served. When you go to the grocery store, show the items going in the cart. Be prepared, you may feel like you’re going crazy ‘talking to yourself’ all day.
2. Turn off the TV. If the TV is on as background during the day, turn it off. It is really hard for a child to decipher language on a TV. Children are better off hearing and seeing you talk.
3. Read to your child. Starting at 6 months, interactively read to your child. You may not read all the words on the page, but point out objects in pictures and what is happening in the picture.
4. Show interest in your child’s language and expand on it. For example, if your child says, “Shoes,” you may follow with “Yes, those are your shoes. They are red. Let’s put them on your feet.”
5. Practice counting. Count everything—fingers and toes, going up and down stairs, building blocks, etc.
6. Ask questions that require an answer other than “yes” or “no.” For example, if your child wants a drink, ask “You want milk or water?” instead of “You want a drink?”
7. Sing simple songs to your child. It’s amazing to me how many very young children know animals, body parts, colors, the alphabet, etc. and all from learning little educational songs.

What’s normal by age?

1 year olds:

• Follow sounds
• Look, when directed to do so (e.g., when you point and say something)
• Babble with voice intonation
• Make sounds (“talking”) when pointing
• Have 1 word

15 months:

• Have 4-6 words
• Bring things to show you
• Point to things
• Follow a 1-step simple command (e.g., ‘go get the ball’ that is 5 steps away)

18 months:

• Have 20 words
• Follow 1-2 step commands
• Know a couple of body parts (by pointing, not necessarily saying them)

2 years:

• Have 200 words (if there isn’t 50 words, we usually classify that as “delayed”)
• Are 50% understandable (the other 50% is babble that means something to the child, but the parent can’t understand)
• Can put 2 word together in a phrase (e.g., “No mommy,” “Go bye-bye,” “I want,” “All gone”)
• Can name simple items when asked (e.g., if you point to something or a picture of it in a book)
• Follow 2-step commands

3 years:

• Have 300-500 words
• 75% understandable
• Can put 3-5 word phrases together

4 years:

• Have too many words to count
• 100% understandable
• Speak in complete sentences (although the occasional grammar problem is acceptable)

What is my pediatrician evaluating?

As your pediatrician is asking about your child’s language and communicating with your child, she is determining if and what kind of speech and language problems exist. If the child has lots of words, but is hard to understand or is having problems with certain sounds, then that indicates a speech problem. If the child seems to understand what is being said to him or her, but doesn’t talk, then that indicates an expressive language problem. If the child doesn’t seem to understand what is being said to him/her that indicates a receptive language problem. Each problem is unique and requires different treatment approaches.

What happens once my child is determined to have a problem?

Depending on the problem, your pediatrician may suggest further evaluation/intervention. When a child has receptive language problems, your pediatrician will evaluate for other conditions with global delays and autism spectrum disorders. For typical speech problems and expressive language problems, it is common to do hearing testing (usually by an audiologist) and to be referred to a speech-language pathologist (SLP), aka, speech therapist.

For public programs, if your child is:

Under 3 years–referred to early intervention programs (these are federally and state funded programs for children with delays).

3 and over–referred to the public school system for evaluation and services. The school will set your child up with an I.E.P. (Individualized Education Plan).

Private services of a speech-language pathologist are also available and sometimes insurance plans cover those services.

If you are concerned that your child may have speech and language problems, talk to your pediatrician about it. She will help you determine if there is a problem to worry about and what to do about it.