There’s nothing like the thrill of hearing your child speak their first word. But what happens if it doesn’t come? Or when it does come, the rest of the speech is incomprehensible? Do you get worried? Or is it normal? Speech Language Therapist Nedra Saunders breaks it all down for us.
Do you have any tips in getting kids to start to talk?
Just remember, once they start you may never get them to stop! Seriously, kids learn what they experience so the best thing you can do to encourage your child to talk is to provide him with a language rich environment. In other words talk to him, from the get-go talk, talk, talk. Talk about what you are doing, for example, “mommy is changing your diaper and oh look your diaper has Winnie the Poo and Tigger too on the back,” and on and on through the whole diaper changing process. This is “self-talk” and the more you do it the better. You also want to do “parallel talk” where you verbalize what your little one is doing. For example, “Oh look, you threw your cereal all over the floor, you must be learning cause and effect!” Be an active listener and interact with your child when they make sounds. Before they start using real words it is a good idea to imitate what they utter. Once they start using real words you want to provide the correct model so try to avoid “baby talk” on your part. However some of those special words for special things are not going to cause irreparable damage, you just don’t want them to hear the incorrect speech patterns on a regular basis. I think I still refer to blankets as blankies to my daughter and she is 28! In addition to talking and listening to your pride and joy, read to her as much as possible. As you read to her point to the pictures to help develop her vocabulary. Above all, make talking fun. Rhyming, finger play and singing are all wonderful activities.
What are signs that there may be a speech problem?
This question is worth a semester course! There are obvious instances where a baby’s speech and language development should be closely monitored or even have immediate intervention. These would include children born with a known or suspected challenge such as cleft palate, hearing impairment, cerebral palsy, Down’s syndrome and other medical problems where speech and/or language difficulties are common. Another concern would be the baby that starts babbling and then stops. The infant is not getting gratification from making sounds and the most likely reason would be hearing loss.
The majority of speech problems are not due to any known medical or physical impairment. Children mature and acquire communication skills at varying rates. The “average” ranges for speech acquisition are quite wide. Boys are almost always a little behind girls and are slower to talk. Rather than focus on the perfection of specific sounds by specific ages, I recommend considering the child’s overall speech intelligibility. Kids should be producing several understandable words by eighteen months and if they are not, I would check with their pediatrician. If you get the “don’t worry he’ll grow out of it” response from your child’s doctor I would do as he says. However, if a few months pass and you are still concerned I would request a speech screening or full evaluation. Many school districts provide these services.
Typically, so many kids make substitutions for letters (For example, T for K—such as saying Dute instead of Duke). When should kids be “growing out” of this?
We all marvel and appreciate the incredible coordination and skill when we hear an accomplished pianist. But most of us fail to appreciate how much coordination and skill is involved in learning to speak. That pianist did not start out playing The Flight of the Bumble Bees. Just like the piano player, children start out producing simpler sounds and then over years acquire more complicated speech sounds and speech sound combinations. In the example above of substituting T for K the child is using an easier to produce sound for one that is more difficult. Speech therapists look at the child’s speech intelligibility and analyze how many errors are being made and the nature of those errors. For example, they consider whether or not a sound is being completely omitted, substituted with a different sound or produced as a distorted version of the target sound.
Depending on the age of the child, these types of errors may be viewed in a hierarchy. If a child is leaving out a sound we have to wonder if they are even aware of the sound. If they substitute one sound for another we know they know that a sound does exist in the word. If they are distorting the target sound this is usually an indication that they are in the process of adding that sound to their repertoire. Many kids will still be making some errors when they enter kindergarten; the most important considerations are the number of errors, types of errors and overall speech intelligibility.
How is language structure tested?
While there are some standardized tests for language structure for even very young children, I am of the opinion that the best method is to observe the child in a natural setting and to do a language sample and analysis. When possible, it may be best to observe the young child in their home environment. I also recommend observing the little one more than once, especially if they are shy or not having a great day the first time you see them. A language sample involves acquiring a verbatim sample of the child’s speech usually in a play situation. The sample is then analyzed and compared to norms of what should be expected at the child’s age. Parent interview is also a method of evaluating a child’s language structure. The reliability of this method is largely determined by the skill of the interviewer. Many parents will pick up on how a question is presented and unconsciously answer in a way that they think is the “right” answer.
Are there ways to avoid speech problems?
Some speech problems can not be avoided no matter what you do. They are to be expected with certain medical or physical difficulties, such as, hearing loss. There are also kids that have straight forward speech articulation difficulties for no known reason, for example the persistent “w” for “r” substitution (wabbit for rabbit). The best way to know that you, as a parent, have done your best to encourage good speech development is to follow the suggestions relative to getting kids to start talking. YOU want to provide appropriate speech models for your child, YOU want to be an active listener with your child and YOU want to create a speech and language rich environment through activities such as reading. TALK, TALK, TALK. LISTEN, LISTEN, LISTEN. READ, READ, READ. A word of caution, try very hard to avoid correcting your child in negative ways. Instead of saying things like “No, say it this way” provide the correct model with some exaggeration. For example, when your child says “I want a dink,” you repeat what she said with the correct pattern, “You want a drink” but DO NOT then ask them to repeat it!
NEVER, EVER talk negatively about your child’s speech in front of him. And whenever possible protect him from teasing by others, especially siblings. Unless she is a born “ham” do not put her “on stage” for friends and relatives. He may do something that you know the world should see on You Tube, but avoid telling him to perform for others unless he wants to do so. It’s okay to ask him if he wants to sing Twinkle, Twinkle Little Star for Nana, but if he says “No” then leave it at that.
If there’s a problem, what can parents expect for the next step?
This depends a lot on the nature of the problem. There is no doubt that early intervention is desirable for just about any problem a child may experience. Our public education system has made great strides in recognizing this and providing services for some at risk children and even infants. But there are a number of speech difficulties that have guidelines that prevent expert intervention until the child is considered at least one to two years delayed in the public schools. For example, “w” for “r” substitution may not be addressed until a child is in the third grade. Do not be afraid to advocate for your child. Most speech therapists are thrilled to work with parents to ensure the best outcome for the student.
Do your best to establish and maintain good communication with your child’s pediatrician, dentist and any other professional that is involved in your child’s care. Prepare for appointments with professionals by writing down questions, observations you have made and take an active role in any treatment program. Never be afraid to ask for a second opinion if you have any doubt at all about what is being recommended for your child.
Be informed. Ask professionals for literature or sources of information about your child’s problem. Use the internet to acquire knowledge, but be mindful of “medical student syndrome.” It is common to read about a disorder and then see or imagine everything that you read!
Most of all do your best to stay calm, keep things in prospective and do what you do best, be a loving, caring and devoted parent. Try to avoid conveying anxiety to your child and don’t forget “worry is like a rocking chair, it will give you something to do but it won’t get you anywhere!”
Are there things we can do at home to improve speech?
Absolutely! The home environment is the key for good speech acquisition. The majority of building blocks necessary for clear speech are in place long before a child enters school. I once evaluated a youngster who had been raised in an idyllic tropical setting that was quite isolated. He basically only had contact with his parents and numerous family pets including dogs. His mom and dad were very loving parents, but both tended to be rather quiet people who did not use much verbal communication. I asked them when they first noticed a problem and they replied “When he started barking.” Remember children learn what they experience.
Do you have any games or books you can recommend to help the child, or get them to start talking?
I have my personal favorites like books by Dr. Seuss and Eric Carle, but the good old classic nursery rhymes are also wonderful. You do not have to have a huge library either because repetitive reading of the same book is beneficial for little ones. It really isn’t so much the book itself but how you read the book with your child. Make it fun, be animated, talk about the pictures, talk about the story, encourage prediction (“I wonder what is going to happen now?”). As your child grows involve them more and more in the “reading” by having them point to objects named or described (“where is the animal that says ‘moo’?”). This reminds me that making animal sounds is a wonderful, early activity to encourage vocalization. Have them “read” as much as they are able. They will actually be reciting the words from memory, but encourage this by pausing at key spots. For example in reading The Very Hungry Caterpillar you would pause when you read “But he was still……” and the child will eventually provide “hungry.”
Make life a game! When you sit down to do the grocery list, have your child near you and make a game out of it by talking about the things you put or don’t put on the list (“I think we are out of elephant food, but wait a minute do we have an elephant to feed? No way, I guess we don’t need elephant food.”). This is also a great time to make a few errors in your speech and then point them out and laugh about them. For example, you might say “I think we need some wettuce, oh how silly mommy is she said wettuce instead of lettuce.” When you are out for a stroll, talk about things you see that we typically take for granted. Look at the world through the eyes of a child. You come upon a mailbox, talk about it, what goes in it and what happens to it after it does. If old enough let your child drop the letter in the box. Then you see a trash container, talk about the differences between the mailbox and the trash container. Any toy or game can be a wonderful learning tool; it is all about how you use it.
Traveling by car is a fantastic opportunity to practice good speech. When you come to a stop light encourage your captive audience to say something or hold on to a speech sound until the light turns green. Do it with them if they need your model. Count all the red cars you see either with actual numbers or by saying “red” every time they see a red car (of course this is contingent upon color recognition, but it can help in the development of that skill too). Use your imagination and just have fun.
Does using sippy cups too long add to it?
This is a new one for me! It has long been accepted that thumb sucking and extended use of pacifiers are not good, primarily because of the negative impact they may have on a child’s dental development. The thing that I would be concerned about is the child’s swallow pattern. When babies swallow they push their tongue forward. That is why you find yourself constantly wiping formula or food from around their lips as you feed them. You put a spoonful in their little mouth and they seem to push out half of it! This is totally normal. Around the time of the eruption of the first dentition the vast majority of children automatically reverse their swallow pattern, that is, they use a mature swallow pattern. This involves placement of the tongue tip up to the spot just behind the front teeth (there is a little bump there called the alveolar ridge). The back of the gum ridge comes together and the back of the tongue bunches up causing whatever is in the mouth to move down the throat. For some little people this change does not occur and they continue to push their tongue tip forward when they swallow. The tongue exerts eight pounds of pressure every time you swallow! So you can imagine what might happen to the front teeth if this swallow pattern continues, the change of a dental malocclusion (bite) is very high. Additionally, because most kids produce “s” and “z” with their tongue tip in the same position it is in for the initiation of a mature swallow, these children are at risk for “lisps” or the “th” substitution for “s” and “z” (thup for soup). Kids should be introduced to a dentist around age three and a good question for mom and dad to ask would be “when should we discontinue use of a sippy cup?” I probably would have let my daughter continue to use her pacifier through college, but at age three her dentist told her “no more pacifier” and she abandoned it just like that!
Any other suggestions?
I could go on and on as it is one of my favorite topics, but I have basically limited myself to speech articulation development and just touched on language acquisition. There are several other areas of communication that may be of interest to you including voice and fluency (stuttering). Concerns about these areas may not come to your attention until your child enrolls in school. I recommend reading Dr. Norall’s interview about Autism and Asperger’s Syndrome for information relative to pragmatic language development, the social use of language.
About Nedra Saunders: Nedra received her Bachelor’s degree in Speech and Language Therapy from San Diego State and went on to obtain a Master’s Degree in Speech-Language Pathology from Stanford University. She then moved on to working at the Palo Alto V.A. Hospital. Nedra was Chairman of the Department of Speech and Language Therapy at Children’s Hospital and Sharp Hospital and Rehabilitation Center in San Diego and taught for several years at U.C.S.D. Extension and University of San Diego. Nedra then became a Public school Speech-Language Therapist until her retirement.
Want to get smart tips delivered to your email in-box? Subscribe to get Breezy Mama updates — it’s free! Click here!