AAP: My child isn’t talking well: Children’s speech and language

October 14, 2008

Heidi Feldman, MD, PhD of the Stanford University School of Medicine in Stanford, Calif. helped pediatricians gained insight into how to recognize normal development in speech and language in children.

Heidi Feldman, MD, PhD of the Stanford University School of Medicine in Stanford, Calif. helped pediatricians gained insight into how to recognize normal development in speech and language in children.

One of the most important roles the pediatrician plays in addressing the child’s speech and language development, Feldman said, is in early recognition, assessment, and referral. Pediatricians should encourage their parents to participate and engage their children at an early age. At an early school age, children exhibit receptive language, and then move on to expressive language. Later on they’ll read, a third language-based skill.

However, when children are developmentally delayed, they require early evaluation and intervention. Developmentally delayed children’s skills develop slowly: at 24 months they may not be meeting the criteria of a 50-word vocabulary, and two-word phrases. If a child is delayed at 2 years and does not have access to early intervention, that child may remain delayed through ages 3 and 4. Proper evaluation and working with a speech therapist will add a favorable prognosis for improvement.

Feldman discussed some of the red flags that parents and pediatricians need to be aware of, from infancy through 5 years and more. If by age 4 a toddler is stuttering more than 10% of the time, for example, an appointment with a speech pathologist should be made. And if a parent says that a 18- to 24-month child understands but is not speaking a lot, this child should be evaluated to see if he needs speech therapy.

There are many misconceptions about speech and language delay that can hinder early intervention, adds Feldman.


Misconception:                                                             Facts:

Boys are very delayed (>6 months).Boys are slightly delayed (1 to 2 months).
Second- and third-borns let their older siblings speak for them.Children have strong motivation to speak when they can.
Children from bilingual households are significantly delayed.Children from bilingual households may show mild delay and early mixing.
Otitis media causes language delay.Otitis media is associated with language delay.


In addition to speech and language delays, speech sound disorders should be evaluated as well. Speech sound disorders affect sounds, voice, resonance, and fluency. Some speech disorders include childhood apraxia, dysarthria, articulation, and phonological rules. In addition, pacifiers and thumbsucking can interfere with children talking.

When you are thinking about recommending treatment for your patient, remember that early intervention is crucial, noted Feldman. Screen early and often, and make sure families have frequent conversations and daily reading with their children.