Ep. 24: Toddler Speech Delay: A Physician’s Perspective
As a pediatric ENT physician, I regularly see patients who are not speaking the way they are expected to speak. This does not mean there is a problem, but an evaluation is possibly needed. Today’s episode of the Dr. Momma Says podcast will share a discussion about toddler speech delay to help parents begin to think about their child’s speech in different ways.
First and foremost, I must remind you that this is a physician’s perspective. Not only am I not a Pediatrician who has much more experience in this area, but I am a surgeon. Nevertheless, I see more than my fair share of toddler speech delay so I feel my input is important.
Many times, when patients are referred to me there is a concern that kids have a hearing loss impacting their speech. Of course, I also see the kids with chronic ear infections and allergies which can lead to intermittent hearing loss and long-term toddler speech delay.
Physicians are not speech therapists; consequently, we tend to look for different things. Before I highlight some of the things I think are important for parents to know about toddler speech delay, let’s all get on the same page about why it is so important.
What are some long-term consequences of toddler speech delay?
This problem is very common with estimates that range from 5-10% of young kids.
There are many associated long-term consequences, which include:
- Kids between 2-5 years old with speech delay have more trouble with reading
- Speech delay after age 5 is associated with more attention and social difficulties
- Some speech and language problems between age 7-13 lead to reduced writing skills with more trouble with spelling and punctuation
- Basically, even after intensive therapy, can negatively affect educational achievements
Many times, I evaluate patients with toddler speech delay and parents are confused about whether they think it is a real problem or not.
Kids do develop speech at their own paces but there are some signs that parents can watch out for. There are important minimal guidelines to let us know if this will fix itself or if help might be needed.
Is speech delay the same as language delay?
These two terms have completely different meanings but many people use them interchangeably. It is a good idea to understand the difference.
A speech delay is a sound disorder, where kids may have trouble pronouncing the sounds in words. This can make their speech harder to understand.
A language delay means that kids have trouble understanding words, or trouble forming sentences or trouble communicating their words.
These problems can happen separately or together. Meaning that some children who have trouble articulating words are very good at understanding words and can form sentences correctly. And there are also children who articulate words very well but struggle to understand sentences or have trouble forming their own sentences.
Another way to describe the differences is that speech is the actual production of words while language is the conceptual processing of communication. (Langage has 2 parts: receptive, understanding and expressive …conveying information like feelings, thoughts, and ideas)
On a side note, voice problems are a completely different animal! Voice disorders are medical conditions affecting the production of speech.
Does learning more than one language cause toddler speech delay?
Children who grow up learning two or more languages often will have some amount of mixing the languages together. As time passes and their languages skills improve, this problem usually resolves.
Most bilingual (or trilingual kids) become nearly fluent in all languages by age 5 or 6.
These children do not usually have articulation problems just from hearing more than one language. Their words are usually clear but they might use incorrect grammar or other language features.
But remember, bilingual kids may have speech and language disorders that other children who only speak one language may develop. So they should be referred for speech evaluations using the same criteria as kids who speak one language.
Questions parents should be prepared to answer
I understand that concerns may not be crystal clear, but it is important for parents to be able to express the areas of concern.
Some of the questions I routinely ask during my speech evaluations include:
- Is your child talking and you don’t understand?
- Do you understand your child, but others do not?
- Is your child not attempting to talk but cries, gestures and points
- How do you know your child wants juice or to use your phone?
- Does your child understand when you talk to them?
- Are there any other developmental delays?
- When was the last time your child had a hearing test?
Watching and listening to your child speak is important
This may seem like a silly thing to say but many kids come to my office for a concern about speech delay but the kids refuse to speak during our visit. Or they speak in a way that frustrates parents because it does not reflect what they sound like at home.
Some kids are shy and do not want to speak but I have found other kids avoid speaking because they are constantly corrected or people do not understand. Finding ways to prepare kids to speak during examinations is important. Check out the audio in the podcast to hear my tip that has been useful for many children.
When should parents become concerned about toddler speech delay?
There are many ways to assess speech in kids and there is no one factor that makes the diagnosis of speech delay. If you google speech delay you will be bombarded with excellent resources and tables with appropriate milestones for kids.
When milestones are suggested it is usually an average and not an absolute number. The farther you get away from the average, the more likely a problem exists.
Like milk expiration date, does spoil on that day, so might be good 1-2 days later, but maybe not some much a week later. One of my daughters does not like foods near the expiration date. Ranges are important.
I will share an easy way to spot evidence of clear-cut toddler speech delay. This is not an average number, but instead, these are values that are a sure outliers. If your child is not reaching these milestones, a speech evaluation should be strongly considered without weighing factors like
- Older siblings
Regardless of associated factors, these values should be concerned far outside the average range. Easy assessment since it can be hard for parents to count the number of words their kids actually say.
Known as the 1-2-3 Rule
- Between age 1-2, kids should say at least one word other than mama and dada
- Some say 20 words
- Between age 2-3, kids should put 2 words together, daddy sit, mommy bye bye
- Some say over 50 words
- After age 3, kids should have 3 word sentences
Tips to encourage speech and language development in your kids
It may not be possible to prevent all language delays. Hearing problems and learning disabilities may not always be preventable. But these are things parents can and should do on a daily basis.
- Talk to your child from the time they’re born.
- Respond to your child’s babbling when they’re a baby.
- Sing to your child, even when they’re a baby.
- Read aloud to your child.
- Answer your child’s questions
When kids come to see me, they typically need a hearing test and an evaluation to make sure there is not some physical problem that may need surgery. But just like most things in medicine, there are usually many factors so it is important to keep all in mind.
As always, much love for supporting my work. I will be adding many more posts to highlight parenting and healthcare tips, so be sure to consider subscribing to my podcast or to my blog to avoid missing a post!