Speech-Language Pathologist FAQs

My child wears hearing aids. He is able to respond to sounds even when he is not wearing them. Is it okay for him to not wear them?

It is important that children have consistent access to all speech sounds.  Many people with hearing aids are able to hear some sounds, such as a dog barking or a car horn honking, even without the use of their hearing aids.   Without hearing aids, a person may easily respond to the presence of sound, but they may be missing so much more!  They may be missing only the quiet speech sounds which are just as important.  For example, a child may hear “Go for a ride?” when you say “Go outside?” or “See the bug” instead of “See the bus.”  In this case, they may be responding to the presence of sound, not the actual clarity of the words/phrases because they are missing the finest details of sounds.  Sounds are the building blocks of words.    

Work with your child’s audiologist or speech language pathologist to understand more about your child’s specific hearing loss and be sure to have your child’s hearing tested at the recommended intervals.  Here are some things to consider and share:  Has your child’s ability to follow directions changed?  Does your child watch other children for cues to see what to do next?  Is your child watching your face more?  Is your child able to hear from a distance and/or in competing noise (TV on, outside noise)?  Even if the answers to these questions do not raise concern, it is important that children have consistent and clear access to sounds to develop speech and language. 

Can frequent ear infections, impact language skills?

Frequent ear infections can absolutely, but not necessarily, impact language skills.  Any change in the ears can create a change in hearing.  Children need consistent and complete access to sounds for ongoing speech and language development.  It is important to monitor developmental milestones and speech clarity.   Take note if there is continued progress in vocabulary development, speech clarity and your child’s ability to answer questions.  Talk with your pediatrician to determine if your child might benefit from a speech-language screening or evaluation as well as an audiological evaluation.  If your child is under the age of three, reach out to the early intervention provider agency in your area and request a speech screening.  

How can I help my child communicate better in child care?

This depends on many things, including the developmental age of the child. It Is often helpful to know what skills the child is able to do and be aware of what should come next, developmentally.  For example, just like children must learn to walk before they can run, they must also learn early communication skills before they can use more advanced skills.  If the child is behind, a speech language pathologist can assist in developing specific goals for the child and recommendations for how to use these skills in child care.   

Provider can create a “language-rich “environment by doing activities such as:  

  • Reading to infants and toddlers is much more than reading words on a page.  The reader can imitate animal sounds, simple words, and even motions to encourage the child to use sounds/words.
  • Playing with toys that do not have batteries that can be used for multiple purposes.  For example, pushing a toy bus saying “beep-beep” or knocking over blocks with it and saying “boom.”
  • Pairing action and sounds.  For example, speech can be used when walking upstairs by saying “up-up-up” with each step. 

Sign language can be a great bridge for children who are not yet talking or if their speech is difficult to understand.  If your child knows or is learning signs, share them with your child’s provider.  Beginning with words that are in the environment which have a purpose is a great place to start.  Be sure to encourage your provider to continue to speak the word while doing the sign so the connection between the two can be easily made.   

How is speech therapy used to help toddlers?

A pediatric speech language pathologist will conduct an assessment through play that will determine if the child is within the typical range of development for communication.  They will look at several areas of communication including speech (clarity of sounds, use of age appropriate sounds) and language (vocabulary, word endings, word combinations, understanding of action words, ability to follow directions, answering questions, and more).    Once areas of delay/disorder are identified and goals are developed, they will be addressed in therapy sessions.  Many speech language pathologists use toys, songs, and silly games during sessions to address these goals.  Parent coaching in early intervention means parents are involved during therapy sessions which are often built around daily routines.  Involving parents is important for carry-over of skills. 

Can sign language be used as an alternative for children who mix up their words when speaking?

Sign language can be a great bridge for children who are not yet talking or if their speech is difficult to understand.  Begin with words in their environment that have a purpose.  Consider words such as: milk, eat, outside, up/down, go, sleep, blanket.   When using the signs, continue to speak the word so the connection between the sign and the spoken word can be made.  Continue to ensure that developmental milestones are being met and if there is a concern, reach out to your pediatrician or early intervention provider agency.  

How do I find out if my child is eligible for speech therapy services if there seems to be a delay?

Keep in mind that sometimes children are “on the verge” of developing new skills and there is a range of typical development.  Contact your pediatrician and share your concerns. Be able to share what you think your child should be doing developmentally and what skills you are not yet seeing.  It never hurts to reach out and ask for a speech and language evaluation.  If your child is under the age of three, you can contact the early intervention provider agency in your area.  A physician’s referral may not be needed. 

What are techniques I can use to improve speech and language skills in small groups of young children? Are there tips I can give my parents to use at home?

Modeling language just above the child’s current level is helpful.  For example, if the children in the group are using single words, model two-word phrases. For example: During snack time, instead of asking the child to say “milk” to request milk, you could model “want milk”.  This tip also works at home. 

An activity that works well in small groups is songs and finger-plays.  This gives most children a way to participate.  They can use motions, singing, words, or any combination that meets their developmental levels.   

Reading is a great small group activity and adding props and using big books can make reading even more fun!  For example, when reading about farm animals, give each child a toy farm animal.  When their animal is on a page, or mentioned in the story, have them hold it up and make the sound.  

Expand beyond the written words.  Comment and ask about the pictures.  Many times, adults focus on naming pictures, but there is so much more!  Pair actions with the photos.  If there is a photo of a child on a swing add “wee” or a photo of a car, add “beep beep”. 

Be mindful to avoid “drilling questions” only.  Instead of asking, “What is this animal?  What does it say? What color is it? How many do you see?,” you could say “Oh wow, look what I see.  It is a _____ (and let the child say the rest).  The pig lives on the farm and loves to roll in the mud. Dirty pig!  Let’s say hi to the pig and all join in to say “hi pig.”  Oh, there are more pigs over here.  Let’s see how many there are.”    

Practicing wait time paired with simple words or phrases is a great way to encourage language.  Here are some examples: Each time a block is added to a tower say “up.”  After doing this a few times, pause and see if the children will say it first.  Another way to do this is by rolling cars down a simple ramp and saying “1-2-3-go” before you release the car.  As you continue to model this, only say “1-2-3” and see if the children will add the word “go.” Sometimes a little wait time is all that’s needed.  In these examples, it is helpful that the child is “rewarded” with an action when he/she uses words.  Keep in mind that sometimes the goal may be an attempt of a word, so if a child says “o” for go, that is a start!  

Are there computer technologies or apps that would help my toddler communicate?

You are your child’s best teacher!  Talking through your day, singing, imitating sounds and expressions, and reading are all great ways to spend time together. There are many options for technology and while many are “good,” there is no substitute for you.  If your child is receiving services, the child’s speech language pathologist may recommend some apps that will help with your child’s specific communication needs.  If so, be sure to know how often and how to best to use them.  Visit the American Academy of Pediatrics at aap.org for screen time guidelines.

Some babies are quieter than others. How do you know if a baby younger than 6 months is delayed in communication?

There are many early communication skills a speech language pathologist looks for in babies.  Some of these include making eye contact, making sounds back and forth with a caregiver, imitating/copying facial expressions, and using simple sounds such as “eh-eh” and “buh-buh.” Familiarize yourself with what typical development is for your child’s age by visiting CDC.org for early milestones in English and Spanish.  If there are any concerns, discuss these with your pediatrician. Remember, if you are concerned, addressing the issue early is always best!  

Does having a very quiet baby indicate there might be a hearing loss?

Some babies are just naturally quiet, so it is hard to say.  Does your child respond to sounds of varying volume levels?  Many children with hearing loss may be able to hear louder sounds such as the dog barking or hands clapping, but miss the quiet, important sounds that make up speech.  If you have any concerns about your child’s hearing, remember early detection is key!  If you are concerned, contact your child’s pediatrician, to share your concerns and request an audiological evaluation by a pediatric audiologist if needed.  

Does music increase a child’s verbal abilities?

Listening to music is a great activity!  It works best when music time is interactive.  Pair motions such as clapping and finger movements and simple sounds like wee and boom-boom when listening to music with your child.  Imitation of motions and simple sounds are the building blocks to learning to imitate more complex sounds and words.  Many times, a child’s early sounds and words are used in response to music with familiar, repetitive songs.  Music time is also great for learning turn-taking skills and it is fun! 

Is “baby talk” okay or should I speak to my baby like I would to an adult so that they will be smarter?

Babies and toddlers benefit from hearing language that is fun to listen to.  “Parentese” is a term used to describe the sing-songy rhythm in the voice of a parent or caregiver.  It is great to use parentese as it draws the infant’s attention to what you are saying. It is also important to note that as children begin to use sounds, they often simplify words such as “wa-wa” for water.  It is okay for adults to use these terms, but be advised that the child also be exposed to hearing the real name.  For example: “Yes, wa-wa.  I see you have water”. 

I am a teacher’s assistant in a Toddler (1-2 years old) classroom. I have a student who is 2 years 1 month (he is about to move to the Two Year Old room where I work) who is not talking very much. He babbles, and talks in his own language, but can say some words (like blue, go, no, and stop). I know he can hear some of what I say, because I have tried singing a favorite song of his, and he will do the motions without me having to model them for him. I was curious if you had any suggestions on how to help him communicate (he knows some signs, but doesn’t always use them), or how we can help him in any other way.

hanks so much for your question. Congratulations! It sounds as if you are already doing many things to facilitate this child’s communication. While some may think that that language skills need to be “taught” to young children, this is simply not true. The best way to facilitate language development in infants and toddlers requires no props or expensive equipment. Language can be promoted by simply talking with children during everyday activities including routine care and play. Too often early childhood professionals are busy with what needs to be done in the classroom like changing diapers, preparing for lunch and picking up toys. When children try to engage us in conversation we might be tempted to halfway listen, give a short response, and get on with other responsibilities. People who study the nature of adult/child interaction tell us that adults tend to talk at children, not with them. Adults tend to give directives such as “Pick up your toys”; “Wash your hands”; and “Come with me.” However, children need two-way communication with turn taking, real talking, and real listening. They need us to get on their physical level, make eye contact, give undivided attention, and have real involved conversations with them. Does it matter how much you talk with an infant or toddler, sing, and look at picture books together?  YES! Research shows that the number and quality of the conversations that adults have with infants and toddlers directly affects how they learn to talk. The number of total words and different words that children hear daily, the number of conversations, and positive affirmations are all related to infants’ and toddlers’ language development.

Following are a few easy-to-do strategies that infant toddler care teachers can use to promote communication development:

  • Read and look at books together. Toddlers love to look at books with adults who talk about the pictures. While they are learning new words every day, toddlers’ speaking vocabularies are still limited. However, they can understand a great deal of the spoken language they are not yet able to produce. Therefore, adults can facilitate language growth as they talk with the toddler while “reading.” Books that picture common objects and everyday events are particularly appealing.
  • Be responsive and talkative during outdoor play. Outings, even simple walks in the grass, open up possibilities for learning new words and concepts. Talk about the rough bark, soft grass, tickly ant, hungry birds, and splashy puddles. Take advantage of every opportunity to engage in conversations about the child’s world because each new adventure stimulates language learning.
  • Talk and play often with the child, using a rich and varied vocabulary. Arrange the environment with materials and toys that encourage talk. Dramatic play gives children many opportunities to hear and use language. Try placing telephones in several different centers. Add little people to the toy car collection. Place attractive puppets in a “puppet theatre” made from an old gutted TV cabinet. Give dolls baths in the water table. Make stick puppets, bag puppets, and sock puppets. Change the dramatic play area frequently and help children learn to use the special vocabulary in different settings such as a shoe store, gas station, campground, stuffed animal clinic, pizza parlor, workout gym, etc. Make language props like a pretend microphone, walkie talkie, cordless phone, or megaphone. Invite children to talk or sing with a karaoke machine or tape recorder. Play back taped “mystery” voices of the children in the classroom and guess which friend was speaking. 
  • Use self-talk and parallel talk. Self-talk is talk that adults use to describe what they are doing while with the infant or toddler. For example, a teacher who is diapering a baby might say, “I’m getting your diaper. Now I’m lifting your feet. I’m putting the clean diaper on. Now we’re finished.” Parallel talk occurs when an adult talks about what a child is doing. For example, while the child is eating the adult might say, “Mmm, you’re eating your peas. Let’s scoop the peas with your spoon like this” while showing the child how to scoop the peas. These strategies tie language to an act or object manipulation, making words come alive and giving meaning for the child.
  • Expand vocabulary by singing simple songs and playing instrumental music and inviting children to slither, leap, or waddle. Use fun, big words like exhausted, rotate, hilarious, enormous, and whirl. Set up an obstacle course and entice children to move under, beside, over, through, between, or around. Move high, low, quickly, or slowly. Use strong movements like gliding, sliding, stomping, marching, tiptoeing, galloping, lunging, twisting, twirling, and flopping.

By providing a language rich environment and engaging in many responsive give-and-take conversations, you should see a tremendous growth in this child’s communication skills– as well as all of the other children in your class. Have fun with it and keep up the good work!

What is Pierre Robin Sequence?

Thank you for your question. Let me just start by saying that although I do have many years of experience working as a certified speech-language pathologist with diverse populations in diverse settings, I have never worked with an individual with Pierre Robin Sequence (or Complex). Therefore, my reply is based on research and not experience. Since this question is rather general, I’ll attempt to simply describe this condition and the role of Speech-Language Pathologists (SLP’s) in working with children with this diagnosis.

Pierre Robin Sequence or Complex (pronounced “Roban”) is the name given to a birth condition that involves the lower jaw being either small in size (micrognathia) or set back from the upper jaw (retrognathia). As a result, the tongue tends to be displaced back towards the throat, where it can fall back and obstruct the airway (glossoptosis). Most infants born with this condition, but not all, will also have a cleft palate. The basic cause appears to be the failure of the lower jaw to develop normally before birth. At about 7-10 weeks into a pregnancy, the lower jaw grows rapidly, allowing the tongue to descend from between the two halves of the palate. If, for some reason, the lower jaw does not grow properly, the tongue can prevent the palate from closing, resulting in a cleft palate. The small or displaced lower jaw also causes the tongue to be positioned at the back of the mouth, possibly causing breathing difficulty at birth. This “sequencing” of events is the reason why the condition has been classified as a deformation sequence. Pierre Robin Sequence/Complex is rather uncommon, and like most birth defects, varies in severity from child to child. Some children may have more problems than others. Problems in breathing and feeding/swallowing (or dysphagia) in early infancy are the most common. Parents need to know how to position the infant in order to minimize problems (i.e., not placing the infant on his or her back). For severely affected children, positioning alone may not be sufficient, and the pediatrician may recommend specially-designed devices to protect the airway and facilitate feeding. Some children who have severe breathing problems may require a surgical procedure to make satisfactory breathing possible. (https://www.cleftline.org/what-we-do/publications/pierre-robin-sequence/)

Treatment Considerations: Since children with Pierre Robin Sequence/Complex may have a variety of health concerns, parents are often strongly advised to locate a craniofacial center where evaluation and treatment planning can be coordinated by an experienced multidisciplinary staff composed of health care professionals from many different specialties- including speech-language pathologists. This is not to imply that Speech-Language Pathologists working in other care and education settings may not work with children diagnosed with Pierre Robin Sequence. Please see the following excerpts from the American Association of Speech-Language Pathologists and Audiologists (ASHA) Position Statement regarding the “Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders: Technical Report” https://www.asha.org/policy/TR2001-00150/

“The area of pediatric swallowing and feeding disorders is one of the most rapidly evolving patient care areas for medically based speech-language pathologists and other professionals serving children. In addition, as an increasing number of high-risk infants survive and enter educational programs, school-based speech-language pathologists must acquire medical knowledge and skills to manage swallowing and feeding disorders. These children are seen in early intervention and preschool programs, and then transition to school settings where they may be in regular classrooms with some specialized services as needed, or they may be in separate special education groups. In any case, school-based speech-language pathologists often provide services for their swallowing and feeding needs. ………

Feeding is a developmental process; when interrupted, children may demonstrate oral sensorimotor dysfunction, undernutrition (malnutrition or failure to thrive [FTT]), poor growth, delayed development, poor academic achievement, psychological problems, and loss of overall health and well-being. Oral sensorimotor function, swallowing, and respiration coordination are important processes that relate to development of normal feeding, eating, and speech motor skills. Therefore, the development of functional, safe eating is extremely important.

The speech-language pathologist is a primary professional involved in assessment and management of individuals with swallowing and feeding disorders. ……….

Speech-language pathologists have extensive knowledge of anatomy, physiology, and functional aspects of the upper aerodigestive tract for swallowing and speech across the age spectrum including infants, children, and adults (including geriatrics). …… Speech-language pathologists also have extensive knowledge of the underlying medical and behavioral etiologies of swallowing and feeding disorders. In addition, they have expertise in all aspects of communication disorders that include cognition, language, and behavioral interactions, many of which may affect the diagnosis and management of swallowing and feeding disorders. Because of the complexities of assessment and treatment in most persons with swallowing and feeding disorders, speech-language pathologists and other professionals work as a team with families, caregivers, and patients. Those teams may vary in their composition of specialists depending on the setting, population, and needs of individuals.

Concerning treatment, the position paper goes on to state: “Regardless of the patient’s age and skill levels, primary goals of feeding and swallowing intervention are to support adequate nutrition and hydration, minimize the risk of pulmonary complications, and maximize the quality of life. Optimizing a child’s neurodevelopmental potential is an additional goal for the pediatric patient with swallowing and feeding problems. Speech-language pathologists strive to facilitate the development of coordinated movements of the mouth, respiratory, and phonatory systems for communication as well as for oral feeding. Intervention processes and techniques must never jeopardize the child’s nutrition and pulmonary status. Primary to a successful oral sensorimotor and swallowing program is the overall health of the child. Medical, surgical, and nutritional considerations are all important. In addition to oral-motor function, positioning, seating, muscle tone, and sensory issues all need to be addressed during treatment. If gastroesophageal reflux is a factor, adequate management is fundamental to other aspects of treatment. Underlying disease state(s), chronological and developmental age of the child, social/environmental arena, and psychological/behavioral factors all affect treatment recommendations.”

To summarize: As you can see, Pierre Robin Sequence is a complex pediatric diagnosis that may result in a variety of challenges for young children. If you are a family member concerned about a child with this diagnosis, I highly recommend consulting with the child’s pediatrician for advice as well as seeking recommendations from a specialized pediatric craniofacial treatment center where a team of medical professionals can coordinate the best treatment plan. 

I have a 4 1/2 year old girl who has trouble with her ‘s’ blends. She can pronounce the ‘s’ sound, but when she blends it with other letters it comes out as “st.” School is “stool”, sky is “sty”, smile is “stile.” She was evaluated at preschool and the only comment made was her r’s sounding like w’s. I know r’s are a later occurring sound, but I can’t find any information on s blends. Should she be evaluated?

Thank you for your question. Let me start by saying that it is very common for young children to have speech sound errors. According to the American Speech- Language-Hearing Association (ASHA) and other researchers, children should be able to pronounce all sounds in English correctly by age 8. However, very few children learn to talk without having some speech sound errors early in their development.

The question is when does it become a “delay” or “disorder”? It is important to know that speech sound production follows a normal developmental sequence with age ranges for when children should be able to correctly produce sounds in the English language. Speech sound disorders can include problems with pronouncing individual sounds (articulation) or problems producing certain sound patterns (phonological processes). In an articulation disorder, words may be pronounced incorrectly by substituting sounds, leaving off sounds, or adding sounds (for example,  substituting  “t” for “k” sound as in “tat”  for “cat”). 

A phonological process disorder involves mistakes with patterns of sounds, for example, substituting sounds made in the back of the mouth for sounds made in the front of the mouth  (example, “tup” for “cup” and “das” for “gas”), or reducing “clusters” of sounds (for example, “poon” for “spoon”). It is also important to know that a family’s dialect or accent may also affect pronunciation, and differences due to accents or dialects are not normally considered “disorders”.

From your brief description, it sounds as if the speech errors that your child displays may be in the normal developmental range. However, whenever there is a concern, it’s a good idea to get as many professional opinions as possible. I would recommend that you get more information from the person who evaluated your child at the preschool. Was it just a quick “screening” or a full evaluation? Was the assessment performed by a teacher or a certified speech-language pathologist?  Ask for a written copy of the screening or evaluation results and have further discussion with the evaluator.

There are many factors to consider when determining whether a child’s speech warrants professional intervention. My recommendation is to also consult with your child’s pediatrician and share your concerns and the results of the preschool’s evaluation.  Depending on the qualifications of the person who previously evaluated your child, you might also want to consult with a licensed, certified speech-language pathologist in your area—usually a free service provided by most public schools. For additional information about speech development, visit: https://www.talkingchild.com/speechchart.html or https://www.asha.org/public/speech/disorders/SpeechSoundDisorders/ . 

Is it difficult to teach young children to speak?

That’s a good question. Actually, we don’t usually need to “teach” young children to speak.  Babies are born with the ability to communicate things like pleasure and discomfort through non-verbal  means such as facial expressions, crying, moving, etc. They actually learn to talk very naturally through social interactions with their families and other people. Learning to talk usually occurs within the first two years of life. What starts out in the first few months as crying, gurgling and cooing, eventually turns into babbling, words and sentences.

It is important to know that a child learns to talk by first learning to understand what is being said to him or her. As you probably know, this is one reason that being able to hear is really important for learning to talk. Babies are able to understand much more than most people think which is why it is so important for others to talk a lot to babies, read, sing and play with them. Up to about 6 months of age, babies will vocalize by using their mouths and tongues to make sounds.  At around 7 to 8 months of age, they begin to mimic others and may use repetitive sounds or one-syllable versions of words to express their thoughts and ideas. Babies continue to learn to speak by repeating and learning one word at a time. Between 12 and 15 months, babies may be able to say several words and understand many more. By the time they are 24 months, most babies are not only learning even more words but are beginning to put one or two words together. They are also able to follow simple commands and understand simple questions.

It is important to remember that while all children develop speech and language usually in the same stages, the rate of their development can vary. This is quite normal. Though learning to talk seems easy and natural for most children, some children struggle with learning to talk and may need early intervention services. Some children may have difficulty learning to communicate because they can’t hear their parents talking. These children may need the services of an audiologist (a trained professional who measures hearing loss and can fit hearing aids). In addition to hearing loss there are many other factors that may also interfere with communication development in children. In these cases families may seek the services of a speech-language pathologist (a specialist who evaluates and treats patients with speech, language, cognitive-communication and swallowing disorders in individuals of all ages, from infants to the elderly). Of course, families should also always discuss developmental concerns with their child’s health care provider.

For children with a suspected speech or language delay, early identification and early intervention services are critical. Taking a “wait and see” approach is not usually recommended since research shows that the development of speech and language during the infant and toddler years supports a child’s development in all of the other developmental domains.  

I hope this answers your question. If you need other, more specific information, please let me know. For additional general information about speech and language development visit www.asha.org and www.zerotothree.org.

I am an in-home child care provider and I wanted to know at what age should I be concerned about the speech of a child?

Speech and language development begins long before a child starts talking. A child’s rate of speech development is as unique as he or she is and can vary. Knowing some general milestones of speech and language development can be helpful in determining when to be concerned about a child. Also keep in mind that communication involves more than just saying words. Eye contact, comprehension, how the child plays, socializes, imitates and gestures are all important considerations as well.

Listed below are a few general guidelines for speech and language development:

By age 12 months, a child should be progressing from babbling to making intentional sounds and a few word approximations (although words may not be clear), should be reaching for objects and using gestures to communicate, should enjoy games like “peek-a-boo” and “patty-cake, and should begin to respond to simple requests/questions like “come here” and “want more?”.

Between one to two years, children should begin to point to body parts when asked, listen to simple stories, rhymes and songs, point to pictures or objects when named, follow simple commands, learn new words on a regular basis, put 2 words together (like “more cookie” “no juice”), use different consonant sounds at the beginning of words, and ask 1-2 word questions (like “where kitty?” or “go bye-bye?”).

The causes of speech and language delays are often unknown. Children who may be at risk for communication delays include those who are born prematurely, children who have frequent ear infections, children who do not exhibit much eye contact, or children who display developmental delays in other domains. Parents and caregivers should be concerned when children exhibit little or no response when others initiate communication (gestures, etc.), children do not react to loud noises or speech of others, children do not walk or use single words by 15 to 18 months, children do not use at least 50 words and some two-word combinations at age 2, or children who seem to be behind their peers with regard to speech-sound development (unclear speech, struggles to form words, or can only produce a limited range of sounds).

When a caregiver has concerns about a child’s speech and language development, he or she should discuss their concerns as soon as possible with the child’s parent and encourage them to talk with the child’s health care provider. Advise the parents to ask their child’s health care provider for a referral for a speech and language evaluation. If the health care provider does not provide a referral and the parent is still concerned, they may seek an evaluation on their own from their state’s early intervention program or a speech-language pathologist in their area.

Child care providers and caregivers can learn more about speech and language development by visiting www.asha.org

Will using a pacifier cause my toddler to have delayed speech and language?

This is a common question, and you will most likely find differing opinions on the answer. Babies are born with a need to suck, and some babies have a more intense need than others. Sucking not only plays an important role in nutrition, but also plays an important role in a baby’s ability to self-soothe, so a pacifier can play a useful role as long as it is not used for too long. Why? Studies have shown that prolonged use of pacifiers may result in increased ear infections, malformations in teeth and other oral structures, and/or speech and language delays.

Many speech-language pathologists recommend stopping pacifier use by 12-18 months of age, which is when speech and language development really begins to “take off”. Also, this is the age that children typically begin to switch from bottle drinking to cup drinking and the age they also begin chewing more solid foods which will promote oral-motor development. As children become more independent at around 2 years of age, they start to develop habits and exert their own demands, so it is better to deal with the pacifier issue before the child becomes too attached.

Suggestions for eliminating the use of pacifiers: Avoid using a pacifier as a way to stop your infant or toddler from crying. Pacifiers are meant to satisfy intense sucking needs– not to delay or avoid nurturing a child or responding to his or her needs. Also avoid putting your child to bed with a pacifier. Encourage your child to use something else to comfort himself/herself such as a blanket, stuffed animal or other “lovey”. When weaning your child off a pacifier, do not let your child walk around with a pacifier in his/her mouth. Teach them they can only use it while sitting down or in a particularly stressful situation (like visiting the doctor). Most toddlers want to wander around, but if they are taught they must sit with their pacifiers, they may give them up on their own. Prepare your child for getting rid of his/her pacifier. Set a special date (their birthday, Christmas, etc.) and let your child put stickers on a calendar as a countdown while gradually decreasing the pacifier’s use. Be sure to offer lots of attention and a substitute for comfort when needed. Many children will respond to these suggestions and get rid of their pacifiers with minimal tears, and the benefits far outweigh a few “fussy” days. 

How would I know if my 12 month old is behind in some developmental areas?

Hi! I’m writing to you about my son who is 12 1/2 months old, 11 months adjusted (6 weeks premature). I’ve been getting concerned because I feel that he may be behind in some developmental areas. He doesn’t have any true words, yet. He babbles Mamama/dadadada/nananana/lalalalala/babababa etc. I notice that most of the time when he is babbling he’s not really “talking” to any of us – he’s pretty much just babbling to nobody. His tone does change when he’s babbling, but it never sounds like he’s asking a question. To be fair he did start babbling a littler later maybe 8/9/10 months when he really turned it on. My other concern is receptive language. All I keep reading is that by 12 months they should understand most things that are said to them. Well, my son doesn’t. I know he understands some key words like teddy (the dog), balloon, up, I *think* the word no (can’t be sure as he listens when he wants to), his name, look and baba (bottle). I suppose he could know more and I’m just not aware of it or he doesn’t show that he knows. I’m not as concerned with the expressive language as I am with receptive. Thank you for reading and for any of your thoughts!

Thank you for your question. Let me start by saying that we know that the first 3 years is the most intensive for acquiring speech and language skills, and it is important for parents to seek advice about any concerns they may have. During the early development of speech and language, there is a “typical” progression in the development of skills, and it sounds as if you have already researched some of these “milestones”. Please be aware that it can be quite common for children not to reach all of these milestones at the same rate and in the same order.

Following is a brief list of some common communication behaviors seen in children between 7 months and 1 year:

  • Enjoys games like peek-a-boo and pat-a-cake
  • Turns and looks in direction of sounds
  • Listens when spoken to
  • Recognizes words for common items like “cup”, “shoe”, “book”, or “juice”
  • Begins to respond to requests like “Come here” or “Want more?”
  • Babbles with both long and short groups of sounds such as “tata upup bibibibi”
  • Uses speech or non-crying sounds to get and keep attention
  • Uses gestures to communicate (waving, raising arms to be picked up)
  • Imitates different speech sounds
  • Uses one or two words (hi, dog, dada, mama) around first birthday- although sounds may not be clear 

My first recommendation is to discuss all of your concerns with your child’s pediatrician or health care provider and seek his/her advice. You mentioned that you have concerns about delays in “some developmental areas”. Are your concerns only related to speech and language or do you also have concerns about other developmental areas such as physical health, motor development, social/emotional skills, or cognitive skills? Your child’s doctor can refer you to the appropriate professional if other evaluations are needed, but also be sure that your son has had his hearing tested recently to rule out any hearing difficulties.

From your brief description, I would say that your son’s speech and language is probably developing generally within normal limits. However, a complete speech-language evaluation with extensive history information, observations, and assessment is the best way to determine an accurate diagnosis. Your pediatrician may refer you to an ASHA certified speech-language pathologist or you may find one in your area by visiting: https://www.asha.org/findpro/.

Please be aware that every state also has an early intervention program serving eligible families with children from birth to their third birthday. In Georgia, you can call Babies Can’t Wait at 1.800.229. 2038 if you think your infant or toddler is developing or learning slowly.  

In the meantime, here are some things every parent can do to encourage speech and language development: Check your child’s ability to hear. Pay special attention to ear problems and infections, especially when they occur frequently. Reinforce your baby’s communication attempts by looking at him, speaking, and imitating his vocalizations. Repeat his laughter and facial expressions. Respond to his vocalizations (i.e. if he says “mama”, you could respond with “mama, yes, mama’s home”). Provide a language rich environment by talking about your daily routines throughout the day in simple language (2-3 words at a time). This may help to build receptive language skills. Use lots of speech/routine games such as “pattycake”, “itsy bitsy spider”, waving “bye-bye” and singing. Frequently read simple, age-appropriate books to your child. Use lots of intonation and gestures when you are interacting with your child. “Watch” as well as listen to your child’s responses, and respond to all intentional communication both nonverbal and verbal (a smile, movement, vocal attempt, or actual word).

Thank you again for your question, and I hope this information is helpful. Please let us know if you have any other questions and keep us informed of your son’s progress. 

We speak our native language at home but also want our baby to learn English. Will this confuse him or cause a language delay?

Although you may hear differing opinions from doctors and speech-language pathologists on this topic, there is no scientific evidence to prove that hearing two or more languages leads to delays or disorders in language acquisition. In fact, it is very important for parents to use the language that they know best and feel most comfortable with. This is how they can help their children learn language, talk about ideas, and learn about the world. Evidence suggests that a strong base in the first language helps a child learn a second language. Language is strongly linked to the development of identity and social and emotional development. Children should be encouraged from a very young age to feel proud of their language and culture.

A Word of Advice for Bilingual Families: At home do what comes naturally to you and your family in terms of which language(s) you use when, but make sure your children hear both languages frequently and in a variety of circumstances. Create opportunities for your children to use all of the languages they hear. Read books to and with your children in each of the languages that are important to their lives. Do not make language an issue, and do not rebuke or punish children for using or not using a particular language. If you feel your child is not talking as he or she should in either language, consult with your child’s pediatrician and discuss whether a speech and language evaluation may be needed.

I’m not sure if my baby’s hearing is normal. What should I do?

Approximately two to four of every 1,000 children in the United States are born deaf or hard-of-hearing, making hearing loss the most common birth disorder. Undetected and untreated hearing loss in young children can result in delayed speech and language development, social problems and later academic difficulties.  It is routine practice in most hospitals to perform hearing tests for babies shortly after delivery. South Carolina and Georgia are 2 states that currently require hearing screenings for newborns. Early diagnosis, early fitting of hearing aids, and an early start on special education programs can help maximize a child’s hearing.

Hearing loss can also occur later in childhood. In these cases, parents, grandparents, and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss, including:

• Not reacting in any way to unexpected loud noises 
• Not being awakened by loud noises 
• Not turning his/her head in the direction of your voice 
• Not being able to follow or understand directions 
• Poor language development 
• Speaking loudly or not using age-appropriate language skills.

If your child exhibits any of these signs or if you have any concerns about your child’s hearing, discuss them with your child’s doctor and arrange for a hearing screening or evaluation. For more information, visit www.nidcd.nih.gov or www.asha.org

Why is it so important to read aloud to my baby?

Early language and literacy (reading and writing) begins in the first three years of life and is closely linked to children’s earliest experiences with books and stories. Reading aloud combines the benefits of talking, listening and emotional bonding and builds the foundation for language development. Stories provide parents and care teachers with a structure to help them talk aloud to children and listen to their responses. Sharing books with babies and young children is one way to share talk and help develop children’s comprehension and expressive communication as well as their social and literacy skills. In addition to all of these benefits, it’s just a fun way to interact with babies and toddlers! For more information, visit https://www.zerotothree.org

Will allowing my toddler to watch children’s educational television programs or videos help my child’s speech and language development?

Some parents may think that by putting their child in front of a video or a TV show that he or she is going to learn language. However, language is acquired best when the child is learning language in the natural context of an activity, play experience or verbal interactions with other people. It can be as simple as talking with your children while they are riding in the car with you, as long as they are involved in what you are talking about. A TV show doesn’t necessarily do that. Some videos may be a little more interactive, but it’s not necessarily the best way for language to be facilitated. Because research has shown that unstructured play time is more valuable for the developing brain than electronic media, the American Academy of Pediatrics discourages screen time for children under two years of age. For more information, visit www.aap.org or www.asha.org.

My 2 ½ -year-old stutters when she talks. Should I be concerned?

Probably not. Children between 2 and 3 years of age often repeat sounds, hesitate between syllables or have periods of normal non-fluency. This usually disappears in a few months. Sometimes this disruption in speech occurs due to lack of coordination skills and the inability of a child to say things as fast as his brain is able to process them. However, if your child repeats the first sound of every word, seems to get stuck on every word, shows obvious tension in the face, and/or has poor eye contact, you should consult your pediatrician and possibly a speech-language pathologist. In the meantime, slow your own speech down so that your child can hear each syllable, keep stress levels in the home to a minimum, and be patient when talking with your child. A calm, relaxed atmosphere can help a toddler speak more fluently. For more information, visit www.asha.org or www.stutteringhelp.org

My toddler doesn’t talk as much as other children his age. What should I do?

Although the stages that children pass through in the development of speech and language are very consistent, children develop language at their own pace.  It is always a good idea to discuss concerns about your child’s development with your child’s pediatrician at every checkup. If delays in speech and language are suspected, parents may also want to consult with a speech-language pathologist certified by the American Speech-Language-Hearing Association (ASHA) for a professional evaluation. A professional evaluation can determine the existence of speech and language delays and yield more specific intervention recommendations for parents. In the meantime, there are some general things that parents can do to help toddlers develop their speech and language skills. Talk a lot with your child and read to your child every day. This will help them understand and learn new words. Listen and respond when your child talks. Expand on what he/she says. Ask your child open-ended questions and encourage your child to ask you questions. Set limits for watching TV and instead play games with your child. Whenever possible use everyday moments as teachable moments. For more information, visit www.asha.org , www.bornlearning.org, or www.zerotothree.org.

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The Virginia Infant and Toddler Specialist Network is supported by the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $5,350,000 with 100% funded by ACF/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by the Virginia Department of Education, ACF/HHS, or the U.S. Government.