Nurture Article | The Portland Hospital Parenting Magazine
Spring/Summer Issue 2014 | Small Talk
Hearing your child utter their precious first word is one of the most rewarding moments for any parent.
Language development is an amazing and exciting journey. But, as with all big steps there can be obstacles, especially if your little one is remaining tight-lipped or babbling nonsense while peers seem to be morphing into mini orators.
So what is ‘normal’ when it comes to learning to talk? And when, if at all, should you worry?
Mike Carroll, Senior Speech and Language Therapist at The Portland Hospital, is keen to reassure parents that all children develop at their own rate, and the majority develop speech and language skills easily and without problems.
Some children are slower to develop these skills because energies are being focused elsewhere - honing motor skills, for example - while others may be chatting much earlier.
“Talking late doesn’t necessarily mean children will go on to have speech and language difficulties in the future,” he says. “It’s important to remember that speech and language skills develop over many years.”
Parents often feel anxious if their child makes errors with the sounds in speech. But mispronouncing words is considered normal while children are learning to speak. Typical examples include ‘do’ for dog when a child is aged two, ‘tat’ for cat at the age of three, and ‘gween’ for green at four plus years.
“We call these examples normal phonological processes, and would only become concerned if they persisted in a child’s speech at an age when we would normally expect these sound immaturities to have resolved,” Mike says.
The f/th sound substitution - teef instead of teeth, for instance – is also a typical pronunciation for children as old as five, and most will simply grow out of it when they learn phonics and literacy in school.
Sudden use of babyish language is normal too. “It can often be triggered by changes in the child’s world, such as a new sibling, and may be a reflection that they are feeling anxious or need more attention. It is generally short-lived and spontaneously resolved,” says Mike.
He is equally relaxed on the topic of lisps. “There is very little you can do with very young children,” he says.
In some cases there are physical reasons for speech difficulties.
Tongue-tie, where the skin that connects the tongue to the floor of the mouth is too tight restricting its movement, can cause speech development problems and breastfeeding difficulties.
Helen Caulfield, Consultant Paediatric Ear, Nose and Throat surgeon at The Portland Hospital, explains: “It can lead to speech problems as the child gets older - for example, difficulty pronouncing the ‘r’, ‘s’ and ‘th’ sounds and they may develop a lisp.
“However, tongue tie can be easily cured with a quick snip of the stringy membrane to release the tongue - an operation called a frenulotomy which takes minutes and involves a tiny amount of blood loss. It allows normal breastfeeding immediately.”
Hearing problems and persistent glue ear – where mucus builds up behind the ear drum as a result of an infection or after a cold, so there is a physical barrier to the sound getting through as normal which can cause mild or moderate hearing loss – are other reasons for speech difficulties.
For this reason, if glue ear does not clear within a few months, hearing aids or grommets - tiny tubes inserted into the ear drum which ventilates the middle ear preventing the build-up of mucus – may be recommended.
“Children with glue ear may have issues with speech clarity missing the beginning or ends of words or substituting “b’s” and “d’s”,” says Hamid Daya, Consultant Paediatric ENT surgeon at The Portland Hospital and Director of ent4kids.
“The condition is very common in children from the ages of 2 to 5 and occurs mostly in the winter. An ear infection or a cold may precipitate the development of glue ear but in most children the glue ear resolves itself within a few weeks.
“However, in some children it may persist and generally if it is present for more than 3 to 4 months it is likely to continue. If it causes a hearing impairment and is affecting a child’s behaviour and confidence then surgery to insert grommets is recommended.”
If a child is not speaking at all by the age of two (when children have on average 20 to 30 words), parents are naturally concerned that this may indicate a communication problem such as autistic spectrum disorder.
However, it may be simply because a child is having difficulty hearing.
“If there are any concerns about a child’s speech development it is important to assess the hearing,” adds Mr Daya.
COMMUNICATING WITH YOUR BABY
Communicating with your baby begins as soon as they are born.
Help early bonding. Skin-to-skin contact is important for attachment.
The key to developing good speech and language skills in young children is to be responsive. When they make sounds, coo and babble with them. Pause and give the baby time to respond with a smile or sound. This is early turn-taking - the basis for early speech and language development.
Make sure they can always see your face so it is easy to engage in eye contact with you.
Give time and stimulation. Young children’s speech and language development is closely linked to play skills.
Let your child know they have special one-on-one attention. It doesn’t need to be anything complex or special.
Let the child lead and resist the temptation to turn teacher on them during play saying, ‘do it like this’ or ‘don’t say it like that’.
Avoid becoming anxious. Model more mature speech and language skills through daily interaction and play.
Birth Newborns communicate by crying and make some basic biological sounds.
2-5 months Babies coo and laugh, and start to alter pitch and structure sounds, string cooing noises together and begin to control their tongue.
6-8 months Babbling and more complex babbling sounds.
8-10 months First recognisable spoken words developing. These might be symbolic sounds like ‘broom’ for car.
10-12 months Likely to have one or two recognisable words used quite consistently. Not particularly easy to understand, but parents tune in and communication can be quite successful.
12-24 months Rapid expansion of vocabulary with early two word phrases like ‘more juice’ as the child approaches two. Begin to understand simple commands - find your coat, get your cup.
24 months + Comprehension of two more complex commands, like ‘get your shoes and cup’. Start to understand words like in and under. Vocabulary developing fast with new words each day and words combined in sentences.
36 months + Grasp concept words relating to size or colour. Increasingly mature speech.
By Deborah Arthurs