Does your child have a speech delay?

By the age of 2, Holly Edwards’ son, Brady, could say only a few words, while some other kids his age were speaking in sentences. Edwards, a Paradise, Newfoundland executive assistant, wasn’t overly concerned, because Brady could understand some instructions and had his own “words” for certain things.

When another year passed and Brady’s speech still wasn’t understandable outside the family circle, Edwards became more worried. On the advice of his pediatrician, Brady was assessed by a speech-language pathologist, who identified him as having a serious speech impediment due to a tongue-tie, making it more difficult for him to pronounce sounds, primarily the “th” sound.

He underwent a frenulectomy, a relatively simple surgery where the lingual frenulum – the band of tissue connecting the tongue to the floor of the mouth – is cut. Along with months of speech therapy, this yielded big improvements in Brady’s ease of speech and self-esteem.

So, what is a speech delay?

Children usually start to use words around their first birthday, about the same time they take their first steps. But what if this doesn’t happen? How do you know if your child is just a “late talker” or has a true developmental delay?

Though speech develops pretty much the same way for all children, the pace can vary considerably, explains Marnie Loeb, a speech-language pathology advisor at Speech-Language & Audiology Canada in Ottawa. “Development of speech happens with so much variation that it can be tricky to tell if your child is delayed by comparing her to other kids her age,” says Loeb. She says that at age 2, there is such a broad range of “normal” speech that parents can easily be discouraged by their child’s abilities when, in fact, their child is likely still in the normal range. However, “there are certain milestones we look for at specific times,” she says.

Speech-Language & Audiology Canada (SAC) offers a detailed chart of speech, language and hearing milestones for you to gauge your child’s progress. As a rule of thumb, children should be able to do the following:

• By 12 months: Use 1 word (e.g., “Mama” and “Dada”), and be able to understand and comply with simple requests (“Give me the toy”).
• By 18 to 24 months: Use 10 to 20 single words and 2-word combinations, follow simple instructions and repeat words heard in conversation.
• By 36 months: Use short, simple sentences, recognize and identify practically all common objects and pictures, understand most of what is said to them and speak well enough to be understood outside the family.

Loeb says a child’s understanding of language can often surpass her ability to speak. Making gestures and following directions, interacting with others and engaging in pretend play indicate that your child understands and is communicating, and there’s likely little reason to worry. Nevertheless, she suggests it’s best to err on the side of caution and have your late talker assessed by a speech-language pathologist who specializes in young children.

Because parents are around their children a lot, they learn to understand what they say. So, the best way to evaluate your child’s abilities, says Loeb, is to determine how easily other people understand him or her. “A less-familiar listener should be able to understand about 50% of what your child says by age 2, 75% by age three and 100% by age 4,” she says.

Speech delay causes

Family history can play a part in speech delays, as can major illnesses or repeated ear and throat infections. Parents can also contribute to a delay by anticipating a child’s every need rather than letting him speak for himself. The possibility of an ongoing language delay increases if your child:

• Was quiet as an infant, with limited babbling and sound play
• Doesn’t try to imitate new words
• Has a vocabulary of mostly nouns with very few verbs
• Uses no or very few gestures to communicate
• Uses very few different consonant sounds
• Has difficulty starting and participating in play with other children
• Has behavioural issues
• Has cognitive delays or disorders such as autism or Down’s syndrome, or impaired hearing

Early intervention is critical

About 1 in 10 children needs help developing normal speech and language skills, according to the Ontario Ministry of Children and Youth Services. If you suspect your child is behind, it’s best to get help right away. “The more time that passes before help is sought and provided, the weaker the foundation on which future learning will be based,” says Loeb. The good news is, if your child doesn’t need the extra help, the sooner you know that, the sooner you can stop worrying.

Here’s how to get started:

• Have your pediatrician do a medical check-up and evaluation on your child. This will determine if there’s something physical that’s causing your child’s speech delay. If a hearing problem is suspected, your child might be referred to an audiologist. Whether the source of the delay is a hearing problem or some other developmental issue, your pediatrician will likely point you in the direction of a publicly funded speech pathology program (some provinces cover them) or a private speech-language pathologist in your area, as wait lists for free support can be long. You don’t need a doctor’s referral to see a speech-language pathologist; check whether the cost for a private practitioner is covered by your workplace health insurance.
• Get your child’s hearing checked. This is especially important if your child has had frequent colds or ear infections. Fluid buildup in the middle ear can interfere with speech and language development.

How to engage your child at home

Here are some helpful tips you can use at home with your little tyke:

• Read more books. Pick out books that fully engage your toddler and read them aloud as often as possible. Talk to your toddler about everything on the page and linger until your child is ready to move on to the next page.
• Engage in 2-way communication. Tell your child what’s happening as you do something and wait for a response.
• Just talk more. Chat to your toddler as you feed or bathe him, and give him time to respond with a smile or eye-to-eye contact. Use everyday activities to help your toddler to make connections between actions and objects and the words that represent them. Point things out when you’re away from home.
• Simplify your speech. Use short sentences and emphasize key words. This will help your toddler to focus on the important information. But also…
• Use longer sentences. Try talking to your toddler in sentences about 1 word longer than the sentences she is using. So if your child uses 2-word sentences, use lots of 3- and 4-word sentences when responding. For example, if your toddler says “a dog,” you could say, “yes, a big dog.”
• Give them choices. You can increase your child’s vocabulary by asking for a choice, such as “Do you want an orange or an apple?” rather than for a yes or no answer.