My child can’t speak prop­erly

As most chil­dren de­velop speech and lan­guage skills within a spe­cific age range, a child who takes longer to learn may have an un­der­ly­ing prob­lem.

The Star Malaysia - - Nation - By Dr LIM BOON CHUAN

As most chil­dren de­velop speech and lan­guage skills within a spe­cific age range, a child who takes longer to learn may have an un­der­ly­ing prob­lem.

HAVE you no­ticed that your three-mon­thold baby recog­nises your voice and smiles when­ever he sees you?

By four to six months, he has started to bab­ble, laugh, fol­low sounds with his eyes, and pay at­ten­tion to mu­sic.

On his first birth­day, he fi­nally ut­tered “Ma” or “Ba” to re­fer specif­i­cally to you, and this cre­ated a sweet and un­for­get­table mem­ory in your jour­ney of par­ent­hood.

In sim­ple terms, speech is how we say sounds and words, in­clud­ing ar­tic­u­la­tion, voice, and flu­ency; while lan­guage in­volves how we use words to ex­change in­for­ma­tion, in­clud­ing ver­bal, non-ver­bal and writ­ten com­mu­ni­ca­tion

While all chil­dren reach de­vel­op­men­tal mile­stones at their own pace, it can be wor­ry­ing if they miss their mile­stones by a sig­nif­i­cantly long pe­riod.

A child is said to have a speech and/or lan­guage de­lay when he does not ac­quire speech and lan­guage skills ap­pro­pri­ate for age dur­ing early child­hood.

Speech and lan­guage de­lays are dif­fer­ent from, but closely linked to, speech and lan­guage dis­or­ders.

Gen­er­ally, a de­lay is a de­scrip­tion for a younger child dur­ing the early de­vel­op­men­tal pe­riod; how­ever, it is said to be a dis­or­der if it per­sists beyond early child­hood and af­fects the child’s func­tion.

A speech (sound) dis­or­der is when a child has prob­lems pro­duc­ing speech sounds prop­erly at the ex­pected age, mak­ing speech dif­fi­cult to un­der­stand.

Mean­while, stut­ter­ing (Child­hood On­set Flu­ency Dis­or­der) refers to a con­di­tion where sounds, syl­la­bles or words are re­peated or pro­longed, dis­rupt­ing the nor­mal speech flow.

In both con­di­tions, the child can un­der­stand or ex­press ideas in words and phrases, but his ut­ter­ance may sound in­com­pre­hen­si­ble, es­pe­cially to strangers.

Mean­while, a lan­guage dis­or­der is when the ear­lier speech and lan­guage de­lays do not go away as the child grows up (some chil­dren with th­ese de­lays do catch up and are known as “late talk­ers”).

The child strug­gles to un­der­stand what oth­ers are say­ing (re­cep­tive lan­guage) or has trou­ble shar­ing his thoughts (ex­pres­sive lan­guage). For ex­am­ple, he can pronounce words well, but is un­able to make two-word phrases by 2½ years old.

It is not un­com­mon to see a child with a lan­guage dis­or­der also have speech prob­lems.

Se­ri­ous signs

It can be hard for par­ents to dis­tin­guish if their child is just a lit­tle slow to reach a speech or lan­guage mile­stone, or if there is a prob­lem that needs ur­gent at­ten­tion.

Re­fer to your child’s pae­di­a­tri­cian im­me­di­ately if you are con­cerned or see the fol­low­ing signs:

Around 12-15 months

● Does not un­der­stand the name of cer­tain com­mon ob­jects, e.g. “bot­tle”, “(toy) car”.

● Does not re­fer to you specif­i­cally us­ing “ma” or “ba”.

● Does not make mean­ing­ful ut­ter­ances.

Around 18-21 months

● Does not un­der­stand fa­mil­iar phrases, e.g. “give me a kiss”, “hug daddy”, “stop that”.

● Does not point to body parts.

● Does not have or has very lim­ited vo­cab­u­lary, e.g. “cat”, “car”. Around 24 months

● Does not seem to un­der­stand sim­ple in­struc­tions or ques­tions, e.g. “Get your shoes”, “Want a drink?” or “Where’s Daddy?’

● Does not say at least 25 dif­fer­ent words.

● Does not com­bine two words to­gether, e.g. “drink milk”, “go out”.

● Can only im­i­tate speech and ac­tion, does not say words spon­ta­neously. Around 36 months

● Does not seem to un­der­stand longer in­struc­tions or ques­tions, e.g. “Get your shoes and put them in the box” or “What do you want to eat for lunch to­day?”

● Does not com­bines words into longer phrases, e.g. “want eat bis­cuit”, “help me mummy”.

Red flags for speech dis­or­der

● Sounds very im­ma­ture for his age, i.e. he uses only a few speech sounds or pat­terns.

● Does not pronounce words the way you would ex­pect for his age.

Red flags for stut­ter­ing ●

A sound, part of a word or phrase is re­peated over and over, e.g. “A a a and I want that one”, “And and and I want that one”.

● A sound is stretched out, e.g. “Aaaaaaaaaaand I want that one”.

● He tries to speak and no sound comes out.

● Eye blink­ing and gri­mac­ing while talk­ing.

A speech-re­lated prob­lem may be caused by oral im­pair­ment due to prob­lems with the tongue or palate.

It can also be caused by oral-mo­tor prob­lems whereby there is a prob­lem in the brain area linked to speech, mak­ing it hard to co­or­di­nate the lips, tongue and jaw to pro­duce sounds.

For lan­guage de­lay or dis­or­der, it may be as­so­ci­ated with other con­di­tions such as brain in­jury and autism spec­trum dis­or­der.

In ad­di­tion, speech and lan­guage prob­lems may also be caused by hear­ing prob­lems (com­monly due to con­gen­i­tal hear­ing im­pair­ment, chronic ear in­fec­tions or glue ear).

There is also strong ev­i­dence that excessive screen time (time spent on watch­ing TV or gad­gets) and lack of stim­u­la­tion can lead to th­ese de­lays.

They may also be part of de­vel­op­men­tal de­lay or in­tel­lec­tual im­pair­ment.

Early de­tec­tion and early in­ter­ven­tion is the ut­most pri­or­ity for speech and lan­guage de­lays.

A wait-and-see at­ti­tude can be detri­men­tal to the child’s fu­ture.

Dr Lim Boon Chuan is a de­vel­op­men­tal pae­di­a­tri­cian. This ar­ti­cle is cour­tesy of the Malaysian Pae­di­atric As­so­ci­a­tion’s Pos­i­tive Par­ent­ing pro­gramme in col­lab­o­ra­tion with ex­pert part­ners. For fur­ther in­for­ma­tion, please e-mail starhealth@ thes­ or visit­pos­i­tive­par­ent­ The in­for­ma­tion pro­vided is for ed­u­ca­tional and com­mu­ni­ca­tion pur­poses only and it should not be con­strued as per­sonal med­i­cal ad­vice. In­for­ma­tion pub­lished in this ar­ti­cle is not in­tended to re­place, sup­plant or aug­ment a con­sul­ta­tion with a health pro­fes­sional re­gard­ing the reader’s own med­i­cal care. The Star does not give any war­ranty on ac­cu­racy, com­plete­ness, func­tion­al­ity, use­ful­ness or other as­sur­ances as to the con­tent ap­pear­ing in this col­umn. The Star dis­claims all re­spon­si­bil­ity for any losses, dam­age to prop­erty or per­sonal in­jury suf­fered di­rectly or in­di­rectly from re­liance on such in­for­ma­tion.

A speech (sound) dis­or­der is when a child has prob­lems pro­duc­ing speech sounds prop­erly at the ex­pected age, mak­ing speech dif­fi­cult to un­der­stand.

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