SPEECH

The Road to Mastering Sounds

BABIES ARE BORN to make sounds. In the beginning, that mostly means crying. But gradually, your baby will start to utter sounds that sound, well, human. Eventually, she’ll put these sounds together to make words. At first, those words may be ones that only you can decipher. Later, her words will start to sound like the speech of a preschooler. Eventually, as your child grows, she’ll start to pronounce her words just like you do.

There are two main components to your child’s communication. One is speech, the other is language. In this chapter, we’ll differentiate between the two and then focus on speech—what it is, how it develops, what you may be likely to notice about your child’s speech development as it progresses, the potential red flags your child may exhibit, and when and how you should address any of these problems.

WHAT’S SPEECH, ANYWAY?

You know all about speech and language because you use them every day, but you may not know the definition of each term. The two are often used interchangeably, but they refer to different things.

Speech describes the physical and motor movements needed to produce sounds and syllables and words and sentences. Think of it this way. Speech involves air flowing up from your lungs through your voice box or larynx, and then moving your jaw, tongue, and lips to create sounds. Language is what the sounds mean or represent.

To illustrate these two concepts, let’s take a sentence that Henry, a three-year-old boy, tells his mom: I wike ice cweam.

Makes perfect sense, right? Henry built a sentence that followed the rules for ordering words correctly in English, included sounds we use in English all the time, and expressed a particular meaning that would be understandable to all English speakers. Without even knowing it, Henry used language to express his thoughts—he likes ice cream!

But the way that Henry uttered some speech sounds—his pronunciation—was different from how an adult would do it. He made a w sound instead of an l sound in the word like. And he made a w sound instead of an r sound in the word cream. If an adult said those same words in the same way, it wouldn’t sound quite right. But Henry’s speech sounds like a typical three-year-old child.

One important characteristic of speech development is that the way children make certain sounds varies considerably with age. What we might consider a mistake for an older child would be perfectly appropriate for a young learner. Henry’s speech would actually be quite precocious for a two-year-old, whereas for a five-year-old it might be cause for concern. But for a three-year-old, he’s pronouncing the words just as he should be.

HOW DOES SPEECH DEVELOPMENT HAPPEN?

One rule of growing up very much applies to speech development—it’s gradual. In the pages that follow, you’ll see that process of speech and sound development.

Babies practice their speech skills long before they say real words. Their speech then continues to develop and progress for many years after they utter those first words and start to form rudimentary sentences.

You might think of your child’s first year as a big rehearsal for the second year, when he will actually take sounds and string them together into recognizable words. The second year, of course, is a rehearsal for the third, when his speech will start to become comprehensible to all sorts of people, from caregivers to peers to strangers on the street.

It takes several years for children to figure out how to correctly say all the sounds we use in our speech every day, whether we’re speaking in English, French, Mandarin, or Swahili. But this doesn’t keep children from trying, which is why you get all sorts of cute and silly word pronunciations from toddlers. Among our favorites, taken from our own kids: ganks instead of thanks, wove instead of love, and pida instead of pizza.

Typically, children master all the speech sounds of their primary language by the time they are in the second grade, around age 7 or 8. As with everything having to do with childhood development, even typically developing children frequently experience bumps along that very long and windy road to big-kid land. We’ll explain what this road looks like for a typically developing child, and you can figure out if that’s a road your kid is on. If it isn’t, we’ll provide some tips for you to get her to a good place.

MOVE THAT MOUTH, BABY!

For babies and toddlers, learning to talk has a lot to do with motor development of the mouth—just as learning to walk has a lot to do with motor development of the arms, legs, and trunk.

Fine-tuning the motor skills of the mouth takes time. When babies learn to walk, they usually achieve a lot of milestones in between (rolling over, sitting up, scooting, crawling, and cruising). When babies learn to talk, they have a long journey before their jaw, mouth, tongue, and lip muscles are fine-tuned enough to make many of the sounds that we use to put together to form words. This period of speech development is characterized by mastery of some sounds as well as the gradual ability to say others.

In newborns, the jaw, tongue, and lip muscles are immature. While they are perfect for their age and size, babies aren’t able to make adult-quality speech. They haven’t developed the crucial fine-motor and coordination skills yet to make the sounds that adults or big kids make effortlessly every day. And let’s be honest—they haven’t had a lot of practice making the human sounds we make, either.

Speech requires your baby to coordinate three systems in her tiny body.

First, there is the physical action that babies (and all humans) make with their mouth, jaw, tongue, and lips to form words. Speech and language specialists describe this complicated ballet of the jaw, tongue, lips, and the soft palate as articulation.

Second, babies also need to practice phonation, or vocal cord vibration. This allows them to make certain speech sounds, like the z sound, as well as vowels.

Third, babies use their respiratory system when producing speech. We need to take in a breath, and we talk while exhaling. When they are just born, babies are concentrating on using their lungs just to stay alive. But eventually, they need to figure out how to coordinate their respiration with their articulation and phonation so they can breathe and talk all at once. It’s easy for us. Not so easy for little tykes.

BABIES ARE CONSIDERED to be universal speech perceivers, meaning they can hear the difference between speech sounds that are in the language they are exposed to (such as English) as well in languages they have never heard before. Researchers such as Peter Jusczyk and Patricia Kuhl have found that babies lose the ability to perceive differences in speech sounds that are not in the language they are exposed to by the time they have reached their first birthday.

This means that babies can learn the speech system of any language starting at birth. But as they get older, they become more sensitive to the speech sounds they hear every day, they pay attention to those sounds, and they block out sounds that are not important.

LET’S LOOK AT DEVELOPMENTAL MILESTONES
IN SPEECH DEVELOPMENT

Babies all around the world develop their speech in the same way. Whether your baby is born hearing Spanish, English, or Russian, her speech sound milestones (again, different from her language milestones) are going to be the same.

Scientific researchers such as John Locke and Carol Stoel Gammon have observed what babies say when they make speech sounds, and they have found that all babies, no matter what language they are exposed to, follow a similar path of speech sound development. All babies, in their first year of life, will produce similar sounds when they babble. This is because they say sounds that are easiest to produce—usually the b, d, and m sounds.

While it’s true that babies the world over follow a similar path in their development of speech milestones, we want to emphasize that the keyword is similar: No two paths are identical. Typically developing babies will begin to say certain sounds—with and without meaning—within a similar time frame.

Now, we’ll take you through the journey of those first few years of life—from the first cries of your baby to the smooth-talking words of a kindergartner.

FROM 0 TO 2 MONTHS

Babies produce reflexive, or involuntary, sounds such as cries (sorry, Mom and Dad—expect a lot of them), grunts, coughs, and burps. They also produce other sounds and noises during feeding called vegetative sounds. These are your baby’s way of telling you what his needs are. His vocalization may be telling you, I’m hungry, I’m tired, or Yum, that tastes good.

Your baby will spend a lot of time crying in his first two months. But all of this crying is not for nothing: These cries, although reflexive in nature, do have communicative functions. For example, a baby’s hunger cry is different from his tired cry, which is different from his discomfort cry.

And as if they weren’t loud enough during their waking hours, it is not unusual for babies to be really noisy in their sleep. Those grunts may come out a lot at night, so if you feel like you are sharing a room with a baby piglet, that’s okay—it simply means your little one is practicing the movements needed to make more sounds.

All these sounds that your baby makes are related to the size and shape of his or her mouth. When children are first born, their tongues fill up the majority of their mouths, leaving little room to move it to make speech sounds. Your baby also has sucking pads, or fatty deposits in her cheeks, which helps her to extract liquid when drinking. So the kinds of sounds that babies make when they are very young do not resemble adult speech sounds—or even the sounds that an older baby makes.

FROM 2 TO 4 MONTHS

Your baby should begin to make his first cooing sounds. These are vowel-like sounds such as oohs and aahs. Babies this age also make lots of gurgling sounds. Because they are still unable to sit upright by themselves, your baby will spend a lot of time on his back, and his tongue will fall to the back of his mouth. So expect a lot of sounds like grrr and other guttural sounds—or sounds made in the back of your throat.

As the cooing picks up, your baby will eventually begin to laugh. A baby’s first laugh is often like a pitched cry of glee, rather than an outright giggle. Do your best to elicit it from your child—in other words, try to engage your baby by doing the kind of ridiculous acts that might get a good laugh out of him. (True fact: Whenever she wanted her kids to laugh, Carlyn sang the Beatles song “Yellow Submarine.” Worked every time.)

There is some more good news at this age: At around 12 weeks, the frequency of a baby’s crying usually decreases. This tends to make Moms and Dads very happy. It also means your baby should have more time to practice his cooing skills.

FROM 4 TO 6 MONTHS

Your baby will start to discover her voice. These can be fun times. You’ll hear loud cooing, soft cooing, medium cooing, and all sorts of extremes in loudness and pitch. You’ll hear squeals and yelps and high-pitched and low-pitched sounds. When you drop something on the floor, you may hear your baby react with a yelp or a giggle. You may have an amateur opera singer in the house, testing her scales throughout the day.

You will also hear vowel sounds (such as a and eh) as well as some consonant sounds (such as d and b). The consonant-like sounds are likely to be sounds made in the back of your baby’s mouth.

FROM 6 TO 9 MONTHS

Your baby will learn a new, big, important skill: babbling. Your baby has begun to string consonant and vowel sounds together.

There are two kinds of babbling your baby will perfect:

1.Reduplicated babbling is what you’ll hear when she says the same consonant-vowel pattern over and over, such as babababa or mamamama.

2.Variegated babbling is what you hear when she varies the consonant-vowel pattern, such as badaba or wadaba.

Your baby’s physical development helps her to begin babbling. At around 6 months, most babies begin to sit upright, unsupported, and now have more room in their mouths compared to when they were newborns. Your baby’s tongue no longer fills up her entire mouth and her sucking pads have dissolved. Now, she has more motor control over her jaw, tongue, and lips, which allows her to make some new, adult-like speech sounds.

All babies, no matter what language they are exposed to, will produce similar sounds when they babble. Remember, they say sounds that are easiest to physically produce. These sounds include the consonants m, b, d, and n and short vowels e, a, i, o, and u.

Some babies may start babbling a bit earlier than 6 months and others a bit later, but if your baby is not babbling by 8 months, it may be time to think about what’s going on. Is she really perfecting her motor skills? Is her hearing okay—does she respond to loud noises? Does she have an ear infection? Check in with your pediatrician if you aren’t hearing any babbling by this time; meanwhile, keep engaging with your baby. Some Simple Things to Do are provided later in this chapter, so consult that section.

THERE IS A lot of research that suggests so-called prelinguistic sounds, or the sounds babies make before they really start talking, are very important for later language development. Some noteworthy scientific studies show that the more sounds babies make when they are infants, the better the language skills they have as children. Here are some things scientists know about prelinguistic sounds:

•The more sounds a baby makes at 3 months, the bigger her vocabulary is likely to be when she is two and a half years old.

•The more mothers and fathers respond to infant vocalizations, the more infants vocalize.

What should you do at home? Encourage babbling and vocalizations. Respond to your baby’s sounds, even if they don’t seem to be meaningful. This will inspire him to vocalize again.

FROM 10 TO 12 MONTHS

Babies shift into a new phase. They start to speak in what speech and language specialists call jargon. Remember the Swedish Chef character on The Muppets? In nonscientific terms, babies sound like the Swedish Chef, putting together consonant-vowel combinations that have all the intonations of your speech. But these sounds don’t actually mean anything—yet. Your baby will sound like she is talking to you, telling you what she wants or sharing a long story. (Carlyn was always pretty sure her sons were sharing their opinions on world politics.)

Practicing sound combinations is how babies get ready to say real words. The more they practice, the better they get. While they are in this jargon stage, they will continue to produce babble, as they had before, but they are now experimenting with putting sounds into more complex combinations.

We know—you’re busy. So, in Figure 2-1, we have presented some of the key milestones for your baby’s first year. In the rightmost column you can check off when your child makes these sounds and the age when you first notice them.

Figure 2-1. Prelinguistic vocalizations.

WELCOME TO ONE

Congratulations! Your baby has celebrated her first birthday. Guess what? This means that she is starting to enter a whole new territory as a talker. It means she is moving to the land of words.

Around age one, babies start to say their first words. Notice that we say “around” age one. Do not worry if your baby’s first birthday comes and goes and she doesn’t have a word yet. We’ll get to the topic of typical milestones for first words in Chapter 3, but as with everything having to do with childhood development, we are talking about a range here.

Speech development is very much related to language development. Research shows that the more sounds babies produce in babble, the more words they will have, and the more practice babies and toddlers have saying speech sounds in their words, the easier it will be for them to say new words.

When babies start to say their first words, the sounds are similar to the sounds they have been practicing as they babbled. For example, if a baby frequently says bababa in his babble, it’s likely that his first words will contain a ba sound, and he might be partial to words like baba for bottle or ba for ball. In contrast, a baby who said ma a lot in his babble might start saying words like mama for mommy or mo for more.

Over the next six months, babies gradually add more and more words to their vocabularies, and the sounds in these words are likely to be the ones they practiced the most when they were babbling and jargoning up a storm. This means you will probably hear a lot of words that begin with ba, ma, and da.

As your one-year-old continues to practice speech, you may notice that she may prefer words with the same sound. Dr. Michelle’s first daughter had many first words with the h sound: hat, hot, hi, hop, and Heather (her favorite aunt). Dr. Michelle’s second daughter was quite partial to the b sound, and her first words included book, ball, bus, and bye-bye. However, you may also hear your child form a new sound or word and then not use it for a while. That’s common and totally okay.

HAVE A HARD time understanding your toddler? You’re not alone. The term to describe how well you can understand someone is called intelligibility. As your child grows, his intelligibility improves.

FROM 18 TO 24 MONTHS

Toddlers become better and better at communicating. They use real words, but also rely on gestures (such as pointing) and vocalizations (such as saying eh-eh-eh!) to get their needs met.

Most children experience a vocabulary spurt during this time—when they add new words to their repertoire each week.

This vocabulary spurt is matched by a speech sound spurt. To keep up with all those new vocabulary words, kids add more speech sounds to their repertoire. Children this age will continue to use the speech sounds they practiced during babble and jargon as well as their first words, but you might also start to hear new sounds such as f, w, and h. You may also hear your child using short, simple words that contain these sounds, such as hat or fish and maybe some variation on water.

Even though kids this age are starting to be able to say new sounds, they still can’t say all the sounds and syllables that adults use every day in their words. But, somewhere deep down, they must know this, and so they start to come up with some pretty clever ways to basically substitute their own sounds and patterns for what they might hear from their parents, caregivers, older siblings, or other kids at daycare—but can’t yet say themselves. Speech and language specialists refer to these efforts as phonological processes.

Here are some common things toddlers do at this age as they use their new ability to make sounds into words but still confront limitations in what they can say:

They repeat the first syllable of a two-syllable word, so bottle becomes ba-ba, water becomes wa-wa, and raisin becomes rai-rai. Specialists refer to this as reduplication.

They lop off the final consonant of a word, so cup becomes cu, car becomes ca, ball becomes ba, and night-night becomes nai-nai. Specialists call this final consonant deletion.

They delete a syllable that isn’t stressed, so banana becomes nana or Cheerio becomes i-o. Specialists call this syllable deletion.

They lop off a consonant from a blend of consonants, so blue becomes bu, truck becomes tuck, or school becomes cool. Specialists call this cluster reduction.

Of course, your child’s limits in speaking can sometimes cause frustration for your child—and maybe for you. One reason children this age can sometimes seem like they are on an emotional roller-coaster is because they so badly want to communicate all their needs—but can’t.

DON’T BE SURPRISED if it takes a little while to figure out what your 18- to 24-month-old child is saying. He’s just getting the hang of learning to speak. At this age, it is likely that his primary caregivers are the only people who can understand him. And it’s perfectly okay if you have no idea what your child is saying quite a bit of the time.

TWO-YEAR-OLDS

By now, you’ve surely observed that your toddler is entering her so-called terrible twos, a stage of development when a child’s behavior is particularly challenging. While this may make for some interesting times behavior-wise, it simply means that she is changing day by day, picking up new skills and testing her independence. One of the things she is working on is her speech skills; chances are your toddler is rapidly improving her ability with speech sounds. During this year, toddlers add more and more sounds to their repertoire, and their speech is likely to become much more recognizable both to parents and others. You might not find yourself acting as an interpreter when Grandma comes over.

Here are some things that kids between ages 2 and 3 will pick up:

They will start to say the end of words, so the 18-month-old who said ba will likely say ball, and ni-ni will likely be night-night by the time he’s around age 2.

They will start to say all the syllables in words, so a child who might have said nana as an 18-month-old can now start to say banana.

They will add more and more sounds to their repertoires and are likely to especially focus on perfecting the p, b, m, n, w, and h sounds.

Even as they are picking up new sounds, typically developing two-year-olds still struggle with certain sounds, and they do plenty of things to simplify their speech to make life easier for themselves and avoid saying the sounds that are tricky, just as they did when they were a bit younger. Here are some things typical two-year-olds do to adapt their speech:

They will make the first sounds in a long word more accurate than the later sounds. So water might be waa-er. Note that that’s a big improvement over wa-wa, which a child might have said when she was 18 months.

They may simplify sounds that are hard to say by saying a sound that is easier. For example, the s, sh, and th sounds are more difficult than the t sound, so you may hear tun instead of sun, to instead of shoe, and tank you instead of thank you. Specialists refer to this as stopping.

They will still have trouble with consonant blends, just as they did when they were younger. So your child may continue to lop off a consonant from a blend of consonants, so blue becomes bu. Or she may just substitute a sound that she finds easier to say, so blue becomes bwu.

As two-year-olds mature, they’ll gradually come to rely on these adaptive mechanisms less frequently and their words will sound clearer.

AS YOUR TWO-YEAR-OLD matures, you’ll be able to understand more and more of what he says. You can expect someone who is not with your child every day to understand about 50 percent of what your child says. Remember, her intelligibility—her ability to be understood by others—will improve as she ages.

If most people can’t understand about half of what your child says by age 3, you might want to consider checking in with a speech language therapist.

THREE- AND FOUR-YEAR-OLDS

By the time your child turns age 3, and then moves on up to age 4, she has graduated from being a toddler to being a preschooler. Think about how her speech reflects her new position in life; she’s now starting to talk more and more like a big kid and can communicate her ideas with words that are understood by other kids as well as teachers and other parents. Preschoolers can generally speak in full sentences and are continually practicing and improving their speech sounds.

Here are some things kids ages 3 and 4 should be able to do:

They should be able to say all vowel sounds.

They should begin to master other sounds, such as k, g, f, and v.

They should begin to master the ability to say new sounds, such as y and l.

Despite all their accomplishments, preschoolers will have trouble with some common sounds. You can expect them to:

Have trouble with the r and l sounds. These are really tricky sounds for three- and four-year-olds to say. Of course, some kids may master them early, but don’t be surprised if your four-year-old still has a hard time with these sounds.

Get tripped up with certain sounds in the middle of words. It can be hard for kids to coordinate their articulators (remember, the jaw, tongue, and lips) from one sound to another, which makes sounds in the middle of words or at the ends of words difficult. A child who has just gotten the hang of the l sound may be able to say lamp or lunch, but not balloon.

Have trouble with the j sound. Words like juice and jump might be hard to say.

Have trouble with consonant blends. Remember how your two-year-old couldn’t say blue? While some kids may have mastered consonant blends by age 4, if your child isn’t there yet it’s perfectly okay.

Have trouble with sh, th, and ch sounds. Words like shark or shoe, thumb or thank, or cheese or chicken may all be tricky for your kid. No worries!

BY THE TIME your child is age 3, you should understand most of what she says; by the time she’s age 4, you should understand pretty much everything she says.

Your child should become more and more intelligible to people other than parents and caregivers who see them every day. Someone like a friend or neighbor who is not caring for your three-year-old every day should be able to understand 75 percent of what she says. By the time your child is age 4, a friend or neighbor should be able to understand 90 percent of what she says. If your child is not there, it’s time to consult with a speech language therapist.

SCHOOL-AGE CHILDREN

By the time your child is a big kid and has entered kindergarten, she should be able to say most of her speech sounds. She may have trouble with certain sounds, like r and s, but for the most part, children this age have mastered all the speech sounds of the English language. Children who are ages 5, 6, and 7 may also have trouble with multisyllabic words, like spaghetti or kindergarten, and may also be using some phonological processes (those systematic ways to simplify speech) in order to say these difficult sound sequences. For example, consonant blends are hard to say, so many times children insert a vowel between two consonants, saying things like balue instead of blue, or gareen instead of green.

At this age, it is important that children can say all or most of their speech sounds accurately, because they will soon be learning their letters and letter sounds, one step in the process of learning how to read. Figure 2-2 shows the mastery of all the consonant sounds in English and the age at which most typically developing children have mastered the sound.

Figure 2-2. Speech sound mastery.

SOURCE: Adapted from Janet Barker Fudula, Arizona Articulation Proficiency Scale, Third Edition (Los Angeles, CA: Western Psychological Services)

RED FLAGS

What to Look Out For and When

Not all kids master their speech milestones right on time. But the good news is that with a little help, you may be able to catch some of these issues early.

Dr. Michelle has identified the top eight red flags that she’s noticed over her years as a speech language therapist:

1. If your baby is not babbling by 8 months: You want to be hearing those babas, mamas, or dadas. Remember, these sounds don’t have to mean anything—in fact, they often don’t—and your baby need only be saying one vowel-consonant sound combination to meet this milestone. But if he isn’t babbling yet at this age, consult your pediatrician or healthcare provider.

2. If your baby is not producing jargon by 12 months: Your child should have perfected the art of talking like an adult—but with words that have no meaning. It’s okay if your baby doesn’t say any real words yet, but you should expect him to be stringing speech sounds together.

3. If your baby is not saying two to three words that contain a couple of different sounds by 16 months: There is an age range at which children begin to say words, but we expect them to say a handful of words by 16 months. These words should contain two to three different speech sounds. If your baby consistently says something along the lines of mama, dada, up, and baba, she’s all set. If your child is not saying any words by 16 months, check in with your pediatrician.

4. If you can’t understand at least half of what your two-year-old is saying: Sometimes it seems like your two-year-old is saying something with perfect authority, but you have no idea what it means. That’s fine—it can be hard to decipher all of your child’s words. But if you can’t understand about half of what she says, you should monitor her; if you still can’t understand about half of what she says at two and a half, you might consider getting a speech evaluation. See Chapter 8 for more details.

5. If you can’t understand most of what your three-year-old is saying: Then it’s really time to look carefully at his speech development.

6. If your preschooler is not saying her k and g sounds by age 3½: These are difficult sounds for kids to make. Both the k and g sounds are made in the back of your mouth and are harder to say than those sounds made in the front of your mouth, like t or d. However, by the time a child is age 3 ½, she should be saying those back-of-the-mouth sounds.

7. If your child doesn’t improve her speech patterns every six months, starting at one year of age: By age 4, she should have acquired most of her speech sounds.

8. If your school-age child is not saying s, r, and l sounds or sound blends (like bl, st, tr) by age 6: These sounds are difficult to say and are late to be mastered, but by the time your child has completed kindergarten, he should be able to say them. Why? Being able to accurately say speech sounds is important for literacy development. Also, the longer a child says speech sounds a certain way, the harder it is to change. If your child has not developed these sounds on his own, it’s a good idea to give him some extra help by consulting a licensed speech language therapist; we’ll give more tips on how to find a great therapist in Chapter 8.

COMMON QUESTIONS,

EXPERT ANSWERS

Having been a speech language therapist to children for 15 years, Dr. Michelle has fielded a lot of questions from parents about their kids. One thing she has learned is that her answers to questions vary greatly depending on the child. Keep in mind that difficulty saying certain sounds may be developmentally normal for a kid one age, but for a child two years older it may signal an issue. Here are some of the most common questions Dr. Michelle gets from parents, and her tell-it-like-it-is answers.

QUESTION: My child has had multiple ear infections. Will this affect her speech development?

ANSWER: It may. Some ear infections can cause hearing loss, which in turn can affect speech development. See Chapter 1 for more information.

QUESTION: Are there any mouth exercises that I can do with my child to help his speech development?

ANSWER: No. Current research suggests that mouth exercises like moving your tongue back and forth, blowing, and practicing lip rounding (puckering) do not on their own improve the ability to make certain speech sounds. What improves the ability to say the right sounds is practice. In fact, that’s what Dr. Michelle does in her daily work with kids—she gets them talking and talking.

QUESTION: My five-year-old still struggles with the r sound. Is this normal?

ANSWER: Absolutely. Kids master the r sound late because it is difficult to produce. It takes many years of practice to say this sound correctly. About 90 percent of six-year-olds can say their r’s correctly in all or most contexts. If by the time your child is age 6 she isn’t saying it correctly, it’s time for her to get an evaluation from a speech language therapist. Consider it something to do over summer break or as fall approaches.

QUESTION: My pediatrician recommended that my son get an evaluation from a speech language therapist—as well as from a feeding specialist. What’s the connection?

ANSWER: Some speech language professionals also specialize in feeding issues because children with motor delays may have problems eating properly as well as saying their speech sounds.

QUESTION: Will extended use of a pacifier affect my child’s speech?

ANSWER: It is very possible, though not definitive, that extended pacifier use and/or thumb-sucking may influence the development and production of certain speech sounds because it affects dental arrangement. When a child has a pacifier in his mouth, he is not practicing his speech sounds and he’s not honing his ability to say new words. Common sense tells us that kids who have things in their mouths much of the time are not getting a chance to practice their speech and language skills. The answer is to ditch the pacifier by age one, especially during the daytime.

QUESTION: My child has problems with some speech sounds. Does this mean something is wrong with her dental arrangement?

ANSWER: Sometimes yes and sometimes no. If your child has missing teeth, she may have trouble with certain speech sounds. Of course, every kid is going to lose her front teeth and may go through a period where certain sounds like s are a little off. That should go away once her permanent teeth grow in. If your child has teeth extracted when she is young—usually the result of poor dental care or a playground accident—her speech may be more permanently affected, depending on what teeth came out and when. Poor dental care can occasionally affect a child’s speech development. Work on your child’s dental care. Brush her teeth twice a day and don’t let her fall asleep with a bottle or sippy cup in her mouth.

A PARENT’S PERSPECTIVE

Gabe’s Story

Discovering and identifying a speech delay does not happen in a day. Take the story of the parents of Gabe, a three-year-old from Brooklyn, New York. As a baby, Gabe was lovely—happy, low-key, the kind of infant who cried only when he was hungry or tired. As Gabe got bigger, he seemed to do all the things other little kids did. Gabe’s dad, who stayed home with Gabe while his mom worked, took him frequently to the playground, library, and play-dates, so he had plenty of chances to observe kids the same age. When Gabe was 18 months, his dad noticed that while other kids were saying a handful of words and even short sentences, Gabe was not saying much. Gabe’s parents also had a hard time understanding what he was saying. Gabe would stand by the fridge in the kitchen and point, saying eeeeee, which his parents finally understood to mean milk.

At his 18-month checkup, Gabe’s pediatrician said he seemed fine. But at Gabe’s two-year appointment, his parents pressed the pediatrician and she recommended Gabe get a speech and language evaluation. The speech language therapist observed that Gabe had difficulty saying words that came easily to other two-year-olds, such as mommy and ball. Over the first few months working with a speech therapist, Gabe began to master sounds like b, p, d, n, m, and h. By age 3, he was starting to get closer to matching his peers.

“It took a year for him to say fire truck,” said Gabe’s dad. “It took a year for people to really understand him.”

A tip from Gabe’s parents: Especially with firstborn children, identifying a speech delay can take a long time. It’s often something you gradually notice about your kid.

A COMMON CONCERN:
ARTICULATION DISORDER

It’s important to look out for any of the red flags (discussed previously) in your child. All children, of course, experience typical variations in speech development, but some children may have particular difficulty mastering certain aspects of speech; when they have these difficulties beyond the point that most of their peers have mastered them, Dr. Michelle recommends dialing up a local speech language therapist.

The most common speech-related concern is an articulation disorder—a bit of a catchall term involving a difficulty with the motor processes needed to produce speech in a precise and efficient manner. (Chapter 7 discusses some less common speech-related disorders, including apraxia and dysarthria).

Children with an articulation disorder usually have trouble saying one or more speech sounds. Moreover, they consistently have trouble with those sounds—in words, in complete sentences, and even on their own. Specialists don’t exactly know why some kids experience articulation disorders and others don’t, but a systematic review of the scientific literature conducted by James Law, a professor of speech and language sciences in Australia, and his colleagues in 1999 estimated that as many as 25 percent of five- to seven-year-olds have an articulation disorder. So if your child has one, he’s in good company!

Here are some common articulation disorders:

Children who lisp. They have trouble saying certain sounds such as s, z, or sh, and they distort those speech sounds each time they use them in words. When a child has a lisp, he is having trouble articulating the sound—he is not moving his articulators in the correct place or sequence in order to say the sound in the same way an adult does. Lisps are common for children under age 6, but if your child is older than that, Dr. Michelle recommends looking into speech therapy to remedy a lisp.

Children over age 7 who have trouble making the r, l, and th sounds. A child who does this consistently may make sound substitutions (saying wed instead of red) or sound deletions (saying geen instead of green).

Children over age 8 who have trouble saying consonant blends. Examples of errors in blends include sound deletions (back for black) or sound additions (balack for black).

Speech therapy, likely for a period of six months to several years, may be the solution to an articulation disorder, depending on the severity of the articulation issues. You will work with a speech language therapist to help your child practice saying speech sounds in words. Your child should practice the same things she learns with the speech therapist at home, too. Practice makes perfect.

SOME SIMPLE THINGS TO DO AT HOME

Every parent can do a little bit to help their child learn new speech sounds and improve the ones she might need to do some work on. This is, of course, as true for typically developing kids as it is for kids with diagnosed conditions. Children learn from their parents and their caregivers, which is why they need your help! So be sure to try Dr. Michelle’s tips at home!

BABIES

Encourage vocalizations and babbling. The amount of babbling a baby makes has a direct correlation to the child’s language skills later on. How do you encourage babbling?

Respond by looking at your baby and talking back when she babbles or vocalizes. This will encourage her to babble again.

Take turns to keep the conversation going. Respond after she vocalizes and wait for her to vocalize again. This helps her practice her language skills, which we will discuss more in Chapter 3. For example, after your baby says babababa, say, Do you see the bottle? That’s right, here’s the bottle.

TODDLERS AND PRESCHOOLERS

Once your child is older, he is talking in complete sentences, but he is not necessarily saying all his speech sounds correctly. That’s okay; he still has plenty of time to perfect his sounds, and the more he practices, the better he is going to get. Remember that there are many speech sounds that he likely can’t say. Don’t worry—he will be making them before you know it. If there are some sounds that you think your child should be saying but is still having trouble with, try to get him to imitate your speech:

Have your child look at your mouth while you are speaking to her. Young children, starting at age 3, can look and learn where the articulators go.

Use play to practice speech sounds and incorporate it into your everyday routine.

•If your child is having trouble with the k and g sounds, then practice saying those sounds when playing. For example, take a toy farm and say the words cow, goat, goose, and cock-a-doodle-doo (and stress the k and g sounds when you say the words). Then ask your child to repeat these words after you say them.

•If your child is having trouble with the b or p sound, get him to say beep beep beep while playing with cars. Or practice pop pop pop and bubble while playing with bubbles.

•You don’t need a specific activity to work on speech sounds. Just practice saying speech sounds in words with your child while playing with her. It will be fun for you and your kiddo.

KINDERGARTEN TO FOURTH GRADE

If your school-age child is having difficulty with one or more speech sounds, try to practice these sounds at home. Older children may have more awareness of their speech, so you might be able to talk with them more openly about their articulators and where to place them for certain sounds.

Sometimes, a child simply needs these things brought to her attention and then she can correctly say the sound in words. For example, saying “that color is not wed, it’s red” may be enough for a child. At other times, children need much more practice in order to correctly say speech sounds, especially those that are tricky, like r, s, and th sounds.

First, talk about how to say the speech sound, explaining where your tongue and your lips go. For instance, if you are practicing the th sound, ask your child to look in the mirror and watch her tongue go between her upper and lower teeth.

Say the sound first, then have the child try.

Practice listening for that sound in words and sentences and talk about what letter or letters make that sound.

Practice these sounds in your everyday routine. If your child has a classmate named Ryan and you are practicing the r sound with your child, you may try saying his name in sentences and talking about what he did in school.

RESOURCES

We know—you really have more questions about your child, and you figure you can just handle it all by consulting Dr. Google. But it’s hard to navigate all the information that is available on the internet. So we want to recommend information from websites that are up to date, accurate, and grounded in the latest science. Dr. Michelle has two favorite sites to recommend; both contain special pages on specific topics that are intended for parents:

The American Speech-Language-Hearing Association (ASHA), the primary professional organization of licensed and certified speech therapists, has resources for parents, caregivers, and professionals: www.asha.org.

•One page has information about typical speech and language development: http://www.asha.org/public/speech/development/.

•Another page has information about speech disorders: http://www.asha.org/public/speech/disorders/speechsounddisorders.htm.

The National Institutes of Health (NIH), the federal agency that provides research on health matters, and a division of NIH called National Institute on Deafness and Other Communication Disorders (NIDCD) both have basic information about speech disorders:

•The NIDCD’s home page provides some helpful information on the latest scientific research on speech and hearing disorders: www.nidcd.nih.gov/Pages/default.aspx.

•You will also find information about typical speech and language development on a specific page devoted to the topic at: http://www.nidcd.nih.gov/health/voice/pages/speechandlanguage.aspx.

•For information about speech disorders, see: http://www.nlm.nih.gov/medlineplus/ency/article/001430.htm.