Children’s Speech: When Should a Parent be Concerned? – Part 1

Note

The following discussion of speech disorders, the first of a two-part series, has been written using a minimum of professional jargon. Speech sounds are referred to by the letter or letters most commonly used to represent them according to American usage. The basic principles outlined apply to speakers of all dialects and languages, though the developmental scale suggested for the acquisition of speech sounds is specific to standard American English.

Angela is a talkative seven-year-old with an endearing lisp. Even though her permanent front teeth have grown in, Angela still pronounces some words like she did when her baby teeth fell out. Her mother wonders if she should be concerned.

Five-year-old Robert likes to talk a lot, too, but he is hard to understand. Family members usually understand his unique pronunciation of words, but people who don’t know him well are often uncertain about what he is saying. This is frustrating to him. He is frustrated by school, too. He wants to learn to read, but he can’t remember which letter makes which sound.

Stephen’s parents have noticed that sometimes he has a hard time getting his words out. For weeks at a time his speech will seem normal, and then he begins “tripping” on words. His parents want to know if this is stuttering.

Problems indicating possible need for speech remediation:

The child is frustrated in his oral communication.
He is difficult to understand.
His speech is the object of amusement to others.

In home countries, there are many resources to which parents could turn. But what can a parent do whose family is living in an isolated location? With some patience, an informed parent can do a lot.

The types of speech problems most likely encountered by field teams do not require the attention of a specialist. Even parents of children with cerebral palsy or cleft palate can carry out a program of therapy detailed by a cooperating speech therapist.

What qualifies as a speech problem?

If a child is frustrated in his oral communication, if he is difficult to understand, or if his speech is the object of amusement for others, he probably would benefit from remediation.

What specifically should I look for in my child’s language and speech development?

Language

Most child development books outline the milestones of language acquisition. If your child is unusually delayed according to those norms, you should speak to your doctor.

It is important to remember, however, that language acquisition is hard work, even for a child. Many young children have a period of rapid physical development accompanied by little growth in the area of language, or vice versa. In most children, the overall development eventually evens out. In addition, parents of children who are growing up in a multi-lingual environment should remember that "mixing" of the languages is a very normal part of language development. Children growing up in a multi-lingual or bilingual environment are learning when to use each language at the same time that they are learning the content of the language. Eventually their brains will sort things out.

Occasionally a baby who is otherwise developing normally stops babbling and experimenting with sound. This is a warning of possible ear infection which could result in hearing loss. The child should be examined by a doctor.

Fluency

Speech fluency is easily monitored by the parent. Most children go through a normal period of dysfluency between the ages of three and six. Many stuttering problems begin at this time when an anxious parent draws attention to the dysfluencies and interrupts the child’s attempts at communication. The best approach to a stuttering problems is patience, acceptance, and an attentive ear. If the dysfluencies become a noticeable problem (using the definition of a speech problem stated earlier), then additional help may be warranted.

Pronunciation (Articulation)

The most common speech deviation that parents notice is pronunciation. When listening to your child’s pronunciation, note:

the sounds he has problems with (i.e., sounds made with the lips, teeth, tongue, etc.)
the position of those sounds in a word (initial, medial, or final)
the frequency/consistency of misarticulation.

These observations can help you determine the severity of your child’s speech problem and whether he is developmentally delayed in this area. Sounds which are made toward the front of the mouth (such as m, n, p, b, t, d) are the easiest to make. They are usually acquired first. Sounds requiring special placement of the tongue (l, r, s, voiced th) are the most difficult.

Usually, sounds in the initial position of words are the easiest, followed by sounds in the final position. Consonants which appear in the middle of words are the most difficult. Any sound which occurs in a “blend” is particularly difficult to pronounce.

Consistently mispronounced sounds are a concern as the child gets older. However, if he pronounces a sound correctly some of the time, he may be moving toward standard pronunciation on his own. Most children develop standard speech by the age of six, although some children still have problems pronouncing the more difficult sounds at age seven or eight.

A loosely-drawn developmental scale for standard American speech production would look something like the following:

By age 3 — vowels p, b, m, n, d, g, h

By age 4 — k, t, th, f, v, ng, j, ch

By age 5 — sh, zh

By age 7 — l, r, s, th

A comment about vowels. Among English speakers, differences in vowel production are usually considered dialectic rather than misarticulations. It is possible, however, to have a nasal or “gravelly” voice quality that is magnified during vowel production. This type of problem should be referred to a speech therapist or physician for consultation.

Voice

Voice disorders are not usually identified by parents because they are accustomed to the sound of their child’s voice. A voice problem may be noticed first by a family friend or teacher. An unusual-sounding voice can indicate physical problems which should be investigated by a qualified physician. Listen for an unusually high or low pitch, pronounced nasality, or a chronically scratchy or gruff voice quality.

Can children outgrow their speech problems without intervention?

As they are learning to talk, all children go through an unconscious self-correction process. They are constantly receiving new language information and adjusting their use of previously-acquired language in order to communicate more clearly. Parents can observe this process in action as they watch their preschooler become more precise and fluent in his verbal expression each successive year.

When standard speech is used in the home and children have plenty of opportunity for interactive communication, most naturally develop standard speech patterns by school age. For some children, however, the usual exposure is not sufficient.

If a child is of school age and the parent is concerned about some aspect of his language, it is quite possible that he or she would benefit from some sort of therapy program.

How can I tell if my child’s speech development is following the usual pattern?

This is where an observant parent has the advantage over a professional speech therapist. Parents can watch their child’s speech development over time and note improvements. If the child’s speech is improving from year to year, then it is likely that he will eventually use standard speech.

Watch your child’s learning curve as he acquires spoken language. If he started talking later, then it is likely that he will also put the finishing touches on his speech at a later stage of development. Parents should watch their child’s:

general use of language
rhythm (or fluency) of speech
pronunciation of words.

Besides voice disorders, are there other speech problems that should be referred to a physician?

If your child has multiple errors in articulation, it would be wise to have a qualified medical person check to be sure there is no chronic ear infection which can impair hearing. If auditory screening is available, it would also be good to have the child’s hearing screened. An oral examination to identify possible irregularities in the structure of the child’s mouth is also warranted.

Reprinted from April 1993 issue of Parents Teaching Overseas. Used with permission.

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Note: the opinions expressed in submitted contributions below do not necessarily reflect the opinions of our website.

Reply
"oneida", Fri, Apr 11, 2008 20:01 (CDT)
i have a two year old boy wiyh a speech problem

i have a two year old boy with a speech problem.

Reply
"Kent Ingram", Wed, Nov 25, 2009 11:18 (CST)
Re: i have a two year old boy wiyh a speech problem

I have a 26 month old granddaughter who uses only one to two words in a sentence. She has trouble forming her words. "I uv whoo "! Should I be worried?

Reply
"rajkunnath @aol.com", Tue, Dec 9, 2008 10:12 (CST)
my 10 year old dtr.

My dtr. Anitha is 10 yrs. She attends speech classes 2x/week in her school for the past 2 years. She is making only little improvement and this child is so frustrated and so tensed about her situation. Is there any computer programmes or any extra help I can give to this child? I am also an immigrant and my dtr. is a healthy child.She is going to undergo a phrenectomy,if this will benefit her..I am very worried to see my sweet girl so tensed all the time. Can you give us some input ? thanks for your time.

Raju

Reply
"Dawn ", Wed, Mar 3, 2010 12:23 (CST)
Re: my 10 year old dtr.

I would recommend she be seen/evaluated in an outpatient clinic at a children's hospital. If ENT or other consultative services are recommended, she can do everything there.

Reply
"sk", Tue, Feb 17, 2009 06:36 (CST)
Some words pronunciation problem for my son

my son is age of 5 and he has problem to pronunce some words starting from "s" or "th" or "dh" .. can somebody tell me the treatement for this problem.

Reply
"brainmap", Wed, Feb 25, 2009 14:19 (CST) [modified by wardl on Tue, Mar 3, 2009 17:05 (CST)]
Hope this helps

There are several programs to help train the auditory processing of syllables, when you refine the brain function and speed at which you comprehend language it in turn boosts your pronunciation, ease of speaking, and memory. http://www.scilearn.com/products/language-series/index.php is for younger kids and Posit science has an (expensive) 8 week program of auditory computer training that is designed for seniors but the principle is the same. Also there is a school in Canada that takes kids with learning disabilities and brings them up to around average. One of the techniques they use is tracing complex designs and letters ( think chinese, erdu, persian) that requires the use of fine motor skills...but it takes practice and focus to reap the benefits. This helps with speaking in a smooth, flowing manner..reading...and listening.

Reply
"babz`", Thu, Jun 11, 2009 11:00 (CDT)
five year old cant speak

my son can imitate anything you say, not accurately ofcos, sing any song on tv, but he can not verbally communicate. he says command words only, like give, go, no, hello, and when he does have a conversation with you, its in baby language.....i have taken him to doctors, and they just want to run further test as they cannot detect anything. They suspect autism, but nothing is autistic about him accept the fact that he wont talk. Help

Reply
"karen", Mon, Nov 9, 2009 21:18 (CST)
Re: five year old cant speak

It may be of help to try teaching him some American sign language. If he can learn to speak with his hands using signs, this would give you an important affirmation that he's able to correctly process and produce language, which may help you with the doctors. Also, it could give him an opportunity to communicate in a more complete way, which may lower his frustration level. There are often sign language books at the library, or you could order online.

Reply
"saskia", Sun, Apr 11, 2010 20:45 (CDT)
Re: five year old cant speak

I have the exact same problem actually my son is going on 5 and he uses 1-2 word communication ..he sees a car and say " car" ..he says alot of words kinda of clearly but he can't talk via sentence he talks in 1 word vocab ..he didn't even start saying thing untill he was 3 years old ..and he is slightly getting better very slowly ..it's frustrating as hell to him and me and his dad doctors say he's fine he's just slow to develop but im worried he won't be rdy for school ....he imitates everything you say quite clearly but im worried he doesn't understand the words you say to him ...he just repeats it all and it doesn't look as if he can "get " what your saying he can understand some very small things i say like " are you hungry" he thinks for a second then nods and says 'sure"

It doesn't help that he is very shy and quiet when he does talk ..and the other kids make fun of him i don't want him to become more introverted.

Reply
"bushra jabeen", Mon, May 3, 2010 07:03 (CDT)
Re: five year old cant speak

get behra test for him, he may be hard of hearing.Otherwise consult a clinical psychologist, he may be an austidtic child

Reply
"Zana Chipperfield", Wed, Sep 30, 2009 03:40 (CDT)
Toddler pronunciation

My 28 month old is happy, very bright and holds conversations well. I wouldn't be concerned about his inability to pronounce certain sounds, but I've recently noticed how he's the only child amongst his peers who's unable to blow into an instrument. I may not even have been concerned about this, but we had HUGE problems breast feeding which were never resolved and I now wonder if it's all connected (i.e. mouth/tongue formation). Anyone have an opinion on this?

Reply
"mama", Wed, Jan 6, 2010 09:30 (CST)
Re: Toddler pronunciation

Have you looked into having his tongue clipped? Can he lick an ice cream cone? You might talk to your doctor or an ENT if he can't stick his tongue out. Which might help. They want to do this to my 1 year old. Good Luck.

Reply
"Michaela", Wed, Dec 30, 2009 18:19 (CST)
Tongue tied?

I really don't know anything about speech and communication, but I have a friend whose son had trouble Breastfeeding and after it was missed for months it turned out he was tough tied. The small piece of tissue under his tongue (connecting to thebottom of his mouth) was too long (connected too close to the inside of his bottom set of gums). With a small in office snip the doctors were able to elongate the lift of his tongue and enable him to drink properly. Has your doctor checked this?

Reply
"Scott", Wed, Jan 27, 2010 05:28 (CST)
Diificulty reproducing sounds

Our 5 year old is working on her 2nd language. We live in Italy, but speak English in home. 4 months ago she started pre-school here, and while she understands Italian well, she has great trouble speaking it.

I noticed that when I sit down with her and clearly say a (simple) word, she has trouble saying it after me. When I add a second word, her pronunciation of the two is almost unrecognizable.

It seemed when she learned English that she had a lot of pronuciation trouble as well, and was slow to learn to speak well, although now her English is acceptably good.

Her hearing seems to be good. If I whisper from across the room (in English) she can hear and tell me what I said.

There seems to be a problem, but what could it be and where would we start to get help?

Reply
"jamal", Fri, Jan 29, 2010 03:32 (CST)
speech problem of 4 year old

my nephew is about 4 years old.just about a week ago he had a mild fever.before his fever he was able to talk and he sounded so sweet.but since he recovered from his fever he has started stammering in his speech.he is getting frustrated and stopping to pronounce the word he had started.we are worried.he was very talkative before that and now he has this difficulty which is a great pain for us. please guide.

Reply
"bushra jabeen", Mon, May 3, 2010 06:57 (CDT)
Re: speech problem of 4 year old

according to my knowledge, there is no connection between mild fever and stammering. If u heve noticed any type of fit during fever then their is apossibility of this kind of disorder.Otherwise there are some common resons,for example, he might be anxious for being absent from his school and he is facincing some academic difficulty or he might have getting undue attention during his ailment.

Reply
"lucy", Wed, Mar 17, 2010 05:05 (CDT)
ssli

my 5yr old has been diagnosed with specific speech and language impairment which is longterm disability, very little seems to be known about it, has anyone any info or experience with this

Reply
"tish", Wed, Mar 17, 2010 23:12 (CDT)
nasal-congested sounding speech

My 2 year old is an incredible talker but difficult to understand. In addition to not being able to make her "s" sound, she frequently makes letter sounds that are accompanied by a snotty/congested/flemmy sound. She's not one to have chronic colds or ear infections... it sounds like she does when she speaks though. Thoughts as to what this might be?

Reply
"Gloria Dye", Wed, May 26, 2010 01:58 (CDT)
My Dear Hannah

My Hannah is ten years old, and still today can not say a complete sentence ! We as her Parents have had her seen by Doctor's and they have told us several different things of her situation. We have had her to a Ear Nose and Throat specialist and they have told us to give her time and she would come around . This we find hard to believe, due to it's been ten years and it's been no better . We have had her hearing checked , we have had her to a psychiatrist family Doctor Health Department , doesn't matter all the same , just a different answer every time . We have just came to terms to just deal with what life throws at her although she cant seem to . It tough on her , it really is, to go to school and to have the other children laugh and point ,to make fun of her to have them call her a retard due to her not being able to not speak , only to mumble or mimic a sound . As for her speaking in a full word I have heard my daughter say mom ,dad,eat,that's about it. she has been taught some sign language but it's very rarely used where we are due to we have no one to teach us , and we don't understand her when she try's to tell us. She is very smart and I can tell when we are talking she focus 's on what we are saying , and she is really taking it in, as we go along, and she try's to join in so much but it's so hard for her to due to the fact that no one can understand her . Our family's wont let her stay the night with her siblings as well due to the fact they can not understand her and they do not want to hurt her feelings. So we are stuck in a war , a war to win our daughters voice , to get her freedom of speech ! I believe among all people that if anyone deserves it , she does , Why ? Why do I believe this ? The day she were born she almost left this earth , but she stayed , many times after that she fought to stay ,for a year my daughter wore a apnea monitor that monitored her heart rate and alerted us of her breathing , and when she wasn't , for some reason ..God let this child of ours stay and no where in my heart do I believe that it was to live with out a voice to be heard ! That mimic has a voice and that hear beats for a reason , I just haven't fount the right Doctor yet , and I believe that one day I will . If not then God will send Him/Her to Her ! Then her voice will be heard , I'm just counting those days , and when this day comes I can look at these other Doctors that cried to me and said that it was ADHD ,ADD, Cerebral Palsy,Down syndrome,Deaf in the left in ear 75% ,then OK five years latter . and just laugh at them and tell them you see she had a voice this whole time you just had to help her find it , it was lost like you at one point and time !

Reply
"suresh paul", Mon, Jul 5, 2010 03:10 (CDT)
speech problem

my daughter is 5 years she talks well but some words (sounds) like rhea, she pronounces it as ea,god as dod.kindly advice

Reply
"caroline", Tue, Jul 13, 2010 03:20 (CDT)
4 year old boy can't speak

My 4 year old boy has not said a word yet. his hearing was tested and was ok. He inderstands simple instructions. He is very quiet. 5 months ago he was assessed and said to have mild autism. My question is will he ever acquire speech?

Reply
"ehtisham", Mon, Jul 19, 2010 07:50 (CDT)
my 2- 1/2 year daughter

i have a two and a half year daughter,she is very playful and confident but she cannot pronounce words well ,e.g she would say lak tok instead of laptop, etc should i be worried , she cannot frame sentences , only 3 words at the max

Reply
"Leah", Tue, Jul 20, 2010 10:43 (CDT)
General Answers

Hi Everyone! I am a Speech-Language Pathologist and I just wanted to give a quick and general answer answer to you all! Speech sounds should not be too much of a concern until after 3 years. Kids are often only 50% intelligble at 2 years and often do not hit the 75-100% intelligibilty mark until 3 or later. Some sounds often do not develop until school age!

Regarding language or use of words, a general thing to remember is think about the age your child is and that is the amount of words they should at least be using in sentences, i.e. 1 year=1 word phrases; 2 years=2 word phrases, etc. Vocabulary wise, kids are often using 10-50 words by 18 months; over 200 words by 2 years, over 400 words by 2.5 years, over 900 words by 3-4 years, and over 2000 words by around 4-5 years. Hope that helps everyone!

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