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When To Worry… Signs of Speech & Language Delays

What’s the number one factor that unites good mothers across cultural, social, and economic boundaries? (I’ll give you my take on those other mothers in another blog!) It’s worry. Most of us obsess about our kids.In the first few months it’s all about their regulatory needs, basically if they are sleeping, eating, and even pooping properly. Once we’re over that hump, we begin to wonder about their motor skills- rolling over, sitting up, crawling, and walking. We eagerly anticipate our baby’s mobility. Usually our wishes are granted, and our baby takes his first few wobbly steps on average between the ages of 10 to 13 months.

Then comes the second year.If the first year’s obsession is waiting for our baby to walk, then the second year’s obsession is waiting for our baby to talk. For some lucky mothers this happens early. A baby begins to coo around 8 weeks, babbles by 6 months, and then he starts to try to imitate common words before his first piece of birthday cake is served. For others it means waiting a little while longer, after the novelty of walking has worn off around 14 to 16 months.

Still others are waiting when that second birthday rolls around. Usually by then even the freakishly calm mother is wondering, Is something wrong? Should I be worried? We consult our families and friends. Invariably we hear any combination of the following, Calm down. It’s no big deal. Uncle Jim (or the neighbor’s son, or my personal favorite, Einstein) didn’t talk until he was 3. Strangely this well-meaning advice is not comforting for most of us worrying mother types because we suspect that something is wrong. More importantly, we don’t want to feel guilty later if we did nothing about it. Most of us also talk to the pediatrician, and sadly our concerns could even be dismissed by our most trusted and revered medical professional. You might be called overanxious. (By the way, in all of my education, I have never seen overanxious mother listed as an official reason babies don’t learn to talk on time.) When one mother took her non-verbal 3 year-old son in to be evaluated at a leading children’s hospital, the doctor advised, have another baby, and then he’ll talk.

Although many pediatricians are wonderful about listening to a parent’s concerns or identifying a potential developmental problem themselves during a visit, some doctors simply have not been trained to judiciously screen for communication delays, particularly before a child turns 2. Many urge parents to wait and see. For some children this could be an acceptable approach. In some cases maturity kicks in and a toddler simply outgrows an earlier issue that caused his parents great alarm. However, from my experience, a child hardly goes from being silent one day to speaking in full sentences the next, no matter what your great aunt so-and-so, the friendly lady at Wal-Mart, or even your pediatrician told you.

Language development simply does not happen overnight for most children. Even though you’ve probably been told not to compare your child to someone else’s or even your own older children, and no two children develop alike, there are patterns of communication skills that babies acquire within certain age ranges. If earlier skills are not mastered within a time frame, communication problems are more likely to develop.

Many pediatricians themselves become worried about their own children at an age when their colleagues might otherwise fail to issue a referral. As a busy pediatric speech-language pathologist specializing in early intervention, that is seeing children with language delays ages birth to three, I typically have several clients on my caseload who are children of physicians. Currently I am seeing four children with mothers who are pediatricians, one who is the daughter of a neurologist, and one whose father runs a family practice. All six of these children began the referral process to be evaluated in our state’s early intervention program before turning two, and four of them by 18 months.

Interestingly two of these mothers, pediatricians themselves, also began their initial conversations with me with a variation of this same question, Should I be worried? With all their medical training, they still weren’t sure enough about developmental communicative milestones to truly know if their own kids were at risk. This is shocking because most parents value their doctor’s knowledge above their own instincts. Often times, parents have expressed deep regret to me that they did not trust their own gut feelings earlier and insist that something be done, even against the advice of their pediatricians.

My advice to all parents has come to be, if you are worried that there’s a problem, there probably is. Occasionally there are parents, and even spouses, who have to be convinced that something is wrong, but more often than not, mothers suspect this long before other people begin to mention it. Even if you are initially pacified by everyone’s advice, but later feel that something really could be wrong, trust your instincts. Pursue additional information until you are satisfied that everything is moving along nicely in your child’s development, or until you find guidelines that confirm your suspicions that he or she is falling behind.

You can find charts that list developmental milestones in communication for babies and toddlers from many sources including parenting books, magazines, and websites. There is one listed on this site as well. Sometimes parents focus on what a baby is (or is not) saying rather than considering all of the other prerequisite skills that must occur before those first words are spoken. Talking is only a part of the communication process. A baby must understand words, have a desire to be with people, and be able to initiate and respond to interaction before words become meaningful. For example, a baby has to recognize who Mama is and want to call her to come get him out of the crib before his babbles of mama mama begin to truly express meaning.

The following guidelines can serve as red flags for parents who are wondering, Should I be worried?

1. Difficulty making and maintaining eye contact with an adult by 6 months

2. No big smiles or other warm, joyful expressions during interaction with another person by 6 months.

3. No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months.

4. No babbling by 12 months

5. No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months

6. No consistent responding to their names by 12 months

7. No words by 16 months

8. No following simple and familiar directions by 18 months

9. No two-word meaningful phrases without imitating or repeating & says at least 50 words by 24 months

10. No back-and-forth conversational turn-taking by 30 months

11. Any loss of speech or babbling or social skills (like eye contact) at any age

The presence of any of these concerns warrants an immediate discussion with your pediatrician and insistence for a referral to an early intervention program and/or speech-language pathologist for a complete evaluation of your child’s communication skills.

Let me also add that babies who are doing well with social and language development exceed these milestones by leaps and bounds.These are very, very low thresholds for communicative skills. If your child is not meeting these basic guidelines, please don’t dismiss your feelings.There is in all likelihood a true developmental delay or disorder present.Seek professional help from your pediatrician, your local school system, or an early intervention agency.

If your child has accomplished these fundamental skills, but you’re still not sure that hes where he should be, please know that there are many, many things you can do at home to improve your child’s ability to talk.This entire web-site is dedicated to educating parents with successful techniques to improve your child’s communication skills. When you learn and implement these new strategies at home, you will make a huge difference in your child’s ability to communicate. Remember, involved and loving parents are a baby’s first and best teachers.You can do this, and this web-site is here to help.

 

 

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Laura

2 Comments

  1. Sonya on January 27, 2008 at 2:54 pm

    Thank you for putting this together! I am one of those ‘overanxious’ mothers who had to listen to doctor after doctor tell me not to worry when my son wasn’t talking. Even at age 3, I was unable to get a pediatrician to help. I too heard all the ‘don’t worry’ statements and the one I hated to hear the most was ‘Oh, when he starts talking you’ll want him to shut up.’ People say the SILLIEST things! Thank you for getting the message and info out there to help all of us who struggle with developmentally delayed children. May God bless you.

  2. Pat on January 28, 2008 at 9:25 am

    Laura,

    This is a great section. As you know, we were very concerned about Brendan when he said a word at 15 months and then never said that word or any others again. At his 18 month check up, our pediatrician gave us the “give it more time” suggestion. I was worried that time wasn’t the answer – and I was absolutely right. A parent’s intuition that something is wrong with their child should never be dismissed – but you are so right that people will tell you that you are worrying too much. I KNEW something was wrong – I am glad that I sought help when Brendan turned 2 years old – and we found you (you are still our angel that gave us the help that we needed and taught our son how to communicate!!). I haven’t read the entire website yet, but please tell parents about the importance of sign language – if you hadn’t taught Brendan and me (and then I taught our other 2 sons and my husband), Brendan’s frustration in not being able to communicate with us would have increased (as would ours!)and would likely have caused behavioral problems. Brendan had no problems with receptive language, but he couldn’t speak due to apraxia – sigh language allowed all of us to know what he wanted and what he was thinking. I believe (based on experience) that any child who isn’t speaking by 2 (maybe even 18 months) and is capable of learning sigh language should be taught this skill. Learning this skill completely changed our lives.

    I am glad that you stressed the fact that pediatricians don’t know it all when it comes to speech delays – and you have underscored this fact with telling your audience that you have pediatricians’ children as clients. Unless you are fortunate enough to have a pediatrician who has experienced speech delays with their own children (or perhaps other patients), they will likley give you the “wait and see” response to your concerns. Too many parents and their children miss the window of opportunity to get started early. This doesn’t mean that your pediatrician isn’t a qualified doctor, it just indicates that they don’t (can’t) know it all and as a parent you have to rely on your gut instincts. I am so glad we did!

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