Working Toward Intelligible Speech in Toddlers

Teach Me to Talk with Apraxia and Phonological Disorders

Speech Intelligibility in Toddlers

“Now that my baby is finally talking, I can’t understand a word he’s saying!” First we want them to talk, but once that happens, we complain that we can’t understand them. This is a big concern among parents of toddlers, especially when you’ve waited longer than you expected for those first words.

“Isn’t it normal not to understand what my two year-old is saying?” The answer to that is, “both yes and no.” Here are the norms:

Parents should understand at least 50% of what a toddler is saying by their second birthday. By age three, parents should understand most (90%) of what a child is saying. By age 4, strangers should understand most (90%) of what a child says.

For those of you who aren’t familiar with typical speech sound development, let’s begin with a quick review of the basics.

Babies begin to use vowel sounds to coo during the first months of life. Then babies begin to add consonant sounds and combine them with vowels to begin babbling between 7-9 months. Babbling is using a string of consonant-vowel syllables. Most early babbling includes reduplicated or repeated syllables (“mamamama”). Near the end of the first year or shortly after, many babies begin to use approximate real words. They also become more sophisticated in their babbling and can sequence syllables with different consonant-vowel combinations.

Bilabials, or lips sounds, /p, b, m/, are usually the first consonants to emerge. (FYI – This is the reason that “Mama” and “Papa” are universal parent names!) Other consonant sounds such as /n, h, w/ are also “early” developing consonant sounds. Most children, or 75%, have mastered using these consonant sounds and all vowel sounds in words by their second birthdays. Consonant sounds that generally emerge before and around age two-and-a-half are /t, d, k, g/ and “ng” and /s/ at the ends of words. Some sources report that /f/ also emerges aroundtwo-and-a-half; some cite between three and four years. Later developing consonant sounds that emerge during the preschool years are /r, l, z, v/ and “ch, sh, j.” The sound “th” is usually the last consonant sound, mastered after age five.

Jargon emerges in most children between 12-18 months. Jargon is defined as unintelligible strings of sounds that mimic adult speech. Some parents refer to this as “gibberish.” Sometimes parents get upset when they hear their children using lots of jargon. Actually jargon is an indicator that a child is learning to sequence sounds and is trying to copy conversational speech. However, in the absence of other “real” words, it can be unsettling for some parents.

Many parents ask, “How should I respond if I don’t know what he’s saying?” My advice is to reword what you think he intended to say to ask for clarification. Hopefully, he’ll try to correct you if your guess was wrong. Other advice is to encourage your child to SHOW you what he wants or is talking about. If your child becomes overly frustrated when you don’t understand, you may be able to slide by with nodding or offering a general comment such as, “Oh!” However, if your child is adamant about telling you something or asking you for things you don’t understand, “faking it” may not work.

This is one reason I love signs or even pictures, especially for difficult words your child asks for routinely that you never get on his first (or seventh) attempt. If he keeps asking you for something and you finally “get it,” store a mental “audio clip” of the word, or take a picture of the object so you can use it to help the next time.

Being understood is an important part of communicating. Let me interject a word of caution: Until a child’s language skills (the number of words he’s using and how he combines those words into phrases and sentences) are at or near an age-appropriate level, intelligibility should not be the sole focus for speech-language therapy OR for parents at home. Overcorrecting a one- or two-year-old child’s speech errors can lead to frustration and a shut-down of progress faster than anything else you can do to a new talker.

What should you do when your child mispronounces a word? Model the word correctly and move on. Your child asks, “Tootie?” You say, “Cookie? You want a cookie? Here you go!”

Actually, before you start to work on specific consonant sound errors, there are other more important factors you should consider to make your child easier to understand.

First Targets for Speech Intelligibility in Toddlers

1. Is my child using the correct number of syllables in a word?

Consider the child who says “ba” for ball, balloon, and blanket. You’re going to be able to understand him better if he is able to use “ba” for ball, “ba oo” for balloon, or “bwa ee” for blanket. Even though these words aren’t “perfect,” you’ll probably be able to figure out what he wants more easily than if all the words sounded the same.

If he’s leaving off syllables (not just individual sounds, but entire syllables), start here first:

Tips for working on syllables – clap or pat the floor as you say the word to help him hear and feel the difference. Try words with repetitive patterns (reduplicated syllables) such as bye-bye, Mama, Dada, boo-boo, Bubu (for bubble or brother), and nana (for banana or grandma). Some kids get so into this that they “double” everything – dog-dog, car-car, etc.  It’s cute at first.  Be careful, though, or you’ll have to fix that later!

2. Is my child using correct vowel sounds in words?

As stated previously, most children with typically developing communication skills use vowel sounds correctly by age two. If your child is substituting vowel sounds or leaving off vowel sounds in words, this can be an indicator of motor planning problems, or apraxia.

Work on vowel sounds by exaggerating them in words, and using new ones alone as “sound effects” in play. For example, if your child can’t say an “ee” such as “green,” “baby,” or “whee,” pretend to be scared during play and let out a big “eeeeeeeeeeeee.” This is also one of the vowel sounds that you can “help” him learn by pulling out both corners of his mouth into a smile. “Cheese” is usually an effective cue not only for picture taking, but learning this vowel sound.

Other vowel sounds you can provide a tactile (touch) cue are “ah” by pulling his chin down with your finger and “oo” by pulling in her cheeks to help her round her lips.

I use lots of animal sounds to work on vowels and really exaggerate the vowel sound.  Think: mooooo, baaa-baaa, meee-ooooow, woooof-wooof, etc.

3. Can my child use two different vowel sounds in words, or does he always copy the first sound for the next syllable?

Learning to “change” the vowel sound for a new syllable in a word is especially difficult for some toddlers. You may continue to hear him say “Coo coo” for cookie, “o po” for open, or “ca ca” for cracker. Work to help him hear and say those differences. Again modeling exaggerated vowels is the best way to do this.

Your child’s SLP may be able to help you come up with “modifications” of particular words that may not be completely correct, but sound “closer” to the intended word. For example, for a child who can’t say “cracker,” you may teach “ca uh” as an in-between more intelligible version of the word. (Some children have difficulty using different consonant sounds in words until age two-and-a-half, but most have mastered this by age three.)

4. Is my child learning consonant sounds in the beginnings of words and syllables?

Usually, beginning consonant sounds come first, but in some children, they continue to omit beginning sounds while adding some ending consonant sounds. It is very difficult to understand children who use words and phrases with predominantly vowel sounds. I have several children doing this at any given time on my caseload. Children who are using mostly vowels absolutely need speech therapy to help them learn to use more consonant sounds.

Your SLP will be able to teach you and your child “cues” to help him learn additional sounds. If you’re working on this at home, you can try the following “tricks:”

Many experts “name” the sounds for young children rather than calling them by the letter. For example, /m/ can be called a “motor” sound, or a “yummy” sound. A /p/ can be called a “popper” sound or “lip” sound. These names can be found in many early articulation books.  Better yet, talk with your child’s speech pathologist.

If you’ve heard your child use consonant sounds at the beginning of one word, or even in a word you couldn’t understand, using these sounds that he can already produce in at least one context is generally easier than teaching new sounds.

5. Is my child using ending consonant sounds?

This is the question about articulation that I’m asked the most. Final consonant deletion occurs in many children until two-and-a-half to three years of age. The easiest ones to work on include /p/ and /t/, both unvoiced consonants. If your child is producing /k/, you may also try this sound. The voiced consonant sounds /b, d, g/ should not be early final sound targets because your child may end up adding a vowel sound at the ends of words such as “bug-u” or “bed-a” in an effort to produce this sound. Once your child is using unvoiced sounds, the voiced sounds should emerge on their own.

I also work on /s/ since this final sound carries so much grammatical information. For example, children need final /s/ to make words plural such as “cats” and “books.” Using plurals is a language concept that emerges around age two-and-a-half, so /s/ is an important sound.

Many children begin using /s/ as a lisp. Although it’s an incorrect way to produce /s/, it’s very common until age 4 or so. You can target this by telling your child to “hide your tongue behind your teeth,” or to say “smile and hide your tongue.”

Other Hot Topics Related to Speech Intelligibility in Toddlers

Oral Motor and Articulation Issues – Pacifiers and Sippy Cups

If your child is using a lisp, it may also be an indicator that he’s developing an “open bite.”  That means there’s a gap between his upper and lower teeth. This can be attributed to prolonged use of sippy cups or pacifiers. Although it’s messy, your child should switch to an open cup or straw when he’s at the table or in another place that you can clean up easily. Save the sippy cups for the car.

Your child should NEVER go to bed with a sippy cup or bottle, no matter how convenient it is to help him to sleep. Leaving the cup or bottle between your teeth while sleeping is what leads to the open space AND tooth decay, especially if you’re using milk or juice. I’ve known several two-year-olds who have gone to see a dentist before age three with a mouth full of little black teeth. It’s not a pretty site! If you can’t kick this habit just yet, at least switch to water.

Straw drinking is great for oral motor and sensory skill development. Look in the toddler dishes/utensils section of the major retailers for many options for these cups. Sports water bottles are also a good option.

I think it’s okay to use a pacifier for sleeping until age two-and-a-half to three, but excessive use during the day is not recommended if your child can calm down without it. If your child has sensory issues and using sucking to help him regulate, keep the pacy without feeling guilty.

It’s a myth that pacifiers prevent children from talking. Most kids try to talk with it in their mouths and then take it out if their parents insist that they don’t understand them. If your toddler is addicted, try to limit it to naps, bedtime, and when he really needs it to see if having an open mouth will help him vocalize more. I don’t let children keep pacifiers in when I’m in their homes seeing them for therapy unless they are falling apart without it. Many children I see work so hard during treatment that they need it to calm down after we’re finished. Many parents of children I see need them to have it for times when no other option works to wind down a jacked-up toddler and end a tantrum. As a mom, I’m just fine with that.

If you have other questions, please feel free to post a comment.

Laura

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