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Speech-Language Pathology, Children

My child is really hard to understand and he is 3 years...

Question: My child is really hard to understand and he is 3 years old. I know what he is saying but when he is around other family members, it is really challenging for them to understand him. Should he get speech therapy?

Answer: A speech therapy consultation would be helpful. The speech-language pathologist would look the child’s sounds and words to determine if there is a need of speech therapy and meeting age-appropriate milestones. Here are some guidelines for when a child should undergo a speech therapy consultation:

  • 8-9 Months: No babbling in a repetitive manner
  • 18 Months: Use of vowels primarily or only a few consonants. Should be understood by parents and strangers 25% of the time.
  • 24 Months: Should be understood by parents 50%-75% of the time and 50% of the time by strangers.
  • 3 Years: Leaving out consonants or unclear speech. Should be understood by parents 75%-100% of the time, and 75% of the time by strangers.
  • 4 Years: Distorted speech that is often hard to understand. Should be understood 100% of the time by strangers.

Something you can do to help: find a word your child has trouble with and say it out loud first and have them repeat it back.


My child is 2 years old and isn’t...

Question: My child is 2 years old and isn’t talking. She has a couple words but usually points or reaches when she needs something. Should I be worried?

Answer: It sounds like your child is using pointing, reaching, or gestures as their main way of getting their wants and needs across to you. This is good! But by the age of 2 the child should have about 200-300 words and beginning to combine words. Here are some guidelines for when a child should undergo a speech therapy consultation:

      • Birth-3 Months: Not smiling or playing with others.
      • 4 Months: Poor eye contact, inattentive to the speech of others.
      • 6-8 Months: Lack of gestures.
      • 12 Months: Difficulty understanding speech or following simple directions.
      • 16-18 Months: No words, or a limited vocabulary.
      • 24-26 Months: Saying fewer than 50 words. Lack of ability to combine words for short sentences.
      • 3 Years: Echoes in words or phrases or many errors in sentences.

Something you can do to help: when your child points to something, say the word of the thing they are wanting before giving it to the child (example: child is pointing to juice in the fridge, say “juice”, and wait to see if they say it back, then give it to them). This is called “modeling” and is a technique used in speech therapy. If you have concerns, check in with your physician about a potential speech therapy consultation.

My child has been receiving speech therapy at...

Question: My child has been receiving speech therapy at school. Should I get extra speech therapy outside of school?  Am I able to?

Answer: Most outpatient speech therapy patients are also receiving speech therapy at school. School and hospital speech language pathologists will often collaborate and work on skills to get extra practice or work on them in different ways so the child is getting treatment in a variety of activities and settings. This can be very helpful with learning the skills and using them in different environments.  Plus, outpatient speech therapy is helpful in the summertime to maintain those learned skills and continue to make progress. Check with your insurance coverage to see if outpatient speech therapy fits for your family.

My child is nonverbal and has a speech device...

Question: My child is nonverbal and has a speech device but I’m worried this will take away his ability to verbally communicate or replace it in the future. Should we continue to use it?

Answer: A speech-generating device is a wonderful tool to learn communication and give the child the immediate ability to communicate. Without a method of communicating, the child may experience frustration which may lead to behaviors. It is a common myth that speech-generating devices will “replace” or “take away” the ability to verbally communicate, but this is false. Research has shown that speech-generating devices or other forms of alternative augmentative communication (AAC) support speech and language development and provide more positive outcomes. If your child has trouble using the device, speech therapy may help teach the child how to ask for things, make comments, and socialize with it.

Something you can do to help: if you child has trouble finding words or building sentences on the device, find the word and show the child where it is. For example, your child wants to play with cars and instead of using his device to ask for it, the child starts to cry or have behaviors--bring the device over to your child, find the “cars” button and show your child that button.  Ask your child to then find the button on his/her own.

What is AAC? How do I get communication device...

Question: What is AAC? How do I get communication device?

Answer: AAC stands for Alternative and Augmentative Communication and allows different ways of communicating other than verbal communication. Communication through gestures, sign language, exchanging pictures, pressing a switch or button, or having a device with buttons of words the child can touch. The goal of AAC is to provide a method of communicating basic wants, needs, and ideas and support communication in an effective way for individuals with severe speech or language difficulties and are unable to verbally communicate. To obtain an AAC system, discuss this with your physician and speech-language pathologist and you can work together on a system that would be most effective in meeting the patient’s communication needs.

I used to stutter as a child but grew out...

Question: I used to stutter as a child but grew out of it, now I’m noticing my 3 year old son repeating words and making it difficult for him to speak. Will he outgrow this too?

Answer: Typically, children who begin stuttering before ages 3 ½ are likely to outgrow stuttering. If the stuttering continues past the age of 3-½, the child may be less likely to outgrow it on his/her own.

With that said, if you notice the stuttering to persist for longer than 6 months, check with your doctor about a speech therapy consultation. The speech-language pathologist will observe the stuttering, determine how severe it is, and decide if therapy is needed, and/or give strategies to use when communicating with your child. Treatment of stuttering has the best outcomes when it is treated early on.

Something you can do to help:

  • Talk very slowly to your child and add frequent pauses, as if your talking at the pace of a snail.
  • When your child stutters, say the stuttered word or phrase back to the child very slowly (example: the child says “I-I-I-I-I want more cookies”, say that back to the child slowly, “I waaant  mooore  cookieees”).  This gives a “model” of slowed and clear speech.
  • Try not to interrupt the child or completing the child’s sentence.
  • Try not to ask the child a lot of questions (example: instead of “what did you eat for lunch? Soup?”, comment by saying “I wonder what you ate for lunch, I had a sandwich”). This takes away the stress of speaking.  “I wonder” or “I think” are good phrases to use when practicing this technique.