Q&A with a Pediatric Speech Pathologist

Many parents have questions about their child’s development – especially when it comes to speech. Below are six common questions answered by a Speech Language Pathologist.

Question 1: My 2-year-old only has a few words. When should I see a speech pathologist? Is 2 too young?

By age 2, we expect children to be using a rich vocabulary of 200 or more words, and using short sentences such as “mommy up.”  If your child is still struggling to develop a rich expressive vocabulary, it is always a good idea to see a Speech Language Pathologist (SLP).  SLP’s can provide guidance and recommendations for language boosting techniques to use at home, as well as intensive individual therapy to get your child talking! Early intervention is really the key to success.

Did you know SLP’s also specialize in recognizing and treating other developmental concerns, including feeding difficulties, social skills, academic and learning delays, and articulation?  Check out the milestones guide at SAGE Speech & Learning to explore the skills your child should have at every age!

Question 2: My 1st grader still can’t say his R sound. Is it time for speech therapy?

YES!!! Did you know there are 21 different types of R sounds in English (Er, Ar, Ear, Ire…)? That is a lot of R’s for a child to master!

The average age of mastery of the R sound is between ages 3 and 6 (source). If your child is still struggling to consistently use a correct R sound by the end of Kindergarten, it is time to get to work. Delaying therapy can sometimes lead to greater difficulty correcting the sound, as children form a hard to break, habitually incorrect motor pattern. Speech Language Pathologists are especially skilled in treating this pesky sound, and intensive one-on-one therapy is the most effective and efficient way to help your child move ahead in their speech skills.

Question 3: My preschooler is smart but is hard to understand in conversation? What is going on?

It is important to understand that there is PLENTY of variability in the preschool ages. That being said, Speech Language Pathologists do adhere to guidelines about expected intelligibility, or clarity, of a child’s speech.  At age 2, we expect children to be about 50% intelligible to an unfamiliar listener.  This number jumps to 75% at age 3, and close to 100% at age 4.

There are many factors that relate to intelligibility, including articulation of individual speech sounds, the ability to correctly produce sound types (“back” or velar sounds, “tongue tip” or alveolar sounds, etc.), as well as rate of speech, second language development, and more.

Early intervention is incredibly important to prevent difficulty in the later preschool or early elementary years! Speak with a licensed Speech Language Pathologist about whether your child is an appropriate candidate for intervention.

Question 4: My child stutters…sometimes. My doctor says to “wait.” How do I know when to seek speech therapy?

Stuttering, or dysfluent speech, is a topic that is very close to my heart.  My own daughter is a person who stutters and I feel very strongly about seeking appropriate early intervention.  I say “appropriate” because there is little evidence-based treatment for stuttering, there are a variety of approaches out there, and the majority of Speech Language Pathologists have never been trained to treat stuttering.

Another hurdle is that most Pediatricians are not Speech Language Pathologists…actually, I have yet to meet a pediatrician who is both a doctor and a speech language pathologist.  I recommend getting advice from the expert, so PLEASE seek out a speech pathologist when you have concerns about stuttering (or any speech, language or communication issue)!

The average age of onset of a stutter is between 3 and 6 years. Some stuttering is “developmental,” meaning it is part of typical development and will pass.  Some stuttering is not.  Since we have little research on stuttering and its characteristics, it is difficult to know when your child’s stuttering is developmental.  It is always best to consult with a speech pathologist who specializes in fluency disorders.

Question 5: What are the best toys to promote language development?

The first piece of advice I give families is to throw away their toys with batteries. Those toys can usually only be played with in one or two ways, which diminishes the opportunity for open ended play.  The best items are simple and old-school; blocks, trains, dolls, and any items that can be used to pretend. Children go through many stages of play development, starting with shaking/banging.  Around 9-12 months intentional play develops, such as pushing a car, rolling a ball, brushing hair with a brush.  By 18 months we begin to see symbolic or pretend play, with a burst in language as well.  Playing WITH your child, modeling ideas and language is the best way to help develop their cognitive, language and play skills.  Try to avoid questions (what is this? What color is it?), and rather provide information (this is purple! A big purple car!).

Question 6: Will a pacifier impact my child’s speech development?

I get this question almost daily from new families! There is no solid evidence that every child who uses a pacifier will develop a speech delay, nor has every child with a speech delay used a pacifier.  What we do know is this; continued use of a pacifier (or thumb sucking, or anything that is in the oral cavity for extended periods of time) can change the shape of the developing mouth, teeth and palate.  Many children who use pacifiers for years will have a more open bite, wider spaced teeth, and the potential for a downward/forward resting tongue.  This tongue position, if it remains during eating/drinking/taking is called a tongue thrust, or reverse swallow.  A tongue thrust is normal in infants, it is not a typical pattern in children as they get older.  As a result of this atypical tongue position, children can sometimes have difficulty with S and Z sounds (a “lisp”) and other speech sounds that require the tongue to be within the oral cavity and resting gently towards their palate.

My best advice would be to use a pacifier as little as possible, and to remove it from use as early as possible!

Read more!

If you liked this post check out this Twinsie Tip article on A guide to Developmental Milestones.

Saren

Saren Schapiro is a nationally licensed and certified Speech-Language Pathologist, with 10 years experience working with children ages 6 months to 18.  Her practice, SAGE Speech & Learning Associates, in Atlanta, Ga provides evidence based speech, language and feeding therapy to children across the metro area, with options for in home, in school and clinic based intervention.  Saren and her team of SLP’s offer parent trainings, school screenings, consultations, evaluations and treatment.  Working closely with allied professionals, such as occupational therapists, reading specialists, dentists and psychologist provides a unique opportunity for families to benefit from a well rounded, team based approach to development!  Coming soon to SAGE, Saren will be helping match special needs or school facilitators with families in need of services!