Melissa was a chatty 3-year-old when her mother began to notice a startling change in her speech.
"Out of the blue," says Melissa's mother, "she started stuttering. I kept thinking it was just a momentary aberration. But it continued and actually got worse."
To a parent, the sound of a previously glib child starting to struggle with language can be alarming, sending thousands of worried mothers and fathers to the pediatrician each year.
But in fact, for many children, variations in language - slow to start, glitches along the way - are perfectly normal parts of development. The American Academy of Pediatrics says one in five children will use words later than their peers. Some troubles, like stuttering, are fleeting and will resolve on their own; others may require intervention.
How to tell the difference is the million-dollar question. "The stages that children pass through in the development of speech and language are very consistent," says the American Speech-Language-Hearing Association. But, "the exact age when they hit these milestones varies a lot."
Speech and Language Delays
Stuttering, in fact, is one of the most common so-called "speech delays" - problems with the ability to properly pronounce or form words. According to Children's Hospital Boston, roughly 90 percent of children will stutter at some point, generally between the ages of 18 months and 5 years. The condition is often the result of a child's vocabulary trying to catch up with free-flowing ideas and usually resolves within a few months. Among the few who stutter for years, the vast majority will recover by age 18. In roughly 1 percent of children (slightly more boys than girls), stuttering can become a more chronic problem.
While a stuttering phase can be troubling, experts caution parents to be patient and avoid overreacting. Such speech challenges can be exacerbated by stress - the child's or the parent's. In fact, well-meaning friends and family who try to "help" by finishing sentences or otherwise moving things along can actually do the opposite of good, inadvertently making a child fearful of talking, and turning a temporary problem into a longer-term one. Instead, try making conversation peaceful. Set aside time for uninterrupted talk, listen intently, and make eye contact. And most of all, show acceptance and understanding, and be open to discussing if your child has concerns.
Because it's often a passing stage, opinions vary on the right time for intervention. Some pediatricians are content with a watch-and-wait approach. Others, noting that intervention works best when done early, advocate evaluating right away. All agree, though, that if the stuttering continues for more than a few months, is accompanied by additional symptoms - facial tics, for example - or if your child seems especially troubled by the condition, a visit with your medical provider is in order.
In contrast to speech issues, language delays refer to the other side of the communication issue - cognitive issues with words and how they're processed. Children with language delays may have trouble understanding others or articulating their own thoughts. Speech and language issues can occur alone or in tandem. But because comprehension issues can be frustrating for children and lead to additional problems such as reading delays later on, experts often advise evaluation as soon as possible.
Since hearing is one of the most important contributors to the conversation, many pediatricians begin evaluations of speech and language delays with a hearing test.
In fact ear infections - the bugaboo of childhood - are often the culprits in such delays. Doctors at Children's Hospital Boston say chronic infections can lead to fluid behind the eardrum that can cause mild hearing loss and, as a result, a lag in speech and/or language. Many doctors recommend ear tubes that drain fluid and prevent repeated infections. The American Academy of Otolaryngology says more than a half a million such surgeries are performed on children annually, making it the most common childhood surgical procedure.
Most important, experts advise parents to pay close attention; hearing loss isn't always as obvious as it might seem. One mother recalls thinking a behavioral problem was behind her daughter's seemingly willful tendency to ignore calls for bedtime. "I was shocked to find out she had fluid in her ears," she says. Certain circumstances - a baby who doesn't leap at a loud sound; a child who doesn't begin speaking by 18 to 24 months - are cause for evaluation.
What you can do
No matter a child's stage of development, parents can encourage building language skills by talking often to children, reading to them, and resisting the urge to force conversation. And keep an eye out for red flags such as skills that lag way behind peers. A good general rule is if something seems worrisome, ask.
In many cases, language will equalize with time. For those that don't, proper and timely intervention is key. After an evaluation by a professional, Melissa's stuttering was determined to be developmental and her mother was assured it would pass.
"After a few months," said Melissa's clearly relieved mother, "the stuttering just disappeared on its own."
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