Why you shouldn’t play the “wait and see” game

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This past month I was contacted by two sets of parents, each concerned about their children’s speech sound errors. In both cases, the parents had been recommended years earlier to “wait and see” if the sound errors would resolve on their own.

“Wait and see” is an unsatisfying recommendation. It often lacks important information such as: How long should I wait? Who shouldn’t wait and why? Exactly what am I waiting for? How can I support my child’s speech while I wait?

I am not a fan of “wait and see”. Here’s why…

Although many kids who are speech or language delayed catch up on their own, 30-40% go on to need intervention. Early intervention is key for these kids. And some of them need years of intervention. 

There are so many parents who hear “she will grow out of it”, or “stop comparing him to other kids”, or “she’s going through a phase”, or “he just needs to slow down”. These comments are well-meaning but unhelpful.

Don’t ignore your gut instinct to get your child help!

As a parent, you are your child’s expert and advocate. The power to help your children is in your hands.

If you are suspicious that something is not right there is no harm in getting it looked at. You can’t go wrong arranging for an early evaluation.

Parents don’t get upset when the evaluation yields good news, but they might regret playing the “wait and see” game. Many parents who wait wish they arranged for evaluation and intervention sooner than they did.

Here’s what could happen when you “wait and see”:

  • While children with delays are in “wait and see” mode, they are missing out. They are deprived for months, or perhaps years, of fully participating in interactions and exploring the impact of their words, both of which are precursors for developing social language competency.
  • When children with speech sound errors continue to make their sounds incorrectly, the errors become habits, making it more difficult to correct in the future.
  • When children with oral placement disorders do not receive intervention, they naturally make adaptations which may cause changes to the teeth, jaw, lips and tongue.

I recommend consulting with a Speech-Language Pathologist (SLP) if you have any concerns about your child’s speech and language development. And whatever your SLP recommends, ask them to explain the reason for their recommendation so that you can make an informed decision.

“Waiting is a trap. There will always be reasons to wait. The truth is, there are only two things in life, reasons and results, and reasons simply don’t count.”  – Robert Anthony

Will my child stop stuttering? What the Experts say…

It can be very difficult for parents to watch their children struggle with speech.

Close to 5% of young children begin to stutter. Almost 75% of them will outgrow stuttering on their own within 12-24 months.

While we don’t know for sure which children will stop stuttering on their own and which will continue to stutter, we do know that the severity of the stuttering does NOT predict the likelihood of the stutter continuing.

 

Children are more likely to naturally outgrow stuttering when:

  • There is no family history. More than half of children who stutter have a family member who stutters. A family history indicates a risk for persistence.
  • The stuttering started early. Children who begin stuttering before 3.5 years are much more likely to outgrow it.
  • The stuttering has lasted less than 6 months. 75% of children who start stuttering will stop on their own within 12-24 months.
  • Your child is a girl. Three to four boys continue to stutter for every one girl who continues to stutter.

Some children have a strong reaction to their stuttering, which can create more tension and more struggling. It is actually the way children feel about themselves and their communication abilities, rather than the type and frequency of their stutter,  that will determine how much difficulty they will have communicating.

You can help these children feel less fear about getting stuck on their words by letting them know it is okay to have some difficulty when learning to talk. Just like it’s okay to fall when learning to walk, or spill when learning to drink.

 

To prevent development of negative reactions and help your child feel more ease:

  • Model a calm and accepting response to your child’s stuttering. Children learn how to react to stuttering by watching how their parents react. Remember that acceptance does not mean you are giving up on fluency.
  • Listen to your child’s concerns about speaking. Focus on the message and not on how he is talking.
  • Talk with your child about stuttering. Be supportive and straightforward to help your child understand what is happening.
  • Avoid putting your child in a position where he feels pressured to talk. Ask less questions and make more comments.
  • Create “special time”. Set aside five minutes each day for one-to-one playful time with your child, with no expectations for speech. Listen patiently and pause before responding to your child’s words.

Because of the high percentage of young children who do outgrow stuttering, some professionals may suggest waiting to see if the stuttering stops on its own.   However, therapy is recommended more often than not in order to give the 25% of children who won’t outgrow their stutters a greater chance to recover from stuttering. 

The decision to pursue treatment for stuttering should be based on the likelihood that a child might continue stuttering without intervention. It is recommended that parents consult with a Speech-Language Therapist to determine their child’s risk for continued stuttering.

 

Therapy by a clinician who specializes in stuttering is recommended when either :

  • The child appears to be at risk for continuing to stutter, or
  • The child or parents are concerned about the child’s communication abilities.

A treatment program designed to reduce children’s stuttering and improve their overall communication skills will include both child-focused treatment and Parent Training.

The Stuttering Foundation is an excellent resource for parents. In addition to providing helpful information, they also offer an international list of clinicians who specialize in stuttering.

And HERE is an excellent booklet written specifically to help parents support their young children who stutter.

Parents of late talkers are often surprised to learn they can help more by talking less.

The term “late talkers” describes children who have a limited spoken vocabulary at around 2 years of age. Keep in mind that first words appear close to 12 months, and children begin combining words prior to 2 years (refer to my blog on Communication Milestones).

If at 18-20 months your child uses less than 10 words, or if at 21-30 months they have fewer than 50 words and aren’t combining words, despite otherwise typical development, then you have a “late talker”.

Because early language development provides a foundation for the development of later language and literacy skills, late talkers are at risk for problems with language and literacy skills in elementary school and beyond.

One of the first things I do when evaluating a child with reportedly limited speech is to observe the parent and child playing together. More often than not these parents “over-talk” during play.

I attribute this “over-talking” to two phenomenons. First, most of us are to some degree uncomfortable with silence, so we organically fill the silent spaces. Second, many parents have the misconception they need to model more words and talk more for their children who are behind in speech output.

Talking more is NOT helpful to Late Talkers because:

  1. Talking more results in longer phrases.  Consider matching the length of your utterance to your child’s level or just above your child’s level. So, if your child is using single words, model single words or 2-word combinations.
  2. Talking more results in less turns for your child. Consider taking short turns saying one thing, then pause, allowing your child an opportunity to take a turn, whether that be verbal, non-verbal or just a sound.  Looking expectantly at your child and staying quiet sends the message it is her turn.
  3. Talking more results in no words being highlighted. Consider using fewer words, preferably “early vocabulary” words, such as nouns and specific words that would be useful for your child to communicate. Using too many words makes it more difficult for words to stand out and get noticed. It is the equivalent of using a highlighter to mark every word on a page. Think about which words you wish tohighlight.
  4. Talking more results in less connection. Consider what your child can pay attention to. If there is too much talking he will likely tune you out. If he has tuned you out then you have lost the opportunity to connect. Without shared attention, your child will not observe how you made the word and the words will have no meaningful connection.

Ways to SUPPORT your Late Talker:

  1. Get on her level physically. Sit on the floor and get eye-to-eye.
  2. Observe what he is interested in and comment on that. Offering words that connect to what he is paying attention to makes them meaningful. And he will be more motivated to attempt saying words related to his own interests.
  3. Match her language level. Match the length of your utterance to her level or just above her level. As I suggested above, if she is using single words, model single words or two-word combinations.
  4. Pause after you take a turn and look at him expectantly. Wait. Wait some more. Waiting is harder than you think!
  5. Listen for her sounds and words. Acknowledge them by repeating and adding one more sound or word. “Dog…. hungry dog”
  6. Resist the urge to request him to repeat you. Children learn best through natural interactions, not repetition.

Be patient, take note of small changes and celebrate progress. Progress can appear in many different ways… more eye contact, more joint play, more attempts, more relevant gestures, more copying, more sounds, more words. Be open to progress in its many forms.

And as always, if you suspect that your child’s speech and language skills are behind (check my blog Communication Milestones), I highly recommend consulting with a certified Speech-Language Therapist.

How grapefruits reminded me of the power of storytelling

According to Speech and Hearing BC,  29% of children arrive at kindergarten struggling to be able to tell a story. Did you know that telling your children stories helps them develop their storytelling skills?

Storytelling uses language to connect your child to people, events, concepts and humour. Stories teach sequencing, improve vocabulary, strengthen listening skills and help children connect ideas. And, the simple act of focusing on your child when you tell a story confirms for them that they are a valuable member of the interaction.

I love grapefruits!  I use a grapefruit knife to carefully separate the “meat” within each section, a tradition that was passed on to me by my grandfather. I fondly remember my “Papa Paul” eating his morning grapefruits.  He enjoyed this simple pleasure delighting in every bite, describing the grapefruit as a gift, squeezing every last drop of juice into his mouth. His lessons of appreciating the simple things in life were not lost on me.

The first time I served grapefruit to my children I shared stories about my grandfather, a truly unique and great man whom they had never met.

I  told them about the time my grandfather taught me to ride a bike, convincing me he was still holding on when in fact he had let go so that I could find my way. I must have hit every parked car on the street!  The story opened up a conversation about trust, fear and one’s willingness to try new things.

Then there was the time he bought a new set of dentures for a man he did not know, but who had lost his only set on the beach.  The story helped them better understand abstract traits such as compassion and generosity.

When my children were a little older, I told them about the time Papa Paul tried to teach my mother to swim by securing her to the end of a fishing rod! Seriously!  This story included a time lapse and provided a segue to discuss planning, considering your options and perspective taking.

To this day when my daughters see me cutting open a grapefruit they request it “Papa Paul style”!  A man they have never met has become a coined phrase in our home, simply through the act of storytelling.

Ways to support your child’s language skills through storytelling:

  1. Include the concepts of time – Using words such as “first”, “and then” and “in the end” will help build sequencing and narrative skills.
  2. Insert pauses – Pauses allow children extra time to process and consider what you are saying. And by pausing, you model how to pace yourself when speaking.
  3. Use descriptive language – Help them visualize the characters and settings in your stories. Talk about the qualities and traits of your characters to help grow their vocabulary.
  4. Be expressive – By matching your facial expression and tone of voice to your message, you help your child develop the ability to read social cues and understand how others feel. (See my blog on Understanding Social Language Skills)
  5. Connect the story to the present – If possible, build a relationship between one aspect of the story and your child’s life. This will help them remember the story and improve their ability to retell it.

Stories are captivating. Tell your children stories about them as babies, or what it was like being pregnant with them. Share stories about yourself when you were a child and about your own family.  Draw them in and strengthen their connection to their world.

“There is no greater power on this earth than story”. –  Libba Bray 

Expand Language with Water Play!

Summer is here! It’s hot!  But, that’s okay for preschoolers because they LOVE playing with water. Sprinklers, water balloons, water blasters, water parks, kiddie pools and the beach. I remember when my kids were little we set up the sprinkler under our trampoline for cool bouncing on hot summer days.

However you enjoy water together there will be opportunities to explore, engage in turn-taking, expand vocabulary and talk about concepts related to water.

It is my personal belief that so long as your child is safe and not causing any damage, let them play with water however they want. What is particularly nice about water play during summer is that it takes place outside! This means no mess and minimal clean up.

One of my favourite water games to play with preschoolers is Sink or Float. You can use it to provide your child with new information and help them think about the world and how things work. This game is also well suited to play with multiple children as it is easy to take turns.

To play you need a large bin filled with water, some random small toys and objects, and a bowl to put your objects in. I like to gather both indoor and outdoor objects. Walk around the yard hand-in-hand choosing small items such as leaves, moss, grass, sticks and flowers. Next, take one object at a time and ask your child to guess if it will  Sink or Float  in the water. Then place the object on the water’s surface and watch what happens together.

Kids go crazy for this!  They love guessing and witnessing the results.

When playing Sink or Floatget down on your child’s level so you are eye-to-eye. Give them opportunities to comment on what they have observed. Ask questions and wait for their answers. Stimulate your child’s language by modelling these water-related conceptual words:

“wet – dry,  light – heavy,  under – on top,  deep – shallow,  slow – fast”

To help your child understand a new vocabulary word use it at least a few times during play, and then use it again later in other contexts outside of water play.

When  Sink or Float  gets old there are many other ways to play with water together in the summer. Water the garden, run through the sprinkler, use water and a sponge to “clean” things outside, or pretend to be Karate Kid using water and a paintbrush to “paint” the fence. Whatever activity you choose, remember to follow your child’s interest, model water-related vocabulary, give them opportunities to take turns and respond to their words.

There is no right or wrong way to play with water. Be prepared to get wet, have fun and connect.

The Unknown Risks of Pacifiers

Using a pacifier can be an easy and effective way to help your baby fall asleep. However, pacifier usage does have its drawbacks. Among the most significant, is the increased risk of developing ear infections.

Ear infections are twice as common in children who use pacifiers.

Sucking on a pacifier can increase the movement of nasopharyngeal secretions into the middle ear. As a result, when a child has a cold, pathogens are more likely to enter the middle ear.

A child’s first middle ear infection results in damage to the mucosa of his middle ear, predisposing him to further infections. And with multiple ear infections, if there has been damage to the eardrum, bones of the ear, or the hearing nerve, there is a small risk of permanent hearing loss.

Acute otitis media (AOM) is a common middle ear infection in young children. It is much more common in children from 6 -12 months than in children from 0 – 6 months.   It is the leading cause of doctor’s visits by childrenand is also the most common reason children receive antibiotics or undergo surgery.

Ear infections can take up to a month or longer to heal. With fluid in the ears making it difficult for your child to hear sounds, it is inevitable that she will miss out on some of the speech models and stimulation that support typical speech and language development.

Children who suffer repeat ear infections commonly experience an accompanying delay in development of speech and language skills. 

Signs your child might have an ear infection:

  • Pulling at the ears
  • Not responding to sounds
  • More crying than usual
  • Trouble sleeping
  • Fever

Some other risk factors for AOM include: a child’s age, recent illnesses, allergies, genetics, and a history of gastro-esophageal reflux disease (GERD).

Pacifier use is one of the few AOM risk factors that parents can control!

A further consideration when deciding on pacifier use is your child’s age. A child as young as 6 months engages in sound play, and by 12 months he is using words, with his vocabulary growing up to 50 words by the time he is 18 months old.  (See my blog on speech-language milestones.) So from 6 months onward it is preferable to limit anything that might inhibit your child from engaging in sound play, taking turns in interactions, or attempting to produce words out loud.

Maintaining a “pacifier free mouth” for your child during this period of extensive expressive language development is simply a good idea. 

If your child of 2 years or older is already using a pacifier and you would like to get rid of it, here are a few ideas shared by some creative moms.

  1. The Pacifier Fairy: Explain to your child that the Pacifier Fairy needs pacifiers for the new babies. Help her gather all her pacifiers in one bag and leave it beside her bed one night. Explain that the fairy will leave a special gift to thank her for her help.
  2. Exchange the pacifiers at the Toy Store: If there is a toy your child especially desires, explain that the toy store will exchange pacifiers for toys. This will require you speaking to the customer service representative at the store and arranging the exchange in advance.
  3. The Broken Pacifier: Make a small incision in the tops so they no longer work. Explain that the pacifiers are broken and take them away.

Sucking on a pacifier helps a child relax their nervous system and so is often used for comforting.

Tips to help ease the transition:

  1. The earlier you take away a pacifier, the easier it will be. Ideally get rid of it in the second 6 months.
  2. Go cold turkey if you can. Or start by using it only at bedtime.
  3. Offer a special snuggly toy as a replacement.
  4. Introduce other sensory integration activities during the day: blowing bubbles in water through a straw, kneading dough, a slow firm back rub.

Regardless of how you get rid of the pacifiers, be prepared for three challenging days ahead. Remember that many generations of children have endured this rite of passage, and your child shall too. The undeniable long-term gains you are securing for your child are worth it.

For further reading:
Rovers, M.M., Numans, M.E., Langenbach, E., et al, (2008). Is pacifier use a risk for otitis media? A dynamic cohort study. Family Practice, Volume 25, Issue 4, 233–236

Nelson, A.M. (2012). A comprehensive review of evidence and current recommendations related to pacifier usage. Journal of Pediatric Nursing, 27, 690-699

The One Question I Am Asked Most Often

The one question I am asked most often is from parents wanting to know if their child has the level of speech and language abilities that are expected at his age. First-time parents especially, may not have previously witnessed a child moving through the stages of development. In such cases, it is not unusual to feel some uncertainty.

January, a time of year brimming with reflection and planning, is the perfect time to check if your child is developing as expected. Following up on any concerns you have now affords you plenty of time to pursue an evaluation and recommendations before the start of the next school year.

Typical speech and language development follows a predictable progression however, children develop at different rates. For example, although not all same aged children will be able to understand and answer the same types of questions, they will all learn to answer basic “yes/no” and “where” questions before the more complex “how” and “why” questions.

Below is a summary of COMMUNICATION MILESTONES. Consider these to be average ages at which most typically developing, monolingual, English-speaking children will acquire these skills. The ages are provided as a general guideline.

Scroll down the checklist to your child’s age. Descriptions of pre-linguistic skills, listening skills, verbal abilities, pragmatic skills, and literacy development have been included for the applicable stages.

From 0-6 months
☐   Responds to voice and sound.
☐   Turns his head toward source of sound.
☐   Watches the speaker’s face.
☐   Establishes eye contact.
☐   Babbles to gain attention.

From 7-18 months
☐   Stops an activity when her name is called.
☐   Listens with interest to new words.
☐   Answers questions when presented with two choices.
☐   Responds to “no”.
☐   Tries to communicate with actions and gestures.
☐   Copies the simple actions of others.
☐   Expressive vocabulary grows to 50 words.

From 19-24 months
☐   Beginning to understand simple one-step oral directions.
☐   Understands 300 words or more.
☐   Understands in, on, another.
☐   Answers “yes/no”, “where”, and “what’s this” questions.
☐   Strangers will understand 25% – 50% of what he says.
☐   Using intonation (raised pitch) to ask questions.
☐   Has an expressive vocabulary of 50-200 words.
☐   Starting to combine two or three words together.
☐   Asks limited “wh” questions.
☐   Begins to use pronouns.
☐   Using turn-taking verbally.
☐   Waves bye-bye.
☐   Recognizes some books by their cover.
☐   Will attend to a toy or a book for up to two minutes.

From 2-3 years
☐   Answers simple “wh” questions logically.
☐   Beginning to understand some time concepts: wait, later.
☐   Understands size differences.
☐   Strangers will understand 50% – 75% of what she says.
☐   Frequently omits consonants in the middle or at the ends of words.
☐   May exhibit initial word repetitions (normal stuttering).
☐   Expressive vocabulary grows to 1,000 words.
☐   Maintains topic over several conversational turns.
☐   Makes conversational repairs if her listener doesn’t understand.
☐   Using pronouns my, me, mine, you, your, yours, he, she, and  we.
☐   Using plurals.
☐   Requests permission.
☐   Begins to use language playfully (jokes).
☐   Begins to describe colors and size.
☐   Holds a book correctly.

From 3-4 years
☐   Follows simple two-step oral directions.
☐   Answers more complex “how” and “why” questions.
☐   Understands beside, between.
☐   Identifies colors.
☐   Strangers will understand 80% of what he says.
☐   May frequently talk to self.
☐   Uses words to express feelings.
☐   Using pronouns they, us, hers, his, them, and her.
☐   Begins to pay attention to print.
☐   Participates in rhyming games.
☐   Able to make some letter-sound matches.

From 4-5 years
☐   Follows simple three-step oral directions.
☐   Answers “when” and “how many” questions.
☐   Understands comparative and superlative adjectives, such as bigger, biggest.
☐   Understands time concepts, such as week days, yesterday, today, tomorrow, next week.
☐   Understands concepts of position, such as first, middle, last.
☐   Strangers will understand 75% – 90% of what she says.
☐   Beginning to use language to resolve disputes with peers.
☐   Understands the purpose of print.
☐   Understands story sequence.
☐   Can answer questions about simple short stories.

From 5-6 years
☐   Follows instructions given to a group.
☐   Understands opposite concepts.
☐   Understands left / right
☐   Strangers will understand 90% – 100% of what he says.
☐   Asks the meanings of words.
☐   Asks questions to obtain information.
☐   Uses yesterday and tomorrow.
☐   Understands that spoken words are made up of sounds.
☐   Begins to write letters and some familiar words.
☐   Begins to recognize some written words by sight.
☐   Reads a few simple books from memory.
☐   Able to print own name.

Use care when reviewing the above speech-language milestones, and applying them to your child. Remember that normal development varies quite a bit, and it is hard to tell when your child will get to each stage.

You know your child. And it is normal to compare your child to other children. If you suspect that her speech-language development is behind for her age, then there is no harm in consulting with a certified Speech-Language Pathologist. Sometimes just a short conversation can clear up any worries. Trust your instincts.

Here are some clear indications that a child would benefit from a speech and language evaluation. If any of the following apply to your situation, then I recommend contacting a Speech-Language Pathologist.

1. If your 12 month old does not respond to his name.
2. If your 30 month old has not begun combining two words together.
3. If adults regularly have trouble understanding your 3 year old.
4. If your 4 year old does not answer simple “wh” questions.
5. If your 3 – 4 year old grabs toys from other children instead of making verbal requests.
6. If your 4 year old repeats sounds or parts of words.
7. If your 5 year old has trouble following directions.
8. If your 5 year old can not make a rhyme.
9. If your 6 year old is not making all of her speech sounds clearly.
10. If your child’s teacher has expressed concerns about his speech or language skills.