How to Identify a Speech, Language or Feeding Issue in Kids

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Speech language pathologists deal with multiple speech, language, feeding and voice issues. On this week’s On Call for All Kids, Therese Montanari, M.S., CCC-SLP, director of the Speech-Language and Feeding division at Johns Hopkins All Children's Hospital, discusses the most typical speech and language concerns that children may be experiencing.

What should parents be looking for?

The first area of concern is a child who is demonstrating a language delay. This may be an expressive language delay/disorder, which is characterized by children who do not have the sounds, words or phrases they should have for their age. For example, if your child is 2 years old and not talking in two to three-word phrases, he or she does not have a vocabulary of 50-100 words. This is when parents may want to seek professional help by a pediatric speech language pathologist.

There are milestones for each age of what is expected for expressive skills. One main reason parents need to start with early identification is children who understand the world around them but cannot express their needs often become very frustrated and often we may see behavioral issues develop, for example hitting, throwing, biting, screaming, etc. When a family comes in for a family evaluation, a speech language pathologist will look at the child’s play, understanding of language and overall communication (gestures, sounds, words). Parents can help overcome language delays by offering choices (for example, do you want the ball or car?), modeling words/sounds, playing with a farm and modeling all the animal sounds or car sounds. 

What are some speech expectations for children of different ages?

• 6 months: babbling, repeating sounds: mamma, dadadada
• 1 year: saying from one to three words (e.g., mama, dada, bye bye), using gestures and pointing
• 2 years: say at least 50-100 words, putting together two-word phrases, pointing to objects
• 3 years: Uses about 1,000 words, speaking in three- to five-word sentences, says their name, asks questions, sings songs
• 4 years: talks in sentences, vocabulary more than 1,000 words, names letters and numbers

What else should we look for?

Another issue is children who present with an articulation/phonological disorder. This is children who typically have difficulty making specific speech sounds and others may not understand their speech. They are making sound substitutions such as tar for car or do for go. The general rule of thumb is: others should understand their speech for a 2-year-old 70% of the time, a 3-year-old 80% of the time, a 4-year-old 90% of the time and when they start kindergarten others should understand 100% of the time. Children can present with a mild articulation disorder to a severe disorder.

There is also a subset of children who have difficulty with motor planning, sequencing sounds together in a multisyllabic word like spaghetti. This is called childhood apraxia of speech. When a child has an articulation/phonological and/or apraxia of speech you will want to see a licensed speech language pathologist who can give a differential diagnosis from an articulation disorder to an apraxia of speech.

How early should parents start to look for the above speech and language concerns?

First, it is important to note that communication starts from birth with that first smile and eye gaze. By 18 months, if your child never babbled, used jargon with different sounds, played with different sounds throughout the day, and is not using single words to get his or her wants and needs known, this would be when we would recommend seeking a speech and language evaluation. If your child has other medical issues, ongoing ear infections and/or a medical diagnosis, it may be recommended to see a professional at an earlier age.

What can families do at home to facilitate speech and language development?

Talking to your child, modeling labeling of toys and objects, use rising/falling intonation when playing, reading/labeling pictures in a book, giving a child choice when playing (“Do you want the farm or bus?”). Allow time for your child to try to imitate or copy the words you are modeling.

If a parent has concerns, how would they start to seek services?

I would recommend that you start with your child’s pediatrician and discuss your concerns. Request a speech-language evaluation and a referral for a pediatric speech language pathologist, if needed. At that evaluation, the therapist will start by asking the caregiver their concerns, review history, establish rapport with the child through play, as well as assessing language skills through play and formal testing. The therapists will review results at the end of the evaluation and recommend therapy and practical language strategies to use within the home environment to improve speech and/or language skills. If any other referrals are necessary, they would discuss with the family as well.