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When should parents address a child's speech or language difficulty? 

All kids make mistakes as they learn to talk — saying "wabbit" for "rabbit" or "theethaw" for "seesaw." But when does a cute mispronunciation suggest a possible disorder? We turned to Dr. Lewis First, head of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, for tips on untying young tongues.

KIDS VT: How common are speech and language problems in kids?

LEWIS FIRST: About one in five children will be a late talker, but the vast majority catches up by the time they enter elementary school. If not, parents should schedule an evaluation by the child's doctor to make sure there's not an underlying concern. Doctors can identify problems with speech, or how kids say their words; articulation, which refers to how they form sounds; or language, which refers to the whole system of expressing and receiving information, then sharing that understanding with others. Language problems can involve both verbal and writing skills. Of course, all of these can overlap.

KVT: What causes these problems?

LF: When a child has difficulty with speech and/or language, it can mean there's a problem with the nerves running from the brain to the mouth, tongue and palate. Or that there are difficulties around those particular parts of the anatomy, such as a short tongue or a cleft palate causing these body parts not to function properly. A child may also have a hearing problem. But many speech problems are of unknown origin.

KVT: When should parents seek help?

LF: If parents think their child cannot hear, or if the child doesn't respond to loud noises in infancy, or by 6 to 9 months isn't babbling or making sounds, that's a concern. By one year of age, a child should be able to make some gestures, wave bye-bye and say a few syllables indicating what he or she wants, such as "mama" or "dada." By 18 months, a child should be able to say about 20 words. By age 2, about 50 words. A good rule of thumb is the "rule of fractions." You should be able to understand at least half of what your child says by age 2, three-quarters of what a child says by age 3 and essentially all of what a child says by age 4.

KVT: What can parents do to prevent problems from developing?

LF: One reason some children are late talkers is that their parents didn't introduce enough verbal stimulation in their first year of life. Parents should spend a lot of time in that first year communicating verbally with their child — talking, singing and imitating their child's sounds. Parents should also read to their child beginning in the early months of life and use a finger to follow the words and point at pictures. Take your child with you during normal daily routines, and say the names of foods in the grocery store or items in the house, even if your baby cannot yet respond to what you are saying.

KVT: What's the first step in addressing a speech/language problem?

LF: Your child's doctor will probably start with a hearing test and subsequently do developmental tests to determine if it's a language problem or a speech/sound problem. In either case, a doctor may refer your child to a speech and language therapist for further evaluation. Oftentimes, the therapist will recommend exercises that families can do with the child to address the problem.

KVT: How common is stuttering?

LF: About 3 million people nationwide stutter. It's very common between the ages of 2 and 5. Any child learning to put together words is going to stop and pause. But when a child starts to repeat a sound or syllable four or more times, that's when we arrive at a diagnosis of stuttering. The vast majority of stuttering between ages 2 and 5 goes away with time. If it lasts for more than six months or continues into elementary school to the point where a child is embarrassed or teased for it, the child should be evaluated.

KVT: Can certain situations exacerbate stuttering?

LF: Stress will increase it, so parents should try to create a stress-free environment. That means making talking fun and not correcting your child all the time. Parents should avoid phrases such as "slow down," "take your time," "take a deep breath," and "think before you speak." That only makes your child more self-conscious. Let your child finish the phrase. Parents should speak clearly and look at their child while the child is speaking, and not turn away. The name of the game is helping your child gain control over it. Parents should know that stuttering isn't a sign of bad parenting or that a child is not intelligent.

KVT: What are other common speech impediments?

LF: There's lisping. Early on, all kids will have mispronunciations as they refine the connections between their brain and their mouth, tongue, palate, and vocal cords. So that's where you get "w" for "r," such as "wabbit," or "th" for "s." These can be neurological or anatomical in nature. Kids can outgrow them or speech therapy can help overcome them.

KVT: Can speech/language problems be emotional or psychological in nature?

LF: Absolutely. Emotions and environment can intensify speech problems. Some kids become mute due to abuse. If an infant is not responsive to noise and doesn't want to cuddle, doesn't return a smile, doesn't notice noises and/or acts like she is in her own world, that may be part of a larger developmental problem that warrants further investigation by your baby's doctor.

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