Why the Delay?


While our kids are in their first couple of years, we anxiously await hearing them speak their first words. Many times, there is much interpretation involved, as mere sounds are called words for that landmark moment. As kids progress past that mark, however, we are much less likely to be as forgiving, and begin correcting pronunciation of every new sound that comes out of their mouths. When they get to be two years old, we begin to worry when the speech doesn’t sound like what we expect, or like other kids around them. This is oftentimes when kids show up in my office upon referral from their pediatrician: to check their ears.

Kids can have many issues with speech and there are many causes of those issues. They can range from anatomic problems like a tongue or lip attachment (tie), to hearing issues, to a simple delay in speech production.

When kids show up in my office to sort these problems out, we start with a simple exam. If the tongue is mobile enough and has enough length to touch the roof of the mouth, or sticks out far enough to lick an ice cream cone easily, then it’s long enough to create normal speech sounds. If not, however, it’s a simple thing to release the attachment and give it some more length. For kids under a year of age, we can do this in the office with a little numbing and they will be able to nurse or take a bottle within minutes. I also see many kids who have an upper lip attachment, which will not cause speech issues, but can cause issues with the front teeth not coming together completely. This attachment can also be released, but since it’s noticed later when teeth are coming in, we often will do the procedure in the O.R.

Once the mouth is deemed to be fine, we check out the ears. If there is fluid behind the ear drum, sometimes accompanied by a history of recurrent ear infections, then this can definitely cause speech issues. These kids can hear, but everything sounds garbled. If they are looking at you and know what you’re talking about, they will follow the conversation, but when you are behind them or they aren’t focused on you, they will miss a lot of what you say. I realized my own son had an issue at an early age, when I noticed that he always wanted to be in front of the TV when he sat on the couch with us, because he couldn’t hear well. If there is fluid and it’s there for more than a few months, we would drain it by placing tubes in the ears.

If the tongue and ears are normal, the next step is a hearing test. At a young age, kids won’t raise their hands when they hear the beep; but there are ways to assess their hearing that don’t require much/any participation. If the hearing is significantly abnormal, then more testing follows with hearing aids being a possible course of action.

If all of the above check out fine, then the child is probably just “slow to talk,” and when the age is appropriate, we would recommend speech therapy to help them along.
Be careful what you wish for, though – once kids start yacking it up, they won’t stop …
for years!



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