Frequently asked questions about speech development

Parents frequently have questions about their child's hearing and speech-language development. With the help of an audiologist or speech-language pathologist, it is possible to evaluate your child's hearing, speech and language skills.

Common concerns about speech and language development

My child is 2 years old and not talking.

While there is a wide range of variability in normal development, a 2-year-old should be using words and phrases to communicate his or her wants and needs. It would be a good idea to schedule a speech-language evaluation to assess your child's skills if he or she isn’t talking by age 2. A speech-language pathologist may provide suggestions and recommendations.

I have a hard time understanding my 2-year-old.

A 2-year-old does not say words as precisely and correctly as an adult. But you should be able to understand your 2-year-old approximately 50 percent of the time. It is common for children this age to mix nonsense words and real words.

My 4-year-old can't say "r" and "l" sounds correctly.

This is very common. A child is not expected to say these sounds correctly on a consistent basis until he or she is about 6 years old. If you are questioning whether your child's speech skills are appropriate for his or her age, a speech-language evaluation can help identify whether pronunciation skills are age-appropriate of if speech therapy may be needed.

My child is not responding to environmental noises or people's voices.

There are many reasons a child may not respond to people or noises. Consider scheduling a hearing evaluation for your child. If the hearing assessment shows that your child's hearing is normal, your doctor may recommend a speech-language evaluation to ensure your child understands what is being said.

My child is having difficulty paying attention.

Many different factors can result in a child not paying attention. Hearing problems and difficulties understanding language should be considered before having your child evaluated for language development issues.

My child is not interacting well with the other children.

Some children avoid interaction with other children because they are shy, have difficulties communicating or because of a limited set of interactive skills. A speech-language evaluation will assess your child's skill set to better evaluate the situation.

My child is having difficulty explaining his ideas or answering questions.

Children can have difficulties thinking of the word they want and/or have trouble putting their words into sentences. This may be a form of an expressive language delay. A comprehensive speech-language evaluation would need to be completed to get a good picture of your child's skills.

My child does not seem to follow directions.

Your child may not be following directions because he or she has a difficult time understanding the words or the sentences used. Your child may also be having a hard time hearing the instructions spoken to him or her. A hearing assessment and speech-language evaluation would help determine what is causing these difficulties.

My child is not eating the foods I would expect her to eat at her age.

Sometimes your child may have a problem with eating certain foods, he or she cannot explain it to you. In this case, we recommend a feeding evaluation by a speech-language pathologist to determine the causes of the feeding problems and to plan a way to help solve them.

My child is choking and gagging on food.

Children occasionally choke on foods if they are eating rapidly or haven't chewed their food thoroughly. If this happens often, a speech-language pathologist should complete a feeding evaluation. The evaluation may include a swallow study to be sure that there is not a structural or functional problem causing your child to choke or gag.

My child's voice is very raspy.

While some children will have raspy voices from time to time, other children have this type of voice all the time. It may be from yelling or making noises/sounds. In this case, we recommend an assessment of your child's vocal cords and voice-use patterns. This includes an evaluation by a speech-language pathologist and an ear, nose and throat physician.

My child does not seem to be interested in communicating with me.

When children are younger, they often do not have the communication skills to verbalize everything they are thinking. Younger children often then use different ways to help communicate their message. This may include gestures or pulling you toward things. If your child is not using these other forms of communication, we recommend a speech-language evaluation.

My child is starting to stutter.

Repeating words or parts of words, or prolonging speech sounds (speech dysfluencies) occur naturally in everyone's speech. Most children between 2 and 6 years of age experience an increase in speech dysfluencies as they are learning new language skills and developing better control of the muscles of their mouth to produce speech.

Normal dysfluency in children is usually characterized by repeating the first word in a sentence or phrase. There are several things a parent can do to minimize normal dysfluency so that this does not progress to a stuttering disorder. If you are concerned about your child's dysfluencies, consider scheduling a speech-language evaluation.

What occurs during a speech/language evaluation?

Before each evaluation, we ask parents to provide information about their child by filling out a case history form before the appointment. We also ask that you accompany your child to the evaluation.

At the appointment, a speech-language pathologist will present your child with tasks to assess various speech and language skills. Formal tests that may be completed involve things like having your child talk about pictures or situations, point to pictures, or respond to verbal requests or questions.

The speech-language pathologist also will engage your child in interactions to assess his or her ability to use communication skills when talking with an unfamiliar adult and to determine if your child's speech clarity is age appropriate.
We will also complete a brief examination of the structures of the mouth, including the lips, tongue, teeth and palate. Before you leave the appointment, the speech-language pathologist will discuss the findings with you and make suggestions and recommendations for improvement.