My Child Has Not Started Talking

August 20, 2020

I recently met a couple with a 2½-year old son who voiced out their concerns to me that their son has not started talking. He has not uttered a single comprehensible word and he only uses finger-pointing and gesturing for communicating. Other than this, he had an uneventful birth history, is a very active and energetic toddler with normal physical development, and has no symptoms to suggest any underlying illness. What could be the reason for this speech delay?

Before we start to discuss the possibilities, in this case, I would like to comment that children develop progressively on their own timeline. About 10 to 20 percent of two-year-olds, the majority being boys, are late to develop speech and language. Given time, most of them would catch up by three years old. There might not necessarily be a serious problem if a child seems to start speaking a bit later than others because he or she is a ‘late bloomer’. However, there are things that are typical for the common majority of children depicting what they can do at a certain age. For instance, a typical two-year-old will be able to speak up to 50 words in two or three-word sentences. The vocabulary of a three-year-old is certainly much higher with up to 1000 words. They can even tell short stories. Knowing what is normal helps to detect what is not. Below are the common speech milestones in children:
  • Birth to five months: Coos / Laughs / Cries / Giggles / Makes noise when talked to
  • Six to 11 months: Babbles / Says first word / ‘Ma-ma’ or ‘Pa-pa’ / Repeats sounds
  • 12 to 17 months: Vocabulary of about 5 words / Can imitate simple words
  • 18 to 23 months: Uses two-word sentences / Vocabulary 50 words / Unclear pronunciation
  • Two to three years: Uses three-word sentences / Answers simple questions / Uses pronouns like ‘you’, ‘I’, ‘me’ / Uses descriptive words such as ‘happy’, ‘big’ / Strangers may not understand speech
  • Three to four years: Identifies colors / Describes the use of objects / Expresses feelings and emotion / Strangers may understand what is said


A child may have speech delay if he or she is unable to fit in the common milestones. Most of the time they will catch up at a later age but it is important to not miss actual problems that cause speech and language delay. They include:
  • Hearing loss
  • Prematurity and development delay
  • Autism spectrum disorder
  • Learning disability
  • Neurological disorders – Cerebral palsy / Muscular dystrophy / Traumatic brain injury
  • Ankyloglossia or tongue-tie
  • Parental neglect or lack of stimulation

A suspected child with speech delay will be assessed for risk factors of having the conditions above. Questions will be asked on birth history, family history, speech and language capabilities, and developmental milestones. The child’s ears, mouth, palate, tongue, and the neurological system will also be examined. Depending on this initial screening, the child can be further subjected to audiological tests, referred to as an ear, nose & throat surgeon, speech-language pathologist, or a pediatric neurologist.

Audiological tests to assess the child’s hearing include Otoacoustic emissions (OAE), tympanometry, and brain stem evoked audiometry (BSER). If a child is found to have hearing loss, this is further categorized to type; conductive hearing loss or sensorineural hearing loss and severity of the hearing loss; mild to profound.

Treatment of speech delay will depend on the cause. If the developmental delay is merely speech with no other associated conditions, speech and language therapy may be the only treatment needed. It offers a good outcome especially when initiated early. Even when speech delay is caused by other additional factors, speech and language therapy by a trained therapist helps as part of an overall effective treatment plan.

When the speech delay is associated with other disorders as mentioned above, it is important to address those issues as well, in addition to speech and language therapy. These include treating the hearing loss, correcting mouth or tongue abnormalities, physical or occupational therapy, behavioral therapy and also treating underlying neurological disorders.


As parents, it is good practice to be observant of your children’s capabilities and developmental milestones. Equally commendable would be to encourage and nurture your child’s speech by the methods below:
  • Talk to your child. Use proper words with good eye contact. Give your full attention.
  • Point or gesture to the objects as you describe or narrate.
  • Read together with your child. Tell easy to understand stories.
  • Be patient when talking to them. Explain things carefully using simple words.
  • Sing together simple songs or nursery rhymes.
  • Let them answer questions posed by other people instead of answering on their behalf.
  • Ask them questions with multiple answers and give them plenty of time to answer.
  • Allow your child to interact and play with children who have good speech and language skills.
 
As a closing note, your child’s speech delay might just be him or her being a ‘late bloomer’ but it can be caused by something else as mentioned above. Be vigilant. Bring your child to a medical practitioner preferably before three years old for an early assessment and intervention as this has proven to bear successful outcomes.


 
Dr. Mohd Adzreil Bin Bakri
Consultant ENT, Head & Neck Surgeon
Columbia Asia Hospital – Setapak

MBBCh BAO (Ireland), MRCS (ENT) (Edinburgh), M ORL-HNS (UM), CMIA (NIOSH), AM (Malaysia)
 
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This article first appeared in BabyTalk.

 
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