When should parents seek Speech Therapy?

No two children develop in the same way, even from within the same family! Some children are talking a blue streak by 2 years, while some are only saying a handful of words by that age. So how is a parent to know when to worry?

That’s what milestones are for. Milestones mark the stages for when most children would have acquired each of the skills. Putting it another way, a child who has not met these milestones is far behind most of his peers.

Despite well-meaning professionals and friend’s advice to adopt a wait-and-see approach, it is always better to identify areas of need early on. Research has shown that the earlier children acquire their language skills, the better their outcomes tend to be. If the problems are treated early, the toddler has a chance to completely catch up with their peers. And even if they don’t, their outcomes are significantly improved by getting treatment early.

So if you have a feeling in your gut, talk to a paediatrician or speech therapist. Talking to one may help to put your mind at ease, and if there is truly a developmental issue, at least you can get it treated sooner rather than later.

For parents who are concerned, here are some red flags regarding speech, language and feeding skills that may warrant speech therapy for your child.

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Social and Emotional

Social and emotional skills are important for helping a child interact and relate to others. If a child shows any of the red flags below, speak to your paediatrician and ask for a referral to a speech therapist and other relevant professionals.

• No big smiles or happy expressions directed at people by 4 months
• Not copying facial expression like smiling or frowning by 6 months
• Does not enjoy playing with people by 9 months
• Not making sounds and actions to get attention by 14 months
• Not playing games like “peek-a-boo” and “pat-a-cake” by 14 months
• Not pointing to show others something interesting by 24 months
• Not engaging in pretend play by using objects to stand for another object by 24 months
• Not imitating the actions of adults and older children by 24 months
• Not playing appropriately with toys (e.g. spinning the wheels of a car to watch it spins rather than rolling the car)
• Appearing to ignore people
• Has tantrums and meltdowns when routines are changed or when moving from one activity to another

Language / Communication

Language and communication skills are important for your child to express his needs and wants as well as to understand what he hears. At any age, a sudden loss of words, babbling or social skills is a red flag. If your child shows any of the symptoms below, talk with your paediatrician and ask for a referral to a speech therapist.

• Not turning head towards sounds by 4 months
• Has difficulties making and sustaining eye contact with an adult by 6 months
• Not responding to own name by 9 months
• Not making sounds to express joy and displeasure by 9 months
• Not taking turns with parents through the use of expressions, smiles and sounds by 9 months
• Not understanding “no” by 12 months
• Not babbling by 12 months
• Not using gestures like pointing, waving, clapping by 12 months
• No first words and no attempt at imitating a word by 16 months
• Not using words, expressions and gestures to communicate needs and wants by 16 months
• Does not consistently following simple and routine requests by 18 months
• No spontaneous 2-word phrases by 24months
• Not taking part in to-and-fro conversations with another person by 30months

Cognitive

Cognitive skills are the skills your child uses to understand, explore and learn about the world. If you notice any of the red flags below, speak to your paediatrician and ask for a referral to a speech therapist and other relevant professionals.

• Not reaching out for things by 9 months
• Not exploring things with mouth by 9 months
• Not looking for things he sees you hide by 12 months
• Not copying gestures like clapping by 14 months
• Not engaging with container play by 14 months
• Cannot stay with an activity for more than 1 minute by 16 months
• Not identifying a few body parts when named by 24 months
• Not beginning to sort objects by categories by 27 months (e.g. animals in one box and vehicles in another)
• Has difficulties in solving simple problems as compared to his peers
• Unaware of changes in his/her environment and routine

Feeding

Feeding skills are important as your child transitions from milk to soft food to solid food. If your child shows any of the red flags below, talk to your paediatrician and ask for a referral to a speech therapist.

• Excessive drooling after 24 months
• Mouthing objects after 24 months
• Coughing/choking excessively during meal times
• Has problems with sucking, chewing or swallowing
• Has problems with control and coordination of lips, tongue and jaw
• Has difficulties transitioning between food stages
• Has difficulties chewing soft food by 12 months
• Not drinking from a regular open cup by 15 months of age

Conclusion

Considering how early typically-developing children achieve these skills, these milestones are considered pretty generous. So if you see any of these red flags in your child, it is imperative to talk to your paediatrician.

If you are still unsatisfied with their answers, get a second opinion. Many a time, mothers know their babies best, and their gut feeling can very well turn out to be a real concern.

Remember, the worse outcome is that you might have wasted a little time and money. But if it turns out to be a real developmental disorder, the precious time you gain from early intervention can make a HUGE difference to your child’s future. So if you have any concern, act today.

Resources:

1. Adapted from

1. CARING FOR YOUR BABY AND YOUNG CHILD: BIRTH TO AGE 5, Fifth Edition, edited by Steven Shelov and Tanya Remer Altmann © 1991, 1993, 1998, 2004, 2009 by the American Academy of Pediatrics
2. BRIGHT FUTURES: GUIDELINES FOR HEALTH SUPERVISION OF INFANTS, CHILDREN, AND ADOLESCENTS, Third Edition, edited by Joseph Hagan, Jr., Judith S. Shaw, andPaula M. Duncan, 2008, Elk Grove Village, IL: American Academy of Pediatrics.
3. Milestones by Teachmetotalk.com
   Disclaimer: This milestone checklist is not a substitute for a standardized, validated developmental screening tool.