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ASK DR. K: Toddler's speech can be an issue

by on March 04, 2014 11:00 AM

DEAR DOCTOR K: My 4-year-old still mispronounces many words.

Adults outside of our family have trouble understanding what he’s saying. Should I be worried?

DEAR READER: Just as it took time for your child to learn his first word, it takes time for children to learn to speak clearly and correctly.

To see what the latest thinking on this is, I talked to pediatrician colleagues at Harvard Medical School.

In their first couple of years of life, all children pronounce words incorrectly as they are learning to speak.

By 3 years of age, children pronounce most of their words correctly and a stranger would understand at least three-quarters of them.

By 4 years of age, mispronounced words are less common.

However, even at this age, many children still use words incorrectly and have difficulty with certain sounds, especially f, l, r, s, v, sh and th.

Stuttering, an interruption in the normal flow of speech, can be a phase in the normal speech development for some children.

Stuttering is typically first noticed between the ages of 2 and 5, though sometimes it begins as early as 18 months of age.

Many cases of stuttering last for only a few months, and most children who stutter stop completely before the end of their childhood.

If your child mispronounces words, makes grammatical mistakes or stutters, you can help at home by doing the following:

• Encourage conversation. Set aside time each day for sitting down and talking with your child one-on-one. Also talk while doing everyday activities such as grocery shopping or making dinner.

• Use adult language, not “baby talk,” when speaking with your child.

• Speak to your child slowly and clearly.

• Make eye contact and use facial expressions and other body language in addition to words to enhance communication with your child. It’s often your expressions and body language that help them to learn the meaning of words.

• Be a patient, attentive listener.

• Do not finish your child’s words or sentences and do not interrupt.

• Do not pressure your child to speak to strangers or perform in public.

If you are still concerned, talk with your child’s doctor.

He or she can refer you to a speech-language pathologist for further evaluation if needed.

Speech-language pathologists can help you and your doctor distinguish normal variability in speech development from a true problem.

Not every blossom unfurls the same way in the morning sun, and not every child progresses in the same way through the stages of childhood development.

It is sometimes said that even Albert Einstein was very slow to speak (although several biographers have expressed doubt about that).

In any event, some kids are precocious in one area and slow in others — and then catch up.



Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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