SM13: Pediatric Speech Delays Can Be Managed if Caught Early

SCOTTSDALE, Ariz.—A small child who is having trouble talking, or isn’t talking at all, can be a big source of distress for parents, but early intervention can be effective, said a panel of experts here on Jan. 26 at the Triological Society Combined Sections Meeting. Click here to listen to the complete session on speech delay.

The experts also said it is important to distinguish between what is a problem and what isn’t—a task that might be difficult when the scenario is presented by worried parents—and to understand what helps and what might not be worth trying.

Risk Factors

Carla Zimmerman, PhD, an Arizona speech pathologist in private practice, said that speech delay should be thought of in two ways—how a child produces speech sounds and difficulty with the content of messages and vocabulary. Girls generally outpace boys in speech by only a few months, so a lag in a boy’s speech shouldn’t be chalked up simply to a gender difference, she said.

“Late talkers,” or kids who don’t start talking until they are between 18 and 30 months of age but seem to understand well, will frequently outgrow the problem; about 35 to 60 percent will go on to be normal talkers, Dr. Zimmerman said. “The problem is, we don’t know who those kids are,” she added.

Risk factors of speech delay include minimal babbling as an infant, a history of ear infections, limited consonant sounds, failure to link pretend ideas and actions together when playing, failure to imitate words, use of mostly nouns and few verbs, trouble playing with peers, a family history of communication delay or learning problems, mild comprehension delay for the child’s age and the use of few gestures to communicate. If a child has a limited vocabulary for his or her age and any of the risk factors, it’s best to consult with a speech pathologist, said Dr. Zimmerman. “There is a window of development for children, and if we catch the children early enough that they’re still in that window of potential learning, we can get a lot more bang for our buck,” she said.

Ankyloglossia

Ankyloglossia doesn’t affect speech unless it’s very severe, Dr. Zimmerman said. Panelists said that the decision to recommend and perform frenulectomy can be a touchy subject.

Moderator Kenneth Grundfast, MD, chairman of otolaryngology-head and neck surgery at Boston Medical Center, said he’ll typically just do the procedure rather than argue with a neonatologist about its merits, but if the child is two to three years old and will require general anesthesia, he’ll usually try to talk the parents out of it, with mixed success.

Other Underlying Variables

In some cases, the problem can be larger than a speech delay—it could be linked with autism. “If you see a child who has difficulty with social relationships … communication issues, any repetitive behaviors or overly restricted interests, there’s a really good chance that this child is going to fall within the autism spectrum,” Dr. Zimmerman said.