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When should a parent be concerned?

When should a parent be concerned?

“Sally is a talkative seven-year-old with an endearing lisp. Even though her permanent front teeth have grown in, Angela still pronounces some words like she did when her baby teeth fell out. Her mother wonders if she should be concerned”

“Five-year-old Damien likes to talk a lot, too, but he is hard to understand. His family usually understands his somewhat unusual pronunciation of words, but people who don’t know him well often can’t understand him. This is frustrating to him.”

“Stephen’s parents have noticed that sometimes he has a hard time getting his words out. For weeks at a time his speech will seem normal, and then he begins “stumbling” over words. His parents want to know if this is stuttering”


Language problems often go unnoticed as there are so many contextual clues that help these children get by. Most child development books outline the milestones of language development.  If your child is unusually delayed according to those norms, you should speak to your health visitor or doctor.

It is important to remember, however, that language acquisition is hard work, even for a child. Many young children have a period of rapid physical development accompanied by little growth in the area of language, or vice versa.

Some children have difficulty in understanding what others say to them (receptive difficulties) and need practice understanding sentences of increasing length and complexity.  Other children have difficulty putting sentences together (expressive language difficulties) and this can be enhanced by modelling and rehearsal using large doll play and puppets.

We have developed a range of games and activities to help children with language difficulties.

Particular things for parents to look out for are:

  • Does he understand you, even when there are not visual clues to help him guess what you said?
  • Is he beginning to link his words up into simple sentences?
  • Can he put together a range of different kinds of sentences?
  • Does he talk about a range of topics or does he focus on just a few?

If you are concerned, talk to your Health Visitor or doctor who may advise an assessment by a Speech and Language Therapist


Many children go through a normal period of dysfluency between the ages of three and six. Many stuttering problems begin at this time when an anxious parent draws attention to the dysfluencies and interrupts the child’s attempts at communication. The best approach to a stuttering problem is to give the child time to talk, and avoid rushing him or drawing attention to his difficulties.

Things That Help

  • Provide a calmer, less-hurried life-style in the home.
  • Speak less hurriedly when talking to the child.
  • Allow the child to finish his thoughts.
  • Try not to talk for the child or rush him to finish his thoughts.
  • Pause a second or so before responding to the child’s questions or comments.
  • If there are siblings, set up talking rules in your family:
  • We take turns talking.
  • Each person does his own talking.
  • We listen to each other.
  • If your child begins to talk to you while you are doing something that requires concentration (e.g., driving a car or using a knife), tell him that you can’t look away right now, but that you are listening and that he has your attention.
  • Pay attention to what the child says, not how he says it.  Respond to the message.

Things That Hinder

  • Finishing the child’s sentences.
  • Rushing the child to finish his thoughts or sentences.
  • Interrupting the child while he is talking.
  • Frequently correcting, criticizing, or trying to change the way he talks or pronounces sounds or words.
  • Encouraging or requiring him to talk rapidly, precisely, and maturely at all times.
  • Speaking to the child at a rapid rate, especially when telling him to slow his own rate of speaking.
  • Maintaining an overly-rapid life-style within the home, or constantly living with time pressure.
  • Making the child give little recitations or plays to visiting friends, relatives, or neighbors.
  • Telling the child to stop and start over when he begins stuttering.

If the dysfluencies persist for longer than 3 months, or the child is becoming aware of it, it would be helpful to see a Speech and language Therapist for advice.

Pronunciation (Articulation)

Even with good receptive and expressive language, a child’s pronunciation may prevent you from understanding them

A good idea is to listen carefully for what sounds he has difficulties with, and how consistent he is in his mispronunciations.

Sounds which are made towards the front of the mouth (such as m, n, p, b, t, d) are the easiest to make. They are usually acquired first.

Any sound which occurs in a “blend” (sp, st, sk, pr, fl, etc) is particularly difficult to pronounce.

Consistently mispronounced sounds are a concern as the child gets older.

These are the ages by which we would normally expect sounds to be established

By age 3  —  all the vowels, and also p, b, m, n, d, g, h

By age 4  —  k, t, th, f, v, ng, j, tch

By age 5  —  sh, zh, s blends (sp, st, sk, sl, sn, sm)

By age 7  —  l, r, s, th

A Speech and Language Therapist will be able to listen to your child and advise you whether his speech is simply immature or will need some extra help to get any problem sounds sorted out.  We have also developed a wide range of games and activities to promote sound discrimination and phonological development, important precursors to clear speech and later for literacy skills.


Voice disorders are not usually identified by parents because parents become accustomed to the sound of their own child’s voice. A voice problem may be noticed first by a family friend or teacher.

An unusual-sounding voice can indicate physical problems which should be investigated by a doctor. Listen for an unusually high or low pitch, pronounced nasality, or a chronically scratchy or gruff voice quality.

Can children outgrow their speech problems without intervention?

As they are learning to talk, all children go through an unconscious self-correction process. They are constantly receiving new language information and adjusting their use of previously-acquired language in order to communicate more clearly. Parents can observe this process in action as they watch their preschooler become more precise and fluent in his verbal expression each successive year.

If you have concerns, it may be useful to see a Speech and Language Therapist to put your mind at rest – or give you ideas about how to help.

Besides voice disorders, are there other speech problems that should be referred to a physician?

If your child has delayed speech it would be wise to have a hearing check to be sure there is no chronic ear infection which can impair hearing.

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