Dr. Bob: I am worried that my 24-month-old son has only a few words. He seemed to be delayed at 18 months, but we were told just to wait and see. His motor development seems fine (sitting at 6 months, walking at 11 months) and he is very playful. Should we be concerned about his development?
Answer: The concerns here are predominantly in the area of language. A recent ASK DR BOB column addressed the issues of more global developmental delays (https://mychildrenschildren.com/developmental-concerns-december-13-2024/).
Speech and language delays are fairly common in my experience. The good news is that these problems tend to improve over time. Let’s review several things –
- There are two types of language – receptive and expressive. Receptive language is the receiving of information (the language of others), processing it and then reacting to it. Expressive language is the process of expressing oneself through speech. Expressive language delays tend to be more common than receptive language delays.
- Receptive language delays are typically characterized by difficulty in responding to language clues. The child might have difficulty hearing or responding to what appears to be a very clear communication. Hearing assessment is crucial in this situation. Hearing tests can determine if the conduction of sound waves is making it through and that the sound waves are being processed by the brain. Receptive language problems can be more difficult to analyze and more difficult to treat. They might signal the need for more aggressive intervention, so diagnosis is important and needs to be timely.
- Expressive language delay is more likely to be related to delayed onset of speech that will take care of itself. In my experience, there is often a history of delayed speech onset in one of the parents. Why the onset of speech might be delayed can be due to a variety of factors. Sometimes “slow” talkers really take off in a very short period of time once they get going. Expressive language delay can certainly be related to speech problems.
So, what to do? One of the most important things to do from birth is to constantly provide a verbal environment for your child. TALK, READ, SING are three actions that should be highlighted at every opportunity. The acts of talking, reading and singing provide a strong foundation that will encourage language development and enhance nurturing. Specifically, for the delay –
- Be sure to attend all of the well child checkups and keep your pediatrician up to date.
- Remind yourself that speech delay does not mean that your child will have permanent delays. Interventions can be so helpful. Do not imply or even hint to your child that speech delay is bad. Help is on the way.
- Always encourage a verbal interaction when discussing things – like “let’s put the red ball on the table next to the fork and the glass of milk.” Complex sentences enhance language development so much more than simple sentences.
- Restrict screen time. It does not help speech and language development.
- Get the evaluations that your doctor recommends. Actively seek out referrals to evaluate for receptive and/or expressive language delay like hearing tests and speech/language therapy.
- Ask about speech therapy. It can make a world of difference and boost the confidence of your child…and it can start at an early age.
It is important to have a speech and language rich environment for our children, especially those that are having some delays. TALK, READ, SING at all times!
Dr. Saul is Professor of Pediatrics (Emeritus) at University of South Carolina School of Medicine – Greenville and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.