Speech delays in children: When should you worry?

What you need to know:

We eagerly await our children’s first words, so it can be disappointing if they are slow to come. But the good news is that most children who seem to talk “late” catch up without any problems by the time they are two years old. Here is what to expect with your child’s speech development, and how to tell if you need to see a specialist.

Sonia Nantumbwe, a housewife, happily recorded the developmental milestones of her firstborn son. At five months he was sitting, at six months he began babbling, and at one year he was walking. However, it took him long to speak.

“It took my son a long time to graduate from babbling to mentioning words,” says the mother of three, adding, “When he made two years, he could not even say, ‘mommy.’ I gave birth to two more children and by the time each of them made two years, they could sustain a conversation. My firstborn, though, was still struggling to say a word.”
Nantumbwe’s son is now six years old and still speaks like a baby. Listening to him, one can think he is three-years old and those who are not close to him take a long while before understanding what he is saying.

As happens with other developmental milestones, the age at which children learn language and begin talking varies. Some can call out ‘mommy’ and ‘daddy’ at one year, while others can barely speak by the time they make one year.
Isaac Ojok, a language and speech therapist working with CoRSU Rehabilitation Hospital and Centre for Autism Intervention Kampala, says the learning of language begins in the womb.
“The child (fetus) hears the voice of the parents and responds. If the mother tells the child to turn, he or she moves around. When the child is born, they will acquire language from the environment around them and learn to speak.”

By the time the baby is six months old, he or she should be paying attention to the sounds around them and recognise the names of common objects. At this point, they are supposed to be making cooing and babbling sounds. By the time they make one year, they can string words together. When a two-year-old does not have a wide range of speech sounds in their babbling, there is cause for alarm.

Speech delay in late bloomers
Language is the entire system of giving and getting information while speech is the verbal expression of language. A child with a speech delay can use words and phrases they have learnt from the environment around them to express ideas, but it is difficult to understand them.

As a child, Nantumbwe had difficulty with her speech and was generally a late developer. “My mother told me I began talking when I was five years old. By the time I joined Primary One, I could not mention some words properly and I would always substitute letter Z for G. My relatives have convinced me not to worry, saying my son will eventually talk just like I did.”

Ojok concurs, saying genetic composition is a major factor in speech development. “If one of the parents laboured with speech and other developmental milestones when they were children, the child may follow the same trend. These developmental delays are not stimulated by anything but come from the genes.”
As a parent or guardian, the most important thing to do with a late bloomer is to find out if they can understand you when you speak to them or not.
“My son follows my instructions and when I talk to him he responds both with gestures and with his baby talk,” Nantumbwe says, adding that this is what reinforces her belief that her son will eventually perfect his speech.

Delayed speech affects social interaction
Although Nantumbwe’s son has developed motor, play, and thinking skills, she has delayed to enroll him in school. While his siblings could understand him, other children in the neighbourhood do not. Whenever he attempts to talk to them, they laugh at him and mimic his speech.
“As a consequence, when the boy needs to drive a point across to his playmates, he throws tantrums. When he joins them in the compound, he is either breaking their toys or beating them up. Many times, the children exclude him from their games because of his temperament. So, we end up spending the day together, indoors.”

Ojok advises that children who achieve speech later in life are affected in their social interactions. “A child who cannot communicate properly with their peers has to deal with a lot of frustration. To get the attention of their peers and parents, they acquire inappropriate behaviour, such as, fighting and biting, to drive forward whatever point they have.”

Other causes
Besides blooming late, there are other structural problems that can cause speech delays and according to Ojok, most of them have to do with facial deformities.
“Structural problems affect the tongue and palate and tongue tie is one of the most common ones. Normally, a tongue is able to move in all directions because the frenulum that holds it down does not extend to the tip. However, when the frenulum extends to the tip of the tongue, it makes it hard for the tongue to move.”

A tongue which cannot move greatly affects a child’s speech. On the other hand, some children are born with cleft palate, small jaw, lock jaw, and Pierre Robin Syndrome, all of which can cause speech delays if they do not get reconstructive surgery. However, the surgery, on its own, is not a quick ticket to improved speech. They need the help of a speech and language therapist because the social stigma associated with the different conditions may cause them to remain silent.

Language delay
A child with language delay has not yet been able to grasp the entire system of giving and receiving information and as such, does not have the material to use in speech. Hearing loss is one of the risk factors of language delays. When a baby is deaf, they will always try to babble but those babbles will eventually vanish because they can only imitate what they can hear.
“Sometimes, there is a problem with the left hemisphere of the brain where language is formed and communicated to the tongue, and this makes it hard for the child to express himself or herself,” Ojok says, adding, “This can be caused by genetic conditions, such as Down Syndrome, cerebral palsy, and Autism, which is a developmental disorder.”

How to help your child’s speech development
• From infancy, spend time communicating with the child through sound and gestures and respond to the baby’s coos and babblings.
• Use gestures along with your words as you are talking to them.
• Read to the child, sing to them, and play games with them.
• Point to objects, colours, and fruits, and name them.

What a parent should do
Many parents of children with speech delays, especially late bloomers neglect the importance of seeking medical help. For instance, it has never occurred to Sonia Nantumbwe, a housewife, to take her son to a language specialist. “I had the same speech problems, although I was never aggressive in my behaviour. I just know that within a few years, his speech will normalise.”

Isaac Ojok, a language and speech therapist working with CoRSU Rehabilitation Hospital and Centre for Autism Intervention Kampala, however, advises parents such as Nantumbwe to visit specialists. “A parent has to take the responsibility to visit different specialists by the time the child is three years old so that they can perform assessments. The least they can do is visit a pediatrician. It is important for the child to have an early evaluation by a speech and language therapist.”
The therapist will evaluate what the child can understand, what they can say, the different ways in which they communicate, such as pointing or head shaking, the clarity of speech, and the oral-motor status of the child.

Ojok adds, “The therapist will work with the child to improve their language and speech skills and will also give the parents the exercises they can perform at home to help the child.
This year, Nantumbwe took the brave step to enroll her son in school. “I thought there was nothing he could learn, although the teacher encouraged me, saying his speech would improve with the company of other children. Indeed, these past two weeks, since the term began, I have noticed an improvement in the way he mentions some words. However, he is still aggressive towards others.”

Although late developers eventually catch-up with their peers, speech and language delays may signal an underlying condition, such as autism or hearing loss. As a parent, your first call should be to a paediatrician, who will examine the child and then, recommend a therapist.

What should be done when a child delays to speak?

I was told of herbs that can be put on the baby’s tongue to hasten their speech within one or two weeks.
Jeninah Nabukeera, Journalist

One of my nephews took long to talk and his parents took him to a specialist. Parents must always seek professional assistance. Gloria Kambabazi, Administrative Assistant

Parents must take the baby to the hospital for thorough examination by a doctor and advise on what to do.
Brenda Nawulere, Housewife

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