Speech Development

When should a parent worry about speech development in their toddler?

As with all aspects of childhood development, each child acquires skills at a unique pace.  There are some general guidelines.  An average one year old has three words:  "Mama," "Dada'" and something else.  An average two-year-old is starting to use two word phrases.  There is a wide range of normal here with regards to speech development.

Some fifteen-month-olds only have three words and some eighteen month olds are speaking in full sentences!  The number one concern in the face of delayed speech acquisition is hearing status.  It is obvious that one must be able to hear language to adequately reproduce it, however significant hearing loss is often not diagnosed until a child is over two years old.(This is why Maryland has instituted a mandatory newborn hearing screen.)

A child who is able to follow two part commands given with no gestures probably has adequate receptive language skills, but this is just a rough screen.  An eighteen month old who uses no words, a two year old who has a vocabulary of less than ten words which is not growing in the previous two months deserve a closer evaluation.

Your pediatrician is the best place to start with concerns of speech delay.  The next step is often the Infant and Toddlers Program.  This program is run by the Maryland Department of Education and is available to all children in the state.  They do an excellent of evaluation of hearing and speech.  They then implement speech therapy if needed.

What are some general guidelines as to what to expect as far as speech development at various ages?

As mentioned above, the average one-year-old has three words.  The average two-year-old is using two word phrases.  A three-year-old should be using sentences.  At least 75% of his speech should be intelligible to strangers.  They are starting to use pronouns and learn colors.  The speech of a four-year-old should be easy to understand, although they may lisp or have difficulty with initial consonants.  They use adjectives and adverbs and can define words they know.

Can speech problems develop due to overuse of a sippy cup?

I am not aware of an association of sippy cups or straw cups with speech problems.  Chronic sucking, whether of a thumb, finger or pacifier may promote a habitual tongue thrust which may cause a child to have difficulty with the "s", "ch", "sh" and "z" sounds.  This means the tongue goes between the teeth rather than staying behind them with these sounds.  Although a tongue thrust is not uncommon in children who were not "suckers."  Children with enlarged adenoids and possibly repeated ear infections may be more likely to have a tongue thrust.

Permitting a child to use a pacifier for much of the waking hours may be associated with speech problems and delay not to mention problems with poor alignment of the teeth.  I encourage parents to limit pacifier use to bedtime and stressful situations after twelve months.

My four-year-old still does not pronounce her "r" correctly by speaks very well otherwise.  Should I be concerned?

No, difficulty with "r" sounds is pretty common until a child is six years old.