Speech Issues in Toddlers

Parent Q&A

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  • Frequency of speech therapy?

    Sep 18, 2021


    My 2 year old has been referred by his pediatrician at Kaiser to speech therapy for an expressive delay.  His receptive language is fine and he has no other developmental delays.  We are currently scheduled for an appointment every 2 weeks.  I am curious if this is a standard frequency or if I should be pushing for more frequent follow up.

    Thank you!

    it should be at least 1-2 times a week

    Typically, anything do you want to get improvement in is best done at least once a week. My kid is now 20, but he had his speech therapy from the school district weekly. It was both at the Berkeley and Oakland School District since we moved, and both were fantastic. Have you done the IEP assessment with your school district yet? I forget if a child needs to be two or three years old for that. Whatever that is, submit a request for an IEP immediately when your child is eligible, even a little bit before that.

    Until then, try to push for more or supplement with private sessions. They simply may not be able to provide you more frequent sessions, so you need to look for other sources of therapy. Take care and good luck

    We took (via video) my now 2.5 year old grandson to speech therapy January-March of 2021.  He is one of the "CoVid kids" who showed the same delays you are describing.  His therapist worked via doxy.me with me weekly for 12 weeks, and it really got him speaking.  two weeks is a very long time when a child is only 2:  I'd push for more frequent sessions.  BTW, the therapist said that due to CoVid and not being able to be around anyone but our family, he wasn't exposed to other kids' language and kids rely on that to learn speaking.  so even though you are reading to them and talking and singing--they still need other children as models.  He started with nine words of expressive language and at 12 weeks of therapy was at more than 100.  good luck--you will get there!


    Your situation sounds so similar to mine.  My daughter is currently receiving speech therapy through a private speech therapist paid by our Kaiser insurance. Based on reviews, I selected a speech therapist from a list that was given to me by Kaiser. 

    It was her Kaiser pediatrician that first detected the speech language delay and like your son, there's no other developmental delays.  My daughter is a few years older than your son and we were approved to received in-person therapy for one hour, once per week. In our situation, it was determined at her initial assessment that one hour per week was sufficient and matched what our Kaiser plan covered. Perhaps the 2 weeks schedule might have been decided based on your plan benefits.  If that's not an issue, then I suggest pushing for an appointment every week if you feel that's needed for your son.  Parents know their children best and you know what he needs.  It can't hurt to ask and request.

    Having Kaiser cover the services has been so valuable and I can't say enough how speech therapy has been a blessing for my daughter. It's been a wonderful experience for us and changed her life.  She's more confident, able to express herself better and getting the help she needs to thrive. Best of luck to you.

    My sister is a speech therapist. She says if he isn't talking, she would recommend 2x/week for 45 minutes. This is usually covered, although she practices in New York.

    We also received Speech Therapy through the RCEB, had it 1x a week between KP & RCEB. We had Lakshmi from Kaiser & she was AMAZING. I’d recommend seeing how this frequency works for you & your kiddo before exploring more options. I found the sessions more about educating us parents rather than the kid so we could work consistently snd effectively w our kid.

  • Hi! My 17 month old toddler was just approved by the Regional Center of the East Bay for some early intervention due to an expressive language delay. Kiddo has one word (mama) and makes some “nana” types sounds but has very few other sounds, and was never a big babbler.  We will hear within the week what free services we are actually going to be offered (and whether they will be live or over Zoom), but I am wondering whether anyone else with kiddos who have successfully navigated an expressive language delay have any advice they might be willing to pass on? In particular, if the free services we are offered are only via Zoom we may consider going the private route since I’m struggling to imagine how well Zoom sessions will go with a 17 month old… Does anyone have any recommendations for SLPs in the area?


    I was in exactly the same situation 4 months ago, except my kid wouldn’t & still won’t say mama. We were approved for weekly zoom speech therapy through RCEB. RCEB covers what insurance won’t cover. So, our insurance does 2x a month (one in person & one zoom) and RCEB fills in the other 2x a month. The Kaiser therapist is significantly better, but I can’t look a gift horse in the month. So much of this is training the parent not working with the kid so zoom is effective. We’ve been in speech therapy for several months now and although my kid won’t say mama, there are other new words. Is it time, therapy or a combo, who knows.

    Hi there - my son is now 3.7 years old. We started him in speech therapy at 15 months old after the RCEB found a mild expressive speech delay, and we continued via video during the pandemic. I'd be happy to offer advice, if you want to get in touch.

    Hi there,

    This will probably be a minority opinion, but here goes:  I worry that, in our wish to do the best for our children, we pathologize normal variations in development.  My second child was a late talker.  I had one conversation with a speech therapist, who gave me a dire warning that any speech delay meant a cascading series of other developmental delays.  But I'd seen my older child walk "very" late, and just start running one day, so I decided to wait and see.  I knew her hearing was fine, and I knew she was otherwise normal and healthy.  She started talking in multi-word bursts around the time her brother was born, when she was a bit over two, and has been completely normal in her speech development since then - no other delays of any kind.  I recommend the book "Late Talking Children" by Thomas Sowell, which talks about how common this issue is, especially for children with engineers or scientists in the family.  Best of luck to you!

    We used WorkWorks in Oakland when my son was 5. Great staff, but the office is not in a great area (behind Kaiser, but on this street with no parking, didn't look super safe). Call them and see if they are open, or if they have referrals to other private SLPs. 

    Hi there! We were in a similar boat not too long ago with our son. He was diagnosed with a language delay & on the autism spectrum by Kaiser at about 15 months, and we ended up receiving speech therapy through the Regional Center. We started pre-pandemic, so his first couple of sessions were in person, but pretty soon everything moved to Zoom. It was amazing how quickly, with the guidance of our speech therapist, our son acquired a few words (after not using any up until that point), started pointing (which he had barely done before), and overall got more excited about communicating! I have to say, while it's definitely not the same as in-person services, our experience with Zoom speech therapy has been a positive one. In our case, our therapist taught us parents many techniques and gave us things to work on at home with our son, which was really helpful. Lots of things that we could easily integrate into our everyday lives. 

    Feel free to reach out directly if you have any specific questions about dealing with a language delay, the Regional Center, ... . I know for us the initial diagnosis was scary and figuring out all the services that may be available isn't always easy. All the best to you and your kiddo! 

  •  My adult son reported to me last week (from SoCal) that his grandson--- my GREAT-grandson-- speaks only "gibberish". (Son calls me every Thursday.)   The child's mother (my grand-daughter--born with her mother was barely 18)  led me to believe, all this time, that 2 l/2 year old Joe, was mute. We even talked about 'selective mutism'.  Gawd!  Why such a story was invented is troubling...but not to waste time/energy on.  The well-being of my great grandson is my concern.   Joe doesn't even say 'mama' or 'daddy' reports my son.  Will it all be ok when Joe turns 3 or even 3 l/2 ?  That's when my ex- husband began to speak ---and now goes non-stop; ditto for my step-son.   About 10 days ago, in an email, I did ask my daughter-in-law, Keira, if Jack's hearing had been professionally tested.  She hasn't answered...and I have to assume she doesn't want to answer...she has been becoming more distance in the last couple of years (I also know she's under a lot of pressure these days: both of her sons are home, doing college work--with their girlfriends living there too....6 adults living under one roof -------- I have another son, who lives 6 mins away us.  Bryan has seizures,  learning -disabilities and is bipolar; I understand the SHAME one can take up because your child/grandchild isn't perfect; I did a version of that for a while.--- so maybe that's what my daughter-in-law and her daughter are into- for the time being---.    I do feel that ultimately, if Joe continues with gibberish, past 3 l/2, then son/daughter-in-law will look for professional care for their grandchild--- they have the $ to pay for it, as well.  Regional Center, in SoCal, however, has a special program for children up to age 3, who aren't speaking.  It includes testing, feedback, references, list of books, even training for parents---all for free, but--it's my understanding--that it ends when the child is 3 years old.  PS: Joe's sister Lizzie, age 16 months, is talking-- yes, I'm aware that girls tend to excel in this area.  ---We haven't been with that part of the family for over a year because we moved to a smaller place---gawd! what an undertaking--then I was ill for a few months and then the lockdown came. --- I'm the only driver for myself and elderly husband.  (I cannot leave elderly husband at home, alone, to fly to SoCal--something I'd do in a minute if he wasn't frail and prone to falls...husband won't fly)  So I canNOT be there to seek a place in a conversation for me to say anything.) What I seek here on BPN are your suggestions, based on what you did, or what a friend did about a gibberish-speaking child--- including 'just wait and see'.  I want to have a toolbox of things one can do, when and IF someone wants my input and/or something that advocates my doing nothing.  Thanks so much!

    I'm sorry to hear about this and I can tell you care about your family. Based on what you are describing though I don't think you are in the position to offer help if it's not wanted and you may not have the whole picture. It's also possible she is getting help for her child but does not want to discuss. I'd defer to the pediatrician who would refer them to speech therapy, hearing testing etc. Instead, you can offer your support in other ways since as you say she's under a lot of pressure. Maybe a gift card for food delivery services if you have the means or just reaching out to tell her that you are thinking of her, without offering advice or asking questions, but leaving open the opportunity for her to share what she feels comfortable with. 

    I absolutely recommend getting the child help as soon as possible. After a child turns 3 years old, they should contact their local school district and have an assessment done.  There are lots of free resources out there, they just need to get the child into the system. Also, do they have a pediatrician that can advise them?  

    before my son could speak we used sign language. He used about a dozen words regularly for about six months before he started talking. There’s a great series you can buy on Amazon prime videos called baby signing time. I highly recommend it! Signing actually help him talk as well. 

    My nephew talked gibberish until he was about three, and emerged speaking almost fluent English when he was ready. You may very well have nothing to worry about.  But I am not a pediatrician!

    Hello, I’m a Pediatric Audiologist...0-3 years is the critical age of learning language, communication. If he truly has zero words at age 2.5 years and speaking “gibberish” its essential that he follows up with his pediatrician, hearing test and speech evaluation to assess where he is at and what services he may potentially need. Given that you are not the direct parent/guardian of this child, it is up to them. Perhaps you can kindly discuss with them, you can also refer them to the American Speech, Language, Hearing Association (ASHA) for guidelines for speech at each age group. Obviously, if there is neglect by the parents/guardian that is a separate issue...but you didn’t mention that. Best of luck

    Hi. I am sorry to hear about your great grandson. My son was just shy of two years old and we noticed he wasn't speaking very well compared to his older sibling. If your great grandson was under 3 years old, you could go to the region to have him tested. Over 3 years old, you have to go through the school district. They will do an assessment and test his hearing and vision as well. I recommend getting an assessment sooner versus later as there are lots of children who suffer from speech delays who do well once they are diagnosed and the district provides them speech therapy. Good luck to you. 

  • Hello,

    I've searched in the archives but found no mention of no/low-cost early intervention "birth to three" services for toddlers. I have Kaiser insurance and was referred by my pediatrician to a group class on communicating with toddlers, but it did not seem to pertain to the issues my son has (probable moderate apraxia of speech). We may still be able to get an appointment for an evaluation, but I have my doubts about whether Kaiser really knows or cares about this diagnosis. Has anyone had a different experience? Or if you ended up going somewhere else for a screening and services, where did you go? How helpful was it? 

    Thank you! 

    Regional Center of the East Bay offers developmental services to children under 3 years old. You can self refer and they have a specific amount of time to respond to you and to evaluate your child. If she qualifies they will provide a speech therapist on a weekly basis. 
    My 2 year old was evaluated by the Regional Center and by Kaiser. Kaiser’s services were abysmal compared to what Regional Center was able to provide -  a highly skilled SLP who came to our house every week. 510 618 6100

    The Regional Center of the East Bay serves kids 0-21 with developmental delays/disabilities. They can assess and provide free services but it takes about 2-3 months to get started. We did this plus get a speech eval from Kaiser. It took  lot of pushing and a sympathetic pediatrician. First they would have you do an ASQ short questionnaire ( looking for autism). I also paid a private speech therapist to do one time observation-- not cheap.  Lucky for us, he started "talking" a month later ( was 20 months old at the time with no speech-no babbling) Good luck!! Don't wait!!

    My son had a mild impediment. We emailed his Kaiser pediatrician explaining the problem (lisp and trouble with making "th" sound). This was when he was four and in pre-school. Our pediatrician referred us to the speech therapist without an appointment, and my son was evaluated and a plan put together. I was very impressed with the therapist, and after 3 months my son had significant improvement. We continued therapy once a month for a little over a year since it was diagnosed as mild. Have you specifically asked for a referral for an assessment? Could it be that your son is too young to really diagnose at this point?


    You might want to research/contact the local regional center (www.rceb.org -- the Regional Center of the East Bay is located in San Leandro). They do early intervention for toddlers (0-3); our kid is just going through a speech assessment there. They'll do an assessment and if your kiddo qualifies, they'll make a treatment plan and he/she can get any services that Kaiser doesn't provide. So if you're doing a group class on communication at Kaiser, they won't have him do the same thing, but they may offer some other type of therapy. It's free, though there may be a fee for higher income families. So far our experience there has been good. Hope this helps!


    Contact the Regional Center. They offer evaluations free of charge and will provide speech therapy at your home if you qualify. Our daughter was just diagnosed with ASD and we will only been able to work with them for a couple of months since our daughter turns three soon and that's the cut off age when the school district takes over. We wish we could work with them longer since our case manager has been great the services we have received have been awesome. 

    Oh one other thing, we just got our daughter evaluated at Kaiser for speech just in case something happens with the school. She got approved for speech for an hour a week but we would have to do copays and bring her to Kaiser for sessions. Regional center services come to you so  it's been super convenient for us. Good luck!

    Kaiser tried to send me to one of those classes. I asked if it was required in order to receive future services and they admitted it wasn’t. I didn’t have childcare to be able to attend so they agreed to send my (then) 20 monther for evaluation (she didn’t qualify for regional intervention). I usually despise kaiser (we’ve since switched out of frustration) but I LOVED our speech therapist. Her name was Lakshmi V. In Oakland (sorry I don’t remember her last name other than it starting with a V). She was warm and attentive and enthusiastic and my kid loved her too and eagerly participated. At that age therapy is more teaching the parents how to engage but I found it fairly helpful and after about 2-3 months the kiddo caught up to where she was supposed to be (probably would’ve happened without therapy but it certainly didn’t hurt!)

    Hi - fellow KP mom here. I recommend that you seek out support for your child simultaneously in two different ways. First ask your KP pediatrician for a referral to the pediatric development office in Oakland for an evaluation. When you have that evaluation a very experienced speech therapist will thoroughly evaluate your child. Most therapy provided by Kaiser for speech is done by outside therapists that Kaiser pays directly (of course you pay your co-pay if any). Secondly I recommend that you contact the Regional Center Of The East Bay. They will also do an evaluation and can provide you with early intervention support as well. If you’re lucky, both KP and the RCEB will offer you services. You can take advantage of both and get as much intervention as you can for your child during these early years. Feel free to message me if you have any questions!

    You may want to call your school district about this.

    For all suspected developmental delays for kids under 3, Regional Center is responsible for the assessment and intervention. Uncertain if intervention is completely free these days. I believe there is a sliding scale and insurance is expected to provide at BB least part of it.

     That said, Regional Center is on the hook to evaluate. And there are tight  timelines for getting evaluation done, so look up the deadlines and make sure to communicate in writing as well as by phone. Even if your income is too high for all services to be free, the kid gets the evaluation, diagnosis and treatment planning.  If qualified for Regional Center services, there is a case manager/advocate who helps and facilitate transition to school district when kids turns 3. Totally worth wading through the red tape to get it done. Good luck!

  • Hello BPN parents,

    My adorable daughter who is just a few weeks shy of turning 18 months old has only 2 words in her vocabulary. At this point she is only able to say mama and papa and I am starting to feel concerned that she may have a possible speech delay. At this age I know that most kids should be speaking closer to 4-10 words which she is not even close. She also does not tend to repeat for as much as we encourage her too. At her 15 month check up her doctor seemed a bit concerned but said we would reconnect at her 18 month check up. I feel like no progress has been made and was wondering if anyone else had the same experience with their little one. I am not sure if I should wait or seek an evaluation. I am guessing that the earlier the intervention the better. She seems to understand directions well and is otherwise developing great. We are Kaiser members and I have been told that they do not offer services until children are over 3. Is that true? If anyone has had similar experience I would leave to hear about it. Thank you!

    Hi! I would press the doctor for a speech and language evaluation. Kaiser offers services starting at birth! If your doctor will not recommend your daughter for an evaluation, I would get a new doctor. I am a speech therapist and have found that many doctors are not knowledgeable enough about speech and language development and the "wait and see" method is NOT effective. If anything, children must get early intervention services to make solid progress. The other option you have is trying to talk to your school district- some districts offer birth-5 services for their students. Hope this helps!

    At 18 months, there is still a lot of variability in speech.  My son was in a similar situation, and my pediatrician responded the same way your did - keep an eye on it, and reevaluate in a few months.  We reevaluated at 21 months, and he was still a little bit behind (10-15 words as opposed to 20-50), but we decided to wait a bit longer (especially because he's being exposed to multiple languages, which often results in a bit of delay in starting speech), and now at 24 months he is gaining multiple words a day.  If you are worried and want to be proactive about it, contact the East Bay Regional Center (http://www.rceb.org/ - assuming you live in the East Bay).  The Regional Center will send someone out to your house, or you visit them, and you do an initial evaluation, and if your child meets the requirements of needing speech therapy, they'll cover a large portion or all of the costs for speech therapy, even if your insurance doesn't, until the child is 3.  After the child turns 3, my understanding is that responsibility for speech therapy goes over to your school district.  I would recommend waiting a bit longer to jump into therapy, especially if your daughter is being exposed to multiple languages, but there's also no harm in contacting the Regional Center and finding out more details.

    HI there,

    I just read your post and had to reply! I'm a speech-language pathologist (and soon to be mama) and wanted to answer some of your questions/concerns. So, by 18-24 months of age, children typically have a large spurt of expressive language acquisition. At 18 months, she should have an expressive vocabulary between 20-25 words and by 2 years around 50 words in their lexicon.They should understand much more than they speak it sounds like she does as she's able to follow simple directions etc. - so that's good! Here's a link to what the American Speech Language Association has on early language development http://www.asha.org/public/speech/development/12/

    With regards to seeking out an evaluation, I would if I were in your position. I'm not sure about Kaiser only taking children after age 3, but the Golden Gate Regional Center (GGRC) through their Early Start services for children birth-3. I have a close friend who was in the very same position with her daughter being 18 months and she wasn't even saying mama/papa and was evaluated through GGRC and they began in-home services. And you are right, early intervention is the highly effective and best practice!

    Please let me know if you have any more questions! I'm happy to help.

    kind regards,


    My daughter had a similar language delay at 18 months.  Her pediatrician recommended an extensive language assessment at kaiser (I think it was $400 out of pocket).  They determined that my daughter's receptive language/comprehension was very high but her expressive language was behind  for her age. Kaiser wasn't too concerned because my daughter's language comprehension was not an issue. Fast forward 3.5 years and my daughter is a chatterbox with an extensive vocabulary (she caught up to other kids at about 2.5 years old).  My second child also behind her peers in terms of expressive language.  This time I am not worried and I am not pursuing the language assessment. Children develop language at different rates but just to be on the safe side, to allow for intervention, you can have her assessed at Kaiser.  

    In Alameda County Help Me Grow is a great resource, http://www.first5alameda.org/help-me-grow-parent-resources or  call them at  888-510-1211

    Please contact The Regional Center East Bay to schedule a speech and language test.  These assessmenta fall under Early Intervention and should be no cost to you.  14 years ago I was in your same situation---wondering ahould I be concerned/ should I get testing. I decided to get my child tested to let the experts determine if early intervention was needed.  I found out we did need speech and language services.  I am assuming this Federally Funded program is still available.  From 20 months - 3 years we had free services.  At 3 years speech services go through the public school system where the child is retested and receives services at 3 yrs old until no longer needed.  I encourage you to have your child tested.  Either they will require services or won't. If they require services, you are giving them the best opportunity to catch up to their peers.  If they don't require services then your mind can be put to rest. 

    Absolutely get an evaluation. You have at least 2, maybe 3, reasonable cost/free options: insurance (yes Kaiser can do speech therapy under age 3, but I'm not sure it's any good. I know some parents have described the services they received as more parent education than direct therapy, but not sure if they have other options at that age), Regional Center of the East Bay (assuming you live in Alameda or Contra Costa County, it would be a different regional center elsewhere), and possibly your school district. The earlier the better for sure, so go ahead and ask those places for evaluations. The only harm is if she comes up borderline in an evaluation, some places won't qualify her and won't give her another evaluation for 6 months.

    I've been there. Kaiser member, and my son seemed "late" in his verbal development but only to me. Everyone else gave a million reasons why he's just fine, and the Kaiser doctor seemed unconcerned. I realize in order to get free treatment your child needs to be VERY delayed (services goes to those who really need it, I get it), and if you are borderline or within range nobody will offer you anything for free. The answer, if you can afford it, is to pay for private evaluation. I recommend Work Works in Oakland (near Kaiser Oakland), call and speak to one of the directors, and see if they feel you should come in for an evaluation. If you don't want to go private, at your 18 month appointment, keep hounding the doctor. What they will do is send you a paper worksheet which you will fill out, and if you raise the right red flags, you will be referred to speech therapy and or a developmental specialist, or, you might not. You really do need to keep asking and pushing, and it will take time. For my son, I listened to the naysayers till he was 5, did nothing, and eventually went the private route. He got private speech therapy for some language processing issues, and now at 6 he is doing great and no longer needs speech therapy. Wish I had taken him in earlier.

    Do not want wait! I can't stress the importance of early intervention. My daughter, who is now 3 1/2, also had only a two words at 18 months. We pushed our pediatrician for a referrals to a speech therapist, ENT (to rule out any ear issues) and to the regional center. Turns out, my daughter needed ear tubes because she suffered from ear infections as an infant and couldn't hear properly. Insurance initially didn't want to cover speech therapy but the regional center stepped in and covered the costs until my insurance kicked in. It has been tough but speech therapy has worked wonders! My daughter is still delayed compared to kids her own age but speaking enough to communicate effectively. Definitely ask your pediatrician for referrals to the regional center or a speech therapist who takes your insurance. 

    You are correct to think that early intervention is best for a potential speech delay. Two words at 18 months is a bit low. The first thing her doctor will do is a thorough hearing screening. Fluid in the middle ear is the most common type of problem leading to speech delay and is easy to clear up. Even a slight reduction in hearing acuity can have an impact on language learning. Most importantly, don't take a wait and see approach as these months are important for language acquisition. Good luck and don't worry, you're right on top of things.
    A Speech-Pathologist

    As the mother of a 2 year-old who just went through the "when is he going to start speaking??" ordeal, my advice to you is: stop worrying. You say that she understands directions, so there are no hearing or comprehension problems. My son didn't say more than 2 words at 18 months either, but it was clear that he understood what we said. Between then and 24 months, he added a handful more words, but overall wasn't very verbal at all. I know, it's hard when you're around same-age children who are more verbal; you can't help wondering if there's a problem. I always tried to remember that there's a range to these milestones. Some children start on the early side and some on the later side. We're also with Kaiser, and at his 2 year checkup, I discussed it with his doctor. Honestly, I wasn't terribly concerned, because I could tell that he understood so much, and was taking everything in. But we were visiting the in-laws the week after, and I wanted a "the doctor said" response ready for them. His doctor did a couple of checks, and said that when children aren't particularly verbal at 2, the two main areas of concern are hearing problems and autism. As my son could clearly hear, and didn't show early signs of autism, he was probably just a late talker, but it was up to me whether I wanted an evaluation. She gave me the evaluation questionnaire (you fill it out, send it back to Kaiser, and they contact you about next steps). I took the questionnaire home, read through it, and decided against an eval. Why? Mainly because reading the questions gave me perspective: instead of hyper focusing on the one thing he wasn't doing, I saw all the developmental things he was was doing so well. Lo and behold, a week or two after he turned 2, it started: each day, more words. He started repeating after us, and putting words together. He's behind some of the children who started speaking early, but I have no doubt that he'll catch up. I don't think any amount of us prodding him to repeat after us at 18 months would have changed the outcome - he just wasn't ready. My advice is that if you can rule out hearing issues and early signs of autism, just give her time, and don't act like there's anything wrong with her, as she'll pick up on that. 

    Hi, my son had language development, and was also a late walker.  It as a long journey, and with a lot of work on my part (research and insisting on tests and access to specialists) before we found out that he had a hearing issue, as well as low muscle tone.  Was your daughter's hearing tested?  In my son's case, he had a cold at one point, and then fluid remained in his ears long after the cold was gone, to the point that his hearing was affected.  The doc suggested tubes, but at that point his ears finally cleared (long story).

    And, it's not true that "services" start at age 3 at HMO.  Sure, the school district assesses kids when they turn 3, if you request it.  But, your HMO should be able to refer you to their specialist, at least definitely a developmental one (I asked for two different ones, because the first one only read my son's letter written by his preschool and his assessment was pretty much that same letter he paraphrased!).  So, request a developmental specialist (I liked Dr. Reiff in SF Kaiser - and he might be the only dev specialist available now anyway), ask for hearing test if there wasn't one, and see if there are any other physical or behavioral concerns that would require a specialist.  In our case, my son had to be seen by neurologist, and is still under her observation (Dr. Jean Hayward at Kaiser Oakland is fantastic).  

    Regards, and good luck!

  • Our just-turned two boy speaks less than 15 words. Our healthcare provider just told us that by his age most kids have 100 words in their vocabulary and should be able to speak two-word phrases. He says mommy, daddy, bubble, ball, "dat", and makes really good animal sounds, but not much else. Our provider is not concerned about him being on the autism spectrum because he is meeting all other milestones, but I do worry about this speech delay. Granted, he is a younger sibling to a very vocal sister, and for better or worse we have always understood his motions so he hasn't really needed to speak to get his needs met. (He says more words at daycare than at home, I'm told.)

    We are working on changing our own behavior in this regard, and are actively encouraging him to make words, but he clearly can't, and diverts the attention by getting silly and saying our names instead. I don't want to go down the route of getting him evaluated just yet for fear of pathologizing him, but will in another six months if nothing changes. In the meantime, I'm seeking suggestions of how to encourage him to find his words. Do audio games/programs work? (I'm inclined to think not, but I'm open to it if the science shows something works.) Other ideas?

    Mom to a boy of few words

    Hello there,

    One of of our children had a severe speech delay, with only a few sounds available to him at 2 1/2 years of age.  We had him tested, and under our insurance were able to get him speech therapy.  We continued with that at three times a week for three or four years through Alta Bates.  It made an enormous difference.  We then tapered off to twice a week until he was eight.  At that point our insurance wouldn't cover the cost and though it was recommended that he continue, we chose not to.  I wish I had.  Today, he is 15 and speaks with a slight impediment, making him a little difficult to understand, and when he is tired, his speech is even more impacted.  Still, he is an A student, very popular and has his eyes set on a top college.  For all of our children we have found that early intervention is the key to bridging the gaps, and that it is critical to do so at an early stage.  Don't worry about your child being labeled.  None of that occurred with any of our children and they are all doing well.  I don't think that would have been the case had we waited things out.  Advocate for your child --- they can't do it themselves.  Good luck to all.

    Not sure I can offer advice, but just wanted to say that our boy didn't speak at all until around 21-22 months, and didn't have many words at age 2. All other milestones were met on time, so our doctor wasn't concerned.  Now at 2 1/2, he's having a language explosion! One thing that I noticed: whenever we had family visiting from out of town, or did new experiences or visit new places (we just moved, so there have been a lot of those!), there was a noticeable increase in his language within a few days. Made me wonder if he just gets into a habit of communicating with us and needs the stimulus of new experiences or new audiences to trigger more speech.  Instead of games or TV, I'd just try outings to new places. Even a month ago, my mom also happened to be home when we had a babysitter, and reported to me he spoke to her in almost full sentences (which he NEVER did with us), so I do think it could be situational. I'm no expert, but wanted you to know you're not the only one!

    I would recommend you to immediately contact your son's primary doctor and insists to be referred to Regional Center to get tested.  My son was tested at 2.5 and received private speech therapy one on home at our house before 3 years old.  After 3 yrs old, he was transfered local public school with an IEP for service.  I hope this is helpful as I went through a lot with my older son and had to spent great amount on private services (didn't want to deal with crappy one with local public school).  It is best to get it before 3 years old.  Good luck and let me know if you have further questions.

    My grandson was speech delayed and I thought this was perhaps due to part of his family speaking Spanish.  It is not uncommon for bilingual children to begin speaking later.  However, when he turned three and still didn't have the 100 words that people outside the family could understand, I suggested that my daughter-in-law have him evaluated by the school district.  The district qualified him for intervention with a speech therapist who worked with him and the family.  I wish that we had started even earlier.  He does have language processing difficulties and requires ongoing support resources. 

    I have been a infant development specialist for many, many years. Some children just develop words later, some need support. I have a few questions, if you don't mind. Does he understand everything you say? Can he follow simple directions? Does he get frustrated when not understood? Personally, I go with getting an evaluation and possibly speech therapy "just in case". It won't hurt him and it really might help. A good speech therapist would tell you if therapy is needed now or if things can wait. It sounds like you are already concerned. I think as parents we often look for 'reasons' (a vocal sibling, anticipating his needs, etc) but if underneath you are worried, get the evaluation. Then you'll know you've done what you can in the moment. If he doesn't need therapy, great! In the meantime, I stay away from audio games. There is nothing better than communicating with an engaged person. Read --lots-- ask questions--"what is this? It's a dog! What does the dg say?" Label things in your house." I"m getting you a fork! Here it is. Here's a fork!" 

    Good luck-

    Here's what I learned when I studied language acquisition as part of a linguistics degree.  Learning  language is a complex process.  Producing speech is just part of it.  Anything up to age 3 is considered in the normal range for beginning to produce regular speech.  Children learn language from other humans.  Video's, tv, audio tapes, etc are pretty useless for primary language acquisition.  It is very difficult for someone without training to help a child overcome obstacles to speaking and attempts to do so often cause anxiety and may create a bigger problem than the one you are trying to solve.  

    At the time I was studying linguistics I got to see this in action. I had a niece who did not speak more that a couple of words until she was nearly three.  She did seem to understand when others spoke to her.  She did  communicate through gestures.  She did participate in "conversations"  but babbled where she would have spoken.    Her parents decided to wait and see.  All of a sudden shortly before her 3rd birthday she began to speak more words.  Within a few weeks she was speaking full sentences.  Within a couple of months no one would have know she was a late talker.  

    If you are not concerned that the lack of speech is part of a bigger problem then probably the most helpful thing you can do is relax.  Play with him, sing to him, read to him.  But don't push.  He'll speak when he's ready.  If not it will become clear that professional help is needed and you can pursue an evaluation then.  Good luck.

     I am a grandma with lots of experience-- and a retired speech and language pathologist.   I worked as the primary speech pathologist at the West LA Kaiser and did a lot of parent training with language delayed kids.  First of all, boys are often slower at talking than girls, and just turned two-year-old boys do not necessarily have anything close to 100 words in their speaking vocabulary!  Is this person talking about receptive or expressive vocabulary?  You might consider speaking with a speech/language specialist to get tips on how to stimulate language appropriate to his age level.  There are ways to do this successfully that do not create stress.   

    I'm not sure what you mean when you say you are "actively encouraging him to make words..."  Its' a good idea to do this mainly through praise , repetition and expanding on what he just said.  For example, when he says "ball,"  repeat and reinforce the word enthusiastically that he has said and then add to it.  "Yes BALL!  That's a BALL.   A BIG ball." or "yes, ball!   Let's roll the ball! (and roll the ball to him)  Repeat and expand using the target word again.  Children that age learn by repetition of words and short phrases that are within their grasp.    When they generate new speech/language, praise and repeat what they just said.  Then expand it.   Also, when reading or looking at pictures, use this as an opportunity to stimulate language.  Rather than read the words, talk to the child about the pictures, using words or short phrases to describe the picture.  If he tries to generate any kind of speech, reinforce enthusiastically!!  Sometimes anxious parents ask questions a lot when looking at books with a young child.  "What's this?"  "What's that?"  This is not a good way to stimulate language. At his age you can encourage speaking by repetition and praise. 

    When teaching new vocabulary to a new talker, say one word or two words at a time.  Name things and see if he repeats the name.  Praise, repeat again, and maybe expand to two words or a short phrase.   As his language expands, expand your responses.   I am not suggesting you always speak with him one or two words at a time!  I am just saying that when you are in teaching mode, that is the best way to stimulate language. 

    If your child continues to show what you feel are signs of a delay in his speech, consider a professional assessment, including a hearing exam.  If he has had numerous ear infections, this can slow down speech development.  It's important to know if he has a mild temporary hearing loss.   Meanwhile use good language stimulation techniques at his level and make talking fun.  Most kids are just fine and learn to talk.   

    I understand not wanting to label your child but would you be against sending him to speech therapy? I went in kindergarten for my ST sounds and never felt pathologized. I think at 2 any labels that might be assigned to him will affect you more than him but not getting an early intervention could affect him deeply. My sister put off having my nephew tested and didn't pursue speech therapy for a while and he is now 4 and is not very verbal and has a LOT of behavioral issues that stem from it (he is not ASD either) but speech therapy has been helping him since he has started.

    -In the better safe than sorry camp


    Our daughter also didn't say enough words at two nor did she string any words together to make sentences, but was meeting most of her other milestones. We got her some speech therapy through the regional center. It is free until age 3 when the local school district has to start providing services. Altogether she did about 1-1/2 years of therapy. It seemed to do the trick. She is now almost 10 with no problems. I would look into it. Better not to wait in case there is a problem. I don't think my daughter remembers much about it.


    My daughter started speaking early (9 months) and what I did was to read to her all the time. If you are already doing this, great. But if not, sitting and reading to your child, and pointing out and labeling the items in the pictures is more effective than letting the child listen to an audio program by himself. That being said, you can always make audio recordings of the books you read together and let him listen to those while falling asleep, in addition to reading them together.

    My son was slightly delayed in speech when he was 2, and I also never got him checked out because my pediatrician wasn't worried. My mommy gut told me something was wrong, but I was afraid to make a mountain out of a molehill. Fast forward my son turned 5 and was about to enter Kindergarten and his speech was still behind that of his peers. I finally took him to private speech therapy and he improved SO FAST, even with a few sessions. I couldn't help but think if I had put him in speech therapy when he was 2, he would be totally caught up by now. All this to say, don't wait for your son to be so delayed that insurance will kick in for his services. Ask your pediatrician for some sort of evaluation--many will just mail you a questionnaire for screening, but get him tested. If you have the funds, go to a private speech therapist and get him tested there. I will tell you that it is a LOT more work to get these services for free, and you will get it faster if you are willing to pay. But trust your mommy gut. Don't worry about labels or "pathologizing" him (I'm not even sure what you mean by that). Different kids just need support in different areas, and you are helping your son to get the help that he needs. Good luck!

    Engage him in communication in a natural way without pressuring him to verbalize what he wants to tell you.  Talk to him - describing what you/he are doing, what you/he see, what you observe.  Use short, simple sentences, and when he says something to you, repeat it and expand.  "Ball" - "oh here's your ball - it's got red stripes, doesn't it?"  If he is talking more at daycare, you may want to spend some time there to see what is happening there that promotes more initiative in communicating.  Whatever you do, be fun and light about it.  You may also want to start using signs because your main goal at this point is communication - pediatricians counting the number of words a child knows is only a way to estimate that.  There are plenty of books out there about using signs with little ones.  There is also parent info on www.hanen.org.  I disagree with holding off on requesting an evaluation - it may take another 6 months for it to actually happen anyway.  Nobody will pathologize your child, it's called "early intervention" - call the Regional Center of the East Bay and request it.  

    At two, my son had only one word. He clearly was not on the spectrum and we were easily able to understand all his communications even though he couldn't talk.  But we were concerned. I am not sure that encouraging your son to find his words will work if he "clearly can't." We brought our son to a speech language pathologist for evaluation and therapy. It was not remotely stigmatizing or pathologizing. My son thought it was tremendous fun - all the exercises were taught as games & I was with him the entire time. I think earlier rather than later helped him learn more quickly once the therapy started. Good luck to you and your son!

    I understand your concerns,  but as someone who has addressed the same issue, I highly encourage you to go to a speech pathologist now rather than wait any longer. The sooner your son gets support, the easier it will be for him to progress and to do so more quickly. The speech pathologists who work with children work in a very fun and playful way. They can also provide you with recommendations on games and tools that can help at home.

    My son didn't have many recognizable words in preschool.  We had him evaluated for speech delay and our insurance paid for therapy.  When he entered elementary school in Berkeley Unified, he did not qualify for speech services because he tested too high. I met with the Speech Therapist at the elementary school and explained my son's history and she agreed to add him to her list of students who receive therapy. When school began, my son had difficulty reading. The school was required to give him assistance which was ineffective to say the least. After years of watching my son struggle to read, we demanded he be evaluated for a learning difference. The result was no surprise (to me) - my son has dyslexia. I am told that his speech delay and the dyslexia were linked. I wish someone had told me about this link - it would have saved my son from so much. My son is now in 8th grade, he speaks clearly and widely. His speech delay had no detrimental effect, it is the way that Berkeley Public handles his dyslexia that continues to cause him to suffer.


I also have Kaiser and voiced concerns at my girls 18 month visit that she wasn't really saying anything, just making noises. They asked if she could name 5 objects, she couldn't. She knew what I was talking about and what things were called, but would never speak the words. They told me if she wasn't speaking by her 24 mo visit they would be concerned. Sure enough, around 22 months she started talking no stop and became quite the chatterbox, now she is 26 mo and knows sooooo many words. After talking to other moms about this, it can be pretty normal to talk a bit later. Anyway, not sure if that's your situation. Good luck!

Archived Q&A and Reviews


2 year old not cooperating with his speech therapist

Feb 2015

At both his 18 month and 2 year check up our 2 year old wasn't horribly behind but was also not where the pediatrician thought he should be. He progressed in between but to be cautious, we had a hearing test done and it revealed some issues. We have an E.N.T appointment scheduled.

We are working with the North Bay Children Center (we are in Sonoma COunty) and today a speech therapist came to our house to evaluate him and wanted to do an enunciation test (his words are often muffled). She wasn't able to do it as he wasn't being ''compliant'' - her word.

When she walked in, he was playing with his matching cards (picture and words) that he loves. He loves those but She insisted i put them away so she could use her book. He was upset about that and after that was only very mildly interested in her book. He did not repeat any of the words she wanted him to and so while she was able to gather some information, the test she wanted to do didn't happen.

I am now finding myself in a weird spot. Part of me feels like this visit could have gone very differently had she just gone along with the flow a bit and also taken 5 minutes to get to know him. He had never seen her before and within 2 minutes she was asking him questions. She also was rather inpatient (and i have been voted the most inpatient person on the planet by my family so.....) However, i in general assume people know their jobs better than me and that she must have had a reason to use the book? And that maybe it isn't ok that he wasn't more compliant? He is 2 and almost a month and maybe he should be more into answering her questions?

For those of you who have had that experience, i would love to hear how it's supposed to go or how it went for you and weather that was a good experience or not? Thank you M.

Two of my kids were evaluated for speech somewhere in the 3-4 years old range, so they were at the school district and we had to go to them for the evaluation.

My youngest son sat in a closet for like half an hour and refused to come out or even talk. He woman giving the test was a little frustrated but calm and kind with him. She got him talking about his stuff and then eventually moved over to the list of words she needed him to say. She tossed some words in there that weren't on her list to help keep his interest.

Two year olds aren't always compliant. The woman who did the evaluation might know how to do speech therapy better than you but it sure sounds like she isn't great at interacting with toddlers. Anon

I have 2 kids with a variety of developmental disabilities. In the past we have done 30+ hours of therapy per child, per week, so let me see if I can shed some light on this for you....

Short answer: Yes, all of this is normal. Evaluations tend to be a little less sugar coated than actual speech therapy, so don't let this put you off.

''Compliant'' sounds harsh but this is just standard terminology in the child therapy world. It doesn't carry the negative connotations that it does in regular conversation, it simply means 'the child didn't fully cooperate', and believe me they are used to that. It is totally fine that he wasn't testable for some parts, a lot of kids aren't. That in and of itself gives them information. She got him to comply with different testing, attempted some other, and will write up the results.

She had to use the book instead of the cards he preferred because she is doing a standardized evaluation. By using the book to test was he knows she will be able to calculate the results using the evaluation's statistics and tell you and the Children's Center what percentile rank he falls into compared to typically developing children his same age. Then you will have an idea of how far behind his speech is, or if it's even behind at all.

Honestly, it sounds like she could have been a little more unrushed or child-friendly, but this is pretty standard. These folks travel hither and yon all day long testing kids of every ability in every variety of setting you can imagine, and they get paid peanuts to do it. It sounds from your post like she is evaluating him for the Children's Center to see if he qualifies for speech therapy, right? As counter-intuitive as it may seem, she may have even thought she was doing you a favor. I have had evaluators tell me, off the record, that they do not push children to comply with such testing because if they don't comply it lowers the score, it's valid, and it qualifies them for the therapy they need.

I wouldn't worry. Good luck to you guys! Speech therapy, in our experience, has been very successful. A good speech therapist (again, usually a wildly different experience to the evaluation) makes it fun and play based. Special Needs Mama

Eating and speech ''issues'' in 19 month old

Jan 2014

My daughter is 19 months. She says no, mama, dada, wawa (for water), nana (for banana), ba (for butter) and baba (for bottle). She has had this collection of words for a couple of months now. At times she uses them to tell us what she wants; at other times, she just says them because, I suspect, they are all the language that she has right now. I know that on the spectrum, this is a delayed language situation, but I have not felt comfortable labeling it as such yet, or seeking help in that direction if that i what is called for.

Relatedly (at least in my head), she barely eats any solid foods at all. Most days her diet consists of maybe one or two bites of a fruit like apple or banana (though the apple she only chews up and then spits out), a couple of tablespoons of butter (which she loves and asks for by saying ''ba''), and some rock or sea salt. If she eats anything besides this, it is a banner day! I have tried almost every whole food under the sun (no grains), with lots of different flavor profiles: eggs, beef, chicken and fish, soaked and sprouted nuts and lentils, loads of veggies and soups. I continue to offer her a small plate of what I've prepared every day, several times a day at family mealtimes. She is very interested in having her own plate and using a fork to move around the food and pretend to bring it to her mouth (or to ours), but gosh if I can't get her to actually ingest any food. So, what does she eat? A combination of raw cow's milk and goat milk. I have played with reducing her consumption of this to see whether that would spur her hunger for ''real food,'' but to no avail.

It has always been like this for us, and I kept thinking (sort of like with the verbal ability) that our daughter was just developing slowly in this area, and would catch up later. But now it is really beginning to worry me. We have tried baby led weaning, feeding her ourselves, whole v. pureed, you name it. I am an industrious and creative person! But I am kind of out of ideas here. She is also the child at the playground eating rocks and sand by the handful, and this too has been going on for months.

Is there an undiagnosed anatomical or physiological issue that might be impeding her progress in eating and speech? We saw two lactation specialists when she was younger and I had low milk supply and it appeared she had trouble breastfeeding, but they never mentioned a lip or tongue tie. Should I get her craniosacral to see if there is a ''release'' that needs to happen? I have thought about this modality for her sleep issues as well (not sleeping consistently for more than 3-4 hours at a time and needing lots of snuggling to go back to sleep).

Though I am a fairly laid back person in all of this, and have drawn on this to calm my fears and anxieties regarding my daughter's development, I don't want to sit back idly if there is something I can do to help what might be suffering, or dis-ease, or I don't know what.


You must get her checked for anemia ASAP. Calcium and iron limit each other's absorption, so when children drink excessive milk they're at high risk of anemia. I once saw a kid so bad he needed an emergency transfusion due to excessive milk. Persistently eating dirt and rocks can be a sign of significant anemia.

I question how adequate your attempts to limit her consumption were. She should go down to 16oz/day of any and all (preferably pasteurized) milk. The first day she may not make up for it with more solids. Maybe not even the 2nd. But as they say, hunger is the best sauce. Children do not voluntarily starve to death. You may still have some eating issues but I suspect that treating anemia and cutting back on milk are going to need to be the immediate priorities. Pedi

I can't comment on the development side of your question, but the thing that jumped out at me in your post was her diet. Honey - feed your kid!!!! I might be in the minority in this community, but I truly believe that kids need to be exposed and allowed to eat more foods than their parents might. Let the kid decide if she does/doesn't want to eat bread - for now, as long as what you're giving her is organic/made from whole grains/whatever, offer it to her! Bake it yourself at home if you are worried about store-bought stuff having bad ingredients (I prefer to bake at home myself, so I can understand that).

I get it that we as a culture eat too much wheat, but honestly, it's a pretty important part of all my kids' diets (I have twin six-year-old boys and an almost 15-month-old girl). My kids are very adventurous eaters and will try almost anything, but we have not really restricted them from any food groups. But I can tell you that ''soaked and sprouted nuts and lentils'' would probably not go over well. Kids go for stuff that looks appealing/fun and smells good - lentils don't really fit that profile!

Have you tried cheese or yogurt? My baby loves both!

I totally understand parents wanting to instill good, healthy eating habits on their kids. But the important thing is feeding your little one and making sure she gets a diverse array of foods with enough calories to help her grow. It seems her palate is going in a different direction from yours...maybe you should follow it.

Don't mean to be harsh... Annoyed w/the GF Craze

Hi Rachel, It is time to act. You need to find out what is going on. I teach kids with reading disorders and speech disorders are so often the first sign that something was up.

Your daughter's eating and language issues may not be related. Language delays often stem from processing not motor issues. Your daughter needs a hearing test first if she has not had one recently. If she has had ear infections, for instance, her ears may not be clear. If she can't hear well, learning to talk will be hard. She will hear sounds indistinctly and may confuse several of them.

See this page for how to get a free evaluation and speech and language services: http://www.acoe.org/acoe/StudentPrograms/ProgramsAndServices/InfantandFamilySupport A speech and language pathologist will be able to identify if the delay is caused by motor problems and is connected to eating or is a separate thing. And they can provide therapy for both.

The sooner, the better. Language development is cumulative. After you have the hearing test and the speech and language evaluation with the county scheduled read the chapter in Po Bronson's Nurture Shock on how to talk to your baby. It is fascinating. Here is a summary from it with 7 tips for talking with your baby. It is excellent. http://abcnews.go.com/GMA/Parenting/tips-toddlers-develop-language-skills/story?id=9491324

You can alter the trajectory of her language development by intervening now! The good news is that you are still in the realm of "early intervention" and your daughter's language skills are likely to thrive with appropriate intervention.

Also, Kim Lyons who teaches play with your baby classes locally has published a terrific e-book on playing with your baby. It has a section on development and then a ton of ideas for developing all your baby's senses and motor skills. It would be terrific to combine these play ideas with the language tips above. Susan

You don't mention your child's pediatrician. What does s/he say? If I understand correctly, she's mainly consuming milk. This doesn't sound like enough nutrition to me, but I'm not a doctor. Talk to yours. And I'm wondering why you never offer grains? Grains are part of a healthy diet and unless your child has a specific allergy to one or more, there's no reason not to serve them and every reason to offer them for their many nutritional benefits.

You mention that she eats lots of rocks and sand. Taking it at your word that she eats handfuls (plus she eats a small amount of fruit), then she seems to have the mechanics down and her refusal to eat other foods is behavioral, not physical.

Also, if she's really eating that much rocks and sand, that's a warning sign. She could have pica or possibly some developmental delays. One of the causes of eating non-foods like sand is nutritional deficiency. And at a very minimum, she can get lead poisoning from ingesting contaminated soil (more of a concern in some areas than others).

I'm also concerned that you're feeding a small child unpasteurized dairy, which can contain serious pathogens. And that your child is not eating a wide enough variety of foods to be getting enough iron and other nutrients for good physical and mental development.

All in all, I think you have some significant concerns here that should be addressed ASAP by a pediatrician. It may be that everything is normal, but you really should check. glad you're asking for suggestions

My son was speech delayed and had food issues as well. I, like you, was very, very worried and feared the worst. At 19 months, I had him evaluated through the Regional Center with a pediatrician's referal, and he qualified for free, in-home speech therapy. The therapist was amazing! She could tell that my son needed to strengthen his tongue and lip muscles and that he had some oral sensory issues. She came to the house and worked with my son every week. She also developed homework exercises and activites for me to do with my son that helped tremendously! By 2 1/2 years, my son was speaking clearly in complete sentences and was no longer speech delayed. At 3, he was reevaluated through the school district (the Regional Center releases children at 3) and no longer qualified for speech services. Now 10, he has no speech or sensory related issues. In fact, he is extremely articulate and likes public speaking - ha! I would recommend that you have your child evaluated through the Regional Center. Speak to your pediatrician and insist that you get the referral. No matter the reason for your child's speech delay and eating issues, early intervention is key! -- Been There

Hi rachel, I would like to encourage you to speak with a western medicine pediatrician. Hopefully they will refer you to the regional center (in case you don't have insurance). I suspect your darling one might seriously benefit from being assessed for structural problems that western medicine can help.

My first kid was slow to walk and talk, and we met with the RC, but his case was just normal slow development. My second kid has some medical issues, and we are doing occupational therapy to teach her how to swallow, and they look at all kinds of potential issues that we laypeople would never think of--I was surprised at the stuff they thought of to check for. It is HUGELY helpful. They train me to do the work with her, so I control everything that happens to her.

OT and speech therapy both work hand in hand, and I think your instinct that her speech and her eating may be connected is a good instinct. You're on the right track! I would encourage you to enlist the help of specialists to give you the info and training you need to help your little one make progress.

You mentioned CST, of which I am a fan. That plus the raw cows milk diet gives me the impression that youre not into western medicine and therapies. But I really want to encourage you to open yourself to it for now. It's saving my baby's life. Wishing you good luck. OT fan

Hello, I have a 2 year old, so I know it's stressful to wonder if your child is doing what he/she is supposed to be doing each step of the way. My child has always been a very picky eater and would eat nothing but Cheerios if I let him, so your child's eating sounds normal to me. He goes through phases where he will eat more, but they are generally short and far apart.

I know a lot of kids around that age and their speech ability is so variable. Some are speaking in phrases and some know only a few words. So it seems like that is most likely normal too. I wouldn't be surprised if your child has a burst of language soon.

I wonder what your pediatrician has to say. If you are concerned about some kind of syndrome or disorder, I think a doctor would be the person most likely to identify that. Maybe you have already tried googling the issues you see? If you don't feel comfortable raising these issues with your doctor or you have not gotten answers that satisfy you then I think you should consider switching doctors. ask your doctor

Hi Rachel,

I too have a 19 month old daughter, and can empathize what a challenge this age can be when it comes to meal time.

After reading your description, and drawing from my experience as a pediatric speech-language pathologist, I think you should consider having your daughter's iron levels tested by her pediatrician. Due to the types and minute amounts of solid food she is, actually, ingesting, I strongly suspect that she is iron deficient (All the foods you described that she eats have little to no iron, including the milk). Relatedly, depending on the severity of a child's iron deficiency other areas of development can be slowed, such as language (see link). The good news is, if that is the culprit, once iron levels are replenished, her speech and language skills will too rapidly return to expected levels.

How to strategize the best way to get her to eat more nutrient dense foods with a variety of textures requires a more in depth discussion/analysis than I can provide here, since feeding difficulties can be the result of either physiological, sensory based sensitivities, delayed oral motor skills, or behavioral considerations (learned patterns). Teresa

Maybe I missed something in your post but have talked to her pediatrician? I would seek a medical opinion before trying alternative treatments like cranial sacral on such a young child. I would also be concerned about the risks of raw milk.

Even if you have issues with western medical treatments, having her checked out could be very informative. It could tell you if these behaviors are common, within the range of normal, or if they indicate a larger medical problem and potentially either alleviate a lot of worry or give you some direction.

While my child has not had these specific issues, he is small for his age and had some thankfully minor though challenging medical issues. Our pediatrician has always been very calming and reassuring while also proactive and helpful when treatment was needed. Another mama

Hi Rachel, It sounds like your kiddo would benefit from a speech language and feeding evaluation. You could ask your pediatrician for a referral to a speech language pathologist, or seek help through Regional Center of the East Bay which provides services for free for children under age 3. You could also find a private practitioner. The clinician should take a complete history, observe your child eating and drinking if possible, and do a language evaluation which will probably consist of a lot of questions for you, since 19 month olds are typically not very compliant with testing procedures. I would go ahead and get this done sooner rather than later, as language and feeding delays can often be treated successfully, particularly when the child is young. Erin

If your daughter truly eats nothing but milk, butter, and salt, I think there is a decent likelihood that she has iron-deficiency anemia (or is well on her way to developing it). Pica - the desire to eat non-food items like dirt - is one (rare) symptom of iron deficiency. Another symptom is decreased appetite. You can read the basics about it here:


I would suggest that you immediately get your daughter to the pediatrician to find out if that is indeed the case. In fact, I am a little surprised that this did not come up at her 18-month check-up. Screening toddlers for anemia is standard. Has she just not been to the doctor? Or did your doc miss this? If the doc missed this, I would consider finding a new doc. In any case, a pediatrician can put her on iron supplements which will help until she matures to the point of being capable of eating all the delicious food you are making her. (I applaud you for continuing to offer her the family's food and not coercing her into eating things she doesn't want to. I think this is the right way to go in the long run. All the pushing food around on her plate is actually important work; she is learning how to eat at the table with the family, and those are the first steps. Hooray!)

Regarding language, the number of words you describe doesn't sound like a ''delay'' to me (although I am no expert). I just wanted to say that my second child had a similar number of words around that age, and then he went through a language explosion all at once, midway between 18 months and 2 years. Our pediatrician said that is incredibly common. Language development often proceeds in bursts. Also, I think my son had more language than we gave him credit for. The same few syllables actually had many, many different meanings (''ba'' meant ball, blankie, butter, bird, bus... anything that started with b). He was talking, but we were actually a little slow to catch on.

Best of luck to your family. Mom of a milk-lover too

Hi there -- I'm so sorry for your worry about your baby; I know these things can be very stressful. I can't comment about your concern about your daughter's language development (except to suggest talking to a pediatrician about it -- you didn't mention a doctor, but I would strongly suggest talking to an expert about this if you are concerned -- doing so usually makes one feel better about such things!) but I DID want to chime in about your food concerns. 

You said you are not giving your daughter grains, but you didn't say why. If there's no diagnosed allergy to a specific grain, I think you should absolutely reconsider that decision. My 22-month-old has gone through times when he won't eat much, which I agree is very distressing. However, he will almost ALWAYS go for a piece of buttered, whole-grain toast. We buy Alvarado Street brand, and sure, it's not homemade, but it's got real, healthy, whole-food ingredients, and my little guy loves it. Some days he has even had two or three pieces and not much else. (Sometimes we're able to sneak something on it: avocado, occasionally hummus or cheese. And of course there's sugar-free jam, that's always a winner). Other types of grains also seem to be more palatable to him on the days when, maybe because of teething (who knows what it is?) he's not into eating: he really likes steel cut oatmeal, brown rice, and whole wheat pasta -- all whole grains and all totally part of a healthy diet. I know you are worried your daughter may have an underlying condition, and I can't speak to that, but it seems like some grains, in some form or another, are definitely worth a shot! 

Best of Luck! Mama of a Toast Eater

TV or videos for toddler with speech delay?

Dec 2012

My 2 year old daughter has a significant speech delay and is currently in speech therapy. We have not shown her any television or videos yet as I was waiting until she was 2 as recommended by my pediatrician. Are there any good TV shows or videos that are helpful for introducing words? She loves music and dancing, if that helps at all. Is Sesame Street too advanced? Is Barney too annoying? Dora? What else is out there? TV naive

I think you are never too young for Sesame Street (my 18 month old adores it), and I do find Barney too annoying (sorry, Barney fans!). Baby Einstein makes some good stuff, and I've known people who swear by the Wiggles. But don't take my word for it! What I would recommend is checking some programs out for yourself first to see what you feel comfortable exposing your child to, and then watching a few of those together to see what resonates with your child.

Cable TV often has programs on demand, or you can DVR a few episodes of a show to check it out. Your local library will have DVDs you can take home for free, and I think that's the best way to figure out what you like without spending any money. You can also check craigslist or garage sales for DVDs that other parents are passing along for cheap. Video stores, netflix, and amazon will also have videos for toddlers. Once you have 2 or 3 favorites, kids will watch them over and over again, so you can take your time building up your collection. We Love Elmo

I am not sure if this will help with the speech delay, but I found Signing Time to be a wonderful resource. We tried signing with my son since birth, but it was only after watching Baby Signing time that he realized he can sign back to us to communicate. Since then, he has enjoyed the DVDs immensely. He learnt to sign, enjoyed the songs AND repeated vocalizing the words. The Baby Singing Time series is a good start with just 4 DVDs. After that ,if you find it effective and like to take it further, there is the actual Signing Time dvds. We did that a la cart picking the ones that interest us rather than doing the whole series. We have also enjoyed the Baby Einstein DVDs. On the other hand, my son who is 2 does not like Sesame street or the other shows like Cailou or Curious George, as much. I think it is because he does not have the patience to sit through an entire storyline. I understand that watching tv for a child that young may not necessarily be good, but we make it a point to sit with him and watch it together. We also limit it to a program a day so he is not overwhelmed. It is fun to learn together. Hope these help and good luck with your child. ANON

The show my kids started with when they were 2 was Blues Clues (we watched it from Netflix streaming). It's gentle, not a lot of crazy quick editing, and I like that it has a real person who talks directly to the camera (i.e., the audience). This seems to be good from a speech development perspective (from what I've read). Although it's a bit goofy/boring from an adult perspective, I think it's a great show for little kids-- lots of nice lessons about kindness, etc. and a mystery to solve in each episode. Dora, in my opinion, is really annoying and loud, personally I'd stay away from it. And my kids didn't gel on Sesame Street until they were closer to 3. Now that they're a bit older (3.5) they tend to watch Super Why and Curious George (both on PBS). --Blue!

I have many friends with children who have had speech delays are autistic or have some other difficulty with communication. They tell me that The Wiggles have really helped their kids. They are good people, do a LOT for charities and take their own personal time to visit kids in the hospital. etc. Their videos are simple enough for a 2 year old and fun enough for a six year old and the music is not annoying, in fact, it's catchy and entertaining for adults. I personally really like it. I have an 8, almost 9 year old who secretly likes them. They sing about things that are meaningful to children and never talk down to them and are always respectful, no fighting, etc. But seriously, my friends tell me that some of their kids first words were from watching and listening to the Wiggles when nothing else touched them that way. Try them! Wiggles fan since 2003

Research has established over and over again that babies cannot acquire language from an artificial device (computer, TV). But rather that language is acquired specifically from interacting with a human being. Please do not put your child in front of the DVD, computer, or TV, especially if she is delayed. Below is a decent overview of the topic of language development among infants.. I strongly suggest you spend more time spend talking, singing, playing with your daughter. http://www.parentingscience.com/effects-of-television-on-children-learning-speech.html Heather

We liked ''signing time''. My son didn't speak till 2, when he simultaneously learned signs and verbal language. They are positive simple vocabulary videos with lots of images of kids playing, talking and signing. Also, we just watched short music videos of songs we liked... Mainly live performances of artists our son enjoyed. Music is universal! Ah yes, they might be giants also has a kids set of music videos for ''here comes the science'' '' here come the abcs'' and ''here come the 123s'' that we all enjoyed. When language came, it showed up full-force. Mystifying how kids develop differently! Watched a lot of signing time

I'm sorry but please just don't. If your child has already a speech delay, TV or DVD would be the last things that you want to do to her. The very last! If you want to help her improving her speech skills keep talking to her. Talking, talking, talking

There are several studies that have shown how TV consumption is associated with delayed language development (even if it's only in the background and the child is not actually watching it). Wikipedia adds that ''Research on early brain development shows that babies and toddlers have a critical need for direct interactions with parents and other significant care givers for healthy brain growth and the development of appropriate social, emotional, and cognitive skills.''

Here are two links that might be useful: http://www.msnbc.msn.com/id/31051013/ns/health-childrens_health/t/even-background-tv-may-delay-infants-speech/#.UKyhwKPZiSo (casual read) http://lej.cuchicago.edu/early-childhood-education/the-effects-of-video-and-television-on-young-children-research-and-reflection-for-christian-educators/ (academic read)

So please, switch that damn thing off and keep talking to your child! Vera

Lots of people have written in to tell you not to let your speech-delayed kid watch TV. All I can tell you is my own experience. Having read all the studies, we didn't let my first-born son watch TV as a very small boy. He is also speech delayed, so I was especially rigorous about it. Afer age 2 we introduced Sesame Street, Dora and Go Diego. He started talking at 2.5 years old. His first spontaneous words? They were all answers to the questions asked by the characters on the show! (If you've ever watched these you know they often ask the audience to identify the answer to a question.)

When I told his speech therapist about this, she explained that this was very common. There's less pressure about their speech when watching TV and they are more willing to speak up. She ENCOURAGED me to let him watch the shows he liked as much as he liked, as it increased his comfort around speech and got him to try speaking more.

Do you plan to have another kid? There's no practical way to keep a later child from watching TV at a young age once the older kid is allowed to watch. Everyone I know has encountered this issue and ended up letting their younger kid watch TV. My daughter, 20 months younger than her brother, has no speech delay and began talking at 10 months though she's been around TV since birth. I'm not exactly thrilled with the fact that one of her first words was ''backpack!'' for the Dora character ''Backpack'', but she's talking! (She's 14 months now and has about 50 words. I'm constantly blown away by her. And she's exposed to TV for a few hours a day total, in the early morning and before bed.)

Also, the studies that showed that TV doesn't increase speech only showed that -- TV exposure doesn't increase speech. If if you're sitting with your kid, discussing the episode as it occurs, they're getting just as much interpersonal speech exposure as they would be if you were building blocks with them - the problem with TV is that kids don't focus on the lips and learn the speech process the way they do with people. But depending on the source of the speech delay, your kid may have that already and be delayed for another reason. Plus, if you're talking to them during the show, the whole issue is moot. So do what works for your family and don't worry about the nay- sayers. They will ALWAYS exist. They don't know anything about your family or your child, and as a new parent I am slowly learning to tune them out. Good luck! I know the speech delay is stressful, please feel free to email me privately if you'd like to discuss it more. Stacy

Hi - I highly recommend startind with The Letter Factory from Leap Frog. My kids, both speech delayed, were in speech therapy, but this video really got them to practice the sounds of the alphabet. They also watched The Word Factory by Leap Frog. Even if it takes several viewings, your toddler will be learning the alphabet (and words) by sight and overtime will start trying out the sounds. It's the best $;s we spent. Good luck! anon

I wanted to respond after seeing some of the previous responses advising you not to show your child any tv at all. I just met with a speech therapist about my 19-month old yesterday, and she was not at all concerned about a little television viewing. The studies that have been done have more to do with background tv being on all the time, rather than short educational programming. According to Parenting Magazine, 2011 article:

''A 2005 Kaiser Family Foundation study found that viewing educational programs like Dora the Explorer, Blue's Clues, and Arthur between the ages of 6 and 30 months was associated with accelerated language growth. However, general television viewing (including exposure to adult programs) was associated with reduced vocabulary. The takeaway: Limited exposure to educational television may have a positive impact on your child, but a household where the boob tube is blaring all day will not. Says Dr. [Harvey] Karp: it's not OK to plunk your kid in front of the TV for two hours and think that you're building his brain, but it is OK if your eighteen-month-old watches Sesame Street. http://www.parenting.com/article/technology-for-kids

have child with delay, not worried about TV

Speech eval for 19-month old- can it diagnose ASD?

Nov 2012

I've got a speech evaluation appointment for my 19-month old son in a couple of weeks and I'm trying not to worry about it, but I really have no idea what it entails so I was hoping to get a preview from others who have gone through it. Can a speech therapist diagnose probable autism, or do they refer you to another evaluation for that? Can they determine whether the child will be a late talker and there's nothing to worry about? We were referred for a speech eval because of no words at the 18-month well check, and because of some red flags on the checklist. It sounded like the speech check should come first, but now I'm wondering...Thanks for any insights!

Wow, I've definitely been where you are! In my experience a speech therapist isn't able to give a definitive autism diagnosis, they will likely refer you to a behavioral pediatrician or something like it. They will probably tell you what they think, though, so that's something to prepare yourself for. And don't forget to get his hearing checked if you haven't already; that's usually the first step.

19 months is pretty young for an autism diagnosis, though, despite the lack of speech and presence of red flags. I don't know your chid, of course, but I would bet that you don't actually get one at this point, anyway. We started the eval process around 18-19 months but didn't get an actual autism dx until around 2 3/4.

My son is 10 now and awesome


Hi, no the Speech Therapist cannot diagnose your child for ASD, only for speech development delay. A Development Pediatrist and a Psychologist would assess your child for any other delays, as well as ASD. But it takes a few appointments unless the red flags are obvious enough. Still, your child is pretty young, so it may take a few appointments to find out anything. Good thing is, the earlier, the better to provide any development classes should your child need them. Best of luck! FC

It sounds like a stressful time. It is hard to wait and wonder. A speech therapy evaluation is a step in the right direction. So is a referral to the Regional Center of the East Bay. BUT have you considered getting some input from an expert in the meantime? A parent myself, I figure that if I am worried then I might as well search out some clear concrete advise and suggestions. Dr. Laureen Wong, Ph.D. has a private practice in Oakland and has worked with young children with Autism Spectrum Disorder and other social-emotional issues for over 15 years. Her fees are very reasonable and she may not have a wait list right now. Her number is 510-289-7331. Look her up at www.networktherapy.com/LaureenWong a mom who has been there

2 year old with speech delay-similar experiences?

March 2012

My two-year-old(and two months) son has a significant speech delay. He has been receiving speech therapy from East Bay Regional Center for a couple of months. So far there have been no indications from the therapists that he has other developmental disorders. The therapists at EBRC have talked about his low muscle tone and difficulty coordinating fine motor movements in the mouth/jaw area as the cause for his speech delay. They have talked about the possibilty of the actual diagnosis being speech apraxia. Of course, he is still too young to actually give a formal diagnosis and we only started therapy in January. I am interested in stories or similar experiences from other fmailies who have dealt with this and overcome this. I am trying to stay positive and accept that this is a process which might take a few years for our son to catch up in average age range speech. I am hopeful becasue everyone keeps saying early intervention (which we are doing) is key and also in the fact that our son is such an expressive communicator despite his speech delay and that since January I have seen lots of emotional growth and some growth in his speech. But of course I also worry and fret and feel a bit overwhelmed. I'm more interested in people's shared experiences than technical/clinical advice for what to do (as I feel I get that from the therapists and get that information through other resources). Thanks so much.

worried but trying to stay positive mom

Our older son who is now five and thriving in kindergarten was born with severe childhood apraxia of speech and low muscle tone. I would be happy to share our experience with you. Lisa

Our son also had speech delay. It was a sign of other aspects of development being off. He also has poor muscle tone. The most helpful person he has seen is Brian Esty who uses the Masgutova Method of Infant Reflex Integration. This helps with muscle tone which is otherwise very difficult to address. It also helps with left-right crossover and many other things that contribute to speech delay. Often speech delay is really not about speech. Our son is very loquacious now and other problems have been resolved as well. talking boy's mom

We were in a similar situation as you about 9 years ago. It's all well now, and one could never tell that my son ever had a speech delay. My son is now 11.He wasn't diagnosed with low muscle tone until age 3, so his speech and motor delays were interpreted by his day care provider (and even doctors!!!) as all kinds of issues, including mental retardation - all that was very stressful and painful for my husband and me, and was also blamed on me speaking another language to our son. You are lucky your son was diagnosed right away.

I would highly recommend getting a hearing test for your son if you haven't done that already. I would also recommend observing the speech therapy sessions with your son and using whatever you've learned from those on your own. After all, we parents spend a lot more time and have a lot more influence on our kids than docs and therapists.

I also wonder if your son would need physical and/or occupational therapy, in addition to speech. Had EBRC assessed him for that? It would be surprising if the low muscle tone only affected his mouth/jaw area.

In our case, I requested a hearing test which should have been ordered by all those clueless doctors who looked at him when the day care insisted that he had some behavioral and mental issues (and the docs went right along with that opinion instead of trying to diagnose him). It turned out that in addition to the low muscle tone, he had a middle ear effusion (basically, liquig in his ears) that affected his hearing.

My son has received speech therapy from age 3 until he went to kindergarten. For that to happen, we requested and had an IEP from our school district. It was a thourough evaluation, and it was great to find out that he had no behavioral or mental issues, just the hearing and low muscle tone. The school district provided speech therapy, but no occupational therapy (I paid for occup therapy out of pocket for years!).

Once he was about 6, one couldn't tell he used to have speech issues. He is now in a choir, and loves to talk. In fact, we sometimes wish he'd be quiet!:) In fact, I think he was better prepared for kindergarten thans to the speech therapy.

I feel for you. It's so hard when your child is going through something like that, but you caught the issue very early and are doing all the right things. not worried any more

Just wondering if you have had your son's hearing checked? When our son was about the same age we noticed that his speech wasn't developing as quickly as his peers. We saw a specialist at Oakland children's who recommended ear tubes and removal of his oversized tonsils and adenoids. We hesitated at the idea of the surgery on such a young child but went ahead with it and he is literally a different child with an explosion in his speech as well as his self confidence. It sounds like the experts are leaning towards a different diagnosis for your son but thought I would just mention our experience in case it is relevant for you. Good luck. Dinsmore

Speech delay for 2 and half years old

March 2011

My 2 yr and 6 months old cannot say many words.She tries to imitate some words from me but its not clear.Should I consult speech therapist or any othe solution?Please advice.

Hi, I have a 2 year old that says a lot of words, but is still behind other kids his age and doesn't really make 2-word sentences yet. Granted, we are a bilingual household and some delay is to be expected. After testing to see if autism is a concern and finding that it wasn't, my ped told us he was not worried about it and that different kids learn at different rates. A few things that might help you decide if you really do need to be concerned: Does your child understand a large vocabulary? Does She respond to commands? At her age she should be able to respond to more complex, multi-part commands (eg: ''pick up your tissue and go put it in the trash can''). Is she interested in age-appropriate activities? Is she social with others? When in doubt always check in wit your pediatrician. If he thinks there is something to worry about he can refer you to a speech therapist or other professional. Good luck!! Kristina

Hi there, I would encourage you to check with your local school district. Most districts offer an Early Intervention Program. They will screen your child and offer services if needed for free I believe. I'm not sure how old your child needs to be, give the school district a call and they can give you more information. Good luck! Jody

20-month-old's speech delay due to hearing loss

Dec 2009

My son is 20 months and his speech is very delayed. It is at the 6-9 month level. He is working with a speech therapist and we are scheduled to see an audiologist in several weeks. Has anyone *not* realized that their child had a hearing loss until someone convinced them to see an audiologist? I am 99.99% sure that he hears just fine but he does point to his ear all the time, and he has wax pouring out of it constantly. It seems like he wakes up when a pin drops so I doubt it is his hearing causing the speech delay. Just curious if anyone didn't realize their child had some hearing loss, or if anyone has had experience with ear wax being an issue. And if your child did have an issue with wax or fluid causing hearing loss, did your pediatrician pick up on it? Thanks! Another worried mom

Your situation sounds similar to what we had with our son a few years ago but my while my son's speech was delayed, it was not severely delayed. In our case, he seemed to be able to hear, and like your son, he could hear even small noises or whispers so I thought he couldn't have a hearing loss. But I figured out from the internet that my son had severe sleep apnea due to a very large adenoid, so when we went to the ENT we did a lot of tests. As I remember he passed the auditory test pretty much but another test showed he had so much fluid in his ears that the ENT dr said that he must have some hearing impairment, like that when you have a bad cold.

They drained the ears during the surgery and there was a improvement in his speech. More important though in his case was finally being able to sleep deeply at night and not have to mouth breathe (which btw, I didn't even notice he only breathed through his mouth until I checked, then it was obvious). My son also went through periods where he produced masses of ear wax. If I were you, I'd take you son to a natural pathic type of doctor - a conventional doctor will dismiss this but in holistic medicine this is seen as a sign of something. I would also remove all casein (dairy) and see if that improves things. anon

There are times when even well-educated parents don't realize their child has a hearing loss. I highly recommend discussing with your speech pathologist and the audiologist getting an otolaryngology (ENT) appointment for your child. If you have trouble getting an appointment at Children's, you can go to ENTs who have private offices - almost all of them take care of children as well. It's great you are taking care of this right away. Joan

Making my 24-mo child talk more clearly

Sept 2007

Hello, My 24-mo child seems to be a talker, all day nonstop. However many times I do not understand half of what she is saying. I would like to hear tips on how to help her speak more clearly. What books are out there that could guide me? Happy to hear from you

All 2 yo's do not speak clearly, it is how learning how to talk, works. erin

When my daughter was that age, I repeated back to her almost everything she said to me. Partly this was to confirm that I had understood her correctly, but it also let her hear the words spoken back to her enunciated clearly, which I think helped. I did this both when I understood her and when I didn't. If I did understand her, of course it was easy. When I didn't understand, I was repeating what I understood and anything I didn't I echoed back phonetically:
''Iwangogosto'' ''You want to go gosto?'' Shakes head. ''I didn't understand where you want to go. Can you say it again more slowly?'' ''I want go gocy sto.'' ''Oh, you want to go to the grocery store.''
Sometimes, unfortunately, you will echo back something you don't understand, and the kid will confirm, yes, I really did me fahwah, or skweewo, or whatever, and they can't help because that's how they understand the word. Then you're stuck with, ''Can you point to a skweewo?'' (That's a squirrel, by the way, that one had me stumped for a long time. Lots of R's and L's make it hard to pronounce).

When my daughter was a baby, I had a habit of repeating everything I said to her two times, or at least repeating the key parts. ''Look at the doggie. Look at the doggie.'' ''Would you like an apple? An apple?'' I can't know for sure, of course, but I think this helped her receptive vocabulary. I dropped the habit naturally as she got older and her comprehension improved. Your child is probably beyond that stage, though Carrie

Based on my experience, children's ability to articulate words clearly varies quite a bit from child to child. It's certainly not a reflection on their intelligence and not even really their development-my son couldn't articulate many words clearly until way past 3 and my daughter who is now 19 months can speak with relative clarity whatever words and phrases she knows. I think 24 month is still not late in terms of being able to articulate their speech. I can understand that it can be frustrating for you to not fully understand her, but I'd say not to worry, just be patient and when you do understand what she's trying to say just repeat it back to her clearly. caroline

Hello, It is great that you would like to help your child communicate more clearly. I suggest you speak with a speech-language pathologist to learn what the age-appropriate sounds are, and how to go about modeling sounds to get him to work with you, and not feel badly about having unclear speech. Many speech pathologists are available to consult with you on the phone, as well as to do a screening to see what is going on, and how to better help him. Best of luck, Tamara

My very verbal daughter went through a period of ''talking in paragraphs'' which didn't make a lot of sense but which imitated the rhythm and cadence of what she heard around her. It was a stage in her language development. Could this be what is happening with your child? Six months later, my daughter spoke more clearly with no pressure. I've heard that pressure to speak more clearly is one cause of stuttering, so I avoided pressure. You might want to let her be at this age, and not try to ''make'' her do anything. Even at three, many children mispronounce words. Talk to your pediatrician if you continue to worry, and get a speech and language evaluation if your child isn't doing better in whatever time the language specialists who often write in to this newsletter suggest. By the way, if she is exposed to more than one language in her daily life, this can have short term effects on the rate of her language acquisition. And why does this frustrate you so? Might you be in need of other adults to talk with? Little ones, wonderful as they are, don't make good conversationalists or companions for their mothers. Ever thought of joining a mother-child play group like the one at Epworth Methodist Church in N. Berkeley? There's no religion involved. Or contact Bananas to see what they know about groups near you. Mom of a former chatterer

Hello - I have a daughter, almost 17 months, that doesn't say anything except Mama. She says mama for everything. I started doing research and found that she's probably fine (although definitely lagging but that's fine) and that when it comes to two year olds, it's NORMAL to only understand about 50% of what they're saying. Although some kids annunciate beautifully from their first word, most kids take lots of practice to get it really clear. Your child sounds perfectly normal. Please don't correct her constantly, you'll only make her talk less and feel insecure about it. It sounds like she's having a ball ''talking'' to you all day. Her babbling is practicing to sound like you.

I got some handouts from the Regional Center of the East Bay about what normal language development is. They suggest encouraging any type of speech, keeping requests and sentences very simple and praising effort. Don't correct using the word no. If your child says ''doos'' for the word juice, instead of saying ''no, say JUICE'', say ''You said juice, let's get some juice.'' If you constantly correct her, she'll never figure it out. Modeling the correct pronunciation is the best thing.

Be thankful your child is talking. Enjoy it. She's right where she should be. It takes them much closer to 3 or even 4 to really start perfecting their speech. It's the journey that counts. Mom of a babbler too

Give it time, she will on her own. Let it Be.

22-m-o not talking, almost deaf from fluid in the ears

Sept 2007

Hello all..
My son had a hearing test a couple of months ago and had severe fluid in both ears that made him almost deaf. After a short run of antibiotics he passed the 2nd test. The problem is that he is now 22 months old and very behind in his speech development as he couldnt hear before and lost critical time. He WAS in his ''own world'' for those months, happy to play indepedently despite all of the friends surrounding him, not answering to his name etc. There was something off, i even thought(and apparently now that things are out in the open and people are being candid) he could have some form of autism, but learned that the symptoms of someone with autism and someone that cannot hear are similiar(in own world etc) and they suggest you get hearing checked first anyway)- we thought he could be just active- but I pushed for the test, despite our overly flippant pediatricians recommendations and I'm glad I did. He is making small progress as I work with him constantly pointing out every little thing, reading to him and not letting him drift into independent play. where he doesnt have to interact.

After a month and 1/2 of waiting his speech assessment(herrick Campus) is this Thursday. I know they will recommend some kind of therapy based on his personality type to help him catch up. My question is has anyone been through this/ and or have any tips on who to go to/ things to try at home. The biggest problem is that EVERY place has a VERY long wait list. i know about East Bay regional center that helps with cost and he is on that list, although getting my son help is my top priority so I will take him to the first great place that can help regardless of the fact that our insurance is not going to cover this at all until we reach our very high deductible. It seems sad to me that people keep mentioning how early i'm catching it( really how early am I with NO words(only babbling whih started back up when he could hear again) at 22 months) so I shouldnt worry that every place has a waitlist of 2 months, mostly more..It's like they're forcing us to wait until he's so close to preschool age that he WILL be behind when it matters most and more importantly when he's old enough to really know it! Thanks in advance for any advice/support/resources you have to offer! Thanks in advance for any advice you have to offer

I'm so sorry you're going through this, it's so hard to be faced with a possible problem with your child. You will hear a lot about people whose kids also didn't talk or babble, and now you should hear them at the age of 5! etc. You will also hear a lot about how boys speak and develop later than girls, particularly from your pediatrician. But your momgut is stronger than all of that, and if you suspect there's something wrong, you must follow your instincts. Good for you for pushing for tests!! I always used to say that I'd rather people label me an overworried, first time mom than be right.

First of all, yes, the symptoms of autism and a hearing problem can look similar to the untrained eye, and getting a hearing test is always going to be the first step. It's GREAT that you've found a problem and were able to fix it!! One thing that can rule out autism: Does he point, with one finger, to indicate either something that he wants or something he wants you to see? He should point to something, look at it and then look at you. If the answer to this question is no, you have reason to worry. You can also test this by getting his attention, pointing to something and see what he does.

The Regional Center is required by law to respond to your inquiry within a specified number of days. You should, at the very least, get an assessment with them to learn where you stand. You can always go the private doctor route, I recommend Dr. Erica Buhrmann in Albany. By the time you read this you will have had your speech assessment and should know a little bit more. Feel free to contact me directly if you need to talk to somebody about what to do next. Jill

I highly recommend our wonderful speech therapist Frances Graham-Jones. She's been working with my daughter for the last 9 months and my daughter has made tremendous progress in her speech. We were referred to Frances by the East Bay Regional Center and they're paying for the services, but I know that she also takes private clients. Frances has an office in Albany and she's great with kids, I can't say enough good things about her. You can reach her at 510-207-3152. Feel free to contact me if you have any questions. Good Luck! Martha

The SLPs at Herrick (and the occupational therapists, too) are great. But Herrick (and Children's Hospital Oakland) have waitlists, and an almost-2-year-old shouldn't wait.

You should bug Regional Center, because unfortunately after he turns 3, they aren't responsible for early intervention.

In the meantime, call Loren Siegel at Happy Talkers. Besides the Dublin office, Loren has immediate openings for her Oakland office. She's worked a lot with little kids, although she has experience with older students. I'm really impressed with her because she uses a lot of tools, including PROMPT and Links to Learning. Contact info is: loren[at]happytalkers.com Betsy

I can so relate to your situation as my now 4 year old son, was diagnosed with an expressive language delay and Apraxia 2 years ago. Like you, we went through an initial assessment of his speech but through Children's Hospital. CHO recommended that he begin speech therapy immediately but of course, there was a ridiculous waiting list for him to be seen. We were going to go through Herrick Hospital as well but ended up going to see a private speech pathologist. We saw Sarah Thompson (then with Faltz and Associates on Piedmont Avenue and then she began her own practice with a partner at Word Works in Oakland). It was costly to see her as my son required an hour and a half of therapy per week which was not covered by insurance. I can write a book on the hoops we jumped through trying to seek insurance coverage for his speech therapy - ultimately, we were denied several times becuase his speech delay was ''not caused by injury or trauma to the brain'', etc. We saw Sarah for 7 months and then as soon as my son turned three, we had him assessed through Oakland Unified as this is the age when they will first assess a child for speech. The paperwork, process, and assessment went quickly and he began to see a therapist through OUSD last fall - and of course, it's free. Amazingly, through the district's assessment, it was recommended that my son receive 3 hours of therapy per week! The program has been wonderful and I can't say enough positive things about his speech teacher. He has made tremendous progress in just one year and really, the only evidence of a speech issue is a few articulation errors. His connective speech has exploded and he is now easily understood by his peers at preschool and by his teachers! As far as any techniques to use at home, it sounds like you are already doing all the right things! We found that lots of explicit modeling of single words and then phrases then sentences and having the child repeat them verbatim, helped a lot. Lots of gentle corrections and tons of praise helped as well. We read and still read lots of Richard Scarry books that have lables for every single illustration to practice vocab as well. Good luck to you as you wade through the speech process. It can be very frustrating but once your child begins a program, you will begin to see positive results. Kristin

Our experience several years ago was that Herrick had many good speech therapists. So when you get off the wait list, if there is one, you are likely to get someone good. If the wait list is too long there and everywhere else, I recommend you consider finding a private speech therapist and paying until you get off one of the waiting lists. It may be a drag to switch, but if you think the sooner the better to start than it may be worth having to switch. If you do go private, you may want to keep with that person until you're sure you like the one you get from the waiting list, and that they are giving you what you consider to be enough therapy time each week. If you think he needs more therapy time than health insurance or Regional Center is willing to provide, you might want to pay for some privately. It seems expensive, but if the speech delay is only due to hearing impairment I would imagine it wont' be a lifelong expense, and if you can afford it at all it may be w! orth some sacrifice to ensure your son gets help as soon as possible. You should also know that once your son turns three the school district where you live is obligated to provide services. good luck

I can imagine how worrisome and frustrating this situation must seem for you. Thankfully, there are things that you and your family can begin to do at home to bridge the time between now and when you settle in with regular speech and language therapy. Try some of these things:

~ Slow your speech and limit the amount of words that you string together when interacting when you are thinking about .

~Aim for face to face contact, where your mouth movements are very visible and big. Exaggerating the movements of your lips, tongue, and jaw will make the sounds more visually apparent and interesting ('What is mommy doing?! Hmm, I can do that!') to your little one.

~Think about introducing some simple sign language paired with words. You can find these signs on many websites if you run a Google search. Signs won't prevent speech from happening, or slow it down- they will actually accelerate it. They may also alleviate some of the frustration your little one may be feeling in attempting to communicate with you.

~Use music and other motivating play to demonstrate sound production. You might identify favorite songs, and substitute certain sounds in place of parts of the song. Combining sound play with things your child finds motivating will ensure that speech learning is fun and exciting.

~Label everything in your child's environment using your slow, deliberate voice with clear and exaggerated enunciation. Using a singsong voice might help, as well, to make the words sound more interesting.

~Offer a lot of praise (hugs, kisses, smiles, etc..) for all imitations and tries. Regular encouragement will make your child excited about trying new sounds and words.

~Use mirror play- when playing with your child, position yourselves in front of a mirror so that you can see each others' faces. This can be a great time to demonstrate sounds and get some imitations.

~Expose your toddler to a number of interesting activities like the zoo, picture books, walks in your neighborhood, etc... and use these special times as opportunities to show him sounds and words in a gentle way.

~Don't let worry consume you in regard to your toddler's speech delay. Worry might interfere with your positive and natural interactions with him. And remember that this is a 'delay', which means that your baby will eventually catch up, and faster if he receives some therapy and the right kind of interaction at home.

~Though you will also get help with therapy, it will also help a lot if you remain loving and patient, while trying to be a great teacher at home. All of these things should set the right tone for catching up to happen naturally and quickly.

I hope that this has helped. If I can answer any questions for you, please contact me. Deirdre

18 mo. Signing but Not Talking

May 2007

My daughter just turned 18 mos. She started signing at 14 mos. and is up to 100 signs. She's very communicative with her signs, intonations, and babbling. She's also signing 2 word ''sentences'' to express what she's just seen and also about past events. My worry is her lack of talking. We know she's capable of speech because at 11 mos. she could say dog, downstairs, and upstairs. However, now that she's signing so much she doesn't even say dog. We also know that she doesn't have any problems hearing since she can sign what the next songs are when we're listening to CD's. We take a signing class, which happens to be taught by a speech therapist. She thinks that this is just a case of a late-talker, and she points out that I should be happier with a 100 word signing baby than a 20 word talking baby. I'm bringing this up with her pediatrician at the 18 mo. well-baby visit. However, should I push to get a referral to a speech pathologist? Should I just stop worrying as advised by our signing teacher. Please help! Betty

Bilingual (eg. English & Spanish) children where bilingualism is their ''first language'' (ie learn both at the same time) often are briefly late talkers. However, they usually very quickly catch up and surpass their monolingual peers. And this advance has been shown to continue throughout life eg. more cognitive flexibility; recent research has even shown that bilinguals have lower rates of Alzheimer\xc2\x92s. I would imagine that same would apply to bilingual ASL/English. Juanita

Yes, talk to your pediatrician about this. If he thinks it's fine, then good. If not, you need to know what a trained professional in the field thinks about this. Your sign teacher is not a speech therapist; she teaches sign language. Of course she thinks it's all fine. lwolf

Please DO NOT worry about the lack of spoken language in your 18-month-old! I know it is hard because some kids are talking a lot at that age, but my son - who is now 3.5 and talks NON-STOP - said almost nothing at 18 months and was well over 2 years old before he put 2 words together. And also, if your daughter has 100 signs she clearly has no language impairment. Liz O.

I know it's hard, but try not to even think about it. Keep verbalizing as you sign and eventually words will replace the signs. At my daugter's 18 month check-up, her pediatrician asked me how many words she used. I asked ''verbal or signing words?'' (She was a combo kid at the time.) The dr answered ''both - whatever type of language is fine at this age.'' Also, my friends' little guy is currently 18 months and is a rampant signer/VERY limited verbal kid. Mom's a teacher and they're not worried at all. Hope this helps! Worry Next Year

I didn't see the original post, but both of our daughters were mainly ''signers'' until 18 - 22 months. We taught both of our daughters to sign and both of them starting verbalizing later than most of their peers. We never worried because they were still communicating with us using signs, in fact they were combining signs and signing in short sentences. When both of our daughters started to talk, they both quickly caught up with their peers, but also used 5-6 word sentences and had an amazing vocabulary! If your child is not talking at all, it would be worth a talk with your pediatrician, but if they are using some words and signs, I wouldn't worry yet. - A big fan of teaching signs

When to worry about 17-month-old not talking?

May 2007

My son is 17 months old, and doesn't say anything -- not even 'mama' and 'dada'. He babbles constantly and I can tell that his hearing is good. I wasn't worried about the non-talking, but I just read a post in the 'Advice wanted' newsletter from a parent whose child started early intervention for not speaking at 15 months. So that made me wonder whether I should be looking into therapy for my son. I've been figuring that he's just a late blossomer and will follow his own timeline (he's a late walker too), but am I missing a crucial developmental window by not pursuing speech therapy? Don't want to be over-anxious, but don't want to be negligent

At 17 months there should be at least a few words, it's possible that as part of the constant babbling there are actually a few words in there, you just don't recognize them. They'd be single syllables with possibly the last consonant dropped. Bah for ball and Cah for cat, etc. If your momgut hasn't alerted you to a problem yet, you may be right that he's just a late bloomer and he'll get there. Somebody once told me that they had to walk before they could talk, so if he was late to walk he'll also be late to talk.

Some other things, though, that you should be concerned with at this age: Does he point, with one finger, to indicate something he wants or something he wants to show you? (An outstretched arm and finger combined with eye contact; looking at the thing and then looking at you, and then back at the thing.) Does he hand you things or bring you things from across the room? Is he able to communicate his needs and wants with grunts, yelps and hand gestures rather than words? If he doesn't do these things, in combination with not talking, then you should definitely get him evaluated by the Regional Center or by a Developmental Pediatrician. If he does, he'll most likely get to talking eventually.

Having said all that, absolutely no harm can come from getting an evaluation, anyway. When my son was that age I always said that I'd rather be labeled an overprotective, overanxious new mom than be right. Unfortunately I was right, but maybe you're just an overanxious mom! Getting an evaluation can eliminate worry, and that's absolutely fine. Feel free to contact me directly if you have more questions. Jill

Don't worry. My son began speaking at 2 years 5 months (some words before that but not real conversation.) And, my niece began at 3. Both can't stop talking now, at ages 6 &12.

My daughter didn't say any words on her 2nd birthday. I knew something wasn't right at about 18 months, but I also knew she was ''hearing well'' and didn't have any other developmental oddities. Talked with the pediatrician about it; he wasn't concerned. And then, he performed some kind of pressure test on her ears at her 2 year check up, and turns out she needed ear tubes. I was VERY hesitant to do this (I hate all medicines and procedures on children unless they are VITAL), but decided to go for it. The theory was that she had fluid in there and basically, she heard everything as if underwater. They placed the tubes in her ears and she was saying clear words within 10 days. Said her name for the very first time. Tubes fell out less than a year later, and I'm really glad we did it. It was frustrating for HER and me that she was not able to communicate with words. Good luck. Ask about tubes? Chanel

My son wasn't talking much by age 2 (basically just Mama and Dada), and the doctor was not worried--he said many kids start really talking between 2 and 3, and now he's 2 1/2 and has LOTS of words, phrases, etc. Don't worry yet! heidi

I wanted to respond to your post because we went back and forth regarding speech therapy because our son hadn t said any words by 17 months. I too was worried about being negligent. Your son sounds something like ours babbles constantly, late walker, possibly late talker. It doesn t sound like you have serious concerns about him except for the fact that he hasn t said his first word yet so I thought I would tell you our story. When our son hadn t said his first word by 15 months, the pediatrician we had began having us call her every two weeks from about 15-17 months to tell her whether he had said any words. When he hadn t, she sent us for a hearing check, which came back normal, and then on for speech therapy. All the while, our son was communicating with few words (I think he said his first word at the end of 17 months), babbling, responding to people, making eye contact, in other words, acting like a child without serious problems. I will say, he has always seemed somewhat different from other children. Now that I know what he thinks at 3-1/2 (yes, he talks!) I see that he likes to absorb lots of information before acting on it.

We did do about three months of speech therapy before deciding it wasn't for us. I just didn't like having my relationship with him turn into a language lesson for everything. Yes, mama, MMMMM, can you make that sound? Besides, he resists being forced to do things he doesn't want to do. We changed pediatricians when he was about 28 months. We were nervous about stopping the speech therapy, so we found a pediatrician who had a different view of intervention! Our son said a number of words by that time, but he wasn't talking as his primary means of communication. By the way, he didn t say mama until he was about 22 months old. The new pediatrician said a minority of children, especially boys, learn to talk between 2 and 3.

Our son finally started really talking at 2-1/2. He still doesn't say some sounds correctly, but he has a great vocabulary, is creative with words, and talks all the time!

Some people, including the first pediatrician, argued that speech therapy couldn't hurt, so why not do it if it might help? But because we didn't see any other serious issues, we found that our relationship with our son was always better when we relaxed about his development and let him proceed at his own pace.

I think the trend to try to catch problems early has good intentions behind it, and may help autistic children, but I think it has gotten out of control and can make new parents completely neurotic about milestones if their child is one who does not fall on the early-to-normal side of the curve.

Not talking yet - 23 months

April 2007

Hello everybody, I am concerned about my little boy..he is going to be 2 years old on May, and he is not talking yet..he is just using a few words ( duck, dog, dad, momma) but nothing else.. the doctor keep pushing us about this. but we are doing everything we can to help him...rigth now he is going to child care (pre-school) to see if he imitate from the other kids because at home he is our only child.. any advice????please...some times i feel like i,m not doing a good job as a mom.. thank you
worried mom!!!!

You should contact Early Intervention. this is a county by county agency that will provide you with a speech therapist that will come to your home and work with your little one. speech delays are common, and usually pretty workable, but the sooner you get your little one some help, the better off he'll be. You can reach early intervention by calling your local school and asking them, or google it on your computer with the name of your county. margaret

We had the same concern. Our Pediatrician reccomended speech therapy and we took it. (as well as hearing tests) Not to be irreverent, but, it was like dog training where it is about training the parent not so much the dog, ooops! Child!!! It was very soothing to know for medically proven sure that he was OK and to learn how to help him get verbal skills. Quit worrying and just do what ever it takes.

Call your child's local regional center or school district for a referral to the regional center and get your child's language evaluated. You have nothing to lose. Services are free before the age of three and the earlier you act the better if there is a delay. If nothing is wrong, you lose nothing but a few hours. Good luck! Sam

Some kids are just \x93late bloomers,\x94 and they start talking without any special help. Others have language learning disorders, and it\x92s best to get help as soon as possible. In either case, it would not be a reflection on your parenting. You\x92re clearly worried, so why not find out if he could use some speech language therapy to help him catch up (at his age, the ''therapy'' would be play-based and should be fun for him). When children are late to start talking, it\x92s always a good idea to get their hearing checked too. You can talk to his pediatrician about getting referrals for both a hearing assessment and a speech language evaluation. A speech language pathologist would also be able to give you some specific ideas for ways boost his language development at home (not because you\x92ve been doing anything wrong, but because your son has not been picking up language skills as quickly as other kids do from regular interactions). Here\x92s a website with some easy activities you could try right away: http://www.asha.org/public/speech/development/Parent-Stim-Activities.htm An SLP and mom

Our now 6 year old started at 29 months. He hasn't stopped yet (ever???) and is even a great ''discussion leader'' in kindergarten. Give it time.

Since your child is not talking and is now 23 months old, I would suggest that you have him evaluated by a speech therapist. You can do that privately or you can go through the Regional Center of the East Bay (510-383-1200) which may take some time but it is at no cost to you. Try to get the help now so that he does not get frustrated. good luck. Been there. anonymous

23-mo-old talks in her own babble language

Aug 2006

My 23 month old daughter has been talking nonstop for months but in her ''own babble language''. She sings many songs in tune and reads to herself but in babble. Her babble does consist of phonetic english sounds. She understands everything we say. Her intonations, hand movements and facial expressions seem to be in context. She can be very passionate about what she is telling us. She does use some signs and does say a few words - \x93bye bye Daddy\x94, ''hi'', ''mine'' and ''mommy'' but does not always use them. My pediatrician suggested I take her to a speech therapist because she is talking in sentences but in babble. The therapist did an evaluation and her development is on track with some things exceeding her age but her expressive skills are behind. Overall she was not overly concerned. So we need to do exercises with her like repeating words over and over with an object next to our face so she follows our lips and mimics us but most of the time she looks at us like we are nuts and goes about her business. I feel like she is just taking her time and I am not overly concerned as children develop at their own pace. Would like to know if anyone else has had a similar situation and how you handled this. Thanks!!!! Sue

Have you had her hearing checked? If not, get your pediatrician to give you a referral. Otherwise, it wouldn't hurt to have her evaluated by the Regional Center, maybe do a year of Early Intervention since she's still so young Jill

Our 3 yr old son was also talking in his own language when he was turning 2. I really wanted to ignore everyone who told me to look into it, because I too feel that everyone is different and develops at their own pace, but we did get an evaluation by an excellent speech therapist. Our son probably has some sort of auditory processing difference, in that he is repeating what he thinks he is hearing, so what he's saying sounds different to our ears. Now that he is 3, he is definitely speaking English. This would have happened on its own, but he is getting speech therapy, which I think is really helping the whole process for him, and it makes all of us feel better too. Good luck! She sounds like a wonderful kid! Diana

2-year-old talks a lot but is is hard to understand

May 2006

does anyone know about 2 year old words developement. My daughter Hannah is still missing a lot of words from her vocab. she will be 3 in August. she talks all day, but her words are hard to understand. i'm not worried about her intelligence at all. i just wonder why she is so delayed in speech. has anyone else gone through this? thank you

Hi! A speech therapist can certainly help clarify for you if there is a problem. Also, make sure you have had her hearing checked. By the age of 5, when children are ready to enter kindergarten, they have most of the necessary grammatical forms (similar to adults) and their speech production is usually understood by all adults. Until that time, they are still gaining mastery over their tongues and over the language. If, by the age of 3, most other people can't understand your daughter, I'd take her for an evaluation. By age 3, other people can generally understand about 50-75% of another child's speech. If she seems to be constantly misunderstood by others and you are the only one who understands her, then go for an evaluation. Cameron School is a great place to start! Diane

Hi! I'm a speech pathologist in the public schools. Communication is a developmental process and there is still lots of variation in a child of your daugher's age. You can go to the website at www.asha.org to see some developmental milestones that might give you an idea of the continuum. Whether or not therapy is recommended, an evaluation can help you by giving you a ''code'' for your daughter's speech (such as: what sounds she substitutes or leaves out at this point), and you can get some tips on helping her communicate clearly. Below age three, children qualify for evaluation through the Regional Center for suspected Speech/Language delay; from three on, through the school district where you live. Most of the time, you will be asked to have her hearing checked out first.

Some children do not talk until they know they can pronounce things clearly. These children usually use shorter sentences, and fewer words, although they may have an excellent vocabulary. Other children acquire speech by taking more risks with pronouncing new words, using more words, and longer sentences. These children are more difficult to understand because they take more risks with their speech, use longer sentences, and more difficult words. this sounds like your child. Neither way is a better way for acquiring speech or language, only different styles. If you are concerned you may ask your pediatrition for a referral for an assessment. In a nutshell,/p,b,m,t,d/are the first sounds to come in; 90% have /g,k/ by age 4 (d/g, t/k substitutions are common until this age), /l/ by age 5, /r/ age 6-7 (w/l, w/r substitutions are common, /s,z,th,ch,sh,j,zh/ by age 7-7 1/2. If a lisp is a concern, stay away from bottles and sippy cups

Speech/Language pathologist for toddler

Jan 2006

Does anyone have a current phone number for Martha Waegle? She is a speech/ language pathologist who was associated with Faltz and Assoc. but, according to the most recent postings, is now in private practice. The phone number in the posting is out of service. Additionally, does anyone have other recommendations for a sp/lang delayed toddler? I'd love to hear your experiences with other SLPs. Thanks a million! anon

At two years old, my child was discovered to have a speech and language delay. I was very concerned about her, but apparently this condition is not uncommon. My child really benefited from learning baby sign language with Tamara Muhler at Word Works. Once my child started to communicate with me through signs, she started to babble more. This really helped bridge the gap before she started to use words. I was very happy with the natural floorplay structure of our speech therapy sessions. Tamara easily connects with children, and my daughter always enjoyed going to sessions with her. I highly recommend Word Works in Montclair for speech and language services. Susan

I highly recommend Angela Korpela at Alta Bates. I've tried several different speech/ language people throughout the years for my 7-yr-old speech delayed son and couldn't be happier with Angela. -Good Luck

Don't forget that your 3-year-old may also be covered by your school district. You can request your child be assessed, if you have not done so already. You may want to supplement anything your district may offer with private services, but I have found at least in Oakland the SLP's employed by the district are very good. anonymous

I highly recommend Amy Brewington as a speech and language pathologist in San Francisco. She has been working with my daughter and is wonderful! Her website: http://www.sfspeechpathology.com/ Email: amy [at] sfspeechpathology.com Phone: 415-246-8422

Try Kris Nuegebauer in Alameda, 510-306-9066. Glowing reports from friends. Has an astute diagnostic ability about kids in general. You may need to wait for an opening but I think it would be worth a consultation. Good luck! Mom of 2

HMO denied coverage as medically unnecessary

April 2005

Our son is 19 1/2 months old, and was recently evaluated by a speech therapist at Alta Bates Herrick Campus for his speech delay. She said his receptive language is fine, but that his expressive language is at approximately a 9-11 month old age level, and she recommended speech therapy. We have been given two routes we can follow: 1) The Regional Center for the East Bay, which will provide state-funded therapy for our son, if their evaluator deems he qualifies for it (if he doesn't, then apparently they are not an option); 2) therapy through Alta Bates Herrick Campus, if our insurance will agree to cover it.

Our problem is that we have already received a letter from Alta Bates/our HMO saying that we have been denied coverage because they feel the report submitted by the therapist who did the eval of our son doesn't show that therapy is 'medically necessary'. We plan to follow the grievance/appeals process, because if the Regional Center declines to work with us and we can't get our HMO to cover us, then we would in effect be stuck in limbo.

My question after this long ramble is, Has anyone successfully appealed something like this with their HMO (specifically, trying to get coverage for something that is technically called ''developmental delay'', and therefore is not deemed a medical necessity by the insurance company)? We are with HealthNet, and have an Individual/Family plan. We want to help our son catch up as soon as possible, and help him find his words. Any advice/experience from other familes who have been through something like this is greatly appreciate! Mama of Late-Talker

Look up ''Parity'' law as it relates to medical neccesity. I would think that your son qualifies for treatment given that what youre describing is not just about being able to talk but about being able to communicate needs, wants, and to be understood and hence his emotional development. Good Luck

While I do not have direct advice about appeal with the HMO to cover your claim - I thought I would give you my 2 cents about 'developmental delays'.

We were in a similar situation with our son. He was 20 months, with still a vocabulary of maybe 3 (understandable) words, and he still did not say 'ma-ma' (which I think now was stubbornness).

Our pediatritian of course reccomended the audiology and speech evals. - which we were told by our HMO would be covered. We had the audiology test, which was just fine - absolutely no hearing problem!

Then our pediatrition wanted us to follow with the speech eval. Meanwhile, we were often told by friends, family etc. that this was not something to worry about yet, and that it was not unusual for boys to develop later speech. In some cases the brightest kids had speech delays.

Yes, I was still concerned so I did make an appointment (at Children's Hospital) for the speech eval. We were given a report that my son had moderate ''expressive language'' delay, and that therapy was reccomended.

We were also denied coverage for the therapy sessions by the HMO, due to the fact that his audiology was fine, and it was not due to an injury or other 'medical' reason. I may be wrong, but I think it is fairly common for HMO's to exclude this coverage. In the end ?....We gave it time instead of paying out of pocket, or fighting with an HMO (which would have given me more grief than the worry I had about his not saying 'ma-ma' yet.

At about 2.5 years the words finally started to come. I was home with him more, and I also finally got a MA-MA. Each day improved more and more.

Today, he is almost 3.5 and language skills are not an issue at all. He is very bright and talking just fine. I think that being home with him more, and letting him play an age appropriate computer game (the Fisher-Price Computer Learning System, http://shop.fisher-price.com)really helped him a lot.

My advise? I'm not a MD, but I would say give it a little more time. You can begin a fight with the HMO, but by the the time you win, give up, or spend lots of $$ you may find that the words start coming. Eileen

Hi - No, I didn't successfully appeal my 2 y.o. son's speech therapy denial from my HMO. HMOs do only cover physical needs, and speech therapy doesn't have a direct physical impact.

However, we did go the Regional Center route and have been extremely pleased with the help our son is getting. He's light years ahead of where he was just a few months ago, and he loves going to his appointments. It takes quite a while to get the Regional Center process completed & you have to be good about following up to push it along. But it's totally worth it.

Although my son has a very different situation (a genetic diagnosis), he too was denied speech coverage for developmental delay. At the time he was testing with a discrepancy in receptive vs expressive, with recepetive better than expressive like your son. He also had a stutter which the speech therapist diagnosed as not being developmentally based (and therefore a medical issue). Our insurance is Aetna and we are in a PPO. I fought for months (which mostly entailed sending letters from me, the pediatrician, and speech therapist and tons of follow-up calls). I lost.

If the Regional Center approves your son for speech therapy then you can still use Alta Bates Herrick. They paid for my son's speech there till he was 3 years old, at which point I was hoping the insurance company would pay. We now pay out of pocket.

Best of luck! mary

Hi there, your story sounds almost identical to ours and we've been through the appeal process 3 times now for our 5 year old, winning 2 of them (1 Blue Shield, 1 HealthNet), losing the latest w/ABMG and HealthNet. We were also RCEB clients until he was 3. I hear that ABMG is getting stricter about the interpretation of ''medically necessary'' which seems to be so in our case. I am also still dealing with insurance and bill issues from 3 years ago w/AB/Herrick. I was able to appeal based on apraxia, with much help from the website www.apraxia-kids.org, since apraxia is a medical/neurological condiditon. But now, my son is testing at a higher level and the apraxia is not manifesting as much during evals. So, a good thing, but not so good w/the insurance. Good luck, but RCEB does sound like your best bet. Tracy

Our daughter, who recieves therapy from Alta Bates for the same diagnosis, started a few months ago...her pediatrician rec'mnd that we look into therapy. We also had the same options, state funds or private care. We chose private care because the co-pay was relatively low. We had two assessments, more or less to get a second opinion. And the second assessment revealed that often times 'delays' can be 'grown out of'. Which no-one told us originally. This was confusing and frustrating. Our second assessor rec'mnd that we wait about 6 months more to see if her developement improved. It did, some. But, we signed up for therapy anyway because she is 3 and although her input is 100%, her output is about 65-70%. It's hard for us to understand her even though she's trying very hard to create structured phrases. Our biggest concern was how far along she would be before kindergarten.

Consider this, maybe wait until your child is about 2 1/2 years old before dropping tons of cash on co-payments. Often times, kids DO grow out of delays. There can be other things in your child's growth that help him/her excel as a developing person... and right now, speech might not be on the top on the list.

This could be an opportunity for YOU to look into speech therapy options at home. Practicing sounds, sentence structure, over-pronunciation tecniques. These are all part of the therapy processes they do and what becomes integrated daily as you interact with your child. You could be a step ahead of the game in the long run. (Hint: LeapFrog has some great beginner phonics programs... and we think they helped our little girl a lot)

In the end, we were glad we waited a while longer. This gave us an opportunity to do some research, pick up tips, apply techniques... and in the end, we found out we were doing it right all along!

Hope this helps! And good luck! Alena

Hi. I didn't see the original post so don't know if the following comment will be helpful. Have you tried working through your school district for speech services? Many people don't know that school districts are responsible for providing services to children with special needs from birth on, not just when the child reaches kindergarten age.

We live in El Cerrito and therefore had access to the Early Intervention Program at Cameron School in El Cerrito through the West Contra Costa Unified School District when one of our children needed speech and language services as a preschooler.

I believe that it's especially easy to get school district services before a child reaches 36 months, because the idea is to reach out to children who just might have a condition that qualifies them.

Good luck with whatever you decide to do. Brenda

18-month-old with expressive language delay

March 2005

My son is 18 months old and is a late talker. He uses a lot of different sounds (consonants and vowels), gestures a lot, tries to echo back when we sing songs like ABC to him (comes out as ''Ah Ah AH AH''), and it's very clear that he understands what we're saying - he just doesn't use words himself. We talk to him constantly, read to him every day, all the things that we were told to try, but still there's been nothing (except for an increase in the types of sounds he makes when he babbles.) His pediatrician recommended that we have an audiologist and a speech therapist examine him, and the previous postings regarding this on the sight have been really helpful (he was referred to Herrick/Alta Bates). I'm anticipating that it may be a while before they fit us in, and I'm wanting to do things to help my son now, but haven't had much luck finding actual recommendations for exercises to try, etc. Has anyone else out there dealt with this? What sorts of things seemed to help? I am so desperate to help my little boy - he's sweet natured, and seems pretty bright and inquisitive (loves puzzles, books, figuring out how things work), but he just won't/can't talk. I'm afraid this is gonna set him back really far when it comes to being able to go to preschool, playing with others, and so on. Any words of experience or reassurance for a paranoid parent? Thank you so much. Late Talker's Concerned Mommy

I had a similar experience with my son. I knew he was behind in taking at 18 months but everyone kept telling me not to worry because all boys develop differently. He was normal in all other developmental areas and was even doing some signing to help communicate but those words just refused to come out of his mouth. By the time he turned two I knew I had to be proactive even though my pediatrician wasn't worried at all. One of the final factors in making me proactive was when the daycare provider said he wouldn't speak in circle time and could tell he was getting frustrated in trying to communicate with the other children. I knew I wanted to find out what was going on.

I followed the wonderful advice on BPN and called the Regional Center for the East Bay http://www.rceb.org/. Took a few weeks to get an appointment but so totally worth it. Do not wait for a hearing test from Alta Bates - they had a three month wait when I tried to get an appointment. The RCEB does not require a hearing test for evaluation purposes. We had one done at Valley Audiology in Concord and as we knew all along he could hear just fine.

The RCEB evaluated my son in a fun play session and determined that he had expressive language delay but was in line or ahead in development in all other areas. We started speech therapy a few weeks later and it made all the difference in the world after only a few sessions - heck after two sessions I could tell a huge difference and he was participating in circle time. Now four months later he still has some intelligibility issues and isn't completely up to speed but the difference is amazing. I don't know what diagnosis my child falls under and it may be that it would have happened eventually but I know that contacting the RCEB is one of the best things I did. As a mom I know I'm doing everything I can to help my child, I'm not stressed about it anymore, and I'm seeing a huge difference in my son's development - and the best of all - the RCEB services are all free (we did have to pay for the private hearing test). The only regret is that I didn't start the services earlier when I first had concerns so he would be even more on track by now. They have milestones that they can tell if your 18 month old is on track - it is not too soon to have it checked out. You are not being paranoid - your child deserves to be evaluated and get what help is out there. Mom of a Late Talker

Have you thought of teaching him sign language? There are two methods for doing so, one more informal (see the book ''Baby Signs''), and one involving formal teaching of some ASL. The research I've read seems to indicate that learning sign language can actually help in learning to speak. Karen

Try teaching him sign language. Get a dictionary and teach him the very simplest and necessary ones like ''eat'' and ''more.'' Our 16 month old is very expressive and uses lots of different vocalizations but does not say any other word but mama. But his sign vocabulary grows everyday, so he is less and less frustrated with communicating and we believe that, though he will most likely be a late talker(growing up in a bilingual household) he will certainly catch up and excell given these early tools. Good Luck and don't sweat it. Sounds like he'll talk when he's ready and you're doing everything that he needs. veronica

My daughter had a few words at 18 months but not many. Like your son, she is bright and curious. She made lots of babbling noises. I was worried too, especially because she was frustrated. She knew what she wanted but couldn't tell us (but she was trying; we just didn't understand). We did all of the things you're supposed to do to build language - read aloud, talk and label constantly, etc.

So, we did 2 things. First, we got a few Signing Time videos, which helped tremendously. She learned some basic signs like ''more'' and ''drink'' and ''cookie'' :)

Then we enrolled her, at 19 months, in a toddler program a few days a week. Being with other kids (many who were almost 2 and talking) opened the flood gates. Her language exploded. Now, at 2, she has over 300 words. It's incredible. Good luck! anon

If your son's speech is ''delayed'' then so is mine and many other boys I have met. Does your ped really think there's a problem? Our son is 17 months. He knows lots of babysigns and can communicate very well this way but his vocabulary is limited to mama and just this week, bye-bye. He says something like ga gon to say all gone. I'm a second time mom and maybe worry less about these kinds of things than I did the 1st time around. Our daughter spoke many more words by now. My advice is forget about the specialists until he is two if you can stand it! good luck another mom of a boy

First, calm down, take a breath. I think you will get lots of messages saying that their children did not talk until 2 or later! My daughter is 17 months and only occasionally tries to repeat what we are saying. I figure she will talk when she is ready...do I wish she could communicate instead of whining all the time...Hell Yes, but she is not there yet...be patient and I am sure your little boy will be chatty in no time! chilled out Momma

Hi, I remember how it felt to be in your shoes! My son is now 36 months old, and has really blossomed. His speech is still not quite at the level of his peers, but he is definitely speaking and is attending preschool. I really recommend you have your son evaluated by the Regional Center. It's basically special ed for the 0-3 crowd, and services are free. I found everyone I dealt with through them to be professional, prompt and excellent. My son received speech and occupational therapy starting at 16 months until he just graduated at age 3. And it was free! They can tell you what is going on with your son much better than anyone who hasn't even seen him, like me. As far as resources, things get a lot better once you have a speech therapist to show you things you can do. I learned so much and applying it to my interactions with my son really helped him grow. His speech therapist did recommend a book which I found extremely helpful, but it really depends on what your child's situation is. My son had both expressive and receptive delays, so I had to learn how to step down my output and encourage him to try to interact. It was a book called ''More than words'' and is meant for parents with children on the autistic spectrum. This was not my son's diagnosis, but the information was so excellent for him anyway. It's printed in Canada and costs $50, I got mine through Amazon.

Good luck and keep on keeping on. Don't give up on your son, because you make a HUGE difference, and he IS learning and he WILL get there. Once I read a book about a man who went blind at age 7. He said of his school career, that he was glad for his blindness because he didn't waste any time finding out who his true friends were. They were the only ones willing to make time for him and extend themselves in order to know him. I have found the same for my son as he has been in preschool.

Some teachers, parents and children are receptive to him, and others aren't. We find out pretty quickly. Then, we just go on with all that is good and keep on trying to develop those parts of his situation and development that are still challenging. I wish you all the best. Julie

Since your boy is only 18mon, maybe a few monthes waiting will do more tricks in front of your eyes. I didn't read previous posting on this topic, so here is just my two cents. Anyway, it is good to have him tested by specialists. Our speech therapist recommended this book to us: It takes two to talk: A parent's guide to helping children communicate by Ayala Manolson, and I do feel it is a pretty inspiring reading. Good luck, Emily

18 month old who doesn't talk

March 2005

i have this question, my 18 month old daughter won't talk. i know she is smart, she responds to me. she does simple tasks if i ask her, she waves and laughs. she seems happy. she does have quite a temper though. she points and grunts, i respond and we usually resolve the problem. but no words! not one. am i responding to her pointing too fast, so she never needs to talk? or could she have a learning problem. i've tried talking about it with her. she looks at me then continues on her way. she is not mute by the way. she ocassionally dedededede dadadadada etc. what should i do? does anyone have an idea for me? i am worried now. michelle

I would talk to your pediatrician. Our daughter seemed delayed but our Dr. wasn't worried. She told us that our daughter was talking, we just didn't understand her. We tried the Signing Time videos and that helped her communicate with us. But the thing that seemed to help the most was enrolling her in a toddler program so that she spent a few hours every day with other kids who were talking. Now she talks -- nonstop some days :) anon

22 month old late talker

Jan 2005

My son will turn 2 next month and I'd like to get some input on late talking from other parents. He only speaks about 5 words, and does not use them frequently. He does not combine words into 2 word phrases yet either. He generally seems to have little interest in learning to talk. He babbles with the correct intonation (asking a question, counting, etc.), and although I will get his hearing checked I do not think his hearing is impaired.

Otherwise he has met all other developmental milestones, has an unusually long attention span, understands MANY words and phrases, can point out pictures of things in a book, etc. He is also very observant and notices small detail, we often get comments on this ability even from strangers. He is a little on the shy/cautious side but I would not say he is withdrawn or anti-social.

We taught him sign language starting at about 6 months and at this point he uses them all the time, even inventing signs of his own. He will now sign the word (if he knows the sign) instead of saying it verbally if you ask him to try. Sometimes he can get quite inventive trying to express himself this way, and will link 2 or 3 signs in a row to make a ''phrase''. When he was an infant I read that teaching them signs does not delay their speech, but now it is obvious he greatly prefers signing to verbal speech. When we noticed this happening months ago, I have been trying to encourage him to speak instead of sign, but usually to no success.

His 2 year checkup is coming up next month and we will discuss this with his pediatrician. I intend on getting a recommendation to a specialist, just to be on the safe side. I had not been particularly concerned until it dawned on me his birthday is coming up and he still has had such little development speaking. Any advice from parents who have been in a similar situation? anon

Hello, I've heard that it isn't unusual for children, especially boys, to start talking between the ages of 2 and 3. My son, who also knew sign language early in life, didn't talk at all until two days after his 2nd birthday. Now he's almost three and is a skilled speaker, with a huge vocabulary and excellent grammar. I remember being worried when our 20 and 22 month old friends could speak and my same age son could not, but now that he does talk, I realize that he needed to start using words to communicate when he was ready, and that the timing isn't so important. Good luck! Grace

Your post sounds so similar to what happened with a friend of mine. Her daughter was 22 months old, not talking, but interested in language and understanding a lot. Her peditrician and friends were saying not to worry as kids just start talking at different times, but she felt in her gut that something was up and that her daughter did want to communicate, but somehow couldn't. They went to all sorts of specialists to rule out hearing problems, etc., with no results. Someone suggested going to an osteopath--she took her daughter to Dr. Thersa Hong in San Francisco (on Polk--she's GREAT), and she completely reversed the situation. Her daughter said 15 words after the first session. Turns out that the daughter was delivered c- section, which is a problem for some kids as their heads are not compressed in the birth canal. Apparently this may cause later issues in the shape of the back of the mouth, throat, etc. Her daughters mouth wouldn't open as far as ''normal''--she literally couldn't use her mouth to form words. (my friend had felt that it was more difficult to get her to open her mouth to brush teeth than it was with their other child.) The osteopath was able to painless and gently rework that area to open it, and the words just started flowing out. It has been about a year and she is one of the most talkative kids I know now. The change was dramatic. Just a thought in case your son was c- section. nancy

Hi. My son is also 22 months old and says maybe 4 consistant words. He is my second baby, my first was using full sentences at 1 year. I have been surprised by my second son's non- verbalness but I noticed that he understands everything I, his brother, my husband and other people say to him. I've just chalked it up to the individual differences between all children. He has his own way of communicating and most of it is physical, if he want's my attention he'll put his hand on my cheek and turn my head so I'm looking directly at him, he'll take my had at other time to show me exactly what he wants, and he has his own words for certain things like food (um) and water (wadee). If your child can communicate his needs and desires to you then I don't think you need to worry, he'll talk in his own time. I feel like my son has a good grasp of language he just prefers not to use it! Amber

I can't address the issue of signing delaying speach, because we did not teach our son sign language. However, our son had only about 3 words when he arrived at his 2 year check-up. A number of his friends had many more words. His pediatrician did not make any issue of the lack of language, though she did ask me if he understood what I said (which he did completely). Within 2 months he was talking up a storm. Now at 4 1/2 he is much more articulate than most children his age. Many people comment on his vocabulary. My assessment of his situation is that we never talked baby-talk to him. We always spoke to him like we were speaking to an adult. I think, because our verbal interactions were more complex, he needed more time to be able to form conversational speach. Perhaps I'm wrong about this part, but we knew him to be smart (based on his actions) and we knew his hearing was OK and that he understood most of what we said and could follow sometimes complex instructions. So we were willing to be patient and he is fine. Wishing you and your son the best. Karen

I could have written your message a few months ago. I was concerned with my son too when he was around 20 months and could only say a few words. I scoured the BPN for previous advise and recommendations, but I was still not satisfied. I finally made an appointment to see an audiologist to test his hearing. I was not concerned about it because I knew he could hear, but went ahead anyway just for my own piece of mind. On top of that, I had also made an appointment with a speech pathologist. (Exceptional Tots: check out your district for the free service). My son I found out may have delayed speech due to the fact that he was raised in a bilingual environment for the first two years of his life. And was told that he may actually know more words than he can say. Also, the fact that my son's heartbeat stopped during labor and found cord wrapped around his neck was a factor as well.

During the course (about an hour) of his evaluation, the therapist was able to teach him to say a few words showing him to mimic her using a big mirror. We were amazed. I'm using the technic to help my son pronounce letters and words.

As soon as my son turned 2 we put him in daycare thinking that being surrounded with other kids may help him. It did. In three months he was able to recognize and read the alphabets and can count up to ten and can say two word sentences now.

Good luck to you. I know you will do the right thing for your child and I am hopeful your child will catch up. Hopeful Mom

My experience with my 3 1/2 son was the same, and continues to be the same. he has about 50 words and barely put 2-3 words together, i was told ''dont worry boys tend to speak later than girls, (dont fall for that advice) get your doctor to refer you to a regional center were they can refer you to a speech therapist and pay for your sessions once a week for an hour, until he turns 3. If he makes no progress the school district will then continue to provide him w/ speech therapy. If you can afford to take him to a speech therapist do it. best of luck! claudia

Don't worry just yet. My nephew, now 28 mos, didn't talk any more than your son until his 2-year birthday. And, similarly, he recognized oral commands and knew what things were. He didn't know sign language, but he has 3 older siblings. We surmised that maybe he wasn't talking because he didn't ''need'' to, because everyone could usually interpret his actions and babble. Then, one day, quite all of a sudden, right around his 2nd birthday, he started using more words. Within a few weeks, he was making short sentences. Now he talks like a typical two- and-a-half year old.

I also sign to my 16 mo. old daughter--she produces many signs but also says a few words, which seems in step with normal expections for this age, so I see no evidence of signing inhibiting speech. I wouldn't worry--he will eventually realize that the rest of the world communicates orally, and he will want to join in. Best wishes. fellow signer

My three year old daughter was not much of a talker at 22 mos. I wasn't too concerned about it and knew we were comparing her to my older daughter who was very verbal. Also, the words my 3yo said were very hard to understand. Both the pediatrician and I were in a wait-and-see mode. But my husband wasn't. He wanted to do something. So we ended up getting a hearing audigram. Turns out she had a hearing loss due to fluid accumulation in her ears (she had not had infections) so she had surgery to correct this problem, has normal hearing now and just started speech therapy to work on her articulation issues. She talks a ton but is hard to understand.

I guess my advice therefore if you are concerned is to get something noninvasive done like an audiogram for starters. I would have been willing to wait until she was more like three, but in hindsight, that would not have been the best decision and she'd be even further behind I suspect. On the other hand, I heard tons of stories about late starting talkers who turned out just fine w/o intervention! Talk with your pediatrician about it and stay in touch with them about it too. Good luck. Hilary

I know where you're coming from regarding your near-two-year-old boy not being verbal yet. I was in the same position a little over a year ago with my boy, who was then 21 months. At his playgroup and babygym class, it seemed so many of the children about his age were talking a blue streak, and my son was not. It is soo easy (and natural, really) to compare your child with others regarding development. I found myself very concerned, as you do, that something might be preventing my son from talking. Well, it turns out that he started talking a BLUE STREAK a month or so after my worries were at their height. Other moms had told me that it all happens quickly, and it sure did. Now he is considered to be very verbally advanced.

The fact that your son communicates so well in ASL is wonderful, and I wouldn't worry about it hindering his verbal ability. If anything, he'll just be even more well rounded when he does begin talking. Please try not to put yourself into a situation of worrying excessively about his speech development. Remember that every child has their pace.

By the way, my uncle, a gifted geology professor, hardly spoke AT ALL until he was almost three. When he did speak, it was in full, eloquent sentence. ---mama of articulate boy

Your child may be on the normal curve for typical kids, but DO get his hearing checked out and do speak to your pediatrician as well. My kid has special needs and was a late talker. She learned sign language and if she hadn't, I think she never would have learned to talk. It absolutely was the bridge to expressive verbal communication for her. We kept signing, we signed and spoke, we never quit believing she would talk if she could, and she did. She was 5 when she really started to talk and she talks wonderfully now. (She's 8.) Along the way, LOTS of people told me about their kids who started to talk late, some almost as late as my kid and these kids landed up being totally typical kids in every other way with no special needs. If your kid is in that group, then it's a good thing he has sign language to help avoid the frustration of not being verbal yet! Hang in there and try not to worry too much. Your son sounds like a bright, communicative kid who has found an effective and creative way to express himself for now. Keep signing!

My now 4 year old boy did not talk until he was 2 1/2. Yes, he said a few words. He also knew sign and that helped. I did not and do not think it is a problem. My son was always only interested in the phsysical aspects of life. He walked at 9 months. The only problem i found with it was that due to his lack of verbal skills, he became frustrated often and would be physical, bite, when he was frustrated. When he did talk at 2 1/2 it was fine. He started slow and just kept going. I had a neice who didnt speak until she was 3 years, and when she did you'd have thougth she had been talking allalong.

Do not worry is my advice. Dont' get pulled into the ''normal'' world. Every kid is different. I am glad today that I did not freak out about my son. I am not saying you are freaking out either. I probably asked for advice about it here too. Just enjoy your child. yancy

Contact your local elementary school district and ask who handles the ''Birth to 3'' early intervention program. Your school district offers all kinds of speech, behavioral and occupational therapy, but only for children 3 and up. However, since 1995 a federal mandate requires these same services be offered to younger children UP TO age 3 (possibly state or county funded). It may not be in your city, but it will be somewhere nearby.

I live in Lamorinda, and my son started speech therapy at age 2 1/2 at a school in Alamo. That program was affiliated with the San Ramon Valley Unified School District but covered several other districts/municipalities. When he turned 3 we transferred to our local elementary school. He just turned 4 and continues to receive speech therapy in a preschool-like environment. Best thing we ever did for him.

Anyway, when you request an evaluation for your son, someone will likely come to your home (so it's not a scary clinical or medical setting) and observe his communication skills, both receptive and expressive, as well as lots of other things. They will then recommend speech therapy if needed. Did I mention that this doesn't cost you anything? Yes, it's *free*. Well, I suppose it comes out of tax dollars, but costs nothing out of pocket. Call today! Good luck! kathi

I'm sure your pediatrician will tell you this, but the first place to start with a possible speech delay is to get his hearing checked, and then go from there. good luck

My daughter also took only very short naps when she was that age. She would often sleep only 30-40 minutes at a time. As she has gotten older, she has begun to take longer naps and at 10 months she now often naps an hour and a half at a time. She is generally not a great sleeper, and never has been, but is so easy going during her considerable awake time that I have just always figured that she is getting all of the sleep that she needs. If your baby seems really tired then maybe you should investigate some causes of his short naps (too hot/cold, wet, hungry, too much noise etc.) but if he seems generally happy then he is probably sleeping just like he needs to and I wouldn't worry. Annie

Early intervention for 22 month-old?

Feb 2004

Hello, We are the parents of an adopted boy from Taiwan. He is 22 months old, and is about four-to-six months behind on his speech development, with a vocabulary of only about 25 words. Our pediatrician said at his 18-month exam that we shouldn't be too concerned about this until he is two years old. If he hasn't shown significant progress by that time, we would discuss what should be done. However, we're becoming more concerned by the day about his slow development, and it is difficult to ''let things happen'' when there may be something inhibiting him that we could correct.

I have heard from others about Early Intervention for Speech and wondered if a) anyone had some experience similar to ours, b) could explain a bit about E.I., and c) can point us to other resources in the East Bay (Walnut Creek) area.

We have tried many techniques to encourage his development, and although he seems to be gaining words at a faster pace in the last month than previous months (two or three per week), it still seems very slow. His pronunciation is more grunt-ish, but his hearing is normal and he picks up on inflection and syllabic emphasis. His communication input is above average and he understands all of what we say, but his verbal output is limited and most of the verbal utterances are unclear to us which frustrates him. Any recommendations would help!!! Thanks!! Kevin

i just wanted to say that my son did not say his 1st word until age 18mo. and it was slow going after that. he is now one of the smartest kids in his kindergarten. i, too, was worried and had his hearing checked. he was exposed to multiple languages during his first few years and maybe that had something to do with it. anyways, your son could be normal. anon

I think it's too early for you to worry so much. There is an enormous variation in speech development in toddlers - to only know 25 words or even less by 22 months is by no means unusual. My own sister had a very limited vocabulary until about 3, when she suddenly started speaking in full sentences (and she's now, at 19, an incredibly eloquent young woman). anon

Hello: I would like to suggest that you have your child evaluated by a speech and language pathologist. A wait and see approach frequently works, but an eval by a specialist couldn't hurt.

I know that Children's Hospital & Research Center at Oakland has a speech and language department and does evaluations. I also believe that they have a speech and language clinic in Walnut Creek. I'm sure that there are other good resources out there as well. Best of Luck! Michelle

You need to call the Regional Center of the East Bay (RCEB). (If you can't find the number in the phone book, email me.) I was in the exact same position that you are in. I knew that my son had some issues with speech, but listened to my pediatrician who said to wait to see how he developed. My mistake. Your pediatrician is NOT an expert on speech!! I wish I had called RCEB as soon as I felt there was an issue.

The Regional Center will assess your child & provide speech and occupational therapy at no fee till your child turns 3. At 3, the school district will do another assessment & provide assistance (again at no fee) if required.

RCEB & the school district have been life savers. They identified issues with my son & the services they have provided are top notch. I live in Danville and my son is currently in a special preschool that provides both speech and OT.

Do not wait. Hopefully there is no problem, but if there is, the sooner you identify it, the better! rosalind

For free assessment and possibly information about Early Intervention, if you live in the Mt. Diablo School District you can call the Mt. Diablo School District's Preschool Assessment Center at 925 825-0144 to see about a language asessment. I believe that if you are outside the Mt.Diablo School District, you can get assessment and services through the CC County office of Special Education, 925 942-3376. Hope this is of some help to you. Best wishes. Mimi

My daughter is two years old and also has a speech delay, so I totally understand what you are going through. We were told the same thing by our pediatrician (not to do anything until she was two), but decided to go ahead with speech therapy when she was 21 months old. We figured -- no harm, no foul. It's been great. The speech therapist comes to our house once a week, and my daughter loves playing with her. We've definitely seen an improvement in her language skills. We used the Regional Center of the East Bay, which is a state agency. California provides free intervention for children with delays like this, and RCEB administers the program in our area. The program has been great. You should really check it out, because it's free, it's high quality and it's well run. I don't have the contact information at my fingertips, but I'm sure you can find it on Google. Good luck. Anon

Hi, I'll be interested to see what other people have to say on this topic. Our son was adopted from Guatemala and is now 20 months old. He only has 2 words, but uses some signs. Our pediatrician has told us that we shouldn't be worried about speech at this point, unless there is no progression. Our son has good comprehension and can follow directions (when he wants to!), and is babbling more than he used to. So, we are seeing improvement. He told us that boys often learn to speak at a later age than their female peers, and that there is a huge variety of rates at which they can develop. Perhaps you should just keep helping him along, and be patient for the rest... Good luck! anon

We have a similar situation. Our son is now 2 1/2 and has been participating in an early intervention program since he was 18 mos. The program we are in is called Early Start (phone: 925- 743-9710) and we have been very pleased with the progress that our son has made. Mary Hayward is the director of the program. They are located in Alamo, but I think they serve the whole area from San Ramon to WC to Lamorinda. If you call, they will send a speech pathologist to your home to perform an evaluation and tailor a program for you if you qualify for services. They have both speech pathologists and occupational therapists on staff. Once your child is 3 years old, services are provided through the school district. (We are in the Lafayette school district, but I'm sure that WC has resources as well.) Early Start will coordinate the transition for you. The primary alternative to Early Start, I believe, is Regional Center. We did not investigate this since we were happy with Early Start.

The other thing I would encourage you to do is to ask your pediatrician to arrange for a hearing test at Children's Hospital Oakland or some other facility that performs an equivalent evaluation. Our pediatrician also told us when we had concerns at 18 mos. to wait until he was 2 years old. In the interim, we started our son at Early Start, but when he was 2, the pediatrician ordered full hearing and speech screening tests. We had never suspected a hearing problem, but it turned out that our son had hearing loss due to persistent fluid in his middle ears. In October, he had tubes put in and that fully corrected the hearing loss. He has made remarkable progress since then! We also had a full speech and language evaluation done at Children's, and the speech pathologist at Early Start has tailored a program for our son based on those recommendations.

It's great that you are being proactive about your son's needs - good luck to you! Lisa

I have a son with a speech delay and had him evaluated and signed up for speech therapy when he was 2.5 yrs. I wish I would have moved on it a little sooner. If your son is 22 months and hasn't shown significant improvement I would go back to the Dr and ask for a speech evaluation referral. The tests are administered by a speech therapist and are pointing to pictures, repeating words and sentences, naming objects. The evaluators are usually pretty good at working with that age. The other thing you can do is request the school district do a speech evaluation on him. I'm not familiar with W.C. preschool, but you should be able to get a speech evaluation and therapy for him at no cost to you. He may have to be 2 yrs old though. If you go through the school district make sure they do it before summer. You should have the permission to assess forms signed by mid April so they have time to do the evaluation and meet with you to report on the results and recommendations before the school year ends. Otherwise you'll be waiting until well into Sept. Since school districts are so slow and overloaded I got a speech eval through Herrick Hospital who has an early intervention program. I took the results from Herrick to the school district and got speech therapy through the school district. You guys are right on track with your not wanting to wait. If you wait your son's frustration just increases. I found with my son his cognition developed faster than his language and he grew very frustrated. He had lots of ideas, but couldn't find the words to express them. His behaviors were hard to deal with. There is a lot of evidence that early intervention is effective and worthwhile. Whatever route you pursue don't let the dr., speech therapist or school district put you off. They are all guilty of that wait and see approach- push them if you have to. You know your son and what's best for him. glenda

Kevin, We have a child on the autistic spectrum and he has speech delays. We started by getting a speech evaluation at Alta Bates and an evaluation through the Regional Center of the East Bay 925/798-3001. It can take a few weeks to get an appointment and you will need to do an intake call (takes a few minutes). They will direct you from there. Early intervention services are availble until age three and then you are transferred to the school district. I suggest you call as soon as possible to get started.

We work with the Speech Pathology Group on a private basis in Walnut Creek. They contract with RCEB as well, so you may be able to use them through RCEB if/when you qualify. They are great.

Hope this helps get you started. Please email me if I can assist you with anything. It is great you are working so quickly to help your son, good luck. Shannon

Late-talking 2-year-old

March 2004

My 24-month old son seems completely uninterested in talking. He makes all kinds of sounds, babbles, says ''mamma'' and ''babba'' (for daddy) and occassionally we think we hear some words in the midst of the babble. But he doesnt seem to comprehend much, or chooses not to respond (hard to tell which), and doesn't mimic words (although he does mimic raspberries and other sounds that he finds amusing). When he wants something, he'll grab our hands and pull us to the fridge, or to the playroom, or outside. He's very good at non-verbal communication. He can hear fine -- he comes running when we put on a Teletubbies or Thomas the Tank video. He can happily entertain himself and is very independent. His play seems normal -- he puts his dolly to bed, pushes her around in the play stroller, drives cars in and out of the ''gas station'', throws balls, builds with blocks and lego, loves picture books, but he isn't much into interactive play or having me read aloud to him. But he does love to be chased, play hide & seek, peek-a-boo, bounce on the bed together, and he is very affectionate. He is also very curious and an excellent climber -- no problem with gross motor skills -- he gets into everything! He is with his grandmother most of the day, 4 days/week, who speaks Farsi with him, but doesn't get much interaction with kids his own age. We speak a mix of Farsi & English at home. He has an older brother (4.5yrs) who is very verbal and bilingual. We've got an audiology appointment at Kaiser set up in 2 wks and a speech assessment at the Regional Center at the end of April. He'll be going to preschool in Sept. Has anyone else had this experience? Can you recommend speech therapists? Should I be trying to get an assessment from a neurologist too? What are the things to be looking for to determine if it's just a delay in speech or a more serious disorder? I've read The Einstein Syndrome, but it seems pretty flaky and gives false security that everything's OK. I'm currently reading ''The Late Talker'' by Marilyn Agin which is making me more concerned. Any advice is appreciated. Mary

My daughter had the same problem and she is also a bilingual kid. ( Japanese- English). I can talk about it if you are interested in. Please emal me and I can send my phone number. Rie

My now 6 year old son was also a late talker. He barely said two words when he started preschool at age 2. Like your child, he spent his days with a non-English speaker, and he has an older talkative brother who took joy in speaking for his little brother. Within a few months of preschool, however, he began to talk and quickly caught up to his peers. NOthing like a little peer pressure and battles over toys to motivate a little one to talk. My 6 year old is now incredibly verbal with a great vocabulary and no speech impediments. I hope you have the same outcome. Supportive Mom

Speech therapy for autistic 2-yr old

Oct 2003

Hello there, My two-year old does not use words and was diagnosed a couple weeks ago with an autism-spectrum disorder. I am now trying to decide whether to put him in therapy at the Children's Hospital Autism Intervention (CHAI) program in Oakland, or at Alta Bates' Small Voices program. Might anyone have any advice/ experience with either of these organizations? Or perhaps any other recommendations for toddlers with special needs (or for their parents!)? Thanks so much for your help! Aileen

My son is now 4 and went through the CHO PIP program when the CHAI program was just being set up. He is not on the A.Spectrum so I can't speak to that part of your question. However, I also looked at the Small Voice program and felt that I needed the family support group that PIP provided and Small Voice did not have. (Don't know if CHAI has this.) Looking back I think my son would have benefitted from either program and the quality of the therapy/intervention, but our choice was based on the best fit at the time. We still see many of the Herrick therapists privately even though my son was in Early Intervention through CHO. I wish you much luck and strength during this journey. Anon.

When to expect 15-month-old to talk?

May 2003

My pediatrician just voiced some concern over my 15 month old son who is not saying any words yet. He does babble (mama, dada, baba, nana, and various other hard to describe sounds), likes to shout at his toys, seems to understand what is said to him, uses two baby signs (more and all done), and comes to me with his thumb in his mouth when he needs something (nurse, eat, diaper, too hot, etc etc). He doesn't point to things or wave bye bye despite much modeling from parents. I read to my son every day (and he loves books), talk to him in a steady stream, and he also has chances to interact with caregivers and kids at daycare 3 times a week. He loves to play alone and can do so for long stretches, and seems to prefer a quiet environment, gets stressed when he's around a bunch of kids or a lot of commotion. Should I be concerned? At what point is it worrisome if a child is not speaking? What are the signs to look for of a child who has a speech/language problem or even an autism issue? (I have no idea if autism is even in the picture but it is something I worry about!) Thanks for your advice! concerned mom

Your concerns must be so painful and frightening. Please take some relief in that it's a very long way from what you are talking about to even a language problem (let alone autism), especially at 15 months. To gain more clarity, probably the best thing is to have someone with a lot of experience with infants see your son. But you need to be careful, as well- meaning experts can have very different assessments when presented with the same child, and you need to guard against ''pathologizing.'' One of the best people to see is Brad Berman, developmental pediatrician, of ''Progressions'' in Walnut Creek. His name comes up here a lot. But he is usually booked well in advance. Perhaps his office can refer you to someone he trusts if he cannot see you in a reasonable length of time. Hopefully others will have recommendations as well. - been there

You can ask your pediatrician to give you a referral to have your child evaluated and he may qualify for early intervention (play based speech therapy). The therapy is often supplemented with weekly coaching for parents to encourage speech. I was worried sick when my son didn't start talking until almost 2 1/2 and I obsessed over every little thing. There are 2 good books on late talking children that I would encourage you to read(The Einstein Syndrome and Late Talking Children). Also realize that children make dramatic changes during the first few years of life. One day your child may appear a certain way (borderline autistic for example) and then 3 months later, no signs. Or your child may be saying nothing, then really take off a little later. It sounds like you are doing the right thing (reading, etc.) You're not alone..good luck! anonymous

I can't give you really comprehensive advice, but my son only used a very small handful of words by 14 and a half months (bah for ball, duh for duck, maybe one or two others). No mama, no dada. No baby signs, despite modeling. He did point to lots of things (seeming to want their names rather than want them), but wasn't terribly keen on waving. He, like your son, seemed to understand what was said to him, and loved books. He turned two this week, and talks in complete sentences: e.g . ''Daddy come play blocks with Jeff,'' ''Mommy, I need a sharp knife,'' :-) and has a vocabulary of hundreds of words (fragile, violin, frustrated...). His language skills literally exploded between about 16 and 20 months. We did find out that he had a bit of hearing difficulty due to repeated ear infections (and retained fluid in his ear), so this might have affected things, but he's caught up just fine. I'm not saying that you shouldn't be concerned about your son -- just that in one case similar to yours, it turned out there was nothing to worry about. Feel free to call or email me if you want to talk more. Karen

My 28 month old is finally beginning to sound like a talker. He is just now able to link two words together, like ''blue car'' and ''pine-apple''. He really has to think hard to do it. At 15 months I think he may have said only a few words, if any. Talking just didn't happen swiftly for him. I take care of a little boy his exact age and that little boy was talking at 1 year old. He was very different than my boy though. While mine was very active and physical, the other little boy seemed passive and serious. I think the other boy was taking in all the verbal stuff so he could talk so young. Now he is an amazing talker, so it was always hard to see the difference and wonder if anything was wrong with my boy. I wouldn't worry if I were you. I decided to look at my son in 3 month developmental intervals and see if there was a difference. He really lagged for a long time. I did see differences though. And I really was paying attention because even my husband would ask if something was wrong with our boy. I really am so excited that this talking is finally happening, I was worried sometimes. But really, I talked to alot of people about it, including his doctor, and it really does seem to be a different story for every baby. I have two nieces born 1 week apart. One spoke at one year and the other didn't utter a word until 3 years old, not kidding. Now they are both 4 years old and the late talker talks more and pronunciates better than the early talker. everyone is different. anon

Hi, my 16 month old also isn't talking, except Mama, Dada, poo poo, & uh oh, and those last two are more heavy breaths than spoken words. At our last pediatrician visit the doctor reassured me that most kids DON'T have 30 words at 14 months, like my first daughter did. She told us to look for more talking with daughter #2 at 18-20 months, and I know several kids who weren't very verbal until age 2...don't worry too much; it sounds like you're doing everything right! Autism has definitive signs to look for; look it up on the web if you're concerned. My nephew, now 4, was diagnosed at 2 1/2; he talked normally early on, and then stopped talking. Sounds like yours might be just a late talker. Heidi

Your son sounds *exactly* like my 16 month old; he likes to play alone for long periods, gets stressed out by crowds, babbles a lot but doesn't make any sense, doesn't point or wave, etc. My pediatrician has not expressed any concerns with his behavior; I guess every ped. has their own standards, and we need to take it all with a little grain of salt. I think that some kids are just much more laid back than others and as a result will do everything on their own time. It's taken me 16 months to realize this, but eventually he gets around to everything, just later than everybody else. All I can do is model good behavior, keep him healthy and give him all the love in the world, and be patient because he's got his own timeline. On the plus side, though, he slept through the night at 3 weeks and is very very mellow and easy; it's just in his nature, and I can't change that, which helps me to not worry about him, especially when the other kids his age and talking and running around already. Hope that helps. Jill

I also have a 15 month old boy and your toddler sounds pretty normal to me. Part of it is how you interpret the noises your son makes. My son also says mama, dada, baba, and some other strange sounds and I consider those words. He is using sounds to communicate so he is saying words. Additionally, your son is using some sign language to communicate. You might have too narrow a definition of what speaking is for a toddler. I really wouldn't worry if I were you. Danielle

Given that Albert Einstein did not start talking until he was three years old, I don't think you have too much to be concerned about. There are many possible reasons for delayed speech, and most are completely innocuous. I wouldn't start worrying yet. Peter

Kids develop at different rate. But GET A SPEECH EVALUATION NOW anyway!!! And an evaluation by a developmental pediatrician. (Both can be done at children's oakland -- your pediatrician can refer you.) It may be overkill but if there is a problem, the earlier you intervene the better! If you do get an evaluation and there is a speech delay, you will be eligible for free speech therapy and other services through the Regional Center of the East Bay. I know because a pediatrician was concerned about my son at 18 months, and we thought he was over-reacting and we were concerned about labeling our son. When speech did not improve as we had hoped, we finally had a speech eval at 28 months. They said speech delay but didn't address other behaviors that seemed a little strange (repetitive play, for one). At 34 months when we finally took him to a developmental pediatrician he was diagnosed with autism (PDD-NOS). I don't want to scare you -- your child may be completely fine but I do want to encourage you to start the evaluations early. They are very emotionally draining but from my perspective they are very important. These professionals have seen so many kids, and as a first time(I'm assuming) parent it's hard to know what is normal versus not. My son starting talking within weeks of starting speech therapy, and other areas (social) have greatly improved with other therapies and he may even lose the diagnosis in a few years. I only wish someone had pushed us to get him evaluated earlier. If you need more advice feel free to contact me. Judy

I am not a child expert at all but I thought I would write to sympathyze. I believe my son is totally normal and at 14 months he is pretty similar to what you describe. Although he know about 30 baby signs, he only used about 3 to communicate actively with us. He does point to things he wants but when I ask him to point to the tree or the flower or things I know he knows, he usually won't and if he does, I'm not sure its not a random point. He also doesn't wave good-bye and LOVES books and reading. It is one of his favorite things to do. I guess I was a late talker and so was my husband so it doesn't occur to me to think autism at all. Besides my son seems very curious and explores lots and while he can play well by himself, can also be quite social and interactive demanding attention and playing games with us. I have just come to believe that it is partly his legacy from us and partly he fact that he is a first and so we pretty much cater to his needs so he hasn't felt such a need to talk to communicate though he also babbles a ton. I don't know if this helps at all, I will be eager to see the replies but my gut is if you are worried, definitely check it out, and if you aren't worried, it can't hurt to check it out but don't let your pediatrician take away your mothering instinct that all is well. Mother of another babbler not talker

When I was worrying that my 19 month old son literally used no words -- not even mama and dada, my pediatrician said I shouldn't begin to worry about it until he was 2, especially because he was communicating non-verbally by pointing, babbling, etc., just as it sounds like your child is doing (maybe not pointing, but still making his needs known). At 20 months, my son finally uttered his first word, the next day he uttered like 5 more, and by 24 months, was speaking in full sentences. I'm told that this is a fairly unusual pattern, but apparently it's the way I began talking (everyone always said I didn't talk till I was two because I was waiting till I had something important to say). Now, of course, my problem is getting my little 4.75 yr old to shut up. I say, don't sweat it (esp. cause he's a boy) till he's two. If there's still no speech, then I'd talk again to the pediatrician for further evaluation Susan

My son was saying single words at age two but seemed way behind his other friends (especially the girls). If his cousin hadn't been the same I might have been more worried. Well, shortly after turning two he began sentences and using language more to communicate and he caught up quickly. In fact he is much more articulate than other children his age. If you are really concerned you could speak to your pediatrician about getting his hearing checked. The important thing to know is that it is not that unusual to be slower to talk. I have learned that the range of developmental milestones for kids is much wider than you would think. My son was slower in some things than friends and faster in others. Susan

2-year-old won't talk much

Jan 2003

My daughter was 2 years old but she do not speak anything else except 3 words: ''Papa'', ''Mama'', & ''Byebye''. Whenever she want do something or go somewhere, she just pointing with her finger and saying ''Papa'' or ''Mama''. Whatever we teach her to say, she just do not want to learn. Suggested by her doctor, we had her hearing checked and it's no problem. Is there anything else we can do? Carson

A couple of different things you might try. The first is to just become slower and slower to do what she wants when she asks with the pointing method -- or even stop. I'm not suggesting don't feed her, but if she's after a toy, just tell her you don't know what she wants, and ask her to tell you with words. If her comprehension's on target, she'll know what you mean.

Another possibility is to try ''baby sign language''. This method is often suggested to help younger kids (around a year old) learn to talk before they have the physical ability to enunciate -- but it might work with a slightly older child. There is a book called Baby Signs (available in the Oakland Public Library) that explains the extremely simple method. Karen

A good friend of mine didn't talk at all until she was three years old. She is brilliant. I hope that helps! anon

It doesn't sound so unusual that a 2-year-old has only a handful of words. I wouldn't worry about it. Mom of 3

If your toddler is learning/ being spoken to in more than one language, this is totally normal, as long as she communicates in other ways. Even if she is not learning more than one language, some take longer. It sounds like she is trying to tell you what she wants, needs, sees... just not with words yet. Ask your pediatrician if a Speech and language evaluation should be considered. Lisa

Start right away making appointments to have your daughter evaluated for a speech delay, as the waiting lists are often quite long. You can refer yourself to the Regional Center of the East Bay, 383-1200, a government agency with friendly people who will set up an assessment for you. Alternately, a developmental pediatrician, such as Veronica Daly at Children's Hospital, can also do an assessment. Call the intake coordinator, Dee O'Hara, at 428-3351 x4353.

We took our son to Dr. Daly first, then became a Regional Center client, and my son was able to go to a fantastic early-intervention preschool and get speech therapy on the government's dime.

If you feel lost in the maze, e-mail me or call the nice staffers at the Family Resource Network (in the Bananas office), 547-7322. Sarah

I remember a story I heard (YEARS ago) about a neighbor's daughter, who didn't speak at all until she was 4 years old. When she did begin speaking, to everyone's amazement, it was in complete sentences. Also, as another poster said about her friend being brilliant, so was my neighbor's daughter. Joan

I son is almost 3 and has been in speech therapy for about 8 months. When he turned 2 I ask his doctor about his lack of speech and he refered me to the Early Start Program. The phone number is 1-800-6infant. I suggest you call right away! My son also only said about 2 or 3 words at 2. The Early Start Program has been wonderful, my sons gets 3 hours a week of therapy and the cost is covered by the state. They will do a complete evaulation on her and check for any other problems with her development. Again, I suggest you call right away to get started for your daughers sake. Good luck! dana

I had the same problem with my daughter at the same age. And EVERYONE had a story about how Einstein didn't talk till he was 4. The most valuable advice I got was to pay attention to my gut. I knew something was wrong. First, I went through the school system. BIG MISTAKE. She was in speech therapy for more than a year with no noticeable improvement although the school system kept saying she was doing great. Finally, someone said call Faltz Associates in Oakland. They are expensive ($90/hour and insurance probably won't cover it), but worth it. They were right. My daughter started speech therapy there last January at age 4 1/2. At that time her speech was incomprehensible to me, by summer her speech was so good that we knew she could move on to kindergarten in the Fall. By the Fall her speech was even better. So much better that her kindergarten teacher was stunned to find out she had any speech disability. I must admit even I can hardly tell anymore. And she talks non-stop like any 5-year old and it just delights me. She barely spoke at all till 8 months ago. Your child could just be a slow developer, or they could have a disability. There is no way to know at that age, but if they have a disability they will not improve without intervention. You are obviously concerned. Pay attention to your instincts. if nothing else an evaluation by Faltz will put your mind at rest, but if it is a speech disability they will help. A Mom

Our 2 year old girl hardly said a word until after her 2nd birthday. She had developed her own sign language that she used to communicate quite effectively with us. She seemed quite normal in every way. A month after her 2nd birthday, she started to talk and within a another month or so was talking as well as any other toddler that age. I wouldn't worry about it yet--they all develop so differently. And, frankly, all this ''speech therapy'' for 2-year olds sounds like a big scam to me. -another mom

Speech pathologist for 20-month-old's lack of speech?

March 2002

I have a question about my son's lack of speech (he's 20 months old). Can anyone tell me their experience in taking their young child to a speech pathologist or an audiologist? My son has a very limited vocabulary. I guess I am not so worried about that (I have heard countless stories about boys who don't start talking till their 3rd birthday). But, he doesn't follow instructions really well (i.e. give me the cup) and I am not clear how much he understands. He will be having a 21 month check up with his doctor soon. She said that if his speech hasn't picked up by then that she will recommend getting his hearing checked. But, I've also been reading about speech pathologists & wanted to get some input on other's experiences before his check up. Thanks.

You need to get your son to an audiologist immediately! If it turns out his hearing is fine, then you've lost nothing, but if you don't find out now, you will lose PRECIOUS time. I went through all this with my daughter.She will be 4 next month and we just found out she is hard of hearing and needs a hearing aid. At 20 months, she was not talking or following directions, in fact, she didn't even say MOM until she was well over 2 and then it sounded like BO.I don't want to frighten you, but it is true that the sooner you catch a hearing problem, or any other problem, the better. Keep in mind that if you make an appointment now, it might take a few months to get him in to see an audiologist. By the way, the audiology clinic at childrens hospital in oakland is superb,and there is also a speech therapy clinic there. You can find that number on the UCB Parents Network Website. poncho

i would definitely get a hearing test done just to eliminate one possible cause of speech delay. my daughter had a hearing test done at age 2 at Children's Hospital. it was in no way a traumatic experience for her ... they made the whole test rather fun. my daughter had a speech delay and the best thing i ever did was to put her in speech therapy. within six months her speech improved tremendously and her her level of frustration in not being about to communicate her desires dropped significantly. if your insurance does not cover speech therapy i suggest contacting the Regional Center of the East Bay (http://www.rceb.org/) mom of 2 big talkers

Hi! I'm a speech pathologist responding to your request for advice. Your child should definitely get his hearing checked as SOON as possible. If a hearing deficit is ruled out, then I strongly recommend hooking up with a good speech therapist in your area who works with infants. Your son will soon be getting to an age where it may be difficult to recover from such a late start, so it's good that you are looking into this now. Good luck to you!

I would get a referral for both a hearing and a speech evaluation right away. The reason to get both now is that it takes about 6 weeks to 3 months to get into see someone. I went with the hearing test first on the doctor's recommendation -- which I knew would be fine -- and then when it was fine, had to wait another 8 weeks to get a speech evaluation. Then we had to wait another 6 weeks to get a regular slot with the speech therapist and have the insurance authorize it. You really need to be aggressive with the doctors to make this happen based on my experience. Good luck.

I recently took my daughter to a speech therapist. She is just turning two next week, and she saw the therapist last month so (at 23 months) she is about the same age as your son. I got a referral from my pediatrician so that my insurance would cover the cost of the evaluation. It took about a month from the time of the referral till we actually got in to see the speech therapist, at Alta Bates. The evaluation session took about 1 hour and consisted mostly of play with different toys. The therapist would both give my daughter instructions, to test her comprehension, as well as ask her different questions to test her speech. A formal hearing test did not take place during the session, although the therapist did recommend that we also do that so she could be sure we had thoroughly evaluated all posibilities regarding the cause of her speech delay. My daughter does speak but probably not as many words or as clearly pronounced as her peers. At the end of her session, the therapist discussed her findings with me, advised me on ways that I could help my daughter with her speech development and told me she would recommend some additional therapy sessions because she considered my daughter on the border for her age regarding her speech development. About a week later I got a written report outlining the things the therapist had discussed with me. Regarding her recommendation for additonal therapy, she said that although my daughter was on the border and she could go either way on recommending more sessions or not, the reason she chose to recommend additional sessions was because she didn't want to look back, if my daughter didn't catch up on her own, and regret that she hadn't recommended intervention sooner rather than later. (Hope that makes sense -- it did to me.) Anyhow, overall, I would say that the speech therapy evaluation was beneficial and I'm glad I did it.

I had an issue with my son stuttering and repeating words from when he first began to speak. One person I spoke to said they usually wait until after they're three before referring children to a speech therapist. She suggested I should work on a developmental gym program with him, which I wasn't really able to do because we were travelling, but would have been valuable. I finally took him to a speech therapist when he was five and she did a lot of tests, including some that related to hearing and to cognitive issues. It hadn't actually occurred to me that something else could have been going on (it wasn't) but the speech therapist was very thorough in ruling it out. It seems to me that, particularly if the problem could be hearing, it would be important to have it checked out. In terms of ''understanding'' you MAY just be suffering from the syndrome whereby a child is totally unable to hear or understand an order shouted at them from three feet away, but knows all about! the packet of corn chips being opened at the other end of the street. You have to trust your gut feeling on the seriousness of this and many other issues. Most likely, you have plenty of time yet to worry about this and a lot of other things... which is parenting, right? fiona

I would definitely recommend the Children's Hospital Speech- Language Center. It is a wonderful group, and we were lucky enough to work with Gage Herman for a number of years. She is an inspiration, gifted in working and communicating with toddlers, and has great rapport with parents. You couldn't find a better resource. She is in demand, and it might be tough getting in to see her. Try. Maybe your pediatrician is able to help with a referral. We had evaluations done at Herrick at some point and saw Angela Korpela. She was impressive as well. I think you'll be satisfied at either facility. Good luck. Gale

I suggested bringing your toddler in for a hearing test ASAP because the most recent research suggests the earlier children are identified with hearing problems the quicker they get aid that significantly helps their speech and language development. At the same time more than one study has indicated that the older the child at time of diagnosis, the less positive the outcome. If a child is developing speech slowly because of hearing difficulties during an age range when other children are rapidly progressing (24-30 months) that child will keep falling farther behind.

The test is quick, easy, and painless though I found it took a while to SCHEDULE the appt. If there isn't a problem at least you have something less to worry about in this great parenting adventure we are all on.

Luckily I have a great pediatrician (Dr. Charles-Mo) who fully trusted my instincts and gave me referrals. My daughter didn't have a hearing problem but MUCH needed speech therapy.

Because of strange insurance reasons we had the hearing test done at Children's Hospital and the Speech Therapy at Herrick. Each experience was great. Mom of 2 big talkers now

Your doctor probably is just being cautious, after all who says ALL kids start talking before their 2nd birthday? It's hard to say what is ''normal''. It sounds reasonable to wait until he's 2, but listen to your instincts.Really, go ahead and make all the necessary appointments right now for soon after his 2nd birthday, that way you will be one step ahead. And then if he starts talking, you can just cancel. I only know about Children's Hospital, and I thought they were great. I don't think you'd go wrong with choosing them. If you need someone to talk to about this,feel free to email me. Rachelle

Don't wait! Early intervention is important, whether it's a hearing problem or other sort of speech delay. I'm the mom of a speech-delayed toddler. He had his hearing tested at Children's at around 20 mos. (it was normal), and then we did a speech eval at Alta Bates - Herrick Campus. Now he's been in speech therapy at Herrick for about seven months, and he has gone from 3 words at age two to more than 120 currently. Early intervention has made a big difference. Sarah in Oakland

19-month-old understands but doesn't say words

Feb 1999


I would love to hear words of encouragement (or other words if necessary) from other parents of kids who didn't start to talk on schedule. My daughter is now 19 months old, and has not one consistent word that she says. Her receptive vocabulary is great--she can point to probably more than 50 named things--i.e. where's the bird, the sun, your nose, Mommy, etc., and she's learning the names of colors, and even of letters, so I know she isn't mentally retarded or anything, and her hearing must be fine too. And she doesn't seem autistic, because she is tremendously social and responsive. So probably it's just the way she's growing, but for now it's become a great source of worry. Seems that most kids say first words at around 12 months--that was a Loong time ago. We live overseas at present, but will be in the Berkeley area for a couple of weeks in April. By what sort of person should we consider having her evaluated? Psychologist? Psychometricist? Neurologist? Speech Pathologist? Meg

Re late talker: Talk to your pediatrician for confirmation, but I don't think you have to worry. My son didn't use words til he was about 20 months, and then his speech was limited. But at a certain point, he took off, and now, at age 8, he is incredibly verbal and has a vocabulary that puts most adults to shame! He is an only child and seemed to be able to get whatever he wanted in early life with various noises and squeals. In other words, we were really tuned in and just knew what he wanted. Also, he's a kid who likes to watch and take everything in before he ventures out, and this was the approach he took to speech, too. If your child has a good passive vocabulary and understands what people say to him, I wouldn't be concerned.

Re: talking late. I'm sure other people will mention this, but it is a fact that Albert Einstein did not begin speaking until he was 4 or 5 years old. And there was certainly nothing mentally deficient about him! His parents were worried too, and consulted a doctor when he was 3 and still hadn't said a word. But I guess he just began talking on his own sweet time. It's even thought that this delayed speech, when he couldn't ask about things that intrigued him, led him to try to come up with answers on his own, which resulted in him having a very creative mind, not so bound by conventional wisdom as many others. Dianna

Please don't be offended by this question: Has she been given an official hearing test? My daughter wasn't saying anything but mama&daddy at 24 months. We were certain she could hear, since she would do what we told her to do. I was constantly testing her hearing myself (by sneaking up behind her, whispering, etc.) But we got a hearing test anyway (since this is step 1 before seeing any other specialists) and, sure enough, she had moderate hearing loss (which was easily fixed.) In a silent room, she could understand words just fine, but not when there was ANY background noise. So during 7-8 hours of daycare every day, she was not picking up any language skills. I was so mad at myself for not realizing she couldn't hear. I wished someone had warned me. But things have turned out fine. She had to get tubes in her ears, and has gone to a speech therapist 8 times. She is almost 3 yrs old, and as caught up with her classmates in expression/comprehension. Her pronounciation is the only thing that has suffered, (she cannot make k,s or g sounds), but this is not permanent. Good luck! Lara

I'm not any of those -ists, but I think there's no problem here. I have never known a kid who talked at 12 months, and would regard one who did as remarkably precocious. In my world kids walk, not talk, at 12 months (and some of them don't even walk, and that's okay). It sounds to me like your daughter is doing just fine. John

We have a 2 1/2 year old son who is a late-talker. Aside from numbers and letters, Sam says about ten words consistently. He certainly does not communicate verbally at the level of most of his peers. Sam tries to compensate by opening the refrigerator and pulling out the carton of milk when he wants to drink. This morning, he brought me the box of Cheerios. Oddly, while he for-the-most-part does not talk, Sam is able to count to thirteen in both English and Spanish. He is fascinated by numbers. He can also say most of his ABCs. Still, we have been worried for awhile. Sam's older brother started talking well before he turned one. Our pediatrician recently evaluated Sam and convinced us he is not autistic. She suggested we see a speech therapist, who may be able to help get him started. (We are concerned with his frustration level). I want to recommend the book LATE-TALKING CHILDREN by Thomas Sowell. It gives an anecdotal look at a group of late-talking children who may be super-bright in math & science. Mathematician Julia Robinson, and scientists Richard Feynman, Edward Teller, and Albert Einstein were all late talkers. I personally think 19-months is still early. Kids are often on their own schedules. Hang in there. You may have a genius on your hands! Diana

NEWS FLASH: Sylvia can now talk! Yesterday she carried on an entire conversation with one of her dolls. Here is a complete transcript: Baby baby baby baby baby baby baby baby baby..... Well it's a great start anyway! And the 19+ months of wondering about what and when her first word will be are now behind us. Thanks to all who wrote their support to us.
Cheers, Meg