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Toddler Speech Problems

Orofacial Myology as a Cause

When babies are born, they are routinely given a screening that tests their hearing; yet as some of them begin to grow, they may experience progressive hearing loss. This is just one reason of many that may contribute to a toddler’s difficulty speaking. For parents to help their child and to get him or her the attention needed for a speech problem, they need to know what speech problems are, what causes them, and what to do if they believe their child has one.

“It is important first of all to distinguish between speech and language,” says Erin Harrison, a speech and language pathologist. Harrison explains that speech refers to the movement of the articulators (tongue, teeth, etc.), or what most people perceive as how clear the words and sounds are. “Speech problems are usually related to coordination and/or strength of the muscles that serve the lips, tongue, jaw, soft palate, and cheeks,” says Harrison. Language is something that includes vocabulary and grammar, and those problems have their root in the brain itself. A child can have a problem with one and not the other.

Harrison reports that the most common referrals that she receives include:

  • Speech/language delay: The child isn’t talking enough for his age.
  • Poor articulation: The parent feels the child doesn’t speak as clearly as other children the same age.
  • Stuttering: Most children cycle in and out of this normal developmental speech during the toddler years.
  • Regression of speech: A child that has a large vocabulary begins to lose that vocabulary instead of continuing the growth.

Sandra Coulson, president of the International Association of Orofacial Myology (IAOM), is one such specialist who gets referrals from pediatricians and speech therapists suspecting a child has a muscle problem. An orofacial myologist, Coulson specializes in working with the muscles of the face and tongue; proper movement of these muscles is needed for children to create specific speech sounds.

According to IAOM, recent research has found a prevalence of orofacial myofunctional disorders in 81 percent of children that show speech or articulation problems. The disorder involves incorrect habits of using the tongue, jaws, lips, and face. Several things can cause such disorders, including:

  • Developmental abnormalities
  • Improper oral habits (e.g., thumb sucking, teeth grinding, nail biting)
  • Enlarged tonsils or allergies that are restricting nasal airway

“I find quite often that the length of the lingual frenum, the attachment under the tongue, is extremely short or tight, which limits a child’s ability to elevate the tongue for certain sounds,” explains Coulson. “This is often overlooked by the pediatrician, dentist, or speech pathologist.”

Additional Causes

There are many reasons for speech delays beyond those involving the muscles of the face and tongue. Some of these reasons include cleft palate, accidents, mental retardation, and psychosocial deprivation. The treatment method varies depending on what the problem is. Some of the more common speech delays and concerns can be caused by such things as:

    • Hearing problems: Even if your child passed a newborn screening, it’s important to test again to rule out a hearing impairment.
    • Stuttering: According to the Stuttering Foundation of America, around 60 percent of those that stutter have a family member that does as well, suggesting a genetic link. The SFA also reports that around 20 percent of children go through a stuttering period.
    • Siblings: “Sometimes if the child has an older sibling who speaks for him, he has no need to produce articulate sounds,” says Coulson. Encourage your child to speak for himself instead.
    • Tonsils: Having large tonsils can cause a delay in speech because the tongue is pushed forward, making it difficult to make sounds.
    • Allergies: Frequent allergy problems can play a role in speech delay. “If a child is often congested, hearing can be affected, the mouth rests open, the tongue rests forward and can become quite flaccid,” says Coulson.
    • Injury or Environment: There are many speech problems that can be caused by injury. “Trauma to the brain (head injury, anoxia, tumor, meningitis) can result in speech/language difficulties,” says Harrison. Some of these injuries can be caused by car accidents and other such incidents.

“There are also environmental causes of speech/language problems because they impact the nervous system, such as lead poisoning,” says Harrison.

Speech Milestones

According to the American Speech-Language-Hearing Association, it’s important to understand the common guidelines that are considered to be speech milestones to determine if a child is having a speech problem or delay. The approximate milestones outlined by ASHA include:

7 months to 1 year

A child this age should:

  • Turn and look in the direction of a sound
  • Listen when spoken to
  • Recognize words for common items such as “cup” and “juice”
  • Babble with long and short groups of sounds
  • Imitate different speech sounds
  • Have one or two words, although they may not be clear

1 to 2 years

By this age, the child should be able to:

  • Point to a few body parts when asked
  • Follow simple commands and understand simple questions
  • Point to pictures in a book when named
  • Say more words every month
  • Use some one- to two-word questions
  • Put two words together
  • Use many different consonants and sounds of the beginnings of words

2 to 3 years

Between the ages of two and three, toddlers should be able to:

  • Understand differences in meaning (go/stop, up/down, etc.)
  • Follow two requests (get the book and put it on the table)
  • Have a word for almost everything
  • Use two- to three-word “sentences” to ask for things and talk about things
  • Often names objects

3 to 4 years

By this age a child should have the ability to:

  • Hear you when you call from another room
  • Hear television or the radio at the same loudness level as other family members
  • Understand simple questions (who, what, where, etc.)
  • Talk about activities at school or a friend’s house
  • Be understood by people outside the family
  • Talk without frequently repeating syllables or words

Evaluating Milestones

The first sign that a child may have a speech problem is most often when a parent has concerns. Generally the parent will speak with the child’s physician to see if a referral is warranted. There are times when a physician doesn’t take the concern seriously and says the child may just be a “late talker.” While there are parents that may be overly worried and obsessed about the milestone ranges, there are also parents with legitimate concerns that may be getting overlooked.

“With everything we know about the benefits of early intervention, with all the programs available for early intervention, it’s a crime to let the gap between a child’s chronological age and his speech/language skills to continue to widen until he enters school,” says Harrison.

If Your Child Has a Delay

“Children with marked expressive speech/language impairments commonly develop behavior problems in preschool or other settings, including hitting and biting,” says Harrison. “They resort to physical means to control the environment.”

Speech delays or problems should be addressed early. Allowing speech problems to continue can lower a child’s self-confidence, hampering emotional growth. If your child isn’t progressing in speech development, seek advice from your pediatrician. “If the child’s physician doesn’t seem receptive to their concerns, most speech and language pathologists offer free screenings,” says Harrison. “I always tell parents to trust their instincts.”

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