My Child Has Not Started Talking

A child may have speech delay if he or she is unable to fit in the common milestones. Most of the time they will catch up at a later age but it is important to not miss actual problems that cause speech and language delay. They include:

• Hearing loss
• Prematurity and development delay
• Autism spectrum disorder
• Learning disability
• Neurological disorders – Cerebral palsy / Muscular dystrophy / Traumatic brain injury
• Ankyloglossia or tongue-tie
• Parental neglect or lack of stimulation

A suspected child with speech delay will be assessed for risk factors of having the conditions above. Questions will be asked on birth history, family history, speech and language capabilities, and developmental milestones. The child’s ears, mouth, palate, tongue, and the neurological system will also be examined. Depending on this initial screening, the child can be further subjected to audiological tests, referred to as an ear, nose & throat surgeon, speech-language pathologist, or a pediatric neurologist.

Audiological tests to assess the child’s hearing include Otoacoustic emissions (OAE), tympanometry, and brain stem evoked audiometry (BSER). If a child is found to have hearing loss, this is further categorized to type; conductive hearing loss or sensorineural hearing loss and severity of the hearing loss; mild to profound.

Treatment of speech delay will depend on the cause. If the developmental delay is merely speech with no other associated conditions, speech and language therapy may be the only treatment needed. It offers a good outcome especially when initiated early. Even when speech delay is caused by other additional factors, speech and language therapy by a trained therapist helps as part of an overall effective treatment plan.

When the speech delay is associated with other disorders as mentioned above, it is important to address those issues as well, in addition to speech and language therapy. These include treating the hearing loss, correcting mouth or tongue abnormalities, physical or occupational therapy, behavioral therapy and also treating underlying neurological disorders.