All children learn to babble and talk at different times. Before you know it, they can read their favorite book or tell you what they want for their birthday. But, when they can't tell you what they want to eat for breakfast or the daycare teacher can't understand what they say, parents need somewhere to turn.

At Cook Children's Rehabilitation Services, our speech language pathologists (SLPs) are highly skilled and experienced in children's communication development. They work with parents to help empower their children to achieve their goals.

We have about 40 SLPs who serve our patients in our medical center and outpatient clinics. They have expertise in:

• Feeding/dysphagia
• Speech/language skills
• Augmentative and alternative communication
• Hearing loss
• Autism
• Traumatic brain injury and so much more!

As we celebrate Better Speech and Hearing Month this May, Jonathan Suarez, Rehabilitation Services clinic lead, and Suzanne Bonifert, Rehabilitation Services manager, provide answers to commonly asked questions about speech and hearing.

What can I do to get my child to speak more?

Model words for your child, even if he/she doesn’t repeat them. For example, if he/she vocalizes and points to juice, you can say, “juice” or “you want juice.” That way the child is hearing the words even though he/she cannot say them yet.

It’s also good to use comments (i.e. “You want juice.”), rather than questions (i.e. “What do you want?”). Doing so can be less stressful for kids, especially those having some challenges learning to talk.

We also recommend talking to your pediatrician about a referral to see a SLP for an evaluation. The SLP can help you identify your child’s strengths and challenges and may recommend therapy to help give your child a boost!

Is it OK to speak more than one language to my child throughout the day?

Yes, yes and yes! Every child is different and the amount of time they spend using each language can vary, depending on exposure in school, at home or during extracurricular activities.

Sometimes a child may understand multiple languages but will only use one. Keep practicing each language!

Some children may “code switch,” or use both languages when they speak. This is not a disorder. The child is learning how to use the rules of both languages.

How do I know when to be concerned about my child’s communication or when to see a speech therapist?

By the time your child is 12 months old, he/she should be able to speak two to three words. By the time he/she is 2 years old, he/she should be able to speak at least 200 words. By age 3, he/she should be able to speak 900 words.

Trust your gut. If you feel there is a concern, you can ask your pediatrician for a speech therapy referral and have your child evaluated.

Once the evaluation is complete, an SLP can provide information to help with your child’s communication.

Here are links to two helpful speech and language milestone charts:

• Speech and Language Milestone Chart, LD Online
• Speech and Language Developmental Milestones, National Institute on Deafness and Other Communication Disorders

Is there something I could have done as a parent to prevent my child’s speech delay?

No. We often hear parents say, “We never had to worry about my older children talking.” But there is nothing you could have done to prevent your child’s speech delay. In most cases, there are steps you can take now to help your child’s language skills grow.

Since your child has a language delay, we need to be intentional in the language we are using with them.

How long will my child need to be in speech therapy to gain the skills they need to communicate?

Progress can vary from child to child. Our goal is to improve the child’s language while also teaching the parent or caregiver some interaction and language strategies to elicit communication.

What can a speech therapist do with a toddler who cannot sit still?

We can teach language in a variety of ways! Activities involving movement are great for keeping children interested. Sometimes, children are having so much fun that they do not realize they are actually doing a language activity!

Instead of sitting at a table for activities, you could:

• Stand up and sing songs using motions and actions
• Play hide-and-seek
• Play chase while running, jumping or skipping
• Read a book while acting each part out

To learn more about the Cook Children’s speech therapy program, please visit our website. 

Let's begin by looking at the facts:

• About one to three babies out of every 1000 will be born with a permanent hearing loss.
• Infant hearing loss is the most common health condition identified through routine newborn screens.
• Nine out of 10 cases of genetic hearing loss occur in families where both parents have normal hearing.

The earlier children with hearing loss are identified and start getting help, the more likely they will reach their full potential. Hearing loss can cause children to fall behind their peers in speech, learning, reading, and social-emotional development, which can result in lower educational and employment levels into adulthood.

1-3-6 Goal

In fact, the Centers for Disease Control recommend the following 1-3-6 Goal:

1 — All infants get a hearing screen before 1 month of age.

3 — Hearing loss is confirmed before 3 months of age.

6 — Hearing loss intervention begins before 6 months of age.

So now that we know it’s better to identify hearing loss as a baby, just how are babies tested anyway? There are two types of tests used to screen hearing in babies and both are safe and painless.

Types of Hearing Screens

Otoacoustic Emissions (OAE)

For this test, a small earphone and microphone are placed in the ear, sounds are played, and a response is measured in the ear canal. If a baby hears normally, an echo is reflected back and measured by the microphone. When a baby has a hearing loss, no echo can be measured on the OAE test.

Auditory Brainstem Response (ABR)

For this test, sticker electrodes are placed on the baby's head to detect responses while sounds are played in the baby's ears. This test measures how the hearing nerve responds to sounds and can identify babies who have a hearing loss.

The two tests can be used separately or together. Both tests require a quiet, if not sleeping baby. If a problem is found, follow-up testing should happen as soon as possible.

What if My Baby Fails a Hearing Screen?

If your baby fails a hearing screen, you will be referred to an outpatient facility where an Audiologist will complete a more in depth ABR. It will measure the softest level that the ear responds to sounds using different pitches or tones. If testing is done before a baby is 4 months old, the baby can usually sleep naturally for the testing. For older or very active babies, sedation may be needed to help them sleep during testing. It is important that babies are sleeping for ABR testing.

The newborn hearing screen is one of the most important first tests your newborn takes. Babies start learning how to use sound as soon as they are born and listening prepares them to speak. Therefore, if a baby has hearing loss it is important that services begin right away. If you have any questions or concerns about your child’s hearing, contact your Pediatrician and ask about seeing an Audiologist.

See below for additional resources on newborn hearing screening:

• Cook Children's Audiology
• CDC information on hearing loss/screening
• Babyhearing.org
• Joint Committee on Infant Hearing

About the author

Christina Graham is an audiologist at Cook Children's. Cook Children's audiologists focus on diagnosing specific types of hearing loss for kids. They work closely with the child, his/her family, speech pathologists, school personnel, specialists, and physicians to create a plan that will enhance a child's functional hearing and help them learn and develop. To learn more, click here. To make an appointment, click here.