Your child is a real go-getter; maybe they’re a straight-A student or a star athlete. Lately, though, they have trouble breathing during very inopportune times, like before a test or a big track meet. You have seen their primary care doctor and you have seen a pulmonologist. Maybe they are put on an inhaler, but it doesn’t seem to be working like you hoped. So what’s going on?

Have you heard of vocal cord dysfunction? Well, there is a new name for it: exercise-induced laryngeal obstruction (EILO) and inducible laryngeal obstruction (ILO). That’s a mouthful.

Whenever there’s a “trigger” (i.e. exercise, stress, certain odors), the vocal cords narrow and it feels like you can’t get a good breath in no matter what you try to do. It isn’t life-threatening because your vocal cords are actually still open, but they aren’t open enough to fill your lungs. It’s scary. Your child is panicking and now you are, too.

What are the symptoms of EILO/ILO?

• Chest/throat tightness
• Difficulty inhaling
• Noisy breathing
• Shortness of breath

That sounds an awful lot like asthma, doesn’t it? You’re right; EILO/ILO and asthma sound very similar, but there are a few differences. Let’s compare the two:

You have ruled out asthma with your physicians and ruled in EILO/ILO. 

What do we know about EILO/ILO?

Onset can occur at any age, but most commonly, EILO and ILO are diagnosed in 12 to 18-year-olds.

It is most prevalent in our young athlete population and it can lead to anxiety about playing sports because of the fear of not being able to breathe. The same thing can happen around stressful situations like an upcoming AP history test or a choir performance.

Speech Therapy

What can be done to help these kids get back into their sports, extracurriculars, and high-demand classes? Speech therapy and/or physical therapy is the answer! And it’s all about breath.

With speech therapy, we look at how the child is breathing and teach them a variety of strategies to make their breathing more efficient.

We work on rescue breathing techniques that will blow the airway open during an active EILO/ILO episode as well as preventative breathing strategies that will keep the airway open during exercise or stressful activities. We also focus on diaphragmatic breathing or belly breathing, so the child can optimize the amount of air they are getting into their lungs at rest and during physical activity.

With physical therapy, we can look at the athlete’s movement patterns, posture, endurance, and strength that may be impacting their breathing. Oftentimes, stiffness or weakness through the trunk and core changes a person’s breathing pattern, causing them to have difficulty controlling their breath (especially during high-intensity activities).

This can lead to increased fatigue, tension around the neck and/or shoulders, and EILO symptoms. Another area of focus is cardiovascular endurance training to avoid the feeling of “hitting a wall” during exercise.

Through guided exercises, improvements can be achieved by reducing compensations or our body’s way of cheating through movements, training the proper muscle groups, and supporting proper muscle use and form during athletic movements.

What is the common goal? To give the child the skills they need to get back to the activities they love. If your child is experiencing any of these symptoms, reach out to their primary physician to discuss a potential referral to an ENT (otolaryngologist) or pulmonologist for further diagnostic testing.

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. 

Augmentative and alternative communication (AAC) allows non-verbal children and adults the opportunity to learn how to communicate through a speech generating device (SGD). The device, similar in shape and size to a tablet, can be mounted to a wheelchair or desk, and tracks the movement of their eyes to choose preset pictures, words and phrases, depending on skill level.

Many children who are non-verbal experience frustration and behavioral issues due to the inability to express themselves to others. AAC focused therapy has the ability relieve the tremendous frustration that often accompanies lack of communication. Therapy sessions often include games to help patients learn how to utilize their full field of vision and learn how operate the device independently.

“If you’ve had any experience not being able to communicate, even for a short-term, it’s very frustrating when people don’t understand you,” Speech/Language Pathologist at Cook Children’s Rehab Center Carol Edley said. “We’re trying to get them to be independent, intentional communicators, and not be placed in the role of a responder.”

Eleven-year-old Willy struggled with speech his entire life until his mother, Carla Cowdrey, learned about AAC therapy, and knew Willy would thrive with the opportunity to finally speak.

“I really had a feeling Willy could communicate, and this was the way he was going to do it,” Carla said. “And it turns out, it worked.”

Willy has learned numerous words such as go, play, help, mom and recently said “she look”, referring to Carol on the computer monitor, during a telemedicine visit. His word choices are described as a one to two-step process, depending on his choice, and his mom is hopeful for longer phrases in the future.

More recently, Willy has begun using short phrases to ask questions.

“When you start having the child demonstrate what they are thinking, in a manner where they are understood, for lack of a better term, it just makes the family happy,” Carol said. “All of a sudden this child is something more than they thought he or she could be.”

For Marisa Sanchez, AAC therapy has allowed her to hear her daughter Isabella’s first words at six years old, including the word every mother wants to hear: mom.

“Going into this journey six years ago, and not being able to have your six-year-old communicate with you, it’s hard,” Marisa said. “Hearing Isabella say mom for the first time is something I’ll never forget.”

Isabella knew four words on her device in February 2020, and now has access to 28 words to grow her vocabulary.

“We’ve increased the number of buttons presented to give her more language to choose from,” Isabella’s speech language pathologist Theresa Jones said. “She’s recently started using words like “papa”, “go… home”, “go”, “put” and “stop”. This is in addition of her using [the word] mom. Dad got to see her use “papa” for the first time via FaceTime since we only allow one parent with a patient at a time due to COVID-19.”

Edley estimates 30% to 50% of the eye gaze therapy patients have moved to telemedicine in the wake of COVID-19. The change in therapy delivery has given families the opportunity to learn how to adapt when glitches and other life moments occur.

“For the kids, it can be difficult to shift eye gaze from their device to the computer screen that may have a book or some other language activity. But that is life and they would have had to learn to shift attention in busier environments to talk.”

Although COVID-19 has shifted routines and therapies, the Cook Children’s speech pathology team has still been able to work with the AAC SGD vendor to supply the devices for patients and families to continue working on speech at home.

“Excitedly, we gave out a rental device with eye gaze yesterday. She hasn’t had the chance to practice these last two to three months,” Carol said. “It was exciting to see the little girl's reaction. With her, her mother and I have found low tech ways to train her eye gaze. The real thing is so much better.”

AAC eye gaze therapy has given parents hope, and their children, like Isabella and Willy, a voice.

My question to you is...what in the world am I talking about? Our children’s vocabulary is very important, and if we use words such as “this” and “that,” we lose out on opportunities to teach our kids new words. I took a course recently that said that children between the ages of 4 and 5 demonstrate the most significant growth in vocabularies.

A child the age of 4 has a vocabulary of about 1,200 words, but a child the age of 5 has a vocabulary of 5,000 words. That is a HUGE growth in words.

Your child's vocabulary is so important. Think of each skill your child develops as building blocks. Starting from infancy, your child begins by cooing, which turns into babbling that then turns into words and eventually sentences. Research shows that children with higher vocabulary results in better decoding abilities. All that to say that their reading skills will benefit from having better vocabulary.

So what can I do to help my child?

1.Be specific when talking to your children. If I changed the story above to something more like this, it would all make sense…..

The other day I went on vacation. We went to South Padre Island. I enjoyed it because we went parasailing and fishing. My son caught a fish but his line got tangled with someone else’s. We couldn’t stop laughing, but eventually we helped him untangle the line and get it on the boat.

Now isn’t that so much better.

2. Try teaching your child new words or even different variations of the same word. For example: “The elephant is big” can turn into “The elephant is gigantic.” or even “The elephant is enormous.”

3. Use the same word in many different ways. Think about the word “run." The dog ran fast. I ran next to him, but I could not run as fast. My brother tried to run, but he fell down. After I ran, I was really tired. Running is fun.

4 .Make learning new words fun. Instead of doing flash cards (snooze), find something that is interesting to your child and think of words based on the activity. If your child likes playing with farm animals, think of several words you could teach your child involving farm animals. As you play, introduce those words you wrote down.

5. Read books to your child. Books offer so many new and wonderful opportunities for learning words. You don’t have to necessarily read all the words, just talk about the pictures. Try thinking of words you can use multiple times throughout the book.

Vocabulary development is critical for children. It helps with building sentences and it’s important for reading as well. Markus Zusak put it well when he said, “The words. Why did they have to exist? Without them, there wouldn’t be any of this."

If you think about our kiddos, that’s all they know these days. Just walk around at the mall. You see a kid and attached to them is a tablet.

Are tablets the worst thing in the world? I don’t think so, but they may be affecting the types of interactions we have with our children according to a study completed in Toronto, Ontario. They found that for “every 30-minute increase in daily screen time was linked to a 49 percent increased risk of what the researchers call expressive speech delay.”

Now, I know what you’re thinking, “What about those educational Apps that go over colors, ABCs or numbers?” I see your point, but that’s only part of a child’s language. Let’s think about conversational turn-taking or even play skills. I don’t think I’ve come across applications that can teach children those important skills.

I’ll be honest, my son is 2 years of age and there are times where we put him in front of a screen. It keeps him occupied while we complete chores or help his infant sister. It happens and I don’t want you thinking that you are the worst parent in the world.

Just like most things though, everything needs to be in moderation.

My son was at a birthday party recently. All the children were doing an activity and the instructor told the kids to yell for help. All the kiddos obviously said, “HELP!” Except my son, who is really into Mickey Mouse Clubhouse. He yelled out, “Ohhh Tooodles.” If that wasn’t a sign that he is watching too much TV I don’t know what is!! It’s kinda embarrassing considering I am a speech therapist.

Just like most parents, you learn as you go. There isn’t a manual for these sorts of things. If parenting wasn’t hard enough, society around us is also continuously changing. My wife and I have quickly learned that although my son asks for Mickey Mouse dance (that’s what he calls it because of the hotdog dance) it doesn’t mean we have to turn it on for him. There are so many games that we can play. Surprisingly, I was doing chores around the house and he wanted to help as well.

Here are some tips to get your kids away from the screen and be interactive with you:

1.Reenact an episode of your child's favorite show (in our case it's the Mickey Mouse Clubhouse). You can do similar games or even make up your own.

2.Pause the TV show he or she is watching and talk about what you just saw or what you think will happen next.

3.TURN THE TV OFF. Our most fun experiences have been when the power has gone out. That forces us to interact and just play.

Interaction involves an action. Just NOT sitting on the couch in front of a screen.

Have you ever gotten to a point in doing something so much that you feel like you just need to take a break?

No … I’m not talking about marriage. I’m talking more like working out. You know what I mean. You get to the point where you’re doing like 2 or 3 hundred pushups in a row. Who am I kidding? I’ve never done that many pushups. But I have tried having a trainer before. I remember getting to a point in the training where I felt like I could basically take over. As I did the exercises, I knew when my form was off and I knew what exercises I needed to improve on.

Speech therapy can be the same way. So many times, we want therapy to continue year after year after year. I get it. It’s hard to let go of something you know is helping your child. But breaks are sometimes not only needed, but beneficial.

Often, when working out you come to some sort of plateau. You feel like no matter what you do, you aren’t improving. Well, that’s when you can go back to the trainer, who will help you make adjustments and keep the improvement going. Speech language pathologists (SLP) are really knowledgeable and can help adjust your child’s plan of care so your child continues toward attaining his or her true potential.

Let’s first address the purpose of therapy. Your speech language pathologist’s goals should be:

1.Work with you to figure out the needs of your child and how their speech and language difficulties are affecting their day to day life and learning.

2.Come up with a treatment plan that allows for your child to improve in the areas you and the SLP feel are important.

3.Teach you strategies you can use to work on the things your child has trouble with as well as discuss activities that can be done outside of therapy.

4.Teach you to be your child’s speech therapist at home!!

As a clinician, I feel No. 4 is most important. Most kids get therapy maybe 1-2 times a week for about 30-60 minutes. Most parents feel that isn’t enough.

I AGREE!!!

Just imagine if you could learn everything the therapist was teaching and the strategies to teach the concepts. Your child would be getting therapy basically at all waking hours. All of a sudden your interactions change. For example, you know that when your child has difficulty understanding a direction, you can assist them by using the “breakdown” strategy.

This is where you maybe break the direction up into pieces. For instance “Dominic, go to your room and get the ball.”

Well little Dominic may just look at you with a confused face. Kind of like the face my wife says I have when she asks me to do something. But that’s neither here nor there. By “breaking down” the direction, you may first say “Dominic, go to your room.” Then, when that is complete you say “Get the ball.” This allows him to fully understand the direction. Similarly, you may use a strategy that would make it easier to produce a sound, such as providing a tactile or visual cue.

Let’s say little Mia has difficulty producing the “B” sound. We may point to our lips to get her to realize that we need our lips to make lip sounds. Now that is awesome. When children apply what they have learned in therapy, it is wonderful because we want children to improve; BUT when parents apply what they have learned, it is magical. Questions to ask your therapist could include:

1.What are the goals for my child?

2.What strategies are you using to assist my child and teach them the concept? Can you teach them to me and help me do them correctly?

3.What can I do at home to help with generalization of the skill?

Every child is different so each plan of care may differ in how long therapy lasts. At some point though, through ongoing discussions with the clinician there should be an ending point. You get to now apply what you and your child have learned in therapy.

Keep in mind that this isn’t the end-all-be-all. In most cases, I recommend a re-evaluation in 6 months to ensure that there is continued improvement or even to adjust the plan of care. As a therapist, I understand there still may be concerns. I want, however, my parents to feel empowered by the knowledge they now possess. My goal is that the parent leaves my therapy session understanding our objectives and strategies.

Bob Keeshan made a good point when he said “Parents are the ultimate role models for children. Every word, movement and action has an effect. No other person or outside force has a greater influence on a child than the parent.”

Aye, aye captain.

By the time parents and pediatricians recognize and treat the problem or recommend a feeding evaluation, that child may have had years of unpleasant eating experiences. So what happens? They refuse to eat. They throw tantrums at the table. They make mealtimes miserable for the entire family.

What’s a parent to do? You thought your child was “fixed.” The medicine has taken away the pain and the speech therapy has dealt with the sensitivities. Why isn’t he eating? But he has to eat, right? So parents now resort to other methods. They punish and they bribe or even worse, become short order cooks. These solutions may seem to work for a short time but ultimately the issue will linger. Why? The child is scared. He isn’t just defiant or stubborn. He is terrified, and the newest toy or video game won’t be enough to battle that anxiety.

When other options fail or it’s too late, a pediatrician or speech therapist may recommend seeing a child psychologist.

I know it must be confusing and frustrating to parents when they are shifted off to another professional, especially a psychologist. It does not mean that your child is crazy. We are not going to push medications on your child or push parenting classes on you. Though you may have heard differently from other professionals or well-meaning in-laws, we know it’s not your fault your child isn’t eating. For most of the children that end up seeing psychologists, a number of factors over time have played into the development of fears and avoidance.

There are also times where a child may start out eating anything and everything put in from of him then one day just starts refusing. Green beans were fine yesterday and now anything green is off-the–literal-table. Why? Did something happen? Some kids experience food trauma. Maybe they were given milk that was a bit past its expiration. Maybe they choked on a bite of sandwich. We all have had negative experiences with food that may have left us avoiding it for some time, but eventually we try it again. It is different with these kids. They don’t have the benefit of fully developed logic to combat that single negative experience. Instead, one atypical incident becomes the rule.

So now you are face to face with this psychologist. How can she help? My job is to help the entire family (even well-meaning in-laws) understand their child’s specific fear and to set rules and limits at mealtimes. My job is also to work with the child to break down the Big Scary Food into less scary baby bites. We teach relaxation skills and offer coaching to change the way the child thinks about food. Sometimes the anxiety may get in the way of the child’s progress in speech therapy. In these cases, my job may be to help the speech therapist with motivational techniques that can get the child to participate.

Who knew eating could be this complicated? Most of us have no difficulty putting away a burger or plate of lasagna. But for families living with a child that has a feeding disorder, the stress can be debilitating. Having a team of professionals to guide treatment and provide support is essential for the child’s success. It won’t happen by dinnertime, but there is hope. You can pack away that short-order cook apron and you can stop the McDonald’s chicken nugget runs. Your child can learn to eat again.

About the Author

Alaina Everitt, Ph.D., is a licensed psychologist at Cook Children's, who sees patients in Denton and Lewisville. Cook Children's Behavioral Health services provides a broad range of care that focuses on children from ages three years through 17, and their families. We also have some limited services available for children age 2. As part of family-centered care all of our professionals are qualified both through education and experience to work with children who have behavioral and emotional challenges. Our psychiatrists are board certified in child and adolescent psychiatry and our psychologists and therapists are all licensed independently in Texas.

About Cook Children's Speech Therapists

Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Patients and physicians can make an appointment or referral by clicking here.

How do we know that parent-talk builds children’s brains? A study by Betty Hart and Todd Risley, “The Early Catastrophe: The 30 Million Word Gap by Age 3” showed that by age 3, children from lower socioeconomic backgrounds heard 30 million fewer words than children from prosperous backgrounds. This disparity of 30,000,000 words heard had effects on children’s IQ and test scores by the time they were in third grade. Why is this important? All children have the right to full access for learning; to grow their brain; to learn to talk, read and write. What parents and caregivers do and say has a profound impact on a child’s development.

Dr. Dana Suskind, a pediatric cochlear implant surgeon at the University of Chicago recently released her book Thirty Million Words: Building a Child’s Brain. At the center of her program are the “Three T’s.”

• Tune In
  • What does your baby/toddler like to do? Let’s say your little one is super interested in those pots and pans in your cabinet but you would rather baby play with the ball. Think about helping baby explore those pots and pans: making noise, pretending to stir, wearing the pan as a hat, etc. Make it all about baby’s interests.
• Talk More
  • What are you saying to your baby? For example, “Come over here and get this” could have many meanings. A richer language example could be “Walk to sister and get the ball!” By using ‘walk, sister, and ball’ baby hears specific words instead of more non-specific words (‘here’ and ‘this’). By using specific, rich language, baby’s vocabulary increases. We learn to talk based on what we hear. I often encourage parents to ‘be a thesaurus’ – constantly increasing the complexity and richness of their language.
  • Another tip is to teach verbs, verbs, and more verbs. Verbs carry far more meaning in communicating than nouns. For example, the word ‘drink’ will result in more action from parent than ‘milk’. Baby says ‘drink’ parent says, “Oh you want a drink? I have milk, juice, water, ____”. If baby says, ‘milk,’ parent says, “Here’s some milk.” ‘Drink’ can be paired with many other words as children start stringing words together: drink more, drink please, drink milk, drink all gone, drink spill, drink hot, etc.
• Taking Turns
  • From the moment parents meet their new baby, communication begins. Babies coo, giggle, scream, cry, and babble to communicate. Parents then respond with sounds, words, and actions. These early interactions are the beginnings of conversation. As very young children start using words, listen to what they have to say. The more you talk back and forth with them, the more words they learn. The more words they learn, the better readers they will be.

Talking to our babies and toddlers is something we can all do to help babies’ brains.

What can we do as parents and professionals to close that Thirty Million Word gap for all children? How can you use Dr. Suskind’s “Three T’s” strategies to grow your child’s vocabulary?

Communication is the foundation for building relationships and the process of going back and forth between people. If you can’t play with others nicely, make and keep a friend, or understand directions from adults, it will be difficult to interact with others. Those skills begin forming very early with that beautiful smile, adorable laugh and silly babble as infants.

Every child develops communication skills at their own pace. How do you know if they are on target or if they need to see a specialist? We want to make sure your child has developed some of these skills by certain ages. Here are some guidelines on what your child should be doing by 12, 24 and 36 months of age…

If your child isn’t doing some of these things by these ages, don’t despair! Here are a few things you can be sure to try with your growing toddler…

• Imitate your baby’s communication, even if it is just a smile or coo. Adult conversation is all about turn-taking so teach this skill as early as possible!
• Play with sounds. Blow raspberries, cluck like a chicken, make fishy faces, and have fun doing it! This will help increase their awareness and their ability to make sounds.
• Talk about everything and give things a name! When bathing, feeding, and changing their diapers, talk about what you are doing. You might feel silly, but they are definitely listening!
• When your child makes an attempt at communicating, give them big praise, repeat what they said, and then expand it to a bigger phrase. (Example: “A car? Yes! That IS a car! Good job! Hi, car! Go, car, go!”)

You may feel as though your child just isn’t getting it. You may be right. It may take a higher level of intervention to get your child’s communication skills rolling. Speak with your pediatrician about a speech and language evaluation with your friendly speech-language pathologist. We’re happy to help!

About the author

Melanie Van Noy is a speech pathologist at Cook Children's.Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury.

As a child, Rousey was diagnosed with Childhood Apraxia of Speech (CAS), a motor speech disorder. In recent interviews Rousey reports struggling with feeling of insecurity and inferiority following her diagnosis of CAS. During Rousey’s early years, there was question as to whether she would ever be able to use conversational speech. But with perseverance, intervention, and encouragement from her speech therapist and family, Rousey is now a well-spoken adult with a message to children with CAS: anything can be overcome with hard work no matter how insurmountable the odds seem.

Children with CAS have problems saying sounds, syllables and words in the absence of muscle weakness or paralysis. Basically, the brain has trouble telling the body parts necessary for speech how to move in order to form speech. Children diagnosed with CAS don’t follow normal speech sound development and won’t “catch up” to their peers without intervention.

So what causes CAS? Unfortunately, in most cases we don’t know. CAS is a motor speech disorder, meaning something is interfering with the brain’s ability to tell the mouth muscles how to make the right sounds. Possible causes include genetic syndromes, stroke, or brain injuries or abnormalities. While there is no cure, we know miraculous progress can be made given skilled intervention.

Not all children diagnosed with CAS will present the same way, but diagnostic signs or symptoms do exist. A child with CAS:

• May not babble or coo very consistently during infancy.
• Uses very few consonant and vowel sounds and has a hard time combining sounds to form words.
• Understands much more than he can tell us.
• May say a word clearly once or twice, but then doesn’t say it again.
• Struggles to imitate speech models. You may even be able to see him groping or struggling to coordinate his mouth when trying to talk.
• Has more difficulty saying long phrases and sentences than short ones.
• May have choppy speech with long pauses between sounds.
• Can be very difficult to understand, especially if you aren’t familiar with his speech patterns
• May have some difficulty eating

If this sounds like your child, an evaluation by a speech-language pathologist is imperative. A skilled therapist will help determine the best course of intervention. All children are so very unique, and therefore, treatment plans will be custom created based on several factors, including age, severity, and of course, your family’s schedule. However, research shows children diagnosed with CAS have a greater likelihood of success if they:

• Receive frequent and intensive intervention (think 2-4 sessions per week in a perfect world). It’s important to remember the age and tolerance of your little guy when scheduling therapy. Four sessions a week may be too much for him.
• Have the opportunity to work one on one with their therapist.
• Are exposed to a “multi-modality” approach to intervention. This is just a fancy way to say using many different cues and strategies to help them create the sounds, including touch (helping him move his lips to say “pa”), visual (looking in a mirror), and proprioceptive (pairing movement with sounds) cues. These kiddos need to learn and remember HOW to move their speech muscles so your therapist may encourage them to repeat a word or syllable many times.
• Practice, practice, practice at home! Even an intensive therapy program will give your child 3-5 hours a week AT MOST with his speech therapist, meaning he has 163-165 hours per week OUT of therapy room. Use those hours wisely and carve out time to practice everyday to see progress!

Resources for families:

Apraxia-kids.org

References:

ASHA.org - Childhood apraxia

*Photo from Ronda Rousey's Facebook page.

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

She is obviously looking for some sort of action on my part other than my smiling and nodding affirmatively. Since she’s my number one girl, I’ve learned the idiosyncrasies of her developing speech and know exactly how to handle this request. But to the layperson (or even Daddy or Grammy), I’m fairly certain I would need to come to the rescue with my toddler translator skills.

Mamas, I know you’ve been there. Your 3 year old launches into a monologue you find equal parts incomprehensible and adorable. Adorable, that is, until the tantrums and frantic attempts to understand and obey her demands kick in. In my practice, I have observed some masterful decoding mamas and some skillfully adaptive little ones navigating the waters of communication breakdown. Let’s talk a little bit about speech sound development and when to fret.

Articulation is the movement of the tongue, lips, soft palate and jaw to make speech sounds. It’s also the driving force behind your toddler’s incomprehensible speech. As parents, we are so excited when our little bundles of joy begin talking, but oftentimes, that excitement is quickly replaced with frustration when we realize we can’t understand a lick of what they’re saying.

An articulation disorder occurs when a child has difficulty forming speech sounds, most likely due to a structural or motor-based deficit. Most children tend to have some difficulty with certain speech sounds. Because creating sounds is challenging, he may substitute easy sounds for tough ones (think dumb for thumb), delete sounds (ha for hat), or distort problematic sounds (this is most often noted when children have a “slushy” quality). An articulation disorder occurs if these substitutions continue past the expected age.

Are all sounds created equal? In short, no. Children master sounds gradually. Most children can pronounce all of the speech sounds of English correctly by age 8. While each child’s speech sound acquisition is different, the following are age ranges in which most children master certain sounds:

• Introducing the “early birds”: Most wee ones will use m, n, y, b, w, d, p and h correctly between 18-30 months. That may explain why mama, dada and ball are frequently reported as first words.
• Not to be outdone, the middle of the road sounds includes: t, ng, k, g, f, v, ch and j. You may hear your little one utter these sound appropriately as early as 2 or as late as 6 years of age.
• Finally, the late bloomers include: sh, zh, r, s, z and th. This final pack of sounds contains the frequent offenders when it comes to articulation disorders. They are challenging for children to master and can wreak serious havoc on the clarity of their speech. We expect children to master these sounds between the ages of 3-8. (Based on Shriberg, 1993)

As children get older and learn new speech sounds, they gradually become easier to understand by a wider variety of listeners. Developing clear speech is a journey for our littles, albeit a frustrating one at times. And like all journeys, no two are equal. Some children are clear as a bell by their second birthday while others need a bit more time. As parents, we typically understand our babes before the rest of the world and therefore, are awarded the esteemed role of toddler translator. In many situations, one parent has a better handle on their child’s speech sound system than the other. But, as a general rule of thumb (or rule of “fum” if you happen to be a toddler):

• By 2 years of age children can be understood by familiar adults most of the time.

• By 3 years of age children can be understood by unfamiliar adults most of the time.

• By 4 years of age children can be understood by unfamiliar adults almost all of the time.

• By 5 years of age children can be understood by unfamiliar adults all of the time.

(Based on Flipsen Jr, 2006)

Although a continuum exists when it comes to speech sound development, there are a few red flags to be mindful of when chatting with your child.

It may be time to check in with your pediatrician regarding an evaluation with a speech language pathologist if your child:

• Uses only vowel sounds and a few consonants or shows limited babbling at 18 months.
• Seems to have a “slushy” (think mouth full of marbles) quality to his speech.
• Is difficult to understand and has a history of frequent ear infections.
• Leaves off the beginning or ending sounds of words (hatàha).
• Leaves off entire syllables of words (pa for purple).
• Is not understood by people outside his immediate family by age 3.
• Seems to be frustrated by his difficulty with speech or appears hesitant to interact or respond to peers or adults.

So what can you do to help him along?

Above all, it is important to always show your child you value WHAT he is saying regardless of HOW he is saying it. Always reinforce his attempts at striking up conversation with you! When you hear one of those adorable substitutions, help him to learn by repeating it correctly (If he says “tar” you can say “yes! A car!”) and moving on with the flow of conversation. Play face to face with him so he can watch the way your mouth moves to make sounds. Emphasize beginning and ending sounds in your own speech so he can hear them and begin to realize they are part of the word, too. If all else fails, ask him to SHOW you what he needs. And take comfort in the knowledge that this process is a gradual one.

Oh, and my daughter? She wanted to watch Frozen on the big T.V. and relax a little bit. Obviously.

1. Shriberg, L.D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech and Hearing Research, (36), 105-140.

2. Flipsen, P., Jr (2006). Measuring the speech intelligibility of conversational speech in children. Clinical Linguistics and Phonetics, (20) 4, 303-312.

3. http://www.asha.org/public/speech/disorders/SpeechSoundDisorders/

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

The obsessively clean freak with a dozen napkins at meals and the dust pan and broom standing by! I see the crumbs falling to the floor, the grape jelly graze the side of the chair, and the sticky fingers raking through the hair as my daughter enjoys her meal.

As a feeding therapist, I know as her skill in feeding develops so will the awareness of her fingers, hands, face and mouth. 

I MUST wait until she is finished before I attack with my arsenal of cleaning supplies. Sitting with her, eating with her, and having fun with her while she explores her dinner are the best things I can do as a parent.

Maybe you’re wondering, “Will my walls always be covered in food splatters?” or “Why does she continue to refuse foods I know she should be eating to have a well-rounded and varied diet?” “Does everyone’s baby require a bath after each and every meal?” “Is it normal for more food to be in her hair than in her mouth?”

Take comfort, mama. You are not alone in your exasperation when it comes to feeding your child while trying to maintain some semblance of tidiness in your kitchen.

Did you know that a baby’s mouth and hand have the highest number of sensory receptors per square inch than any other part of the human body?

That means the mouth and hands are the most sensitive parts of the body when it comes to what the brain can take in and learn.

So what does this all mean for your dinner table? Put away the fine china and good linens and get ready to embrace the mess. Researchers in the UK "found that playing with food may actually help kids overcome a fear of new flavors and eat a more varied diet, a small study suggests."

Children need the chance to explore new foods and textures with all five senses. In a perfect sensory world, your little one should have the opportunity to touch, smell, and taste new foods unabashedly. So, set the paper towels aside and join in the fun!

Your child will “learn” both good and bad habits depending on the mealtime experiences they are afforded.

For instance, if your child is given peanuts and experience an allergic reaction, he will most likely begin to refuse peanuts!

Alternatively, if broccoli and green beans are offered during a family meal in a way that is fun and supportive, you might find your little guy eating them with gusto! But, don’t be disheartened if he turns his nose up at beets the first time you present them.

Research has shown children may instinctively refuse new foods to survive simply because they are new. In addition, it can take up to 15 presentations before a food is deemed worthy in your child’s eyes. However, with good exposure, no illness or bad consequences, and repetition, children will learn many foods are safe to eat!

What can you do to help your child become a magnificently messy and healthy eater?

1. Make meal times a routine at the table, in their chairs, with NO distractions.
2. Allow your child to explore the foods that you’ve given him with the opportunity to say, “I don’t like this” without consequences.
3. Don’t set your sights on the spoon: allow him to eat with his hands!
4. Let him PLAY! Think finger painting with yogurt or building a tater tot tower.
5. Relax while he digs in and gets his hands dirty. He is learning about the different properties of the foods we eat when he touches, smells, tastes, and looks at the foods that are on his plate.
6. Keep offering the foods you desire him to eat. Remember, experts have found it may take your child 15 times of trying a food to decide how they really feel about it.
7. Lead by example! Tuck into the meal with your child. It is important for our littles to see us eating the same things we are asking them to eat.
8. Try to have as much fun at the table as possible while still enforcing the rules of “manners”. Talk about your day, talk about your food, smile, laugh, and make faces in your cheese. 

Your child may not have developed the oral motor or sensory skills to support a healthy, well-rounded, adult-like diet. Be on the lookout for the following feeding “red flags”:

• Drowsiness or sleepiness at every feeding.
• Poor oral tolerance (spits food out, shuddering, gagging, vomiting)
• Able to chew but prefers liquids
• Frequent gagging
• Coughing and/or choking

If one or more of these signs describes your child, consider talking with your pediatrician about your concerns and a possible feeding evaluation.

Satter, E. (1987). How To Get Your Kid To Eat…But Not Too Much. Boulder, CO: Bull Publishing Company

About the author

Melanie Van Noy is a speech pathologist at Cook Children's.Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury.

You may be thinking, “Am I the only parent in town dealing with dinner drama every night?”

The answer is no. It is reported 25 to 45 percent of typically developing children experience feeding and swallowing problems, while a staggering 30 to 80 percent of children with developmental delays struggle with mealtime (Arvedson, 2008).

Now for the million dollar question: what causes feeding problems? There are several factors that can impede a child’s ability to develop a happy, healthy relationship with food, including: sensory processing disorders, gastrointestional complications, prematurity, and dysphagia.

Food should be fun. And for most of us, it is just that. But children may not see eye to eye with us when it comes to mealtime, causing this to become a stressful time for the whole family. Little ones can be incredibly stubborn when it comes to food choices.

Most parents have described their children as picky eaters at least once or twice. However, it is important for parents to know the difference between “picky eaters” and true problem feeders and when to seek assistance.

Picky eating can be a typical stage in normal development. Ready for the skinny on picky eating?

A picky eater will typically:

• Accept approximately 30 foods. That may sound like a lot, but it’s really not.
• Tolerate a new food on his or her plate and may even taste it once or twice. This new food may become a new favorite. But then again, it might get tossed on the floor. This truly depends on the child’s sensory reaction to the food in question.
• Eat meals with his or her family, but requires different preferred foods.
• Eat only one food from each food texture category (puree, crunchy, solids,etc).
• Consume one preferred food consistently, and then suffers “burn out” and refuses to eat this food for a period of time (picky eaters will usually begin to accept this food again after a brief break).
• Eat new foods after frequent exposure.

So, how can you nudge your picky eater toward the leafy greens and save your sanity? Here are a few simple suggestions for success at the dinner table regardless of whether you’re serving pizza or brussel sprouts.

1.Develop a routine and stick to it. Offer meals and snacks at about the same time each day

2.Don’t force feed or bribe your child to eat. This will likely increase refusal behaviors or even worse, bring on a power struggle.

3.Offer a variety of foods, including 1 to2 of your picky pumpkin’s favorite items, at the family meal.

4.Persistence is key! Remember not to shy away when he shudders at his first taste of peas. You may need to offer those peas up to 20-25 times before he will tolerate them.

5.Explore food with your child. Talk about the way it looks, smells and feels. Invite her into the kitchen to help you prepare the foods. Bring her along to the grocery store or farmer’s market to choose a new fruit or vegetable. Star fruit? Why not?! Eggplant? Coming right up!

6.Make it fun! Serve fruits and veggies with dips. Use cookie cutters to make a Shamrock Sandwich for St. Patrick’s Day or Santa for Christmas. Eat dinner by candlelight. Serve breakfast for dinner. Better yet, have everyone put on their coziest jammies for a pancakes and PJ’s party. Get creative!

7.Practice what you preach! This means you, parents. If you want your little ones to eat salad for dinner, you will need to dive into that bowl of greens yourself and forgo the drive-thru on your way home. Our children are always watching and learning from our actions and habits.

8.Don’t become a short-order cook. If your child refuses the family meal, it can be tempting to head back to the kitchen to whip up the macaroni and cheese he is coveting. Resist! This may promote picky eating.

Now, let’s get down to business. While picky eating can be frustrating, it is a typical stage in normal development. However, problem feeding is a true disorder that requires specialized assessment and/or intervention and is downright disheartening for parents. A child that does not eat well can evoke feelings of anxiety, fear, and helplessness, leaving caregivers struggling for a solution.

A problem feeder may:

• Eat fewer than 20 foods.
• Refuse the bottle/breast or drink a small amount and then refuse during infancy.
• Refuse an entire texture category (for example, a problem feeder may refuse to eat all pureed foods).
• Not accept new foods on his plate and may cry, scream or tantrum at the sight of a new food. Problem feeders may even gag or vomit at the sight of an offensive foods.
• Be unwilling to try new foods, despite multiple exposures.
• Eat the same food over and over, but once he experiences “burn out,” he will most likely not go back to eating that food. This will cause him to slowly, but surely, shrink his group of tolerable foods.

If your child is showing symptoms of problem feeding, talk to your child’s pediatrician regarding a feeding evaluation by an occupational therapist or speech-language pathologist. A thorough evaluation is necessary to determine the best course of individualized treatment for your child.

Hang in there, parents. There IS hope! Our feeding therapists are trained to help your child with a wide array of feeding difficulties.

References:

http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965§ion=Incidence_and_Prevalence

http://www.sosapproach-conferences.com/articles/picky-eaters-vs-problem-feeders

Resources for Parents:

www.feedingmatters.org

www.yourkidstable.com

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

And yet, unless it happens to your child, most of us never think of children having a stroke.

“Unfortunately pediatric strokes have been ignored for a long time as a true entity,” said Fernando Acosta Jr., M.D., associate director of Cook Children’s Pediatric Neurorehabilitation and Movement Disorder Program. “This has changed over the last few years. The awareness is increasing.”

Strokes in adults are often brought on by behavior such as cholesterol, high cholesterol, a history of smoking, too much alcohol and obesity. For children, strokes are usually caused by birth defects, infections such as meningitis and encephalitis, trauma and blood disorders such as sickle cell disease.

“A problem with pediatric strokes, in contrast to those in adults, is that in pediatric strokes, the causes and circumstances are incredible diverse,” said Marcela Torres, M.D. medical director of Hematology at Cook Children’s. “For example, the physicians at Cook Children’s Stroke Clinic see children from 0 to 18 years. Additionally, the potential causes of stroke vary radically from a neonatal stroke to the stroke in a teenager/young adult.

Related Disabilities

Stroke-related disabilities is another area where childhood and adult stroke survivors can differ.

While strokes in children can be devastating, the good news is children often have a better ability to heal because of the greater plasticity or flexibility of the child’s nervous system and brain. A child’s brain is still developing, therefore it may have a greater ability to repair itself. With the help of physical and speech therapy, most childhood stroke survivors recover the use of their arms, legs and speech.

Symptoms of a stroke

The most effective stroke treatments must be given within the first three hours after stroke symptoms start. By recognizing signs of stroke in children and acting fast, you can help medical professionals lessen a stroke’s damage to the child’s brain. Use the following tool to help you think F.A.S.T.:

For more information:

Approximately six in 100,000 children are affected by stroke. Here in the U.S., it is a leading cause of death among children. Nearly 60 percent of childhood strokes occur in boys. Because the causes and symptoms are so different, treating stroke in children requires specialized training, such as what they will receive at the Cook Children's Stroke and Thrombosis Program.

A great way to help children learn to listen and talk is reading aloud. Reading aloud to that growing baby in utero is a jump start to listening, talking and future reading. Reading aloud to children of all ages has huge benefits.

Research on reading aloud to children tells us that it:

• Is the single most important thing to help a child get ready to read and learn.
• Helps a child learn more, unique words. Children who know more words do better when starting kindergarten.
• Helps a child’s brain develop. Language development is vitally important from birth to 3 years.
• Helps a child love to read.
• Helps a child learn.
• Helps parents bond with their child.
• Sets an example for children that reading is important and fun.

The first three years of a child’s life is the most important time for learning. Reading aloud to children boosts their vocabulary, listening and talking skills.

Will watching TV help my child learn?

A parent may ask, “My child loves to watch TV for several hours a day! What is wrong with that?” Watching a little bit of TV isn’t a bad thing. It’s what a child misses by watching many hours of TV. It can cause problems. Children may miss playing games, drawing, hobbies, playing outside and talking with friends or family. Those activities help children learn about getting along with others, problem solving and having fun. Playing and having fun are main ways that young children learn.

Watching TV doesn’t require any interaction with others. It is passive, not active. The American Academy of Pediatrics says no more than 10 hours a week of TV, and no TV for children less than 2 years. This is based on research. When children watch more than 10 hours a week of TV, school scores start dropping.

How long should read aloud time be?

Families lead very busy lives in today’s world. It’s very easy to hand over smart phones or tablets to children for easy, engaging, digital entertainment. Children may learn to swipe screens before learning to turn a page. Reading becomes less important. There is not a set amount of time to read aloud to children. Even 15 minutes a day can make a big difference. Here’s a great example of how reading aloud can affect a child during the first 5 years:

15 minutes every day x 365 days x 5 years = 27,375 minutes OR 456.25 hours of reading aloud. That means the child hears reading aloud 456 hours before starting kindergarten. That’s a great jump-start to being a good reader.

Some ideas for fitting reading aloud into your day and week:

• Visit your local library. Get a free library card for you and your child. Check out books weekly. It’s FREE!
• Visit read aloud story time at the library.
• Read aloud at breakfast time.
• Keep books in the car to read while waiting at appointments.
• Make bedtime book reading a family tradition.
• Have a family story time every week.
• Keep waterproof books in the bath tub for a quick read during bath time.
• Read together as a family every day.
• Have older siblings read aloud to younger siblings.

Reading aloud should be FUN and FREQUENT! It is never too early or too late to start reading aloud to your child.

Resources:

1.Jim Trelease on Reading: www.trelease-on-reading.com

2.Read Aloud 15 Minutes: www.readaloud.org

3.Reach Out and Read: http://reachoutandread.org

4.Reading Rockets: www.readingrockets.org 

References:

1.Anderson, Richard C., http://files.eric.ed.gov/fulltext/ED253865.pdf

2.http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-and-Children.aspx.

3.www.trelease-on-reading.com/rah-ch9.html

4.http://www.wonderbabiesco.org/UserFiles/File/Graven%20and%20Browne%20Auditory%2008.pdf

About the author

Becky Clem, MA, CCC-SLP, LSLS Cert. AVT, is a Rehab Services education coordinator at Cook Children's. Cook Children's offers four types of therapy plans, and tailor them for your child's individual needs. Cook Children's services and specializations include:

• Audiology
• Cochlear implant
• Occupational therapy
• Physical therapy
• Speech therapy
• Transitional care
• SPORTS

We love to hear the first sweet sounds from newborn babies when we feed them and cuddle with them. Then they quickly progress to happy babbling and, at last, WORDS! All within a fast moving, short 12 months. Somewhere between the ages of 3 and 4 years old, a parent may say, “My child has so many words; I couldn’t possibly count them!” Then, babies progress to speaking sentences, having conversations, and using their words for imaginative play. Of course, there are also the fun word skills they learn when they enter the amazing world of reading.

This describes typical, fantastical language development ... BUT what if things are not typical? What if there are concerns? What can the parent expect? When should a parent seek help and from whom?

Some concerns may include:

1. Little or no babbling. Well-formed babbling should be in place by 10 months of age at the latest. Vowel sounds, e.g., ah, oo, ee, etc., are used first, and then they will start pairing consonants with vowels to make syllables like, “ba-ba-ba-go-da-tee” and more.

2. Slow in saying first words (after 12 months)

3. Vocabulary count is low. (See my previous blog on Is my child's speech 'normal?' )

4. Significant drooling beyond 18 months of age.

5. Difficulty understanding what your child says or you are one of the few people that can understand what he or she says.

6. Not speaking in 2 -3 word combinations by 24 months of age, e.g, “I fishing;” “My toys;” etc.

7. Child acts frustrated by difficulties with his or her own communication skills.

8. Child overuses gestures to communicate his or her wants and needs.

9. Poor eye gaze to the speaker’s face.

10. Lack of variety of play skills.

11. Lack of interest in engaging others in play.

Who can help a parent sort out these concerns?

Talk with your pediatrician and ask for referral to a speech/language pathologist for an evaluation if you have concerns. A speech-language pathologist (SLP) is educated and trained to evaluate and treat communication problems from birth through to adulthood. A speech/language evaluation will identify your child’s communication strengths and challenges, and a plan of care will be recommended, if necessary. You, as the parent, will want to see a SLP who is experienced with children.

Speech/language therapy can be provided in a number of different settings - therapy provided in a clinic setting is primarily on an individual basis: one child – one therapist. Therapy provided in the public schools is typically in a group setting. Different settings and models of care can be selected based on your child’s and family’s needs. Participating with your child in therapy is an important part of care and will help maximize your child’s progress.

We all want our children to develop skills with ease. Remember, when that development is on a continuum and there is a range of typical development. However, if there is a concern, ask your doctor for a referral to see an SLP. By identifying potential challenges early and obtaining intervention such as speech/language therapy, the outlook is definitely brighter. Early identification and intervention are key.

For more information:

• Cook Children's speech therapy
• Is my child's speech 'normal?'
•  http://www.cdc.gov/ncbddd/childdevelopment/screening.html
• http://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/developmentalscreening.pdf
• http://www.cdc.gov/ncbddd/childdevelopment/freematerials.html - Positive Parenting tips based on child’s age.
• http://www.asha.org

That question makes me cringe. Not because of the question itself. I understand it. As parents, we all want what’s best for our children. I’m not afraid of the question or looking to evade it. It’s just who is making the choice on what’s “normal.” I use the opportunity to talk to parents. To reframe what may be thought of as normal, go over their concerns and provide perspective.

Here are some basic guidelines that I give to parents on how a child should be developmentally from 1 to 6 years old. Every child is different and this is only a starting point. If you have you concerns, please talk with your pediatrician for a referral to a speech/language pathologist.

• 12 months old - Children usually can say 1-21 words on their own, actively listen, wave bye-bye, look around when asked, "Where is __?" and use real and toy objects to act out common actions, e.g., feeding, cleaning, etc.
• 24 months old - Speak 145-150 words, combine 2-3 words, produce plural - s and - ing words, enjoy nursery rhymes, finger play and songs and put 2-3 actions in symbolic play.
• 30 months old - Say 360-600 words, speak in simple sentences, have his or her speech understood by family members, listen to real stories and start role playing in life experiences, such as going to the doctor.
• 36 months old - Say so many words you can't count them, have his or her speech understood by more than half the people your child meets, use "I, me, my and you" correctly. Answer what, where, when and who questions and retell familiar stories. At this age, children should be asking questions, not learning to read yet, but enjoying books and making friends. 
• 4 years old - Your child should start playing with words and making up stories. Most children at this age will be playing with friends and pretending to be a superhero, a cowboy, a parent or an animal. Children may begin using voices as characters and creating their own costumes and props.
• 5 years old - Most children at this age have started school. They can sit and listen for a whole story. They will start using words such as "know, understand and think." They will talk to ask questions, to explain things and to imagine.
• 6 years old - At this age, most children begin to speak more like grownups, especially at school. They can be polite when talking and know when adults don't understand what they have said. Often times, children will be able to change what they originally said to be better understood. Children at this age should be able to use all of their speech sounds and begin reading.

You know your child better than anyone and of course there will be times when your child just won't pay attention or doesn't feel like reading. But these general guidelines should be taken into account as an overall view of your child's development. I hope this helps give a better understanding of what we observe as speech patholigsts at Cook Children's.

*The vocabulary ranges used in this blog are based on MacArthur-Bates CDI.

About the author

Carol Edley, M.S., CCC-SLP, is a speech/language pathologist at Cook Children's. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury.

What is autism?

Autism is a disorder where a person has difficulty with communicating and interacting with others. There are many forms of autism that can vary from mild to severe.

There are 3 major categories of symptoms in autism:

Social interaction-Children show difficulty interpreting other’s emotions or difficulty in making appropriate eye contact.

Communication-Speech is often delayed or non-existent. In addition there are limited other attempts to try and communicate with others (lack of hand signals, expressions, etc).

Limited interests-Children show very specific interests and lack of interest in other activities.

So, that is the definition…here’s my practical look at how the diagnosis of autism usually evolves.

Up to 12 months-There are very few suspicions of autism prior to the first year of life. Occasionally, a family will pick up on a lack of eye contact or limited verbalization but this is uncommon.

12-15 months-Families and doctors will begin to notice that a child is not progressing in their speech development appropriately. Speech therapy referrals can be made at this time to begin appropriate therapy and to monitor development more closely.

15-18 months-Speech development will continue to lag behind and the other abnormal behaviors will continue to become more obvious. Many diagnoses can be made during this time, especially in severe cases.

What do I look for in a diagnosis of autism?

The main symptoms I look for when consulting with a family about autism is a “lack of joint attention.” An example of joint attention is when a child is playing with a toy they enjoy, they will occasionally bring it over to you and engage you in play with them. Another example is when an adult points to a plane in the sky and the child looks in the direction of the point. When I have a family with a concern about autism, I present both of these examples to the family. If the child does show these behaviors, autism is very unlikely and parents can be reassured. If they do not, further investigation and a possible referral to a developmental pediatrician could be in order.

That question makes me cringe. Not because of the question itself. I understand it. As parents, we all want what’s best for our children. I’m not afraid of the question or looking to evade it. It’s just who is making the choice on what’s “normal.” I use the opportunity to talk to parents. To reframe what may be thought of as normal, go over their concerns and provide perspective.

Here are some basic guidelines that I give to parents on how a child should be developmentally from 1 to 6 years old. Every child is different and this is only a starting point. If you have you concerns, please talk with your pediatrician  for a referral to a speech/language pathologist.

• 12 months old - Children usually can say 1-21 words on their own, actively listen, wave bye-bye, look around when asked, "Where is __?" and use real and toy objects to act out common actions, e.g., feeding, cleaning, etc.
• 24 months old - Speak 145-150 words, combine 2-3 words, produce plural - s and - ing words, enjoy nursery rhymes, finger play and songs and put 2-3 actions in symbolic play.
• 30 months old - Say 360-600 words, speak in simple sentences, have his or her speech understood by family members, listen to real stories and start role playing in life experiences, such as going to the doctor.
• 36 months old - Say so many words you can't count them, have his or her speech understood by more than half the people your child meets, use "I, me, my and you" correctly. Answer what, where, when and who questions and retell familiar stories. At this age, children should be asking questions, not learning to read yet, but enjoying books and making friends.
• 4 years old - Your child should start playing with words and making up stories. Most children at this age will be playing with friends and pretending to be a superhero, a cowboy, a parent or an animal. Children may begin using voices as characters and creating their own costumes and props.
• 5 years old - Most children at this age have started school. They can sit and listen for a whole story. They will start using words such as "know, understand and think." They will talk to ask questions, to explain things and to imagine.
• 6 years old - At this age, most children begin to speak more like grownups, especially at school. They can be polite when talking and know when adults don't understand what they have said. Often times, children will be able to change what they originally said to be better understood. Children at this age should be able to use all of their speech sounds and begin reading.

You know your child better than anyone and of course there will be times when your child just won't pay attention or doesn't feel like reading. But these general guidelines should be taken into account as an overall view of your child's development. I hope this helps give a better understanding of what we observe as speech patholigsts at Cook Children's.

*The vocabulary ranges used in this blog are based on MacArthur-Bates CDI.

About the author

Carol Edley, M.S., CCC-SLP, is a speech/language pathologist at Cook Children's. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury.