"I am calling you about my three-year-old. I am concerned about his speech. He does not pronounce his words clearly, and even though I'm his mother, I don't understand half of what he says. He seems to understand what I say but he doesn't speak a lot. When I ask him questions, he answers in single words or short sentences. I took him to the ENT (ear, nose and throat) doctor to check his hearing, but he had so much wax in his ears that he couldn't be tested. Can you help me?"

This scenario is typical of a parent who is concerned about his or her child's speech development. Speech sounds progress gradually in the preschool years. For example, a child may be able to pronounce the sound of "p" or "m" at one year of age, but may not be able to produce "r" until age three. The ability to make different sounds depends on the maturation of a child's speech system, which over time leads to more precise positioning and control of the tongue, jaw and lips. Maturation rates vary, but most children's speech is intelligible by the age of three.

Language also develops gradually. Parents often report that their children seem to understand more than they can express. It is expected, however, that by age three a child should be able to speak in simple complete sentences and be able to tell a story that has a beginning, middle and end.

Hearing plays a critical role in the development of speech and language. In order to discriminate one word from another (e.g., boy-toy-joy), to imitate words, to acquire new vocabulary and to understand what is being said, hearing must be within the normal range. When the ear canal is filled with wax, or if a child has an ear infection with fluid in the middle ear, hearing levels are reduced and words sound muffled. This can negatively impact speech and language development.

The American Speech-Language-Hearing Association offers the following recommendations to help a child's speech development:
• Check your child's ability to hear, and pay attention to ear problems and infections, especially when they keep occurring.
• Reinforce your baby's communication attempts by making eye contact, talking in simple short sentences and imitating the sounds your baby makes.
• Imitate your baby's laughter and facial expressions.
• Teach your baby to imitate actions, such as peekaboo, clapping, blowing kisses, pat-a-cake, itsy bitsy spider, and waving bye-bye. These games teach turn-taking that is needed for conversation.
• Talk while you are doing things, such as dressing, bathing, and feeding (e.g., "Mommy is washing Sam's hair"; "Sam is eating carrots"; "Oh, these carrots are good!").
• Talk about where you are going, what you will do once you get there, and who and what you'll see (e.g., "Sam is going to Grandma's house. Grandma has a dog. Sam will pet the dog.").
• Talk about colors (e.g., "Sam's hat is red").
• Practice counting. Count toes and fingers.
• Count the stairs as you walk up and down with your child.
• Teach animal sounds (e.g., "A cow says 'moo'").
If you have concerns about the rate at which your child's speech is developing, you might consider consulting with a professional speech-language pathologist.

The Donald R. Reed Speech & Hearing Center is approved as a provider for audiological assessment and facility-based speech-language therapy services in the Early Intervention program funded by New York State Department of Health. This program provides services for children under the age of three who are either suspected of having or at risk for developmental delays or disabilities.

The Donald R. Reed Speech & Hearing Center's staff is experienced in the testing and treatment of children of all ages. Concerns about speech and language development, hearing, and where to seek appropriate medical care are dealt with by the pediatric speech-language pathologists and audiologists on a daily basis. Dr. Tali Lando, pediatric otolaryngologist (ENT), is also available for medical evaluations at the Center. Please call 914-366-3010 for an appointment.

Help for Children with Swallowing Problems

The Donald R. Reed Speech & Hearing Center at Phelps is pleased to announce that pediatric Modified Barium Swallow (MBS) studies are now provided for children 5 years of age or older with swallowing problems. The study is a radiographic (video X-ray) examination of the oral, pharyngeal (throat) and esophageal phases of swallowing.

Children with swallowing disorders may exhibit any of the following:
• coughing or choking during meals
• throat pain
• gagging
• respiratory distress
• frequent colds or congestion
• vomiting during or after
meals The Modified Barium Swallow test minimizes a child's exposure to radiation so that the examination yields the highest benefit with the least risk. The study is conducted by a radiologist and speech-language pathologist. To schedule a pediatric Modified Barium Swallow study at Phelps, call 914-366-3010.