Language Delays in Young Children

Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen. Today we’re talking with two speech language pathologists, experts in language development. So we’re now about two years into this pandemic, and it has impacted all of us no doubt, including our young children. As a matter of fact, one of the most viewed articles in our own online resource library is about language delays in young children during COVID. So if you’re a parent of a young child, you’re probably wondering if your child is reaching milestones like they should be, and one of those big milestones is language development. Is there an actual language delay to be concerned about? If so, what do you do? Well listen in to today’s episode with two of our own speech language pathologists, Shirit Megiddo and Kharyl Anne Piano as we talk about language development in young children and what you can do at home to support that development. Welcome Shirit and Kharyl.

Shirit Megiddo:
Thanks so much for having us. I’m Shirit Meggido. I’m a speech language pathologist. I work at Children’s Health Council. I’m also a board certified specialist in child language, and I’m a mom of my adorable three-year-old son, and I’m so happy to be here today.

Kharyl Piano:
Hi, Cindy. My name is Kharyl Anne Piano, I’m a speech language pathologist here at Children’s Health Council, and I am also a mom of a six month old baby girl, and I’m really excited to join you here today.

Cindy Lopez:
I’m glad that you’re both here and it’s fun that you’re both parents. Many of our listeners are parents as well so you really get what they’re going through right now, too. Let’s talk about language delays in young children, what does that look like? What are the milestones and when do kids typically reach those milestones?

Shirit Megiddo:
The key thing to think about is language development happens in a range and so there isn’t one specific age per milestone. It’s important to think about those early milestones that happened from infancy, such as babbling and babbling could take place anywhere between six and nine months age range. The first words would be the 12 to 15 month age range. Combining words might happen between 18 and 24 months, and then sentences whether it’s, you know, two, three or four word sentences, anywhere between age two and three, but the key thing is to think about that as a range for each of those milestones and to think of what is your child’s abilities and what you’re kind of expecting from your child when you’re thinking about what is normal for your child.

Cindy Lopez:
That’s interesting because as a parent I might think is my child there, is my child doing that is this typical or is this not typical? 

Shirit Megiddo:
When you’re saying is this typical, as long as they fall kind of in line with each other. So, whether it happens exactly in that age range or not is not necessarily as important as does babbling take place and then after that, the first words and combining words. So as long as they’re going in some kind of order and they fall approximate to the range as expected, then we feel confident.

Cindy Lopez:
That’s really interesting thinking about how kids kind of typically develop around language, and I appreciate hearing the range too. So we’re in the middle of COVID, how is the pandemic affecting language development in young children?

Kharyl Piano:
The pandemic has affected everyone in so many different ways, but one of the most significant ways that the pandemic has impacted language in young children, I think is just like overall decrease in social interactions and how we’re interacting with each other. So a lot of families with young children are staying home more often, or they’re not participating in community activities with other children. We’re also social distancing, so we’re not encouraging the same type of engagement with other people like we were pre-pandemic. So just this overall decrease in social interactions also decreases the amount and type of language stimulation a child would usually be exposed to. I just had my daughter, so she’s six months old now and so, you know, like just being born in the middle of the pandemic, we’ve just been really mindful about bringing her to crowded places or like interacting with other kids and now that she’s getting a little bit older, like we want to kind of bring her out more and do like community outings, like even going to the library for story time, but I think just overall families are not participating in those types of activities in the same way pre-pandemic.

Cindy Lopez:
You brought up how we’re social distancing, so our interaction is weird now, right, at the very least, and I also notice, and I’m sure everyone does, when I can’t see a person’s facial expressions, I can’t see their mouth because a lot of their face is covered because of their mask. I’m sure that impacts all this language development as well. Is that true?

Shirit Megiddo:
Absolutely. We’re not used to speaking with people half their face covered and yes, although it is a concern in terms of being able to see the sounds, a lot of the sounds we make, we can see them externally, most of the sounds we make. So for children who have difficulties learning how to make the sounds or if children have challenges with sounds and adults are trying to understand them, I can see that that could be a concern as well as children who have challenges with auditory processing and might need that visual information. So those are things that we keep in mind. However the good news is so far there are no studies showing that the masks are taking away or detracting in any way from speech and language development or impacting them in significantly in that way.

Cindy Lopez:
So I’m thinking about parents that I’ve been talking to as you just talked about kind of a typical developmental process for language development. What if you have like a two year old whose language development really hasn’t started, maybe they’re making sounds, but not putting words together. As a parent, should I be concerned or when should I be concerned?

Shirit Megiddo:
So as we mentioned, ranges, some of those milestones I mentioned earlier, language development happens pretty quickly in those early years between zero and five and something with language is happening from birth and on.  So as long as you kind of know the ranges and know your own child’s abilities and your own family history, you can use that as a guide while remembering that you are the parent, you are your child’s expert and trust your intuition, you know your child the best. 

In terms of a particular question with regards to like a two year old, we do expect children at the age of two to already be using language to communicate their needs most of the time, they might gesture sometimes, but we expect them to rely on words and putting some words together at this point. So that is some guide there to keep in mind.

Kharyl Piano:
Yeah, kind of just reiterating off of what you said about, you know you as a parent know your child the best and so if you feel like your child is demonstrating like significant differences from these milestone ranges that we’ve been talking about, then I would check in and voice those concerns with your pediatrician. Another great resource to take advantage of is also contacting Children’s Health Council for more information, regarding your toddlers speech and language development.

Cindy Lopez:
For our listeners, please reach out if you’re having any questions, CHC, you can reach us at chconline.org. You can reach out to our Care Team, careteam@chconline.org. There’s an appointment button right on the website. You can get an appointment going. You can ask for a parent consultation, a free parent consultation for 30-minutes just to talk about what your concerns are and figure out what next steps might look like.

Shirit Megiddo:
Speaking with the pediatrician, which is a great first resource, keep in mind your gut feeling, and if pediatricians tell you to wait, you can also contact early start if you’re still concerned, if your child is under the age of three, or your school district and your teaching team if your child is over the age of three. Those are important because whether your pediatrician or specialist tell you everything is fine, or whether they tell you, you need to do something kind of trust your own intuition about that because the early intervention is really, really key. At that age we really want to maximize our child’s potential and get whatever services are necessary going.

Cindy Lopez:
Early intervention that just seems like it’s the best thing, no matter what you’re talking about, right whether it’s language development or any other kind of development early intervention is key. 

There are probably parents out there who are concerned about their toddlers speech and language development. Maybe talk a little bit about what a typical appointment might look like so parents can kind of picture that.

Shirit Megiddo:
So a typical speech therapy appointment, especially with the young child that we’re talking about today, it’s a whole family team approach here. So this is now an absence of COVID related safety concerns, but just theoretically speaking, we want to include the family. We want to speak with the parents since they’re the experts, what their children like to do, get a little bit of a head start of what to have prepared, talk with family about the expectations at home. What are some things that the child is doing well and what are some things that are challenging?

And then what we do in therapy is kind of mimic the everyday situations and teaching formally those challenges and exercising them with strategies. For example, if a child is needing some assistance with putting words together and the child is speaking single words. We might have some kind of a real life situation, like a bath time play, or a pretend shopping game or cooking game. And then you might say, okay, we’re making soup together, let’s put the ingredients into the pot. So you might say something like I’m putting the chicken in and the vegetable in so were showing them how to put those words together in a real life situation and then when we do this in therapy we’re teaching a particular skill, explaining, depending on the child’s age how that works, practicing it over and over and teaching the parent how we did this and giving them suggestions of how to do it at home.

Cindy Lopez:
You noted COVID right in a pre-COVID world you would be seeing the family, right, and seeing children in person. So what does that look like right now in the middle of COVID? 

Kharyl Piano:
Well at CHC, we are doing both. So it’s up to the families, whatever they feel comfortable with. They can choose whether to do in-person therapy or teletherapy, where we would meet them over a platform like Zoom, and there’s been a lot of studies showing too that teletherapy is evidence-based, it’s effective and it still gives you an opportunity to work with the families and their child in their natural environment because they are at home. So one of the benefits is that. you’re using the child’s natural environment, what they have, what toys they have, and you’re really coaching the parent on how to use these strategies with their child since they’re the ones physically with their child. So it’s actually a really nice way to get the families more involved and really work on that parent coaching so that they can generalize it into their everyday life, not just in therapy.

Mike:
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Cindy Lopez:
How can parents support their child’s speech and language development at home? Do you have any activities you might recommend or just even thinking about how their interaction with their young child could help speech or language development?

Kharyl Piano:
Yeah. I think as a parent, I think the main thing to kind of think about is creating a language rich environment, so a positive learning environment where you’re creating opportunities for your child to communicate and learn new vocabulary and concepts. Language is literally everywhere. So activities like reading books and singing songs together, playing with toys that allow for more back and forth engagement or imagination. So like racing cars or pretend play. So anything that mimics your daily routine like I’m going to pretend to go grocery shopping or playing doctor with a sick doll all of that those types of activities are really great for creating that language rich environment in your home.

Something I do right now with my daughter, so she’s six months old, and we’ve kind of already implemented in our routine reading books and you might think, how are we reading books for, you know, a child that young? And I think the important thing to think about is it’s not necessarily reading the words on the page or going in order, but it’s more of following their lead, looking at the pictures, describing the pictures. And even if it’s for like one minute, 30 seconds, it’s fine like as long as you’re kind of creating that opportunity for them to hear different types of words and learn new things. So we’ll probably start by doing it for like 30 seconds and then gradually increase as she kind of gets more interesting, but just like keeping it really positive and keeping it to where she wants to engage in that activity is going to be really helpful for that language stimulation.

Shirit Megiddo:
Just to add to Kharyl’s suggestion with the reading, all the daily routines that you’re already doing with your children, whether it’s dressing them, bathing them, cooking together, doing laundry that’s already built into our day. So having your children with you and commenting about what you’re doing in the moment and you can actually choose and pick what you’re particularly wanting to teach your child, that time period. So if your child is that four year old who’s learning to read and playing rhyme games, and you can put the socks in the laundry basket and then make rhymes for every sock ball that you’re putting in there or when you’re cooking. My son is three, and he’s really into all kinds of rhyming games and letters and also just asking a lot of why questions. So I have him cooking. We cook together. We have a ritual every weekend we make waffles, and we’re talking about mixing and ingredients and we sing songs around it, and so just that everyday activity becomes a language rich activity that we’re sharing together, and you’re building memories as a parent and child.

Cindy Lopez:
I think that’s so important for parents just to understand like you can do this. You don’t need special tools just use those everyday situations and everyday routines to help your child put some words to what they’re experiencing. So also, I know, 30 years in education, as a teacher, it was easy to, you know, show a movie of course it was a movie that was related to what they were learning, but what about screen time? Right now during COVID, I mean, we have just in general, not just young kids, but all of us, there’s a lot more screen time between TV and social media and everything else, but what about kids and screen time, especially for young children.

Shirit Megiddo:
Yeah, this is our reality, isn’t it? Whether we’re at school or work, it’s part of our survival in the last couple of years. So everybody’s using the screen in one way or another. A lot of parents are happy about using screens in terms of educating their children and learning language. I’ve heard over my 20 years of practice, “my child is learning a lot of educational concepts and language on the screen.” And my advice about that is, there is no right or wrong in terms of it. Screen time in and of itself it’s not a bad thing, but keeping in mind that language is learned in warm body interactions, when you’re spending time with your child around activities that your child loves. So as long as that’s happening in some way, it’s fine to have your child use the screen for whatever purposes they need, or if you need some respite time as a parent, but what would be best is in some of that screen time, if you’re able to spend that with your child, watching together and interacting about the show and/or if you need them to watch on their own, choosing something like maybe books on YouTube, where somebody is reading them a book out loud, or some kind of an educational programming that’s appropriate for their age, those would be kind of better options, but as long as during the day, they have that warm body interaction with you to some extent it wouldn’t hurt them to spend a small portion of time to front of the screen from time to time.

Cindy Lopez: Yeah and I know with young children that they’re mimicking a lot of what they see. And so it’s easy also, I think for parents, as they see that mimicking behavior to say, oh my gosh, I bet you saw that when you were watching Elsa today, you know, Frozen or whatever and start helping them put some words to that too. So I can imagine that parents would be thankful to hear you say that screens are not all bad. So….

Shirit Megiddo:
I agree with you Cindy about that.

Cindy Lopez:
Yeah. So I think parents are also seeing with their toddlers, tantrums, that they’re not as cooperative as they were once, right? Is that normal? Could it be related to language development? 

Shirit Megiddo:
Oh, gosh, I hope it’s normal on some level because my three-year-old is definitely doing it. Absolutely, it’s normal. We see from anywhere from 18 months to four, and then they repeat again when they’re teens, right.

Cindy Lopez:
Something to look look forward to

Shirit Megiddo:
There’s two things. One is that it’s their way to express some independence in a world that’s so controlled and you have to do this and have to do that, and they’re learning to have their own wills and wishes and wanting to do what they want to do. So there’s that kind of normal tantruming of I have a different agenda than what mom and dad are telling me to do at this time. At the same time, we also see the children who have challenges with expressing their needs and wants by using language, whether it’s to comment or to request or protest, the easier way would just be to use your words. So if a child is consistently tantruming throughout the day more times than you would expect, you would think it must be that that’s the easier way for them. If it was easier to say it with words, they would. So that’s what I would think about is if they’re doing it non-verbally there could be a challenge with requesting, commenting or protesting using words, and the other thing to think about is their emotional state, what’s happening in that moment? Are they tired? Are they hungry? Are they sleepy? Is there a sensory reason? So all of those reasons are good things to check in about with our specialists here at Children’s Health Council or your pediatrician to see if there are some other contributing factors.

Cindy Lopez:
So if I’m a parent and I’m seeing these things, tantrums and uncooperative behavior, are there things that I could do?

Shirit Megiddo:
So kind of thinking about what’s happening in that moment. On one hand, what’s going on in the day. Are they tired? Are they hungry? And checking in about their emotional needs. But also, if you’re asking them, you know, what would you like to eat? It’s an open-ended question or if you’re telling them you need to get dressed right now and it’s hard for them to take that next step in the transition, a lot of children tantrum during transitions, offering choices would be a way to narrow down the possibilities and give them that say, give them that piece of the control that they’re maybe craving such as, would you like to put your pants on first or your shirt on first, if you’re getting them dressed. The other thing I would suggest is modeling the language you would expect them to say. If they’re really wanting to have something to drink and they’re banging their cup as an older child, you’d expect them to ask I’m thirsty, or I’d like to have some juice and they’re just being in their cup and throwing it and demanding it that way, you could say that phrase of juice please and then pause and see if they imitate you because you’re giving them a little bit of a model there.

Cindy Lopez:
Kharyl and Shirit, thank you so much for joining us today, and I think this is really helpful for parents of young children as they’re thinking about what’s typical and what’s not, and when to seek help or not. So what final words or advice do you have for our listeners?

Shirit Megiddo:
The key take home message I think is that relationship that you have with your child and just enjoying the moment we’re working so hard, they’re in school working so hard or they’re in preschool working so hard, just being with your children and doing something that you enjoy together will bring out that beneficial language stimulation naturally and strengthen that relationship you have with your child.

Kharyl Piano:
Yeah and language is everywhere and it’s embedded already in what we’re doing every day, and so I think about like the very busy parent who’s just overwhelmed with all of these suggestions and things that you could do with your child. So I would say to that parent, you know, is to just choose one routine and you’re going to focus and do the routine that you already do in your life. So don’t try to create something more, but try to embed it in something that you’re already doing. And then just take that one moment and focus on that one part of your day, where you’re going to really focus on creating that language rich environment. And so that you’re not thinking about all of these different things, but just choosing that one part of your day where you’re going to target your child’s language, and I think that really helps in making this big task more doable for a lot of families.

Cindy Lopez:
I like that idea of choosing a routine and focusing on that so it doesn’t feel quite so overwhelming like where do I start? What do I do? For our listeners as we mentioned, you can reach out to us at chconline.org. You can reach out to our Care Team at careteam@chconline.org. Shirit and Kharyl talked about therapy, speech therapy for children so we offer that, what we didn’t really mention was evaluations. So if you’re wondering if your child is experiencing some language development issues that needs to be addressed, but you’re not sure about it an evaluation might be a good choice for you. 

Shirit Megiddo:
Essentially there’s an intake component with the parents to try to find out a little bit more of the history of the child and the concerns that you have as parents. Then we use a combination of formal standardized tests along with informal measures to look deeply into those areas of concerns. It might be a single discipline if it’s speech and language only concerns, or if there are other concerns that might come up in the initial meeting, we have multidisciplinary teams, the psychologists, neuropsychologists, occupational therapists to do a multidisciplinary assessment where each team member assesses his or her area of expertise. And then we bring you into the picture again and go over the results in a parent conference and produce a very specific and elaborate report for you that you can learn about your child and what the challenges are and share with the rest of the educational team.

Cindy Lopez:
That’s so great because I think that parents might feel a little nervous about reaching out for an evaluation feeling like, well, I don’t think that my child really needs that, but no matter what, you get really good information from those assessments and you could use that information in whatever way you want, but it can really benefit your child so it’s worth considering. Again, you can reach out to us at chconline.org, and we do offer free 30-minute parent consultations as well. So again, thank you, Shirit and Kharyl. To our listeners thank you for joining us. And we hope that you will listen again next week.

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