Are you concerned because your toddler is a late talker? Should you wait and see, or should you seek help immediately? What are the important language milestones to keep an eye on?

Ms Goh Siew Li, Senior Speech Therapist from the Speech Language Therapy Service at KK Women's and Children's Hospital, gives detailed answers to your questions.

Question by hnulhll

Hi, I would like to know how to help my 3 yr old son to talk more clearly. Most of his pronounciation of words are not clear and I'm concerned what's wrong??

Answered by Ms Goh Siew Li, Speech-Language Therapist Rehabilitation Department, KK Women's and children's Hospital

Based on the information you provided, it seems that you are primarily concerned with your child’s pronunciation. Some speech sound errors are still acceptable at the age of 3. Children at that age are still learning how to make different sounds as they learn new words.

At 3 years of age, you will be able to understand about 75% of your child’s speech. Some errors on the later developing sounds such as ‘s’, ‘l’ and ‘r’ are still expected. In order to help him, you will have to first decide whether his errors are within normal limits.

You can do so by first listing the errors and checking them with a Speech-Language Therapist. In the meantime, whenever you hear your child make a speech sound error, you can repeat the word with the correct pronunciation and use the words several times in your conversation with him to help him become more aware of how the word should be pronounced.

For example:

Your child might say: “Look this is a tat (cat)”

You could say: “Yes it is a cat. Look at the black cat. Let’s walk closer to the cat”

A consultation with a Speech-Language Therapist would be highly recommended if you observe errors on sounds like ‘m’, ‘k’, ‘t’, ‘f’ and ‘b’ at 3 years of age.

Be careful not to associate any negative emotions with the speech sound errors by over correcting your child or getting your child to repeat the word multiple times. Communication is meant to be fun!

Question by zac's mum

Hi, I have a 14 mth old boy. He can only say "ba" and "ma" (non-specific, i.e. everything he points to is "ba" or "ma").

Does he have a speech delay? I see on Baby Centre's milestone chart that by 11 mths most children can say "dada" and "mama" to the right parent.

My PD says the latest boys should start talking is 18 mths. I would like to know if you agree, and also your definition of "talking". Is it as defined above (calling the right parent), or saying at least another word besides these two?

Answered by Ms Goh Siew Li, Speech-Language Therapist Rehabilitation Department, KK Women's and children's Hospital

Normal developing children do differ in when they acquire their first words. In general, children should acquire their first words before 18 months.

When a child is able to use their first words, he/she would be able to say the word, referring to the correct person/ object by himself. He/she should be able to say the word consistently across different situations.

A consultation with a doctor/ pediatrician/ Speech-Language Therapist is strongly recommended if your child has not attained his first words by 18 months. A Speech-Language Therapist can help to provide specific strategies to stimulate the child’s communication and language.

Please also consult a doctor/ pediatrician/ Speech-Language Therapist if your child does not do any of the following:

1. Point to objects of interest
2. Babble and produce speech – like sounds at 6-10 months
3. Look at people who are talking or when spoken to
4. Enjoy social games like peek-a-boo or imitate actions

Question by cindytsl

Hi,

My son is 22 months but he uses less than 30 words, which seems significantly less than what the usual expressive language development we will expect in a child. Congnitively he seems alright and can understand instructions.

While I know that every child develops differently, I also know that children with developmental delay will benefit better the earlier we start intervention.

I would like to know if it is common for toddler to have so few 'functional words' at 22 months. And how should i continue to monitor and decide when to seek help for him, if necessary. thank you.

Answered by Ms Goh Siew Li, Speech-Language Therapist Rehabilitation Department, KK Women's and children's Hospital

You are right that children develop at different rates. At 24 months, monolingual children are expected to have a vocabulary size of over 200 words. Such data for Singaporean children who are bilingual has yet to be established.

A lot of children at 24 months old are also beginning to combine words together. Based on the short description provided, it is hard to diagnose or provide more specific recommendations. However, your child will benefit from increased language stimulation anyway. It will help your child understand more words and give him more opportunities to communicate. Language stimulation can be carried out any time of the day and across many daily activities including showering, washing of hands or even talking a walk in the park.

Here are two things you can do:

1. Try to talk about the things that your child is interested in using short phrases. E.g if your child is looking at your watch. You can say “Watch! Mummy’s watch.”
2. You can add more words to what your child is already saying.

Example:

Child: milk

Mummy: Drink milk. Here is your milk.

At the Rehabilitation Speech-Language Department at KKH, we conduct a parent training program on a regular basis to help parents interact better with their child and create more opportunities to communicate in daily situations. If you have concerns about how to provide language stimulation or with your child’s language development, you could visit your doctor for a referral to the Speech- Language Therapist for a consultation.

Question by rsim

Hi, toddlers who have frequent falls that land on head, are they more prone to be late talkers? Is there any link between the falls on head and their speech disorder? Could you please advise when should we bring our toddler for treatment, at what age/past which month? Thanks.

Answered by Ms Goh Siew Li, Speech-Language Therapist Rehabilitation Department, KK Women's and children's Hospital

Falls can be common for toddlers. Depending on the severity of the fall, bumps and hits on the head may have little effect on children’s speech development. Your pediatrician may be in a better position to advise you about falls, their severity and their impacts on children’s brain/speech development. Talk to your doctor/pediatrician about your child’s falls, the frequency of the falls and the severity (e.g. from what height).

It is strongly recommended to seek a Speech-Language Therapist’s advice in the following cases:

1. If your child is not using single words to communicate at 18 months
2. If your child is not using short sentences of 3-4 words to communicate at 3.5 years old
3. If your child is unable to relate a short story about the things that happened in school at 5 years old
4. If your child does not respond to his name when called or does not look at you when he/she is talking
5. If your child is stuttering for more than 6 months
6. If your child’s speech is largely unclear by 3-4 years old. You can consult your GP/ doctor/ Pediatrician for a referral to Speech Language therapy services for a consultation.

Question by julian69

Hi, what are the common language and talking disorders in children here in Singapore? What are the symptoms & tell-tale signs and at what age should we psy attention & be concerned?

Answered by Ms Goh Siew Li, Speech-Language Therapist Rehabilitation Department, KK Women's and children's Hospital

The following table illustrates some of the disorders that Speech-Language Therapists commonly see in Singapore:

Question by ngohngoh79

Hi Ms Goh,

My niece who she is 26 months old now, she doesn't talk in 3 syllables. when we call her name she will turn and look at us but she doesn't reply us. When we ask her to do certain actions or chores, she will do it but no words will come out from her mouth. Recently she started school and her teacher verbalised that there is no eye contact when she talk to her. when all the other students are seating crossed legged on the floor but she is running around in the class. Should we be concerned about her behaviour and speech?

Answered by Ms Goh Siew Li, Speech-Language Therapist Rehabilitation Department, KK Women's and children's Hospital

You have raised a few issues. First of all, you mentioned about your niece’s difficulty to pronounce 3 syllable words (pronunciation). You also have concerns about her lack of verbal responses to other’s instructions (receptive language and/or expressive language). Her ability to interact with her teacher with eye contact is also discussed (socio-communication/pragmatics).

Last of all, you are concerned about her behavior in class.

Based on the information provided, it seems that your niece may benefit from a consultation with a doctor/ Pediatrician, a Speech-Language Therapist and an Occupational Therapist. The doctor would be able to provide any medical advice or diagnosis and make necessary referrals to the relevant professionals.

The Speech-Language Therapist will be able to assess your niece’s ability to pronounce words (pronunciation) accurately. He/ She would also assess your niece’s ability to understand and respond appropriately to instructions (receptive language) and niece’s ability to use words or combine words together (expressive language).

The Speech-Language Therapist would also assess if your niece interacts and communicates appropriately with her communication partners (socio-communication) to address your concern about her lack of eye contact. An Occupational Therapist can help you to clarify your concerns about her behavior in the classroom.

Question by gacwys

My daughter is 24months now. She only can make simple sound like 'ba' 'ma' 'go go' 'throw'. She was reffered to speech therapy at HPB but i have been waited for the appt for more than 3 months. I'm just wondering is it a must for her to go and see? What can the therapist do to make her talk more?

Answered by Ms Goh Siew Li, Speech-Language Therapist Rehabilitation Department, KK Women's and children's Hospital

Normal developing children do differ in when they acquire their first words. In general, children should acquire their first words before 18 months. When a child is able to use their first words, he/she would be able to say the word, referring to the correct person/ object by himself. He/she should be able to say the word consistently across different situations.

A consultation with a doctor/ pediatrician/ Speech-Language Therapist is strongly recommended if your child has not attained his first words by 18 months.

A Speech-Language Therapist can help to provide specific strategies to stimulate the child’s communication and language. Please also consult a doctor/ pediatrician/ Speech-Language Therapist if your child does not do any of the following:

1. ​Point to objects of interest
2. Babble and produce speech – like sounds at 6-10 months
3. Look at people who are talking or when spoken to
4. Enjoy social games like peek-a-boo or imitate actions

​Ref: T12