boy with speech bubbles written on a black board: signs your child might need help from or referral to a speech therapist or audiologist

Has your child’s doctor referred you to a speech therapist? Or do you simply suspect they may need some extra help with their language or development?

A referral to a speech therapist or audiologist may be warranted if a child has difficulty with hearing, speaking, language, communication or feeding and swallowing difficulties when compared to those of the same age.

Signs your child may need help from a speech therapist or audiologist:

Speech focuses on articulation, sound disorders, voice and fluency. All of these aspects are essential for a child’s verbal skills to be considered proficient.

Articulation describes how the actual articulators (lips, tongue, palate, velar, oral cavity) move in order to produce sounds of speech effectively. If a child has a speech sound disorder they may delete or omit certain sounds, distort sounds or substitute sounds – this may make their speech difficult to comprehend.

In some cases (e.g., apraxia of speech), the child may have difficulty combining the movements of speech sounds in sequences, as required for words and sentences.

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Voicing difficulties may be present in a child who is not able to speak understandably at a consistent volume. A chronically hoarse, harsh, breathy or raspy voice quality, an inappropriate vocal pitch for the child’s age or sex, frequent pitch breaks or voice that is consistently too soft.

Fluency of speech focuses on the rate and rhythm of speech – children who struggle with this may stutter. Characteristics of a fluency disorder include involuntary repetitions, hesitations, prolongations, blocks or disruptions during speech, tension during speech or abnormal movements such as jerking or eye blinking, refusal to talk to strangers because of fear of stuttering or embarrassment.

Language on the other hand refer to the words we use and how we use them. This looks at vocabulary, grammar and rules of a language and its pronunciation. We also look at language within different modalities, that means speaking, reading, understanding and writing.

Having trouble understanding what others say is a receptive language disorder. Having problems sharing our thoughts, ideas, and feelings is an expressive language disorder.

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If you notice that some of the following signs apply to your child, it may be time for speech therapy:

  • Your child uses less than 20 words at 18 months and less than 50 words by age 2. Difficulty with combing two-three-word phrases. Frustrations due to communication restrictions.
  • By age 2, most children understand more than 300 words. If your child has trouble understanding simple sentences, such as “get your coat,” it may be time to see a speech therapist. It is also crucial to note if your child is able to follow the instruction without any additional gestural cue or continued repetition.
  • Your child may not speak consistently in all contexts or with multiple communication partners. They may also have difficulty with effective use of language such as body language, facial expressions, turn-taking, initiating or maintain conversation. If your child does not engage you or others in their play, or if they appear to have difficulty with playing with objects or toys appropriately.

little boy surrounded by language and letters: signs your child might need help from or referral to a speech therapist or audiologist

Signs your child might have swallowing or feeding difficulties:

Difficulty nursing, difficulty swallowing liquids or solids, difficulty sucking or drinking from a cup, difficulty taking foods from a spoon or chewing foods, avoidance of certain types of foods or certain food textures, gagging, choking or coughing during feeding – all of these are red flags that may need to be addressed.

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Signs your child might have a hearing problem:

If you notice your baby does not respond to (or is not always startled by) loud sounds then that may be a red flag to have their hearing checked. Notice if your child is able to respond to your voice, but know that this may vary, especially during the early months of life. However, if your child is older and is struggling to discriminate between certain sounds, has difficulty with pronunciation or responding to their name or instructions consistently, it may be time for a referral to a speech therapist or audiologist.

As a general rule, it is recommended to check your child’s hearing status at least once a year. This is especially critical in early life as early detection allows for early intervention, which in turn yields better overall development. It is best to trust your instinct, and if you have any concerns it is better to book a consult to ease your worries.

Nabeelah Kathrada, speech therapist and audiologist
Nabeelah Kathrada is a speech therapist and audiologist based in the East Rand of Johannesburg. She provides treatment for both children and adults focusing on speech, language, communication and feeding disorders. She is passionate about early childhood development and neurological communication disorders. In her spare time, she enjoys reading, writing and time with her family.