Delayed Speech in 2yr old: GP or HV???(55 Posts)
I'm fairly concerned about ds2's speech now and want to seek some advice. Who should be the first point of call GP or HV?
My first point of contact was my HV and she came over to the house and did a word test thing with him and then told me she thought his speech was quite bad and she would refer for a SALT assessment. The only time I involved the GP was when I wanted to check whether his tongue was tied and if yes, whether it was causing the speech probs.
DS is only just 2 isn't he Connor? Weren't you on our Jan 2008 ante-natal thread?
neither. I would google and make some phone calls to see if you can self-refer to speech therapy or there are any salt drop in clinics, some areas have this. Then if you can't get easy access to salt I would speak to whichever of GP or HV you have most confidence in.
Thanks luciemule, will try to get an appointment with HV. How did things turn out for you if you don't mind me asking?
Hi LaTrucha ds isn't 2 for another couple of weeks - not sure I was on the ante-natal thread- started off on one but computers used to aggravate my nausea when pregnant so I never kept up with it!
Total Chaos - That's interesting didn't know you can sometimes self refer
I don't know if this is true everywhere, but at my DD3's developmental check the HV told me that policy had changed and she couldn't refer for speech therapy until the child was 2.6. MY 2 previous DDs were referred younger.
and also get his hearing checked.
Well, he's 5 now and has just had his first app in our new area (we moved in April to an area with very little SALT). He doesn't pronounce the startss and ends of some owrds and finds C, F, G and R hard to say in certain circumstances. I still think he's slightly tongue tied but I've just taken him to the GP last week who confirmed he has extra large tonsils. He's been referred to the ENT clinic with the thoughts of having them removed. Enlarged tonsils can impact speech so I'm quite relieved it might get sorted through the op.
If you don't me asking, what speech probs do you think your DS has?
I have some memory of us being pregnant at the same time as I had hyperemesis and I think you did too.
That makes DD about 2 months older than your DS. She isn't really talking. Odd word and quite a few of them. She is bilingual. I do see progress though, so personally I'm not worried at the moment.
Ah yes la trucha I did have hyperemesis so I guess we must have bumped into each inbetween visiting the toilet!!
DS seems to have few words (although understands many words and instructions) There are words he has said a couple of times nbever to be repeated and he seems to have forgotten a couple for example a few months ago he used to say "boobs" all the time when he saw me undress or if we were in m&s lingerie department now he doesn't say the word even though he will still point at them.
He can say a couple of family members names quite well but has NEVER said his brothers name, just laugh at you if you ask him to say it and he doesn't have a word that he uses to refer to his brother IYSWIM.
When he says teeth, cheese, trees or juice they all sound almost identical to most people although as I'm with him all day I can notice the subtle differences.
I'm about to make a list of the words he has so I can get a clearer picture
Also if he sees animals he recognises he will make the sound they make rather than try to say what the actually are. E.g snort for pig, woof for dog, hiss for snake
The SALTs can give you a list of sounds children can physically pronounce at different ages and I was surprised. TR, for example if a later one and others like FR can't be pronounced until 5 (these are example btw as I don't have list with me). For a 2 yr old, to be able to say TRee is quite hard and I don't think the J sound is an early one to pronounce so could sound like dooce instead of juice. You'll probably find he chooses not to chat as he has older brothers and doesn't feel the need to talk much. I bet once he's at preschool, he'll be chatting away!
There are other children who say more and I know that the 'line' is that they will be saying more but from my experience and various of my friends that sounds pretty normal to me.
In my very non-expert knowledge, understanding is a better guide at this age.
I made that list at about the same age and there were actually quite a few on it that she ahd said in total - including things said once or that used to be said. There were around 40 I think. I was totally stressed out for her development check (has DS had this? If not concerns could be raised then). The HV asked me if she had 7 yes SEVEN words. So the bar is pretty low and it seems to me he probably leaps it!
First thing to do is ask for a hearing test - that is what the HV should initially refer you for anyway.
He's still quite young for speech, but definitely worth speaking to the HV. For very little ones they prob won't do much anyway - ds2 has a speech delay, he was seen at age 3.0, they gave some strategies to use at home, reviewed in 6 months and discharged, because although clarity was still not good, language had moved to being within normal limits, but with instructions for school (he starts in Sep) to re-refer if they're at all concerned.
Thanks for all the replies. looking at my list ds has about 20 words, half of which I would say would not be recognisable to someone who didn't know him.
I may be worrying prematurely but my only experience is based on ds1 who was the polar opposite.
The HV has just phoned me back and I'm seeing her for a chat on thursday
Luciemule that's interesting about the tonsils. Doctors always comment on the size of my tonsild so maybe ds2 has large ones too?
Certainly my 3 were all massively different in their development - dd was totally articulate by age 2 - she started speaking at 9 months, and was using sentences by 13 months or so.
Ds2 I have just discovered has taught himself Makaton sign langauge watching Something Special, and he uses it to aid comprehension - might be worth doing a bit with your ds - he might be saying more than you realise. It was only when ds2's langauge got a bit clearer that I realised that his gestures were word-specific, and when I looked up Makaton they were the recognised signs.
Connor - my ds was exactly the same - at 2 I reckon he had about 10-20 words, half of which were more like sounds - by the time he was 2.5 I couldnt shut him up! He's not 3 until May, and now talks in complete sentences, knows the words for everything, and will correct anyone if they get something wrong.
I'm certainly no expert, but not quite 2 doesnt sound like delayed speech to me.
Thanks geordie - I flip between not being in not the least bit concerned to blind panic!
DH didn't say a word until well, well after two. He's now a lecturer in language and literature, speaks three languages and reads three more and will not shut up in any of them. This always keeps me sane!
HOpe chat with HV goes well.
i really wouldn't worry too much, the difference between 2 yr olds speech can vary massively.
I found once DS turned 2 he was coming out with new words every day. His playmate was was ahead of him. His cousin is 5 months older and she actually had a referral from the HV six months ago, she wasn't saying anything. Nothing wrong with her speech now!
DS still does the noises for animals a lot of the time.
And agree with Luciemule, sometimes the 2nd child doesn't talk much cos they have older brother or sister to talk for them.
You can always self refer - you do not need to go through HV or GP. If you are worried and especially if you think the HV isn't taking you seriously get your DCs name put on the waiting list yourself ( it may be a long waiting list) if you are happy with his speech by the time he gets an assessment appointment, then cancel - simple as that
FWIW there is normally a big progression in speech development between the age of 2 and 2.5
I would definitely second the self referral idea - I've done that for DS who is just 2 and the SALT that comes to us is lovely and there have been improvements in the few appointments that we've had. I went to the GP first rather than HV and was referred for a hearing test, which showed congestion in his ears so he may have glue ear but we won't know for sure till next test in a couple of weeks. I knew I wouldn't get a referral or appointment for a SALT for a few months so wanted to ensure that DS had help as soon as we thought there was a problem. Good luck with your DS.
My Ds was referred at 2!!! he is 2 and half next month and no way talking in sentences, not even 2 words togther he starts speech therapy tomorrow.
i have no doubt in the slightest about his hearing, he hears things longbefore i do and i have no issues, though he hasn't had a hearing test.
DS either says a word or he does not, there are no "sounds like" at all.
Oh and there has been very very minimal speech progression between 2 and now for us, i have been waiting for it as everyone says, but alas, no he is very clever and very with it also.
Lots of things he says from the back of his throat but the intonaton is so clear other people can understand him.
Apart from animal noises he has less than ten words for sure, that are clear anyway, in fact mabye less than 5 actually (not including animal/vehicle noises) but then he can say excuseme, thank you, sorry, bye etc all in intonation. Actually he can prob say mre than 5 as he can say oh oh whoops etc.
Tis very very difficult, esp when he is very with it in every other way.
maxy, that is what ds2 was like, he had very few words at 2.6. He did have some hearing loss during that time which is the likely cause.
At 3.9 he says a lot more, but still has pronunciation difficulties (eg 'tat' instead of 'cat', 'now' instead of 'snow'), but the SALT thought was best to manage that without 'formal' therapy, as the best thing to do is just to repeat the word back, accenting the correct letter - so C-C-C-Cat, SSSSSSSSSSSSSSSSSnow etc.
With regards to what she suggested at his first appt, it was lots of looking at picture books (which we did anyway), and building up sentences. Things like 'Train. The Train is in the Station. The Red Train is Waiting in the Station.'
Bus. Boy. The Boy is on the Bus. The Bus is Driving.
So you start off with some basic words and build up the sentences from there.
Speech does tend to 'explode' though once they get going - it's not 'linear development!'.
Yes they talk to him like that and he does kind of look at them like "what on earth are you doing?" we look at books sing etc etc he never ahd a dummy or a bottle, I've done everything "right" for want of a better word! Even the salt thinks he just doesn't need to bother with talking just yet!
Will see how the group goes this afternoon
DS1 got referred to SALT by my HV. Seems to be the quickest way round here
Maxy, could you please give us an update later on how you get on at the group? My DS (currently 2.5) sounds EXACTLY like yours - very few words but otherwise very with it and there is definitely no problem with his hearing. We are a bilingual family so I have been blaming the delay on that but am starting to wonder if I should be taking any further action?
I rang up my HV a few weeks ago (DS is 2.4 and says about 20 words total, half of which are unrecognisable to others) to chat to her about his speech. She's referred him for a hearing test first (SALT won't look at him until he gets all clear on hearing) and we're on the SALT waiting list (which is 16 weeks long in our area).
DS always has very waxy ears (to the point where other people have commented on it) ... does anyone know if this could be a hearing problem (I didn't think it was, as he appears to hear everything to us)?
Both ds1 and ds2 have had very waxy ears (it's grim, browny black wax hanging out!!!) but this isn't a sign of hearing loss - ds1 has never had any problems, and I asked about ds2's and they said there was not correlation. He had hearing loss because of fluid in his middle ear (glue ear).
I do think the understanding is a better thing to focus on at age 2 - I remember a friend's ds having lots of 'words', and even some sentences, but he had fairly severe autism, and so although he had 'learned' phrases, he didn't understand langauge spoken to him, he had simply learned that a particular phrase was appropriate at a particular time. If the understanding is there then the spoken words will follow.
Certainly with ds2 they said he had delayed speech, but that cognitive (understood) language was where it should be, and this is borne out by his rapid progress in the last 6 months.
You are definitely supposed to do hearing tests first. However, my DS2 couldn't comply with it, as they conducted one for the 3+ age group even though I told them that the very nature of his problem was that he didn't understand language as a 3-year-old should.
that was my first warning I suppose that the only people who were going to help DS2 to any degree were me, DH, the nursery we moved him to and the mumsnet special needs board. SALTS are the people to assess the problem, but it's usually you that actually accelerates the language development.
I had trained myself up and was really taking action by the time he was 2.9, and I already had experience because his older brother was delayed too.
In retrospect, I'd have started work at 2.0, not 2.9, so I don't think 2.0 is too early to worry.
thanks for posting lily - good to hear there is no correlation.
sorry for thread hijack
Yes lily agree! Also pointing is a key factor.
I will let you all know how it goes! Am dreading it to be honest. It is between 3 and 4....apologies if I have said that already!
Interesting sheep that yours has to have hearing test before he is seen? My DS never had a hearing test, though the other evening, DH went to test ride a motorbike and me and DS stayed with the man in his garage, DS "told" us that he could hear Daddy coming back, we couldn't so I said noooo. Then couple of sexconds later, I heard him!!
Anyway, best dash, be back later.
Lingle what sort of things did you train yourself up on to help your ds? Even if it comes back that ds2 doesn't have a problem I would like to try to do something to help him along just in case
Lots of close observation.
Joining the mumsnet special needs board (though I look at some of my first posts and they are not at all objective -! rather over-optimistic!)
Getting the book I mention in the following thread:
Also also a fantastic book by Linda Hodgson about visual aids.
You do have to research it quite a bit. I remember with great annoyance how DS2 and I used to walk up the hill from nursery when he was about 2.4 pointing out each car saying "what's that? it's a car? What's that? it's a window!". It was a sweet game to play together but completely pointless in terms of language development. Still, never mind, we are getting there fast now at 4.6.
Thanks Lingle I going to see if my local library can order it in first if not I shall buy it. I think it would be a usefull thing to have
Connor, if you can get a picture book with lots of 'every day pictures' they are really good for flicking through and doing the 'sentence build up'. I have one which has one page which is a park, with lots of different things going on, then another page is a kitchen, another is a school etc. But lots of different things to look at.
Make sure you speak really clearly and slowly!
Try giving him little instructions - to start with use 1 step instructions, then build up to 2 step - eg "Get your shoes" then "Go and get your coat and shoes" etc. That should give you a clue if he is processing language.
Also, wrt to hearing, with ds2, he was missing low frequency sounds, so we hadn't spotted he had hearing loss, because he could still 'hear' iyswim, but for speech development you need the full range of frequencies.
Thanks lily. You've made realise that actually ds does process language as he can follow lots of simple instructions such as "sit on the step so we can do your shoes", "put the cup back", "Do you want your gloves?" etc so I guess that is positive
That's really all you really want at this stage Connor - if they're processing language then they probably don't have a 'language disorder'. With ds2 I was very confident that his language was fine, it was his speech that was delayed, which I think was a mixture of hearing loss and v mild hypotonia.
Certainly with ds2, once he started 'getting' speech it was quite fast (albeit about 12 months late - most of his spoken language has come since he was 3), friends who had more of a language disorder were much slower even once progression started to happen.
Do try some Makaton with him - I was STUNNED when I realised that was what ds2 was using - and it really did make a difference to his ability to communicate - because it is quite 'pictorial' I was interpreting it without realising that's what he was doing - I thought he was just gesturing. But it really helped alleviate the frustration of not being able to be understood through speech alone.
Well we're back!!
The women were really nice and not patronising so that was good!
There were two other children, 1 who i think does have delay, she was not with it an dnot at all aware of anything that was going on. Then a boy who was with it but very very very clingy to his mum, so my confident I can do it by myself son stuck out like a sore thumb Not because he is a pain (he is very very good I must say) but the whole thing was very slow, but it went ok and they were nice. As others have said, not sure if it will make a difference to him talking, I think he would probably be better on his own as we spent most of the time with them trying to cajole the boy into doing something and the girl trying to get her to focus
The main issue is the bloomin time, Ds was shattered and a bit cranky and fell asleep on the bus coing home.
They did say it is good he uses correct syllables and intonation for words even though it is from the back of his throat and not actual words. Plus they though him very expressive so all positive really.
My DD is now 4 1/2. At 3 we were trying to get him to pronounce words properly and he started crying say he was. that was when we realised there was a problem. Spoke to the Dr who refered him for a hearing test. We were advised by the consultant that he had glue ear, needed grommits, tonsils and adanoids. He was not referred to speech therapy, I had to contact health visitor who arranged it. Managed two sessions before he started school last Sept. He has had some sucess in school with teacher and speech therapist, but now a year on and his grommits have come out. He had a hearing test in Jan, and his ears are blocked again. Much more noticable now as he constantly says "pardon mummy". They will not put the grommits back in until he has been tested again late in Spring. He speech is suffering again. He has semi masters 'f' and 's' at the begining of words, but not within. And now he appears to be having difficulties with 'r' as a second letter ie tree. I am going to ring the hospital and see if i can speed up his consultants appointment. But you do need to push for your son to be seen.
I think I have been very lucky in that we got seen straight away, though DS speech is very very very limited!!
Though no hearing problems etc.
iam asking on behalf on my daughter,at what age would you worry about your childs speech ? her son is 2 at the end of December.she has noticed a lot of her friends children can say a lot more and some are younger,he can say dadda and mama.but doesnt use them often,he makes noises,like if he drops something he does like a homer simpson "duh" !! or goes oooooh,he is very bright otherwise,and can make himself understood,my daughter was very quick with her speech,but her younger brother was about 2 and a half,i have reassured her, but just wondered if anyone has any views on this,thanks .
OK, sorry to hijack, but following this thread with great interest (and have read other thread linked to).
DS2 is 19.5 months, with a big brother who talks non-stop & followed the usual 'milestones' for speech/languages. DS2 does not have any words at all. He babbles - dada, dayday, deardear, yehyeh, a a a. He also makes surprised/interested noises (two-tone kind of 'ooh/oh')
The thing that really concerns me is that he doesn't point at things that interest him in the distance (well, has done so twice). He points at things in books (although not eg where's the cow?), and at facial features, but he does not point at eg the tractor in the field. HV came round when he was almost 18m, as I was panicking, & she said it was fine as he waves (on demand mostly) & claps (on demand & after others do). She also said it was to be expected as I was 23m when I first talked.
He communicates in other ways - looks at me when he finds a toy funny, has started bringing change mat when done a poo, brings me toys (also holds phone up for me to speak on). He also laughs at/with his brother, as well as at pictures/tv/sounds. He shakes his head/pushes hand away if he doesn't want any more food/drink.
He follows simple commands - no, sit down, come here, get in your highchair (sometimes), give it to Mummy, put it in the box. He mostly responds to his name, unless he is otherwise engaged.
He is a very affectionate child & often climbs on people's laps for cuddles (mostly me, but also, randomly, another mum at toddler group!). He also loves to climb!
He is very laid back & has been quite slow to do everything so far - crawled at 12m, walked at 17m, clapping at 17m, waving at 18m, self-feeding in last couple of months. DH thinks he is just lazy & I compare him too much to DS1 who was the opposite of this, but I do worry!
I will just say, anecdotally, that my grandmother swears my father didn't say a single word until he was 2. He grew up to have no development issues whatsoever, and is in fact exceptionally academically able. So not speaking by 2 doesn't necessarily mean there is a problem. She said he seemed to be storing it up until he'd got the hang of it because his speech went from zero to reasonably fluent very quickly.
If your child is communicating with you in other ways then they could be following this pattern.
My DS is 2 in jan says no words at all still young but he signs and understands language got the hv round who said his language was great but refered to speech therapy as their is a long list and will be older than 2 by the time he gets seen.
She said that better to get him in the system and cancel if he no longer needs it than risk him losing confidence with a late referral.
I thought this was good advice and feel happier and optimistic about it. Hearing more about late talkers but I would push to be seen better to spot any problems early and get in the right track IMO let us know how you get on x x
connor you mentioned your DS possibly had a tongue tie - has this been properly assessed by someone who really knows what they are looking for? Innocuous-looking 'minor' ties can cause major problems, and conversely seemingly major ones can cause no issues whatsoever.
You would hope a speech therapist would be able to assess a tie, but TBH I don't have much faith in anyone except surgeons with a special interest in this area or lactation consultants who are also tongue tie dividers. If anyone looks in his mouth and just opines that it seems ok or not too restricted....well, see someone else who will check it properly by analysing how his tongue moves in his mouth, would be my advice!
ZOMBIE THREAD, so I think Connor long gone.
Jenduck does your DS follow a point? If you point at something, does he look at your finger or at what you're pointing at?
Oops from me too .
Yes, he follows a point & will mostly look if I say look. Also notices things as keenly as anyone else eg today at the park a loud helicopter flew overhead, and he was looking like we all were. Just didn't point at it, but then neither did anybody else!
Meant to say also, he follows my finger to see what I am pointing at (this more within the last couple of months). he also drops everything & has a good nosy if anybody new comes into a room or he sees me looking at somebody else!
Some of you might find the following website useful. It gives you rough guidelines to what to expect of speech and language abilities for children at different ages along with a progress checker:
I would highly recommend the book BabyTalk by Dr Sally Ward.
Very useful tool on looking at and developing children's speech, language and communication skills. Most library's have a copy as well as them selling second hand on amazon.
Also the ican website is a very good resource.
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