Delayed Speech in 2yr old: GP or HV???

[ConnorTraceptive]

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.

Good luck

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.'

or

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!'.