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Two-Year-Old Won't Talk
Q: My two-year-old son hasn't shown any interest in talking yet. He doesn't even try. He totally understands what we say to him, but has not uttered a word (with the exception of "yea"). Should I be concerned?
A: Yes. I would be concerned, although not panicked, that your two-year-old son is not talking yet. Usually, at approximately one year of age, most children are able to say "Mama" and "Dada" and possibly one or two other words. By fifteen months, you expect a child to be able to say five or six different words, by eighteen months ten to twenty separate words, and by two years of age you expect that children should be able to put two words together in brief sentences. We'd also expect that by the time a child turns two that he would have a vocabulary greater than fifty words. Given these milestones, I would definitely be concerned that your child does not say any words at the age of two.
There are a number of possible reasons for this. The first thing to consider is whether or not he is hearing adequately. The fact that he seems to be able to understand what you're saying to him makes a complete hearing loss less likely, but it is certainly important to make sure that he has his hearing tested to look for a mild or moderate hearing loss. It also makes sense to look at what other efforts your son makes to communicate. If he is able to use gestures and pointing and crying to communicate his wishes, then that is further evidence that his understanding is good.
I would recommend that you speak to your pediatrician about this and have his hearing evaluated right away. He will probably have to start some form of speech therapy. At this age, this may consist of increasing his exposure to books and language on a day-to-day basis, but it could also involve more intensive speech therapy. In general, speech and language delays in children are very amenable to therapy.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.