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Speech Problem in Six-Year-Old

Pediatrics Expert Advice from Shari Nethersole, M.D.

Q: Our six-year-old son's speech is very difficult to understand. Family members are often used as translators, and even I have to ask him to repeat himself sometimes. He seems not to finish the end of words and there are many consonants he cannot say or he substitutes. Our HMO refused to have him evaluated by a speech therapist and the school system won t do anything until third grade. I can tell this is slowing up his ability to sound out words. Should we give him more time and work on articulation ourselves, or should I have him evaluated? His hearing is normal.

A: I think you should have your child evaluated as soon as possible. By the age of six you certainly should be able to understand all of what your child is saying and while some children may have a small lisp with certain letters, the vast majority of their speech should still be understandable. I am concerned that you say that the school will not do anything for him. There are laws in the United States that mandate evaluation and treatment of children who have special needs or disabilities. This evaluation is available starting at age three, so even if a child is not in school they are eligible to receive an evaluation.

You should call your school system back again and demand that he get a speech and language evaluation at the start of this school year. If your child does need speech therapy, the school system should be able to provide that speech therapy or refer you to some place that does provide the speech 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.


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