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Questioning Speech Development

Pediatrics Expert Advice from Shari Nethersole, M.D.

Q: I had always thought my 16-month-old son was pretty advanced. He was crawling at 3 months, learned to solve problems early, found interest in things that normally children his age don't. So it was a little disappointing to me recently when I read a parenting magazine that discussed the speech development of children from birth to five years. All of a sudden my "genius" didn't seem so advanced. I was wondering why his speech hasn't surpassed the norm like all of his previous development had. As a matter of fact, it is not even at the norm for his age. Is there a possibility something worse can be going on in a developing stage to cause this incomprehensible standstill? I have been especially careful with pronunciations and have even encouraged him to mimic me, but these attempts have failed. Any advice you have can be helpful to me.

A: The first comment I would make is that development in young children is extremely variable. Yes, there are "norms" for when children should reach a particular milestone, but there is quite a range around all of those norms. For example, most kids start walking around 12 months of age, many before but many after their first birthday as well. Anything in this range is entirely normal. Also, development does not always proceed at a steady rate. Early in infancy, children are acquiring new skills practically every week. As they get past six months, they can have short stretches of time when they don't seem to acquire new skills, and then can have a burst of 3 or 4 new skills in 2 weeks. If an older infant or toddler were to go 2 or 3 months without progressing, that would be more of a concern, and should be evaluated further.

Secondly, achieving these developmental milestones earlier in the range does not in any way indicate that a child is smarter, and achieving them later does not mean that the child is delayed. Each child will develop at his or her own pace, and while it is important to encourage and stimulate children as they try to master each developmental skill, I would not place too much importance on trying to achieve them earlier than other children. Keep in mind that there are different areas of child development, and a child who has early language skills may not be as early with his motor skills, and vice versa. If a child is actually delayed in development (that is, below the normal range), then that should be addressed as soon as possible with the pediatrician.

It sounds as though you have concerns specifically about your son's speech and language. You are doing the right things by making sure you speak clearly, and playing games where you encourage him to repeat or sing songs. It is also important to make sure that your son is hearing adequately. You should talk with your pediatrician further about this. If your son is truly delayed in his language development, then the first step should be to have his hearing tested.

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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.

Please note: This "Expert Advice" area of should be used for general information purposes only. Advice given here is not intended to provide a basis for action in particular circumstances without consideration by a competent professional. Before using this Expert Advice area, please review our General and Medical Disclaimers.


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