Speech-Language Development: Milestones & Red Flags – PediaCast CME 120
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Show Notes
Description
Jamie Boster and Kelsey Schilling visit the studio as we consider speech and language development. What milestones are expected, when might red flags develop, and where should we refer when problems arise? Tune in to find out!
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Topic
Speech and Language Development
Presenters
Dr Mike Patrick
PediaCast and PediaCast CME
Nationwide Children’s Hospital
Dr Jamie Boster
Speech and Language Research Scientist
Nationwide Children’s Hospital
Kelsey Schilling
Speech-Language Pathologist
Nationwide Children’s Hospital
Learning Objectives
At the end of this activity, participants should be able to:
- Differentiate between language and speech in young children
- Identify typical milestones for receptive, expressive, and speech sound development
- Recognize early signs of language and speech delays requiring referral
- Apply evidence-informed guidance to support families and promote early intervention
Links
Speech Pathology at Nationwide Children’s Hospital
American Speech-Language-Hearing Association
Typical Speech and Language Development
Speech and Communication Development – Birth to 3 Years
Disclosure Statement
No one in a position to control content has any relationships with ACCME-defined ineligible companies.
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Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast CME is brought to you by Speech-Language Pathology at Nationwide Children's Hospital.
[MUSIC]
[Dr Mike Patrick]
Hello, everyone, and welcome to another episode of PediaCast CME. We are a pediatric podcast for health care providers.
This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 120.
We're calling this one Speech-Language Development Milestones and Red Flags. I want to welcome all of you to the program. We are so happy to have you with us.
You know, speech and language development are central to early childhood growth, and early identification of concerns can make a lasting difference. In this episode of PediaCast CME, we will review typical speech and language development in young children. We'll consider red flags for concerns and indications for referrals to speech-language pathology, and we will share practical guidance for supporting children and their families.
Of course, in our usual PediaCast CME fashion, we have two terrific guests joining us in the studio to discuss the topic. Jamie Boster and Kelsey Schilling, they are both speech and language pathologists at Nationwide Children's Hospital. Don't forget, after listening to this episode, be sure to claim your free Category 1 education credit, both CME and CEs.
It's easy to do. Simply head over to the show notes for this episode at pediacastcme.org. You'll find a link to the post-test in the show notes.
Follow that link to CloudCME. You're going to want to click on the Materials tab once you're there, and then take and pass the post-test, and the Category 1 credit is yours. We offer credit to physicians, of course, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.
It's because Nationwide Children's is jointly accredited by all of those professional organizations that we can offer the credits you need to fulfill your state's continuing medical education requirements. Of course, you want to be sure the content of the episode matches your scope of practice. Although, when we think about language development in kids, that's really important for all of us who take care of children.
Complete details are available over at pediacastcme.org. Also, I want to remind you the information presented in our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.
Also, your use of this audio program is subject to the PediaCast CME Terms of Use Agreement, which you can find at pediacastcme.org. So, let's take a quick break. We'll get Jamie and Kelsey settled into the studio, and then we will be back to talk about speech-language development, milestones, and red flags.
It's coming up right after this.
[MUSIC]
[Dr Mike Patrick]
Jamie Boster is a speech-language pathologist and a research scientist at Nationwide Children's Hospital. She's also an adjunct assistant professor of speech and hearing science at The Ohio State University.
Kelsey Schilling is also a speech-language pathologist and a clinical lead at Nationwide Children's. Both have a passion for supporting young children and families impacted by speech and language concerns. That's what they're here to talk about, speech and language problems.
What pediatric clinicians need to know, including what is normal and when a referral to speech-language pathology should be considered. Before we dive into that conversation, let's offer a warm PediaCast CME welcome to our guests, Jamie Boster and Kelsey Schilling. Thank you both for stopping by the studio today.
[Jamie Boster]
Thank you. Hi, Dr. Mike.
[Kelsey Schilling]
Thank you for having us.
[Dr Mike Patrick]
Yeah. I am really excited to talk about this. I remember, you know, I do pediatric emergency medicine now, but I did spend a decade in private pediatric practice.
And I will say that there aren't a lot of things that get parents concerned as much as language and speech development. Because you know, you have this brand-new baby, they're slowly growing and speech is definitely a milestone. You know, those first words are always so important.
So, Jamie, to sort of set the stage, how do we define language development and how is that different from speech? Sometimes those words are used interchangeably, but they really are different things, right? Speech and language.
Can you describe what each of those are?
[Jamie Boster]
Yeah. So, speech and language are definitely very different aspects of things to consider. So, when we think about language, we're really thinking about our understanding of words and their meanings.
We're thinking more about grammar and how to comprehend how words are put together to form different sentences and utterances. When we think about language development, we typically think about two different aspects. We think about receptive language and expressive language.
When we think about expressive language, we're really talking about things like the concepts that we're able to communicate and share with others. And then when we think about receptive language, we're thinking about the concepts that we're able to know and understand. Speech is really different in that it is the physical production of sounds, what we typically refer to as articulation when we talk about speech.
And that's actually the motor movements of the mouth and the voice and fluency versus our understanding of concepts, which is what the language aspects of it is. So, you can have children with very strong language skills, but very weak speech skills and vice versa. You can have someone who has very weak speech sounds, but very strong language skills as well.
[Dr Mike Patrick]
So, language is sort of the code and getting across a message. And then speech is actually making the sounds that make up that code, so to speak. Yes.
[Jamie Boster]
Yes, that's correct.
[Dr Mike Patrick]
Okay. So, with that in mind, Kelsey, what are the first steps then of speech and language development in infancy? So, what kind of is normal?
What should parents be sort of looking out for, especially in those first months and the first year?
[Kelsey Schilling]
Yeah. So, babies, when as they start to develop around three to four months, they start to use different, you know, open mouth sounds, what we call cooing and vocal play. They'll kind of, we'll see them move their mouth around, stick their tongue out, figure out how all of it works, blow raspberries, smack their lips, things like that.
And then over time, those productions tend to kind of shift into exploration of consonant sounds. So, things like muzz and guzz and buzz. As that continues to develop, we see those consonant sounds occur in what we call canonical forms.
So, repeating that same sound over again, like buh, buh, buh. And then as we continue to mature, we see those start to be variegated. So, they start to combine different consonant sounds, much like we do, to produce any words that we say.
They also start, from a language standpoint, to recognize their caregivers. They start to understand language and speech just in that, like, it has meaning and pay attention to it. They'll localize to different sounds in the room.
They'll be able to recognize a parent's voice or different sounds in their environment and look and anticipate. And they watch and they smile, typically, as their caregivers will speak to them as they begin to start to understand that language early on.
[Dr Mike Patrick]
Yeah. And that receptive language then is really the first thing that develops, I would think. And then the vocalizations are going to be more cause and effect.
You know, they start to make some noises and let's see what gets the attention of someone else and makes my mom smile, for example. But that receptive language is really happening fast during that first year of life. Jamie, can you kind of walk us through normal receptive language development and what things can parents do to kind of move that along?
[Jamie Boster]
Yeah, absolutely. So, when we think about receptive language development, there's a lot of this happening for children very early on. Typically, we look for something called joint attention, which is that shared attention to objects and concepts in the environment.
And this is how parents can really support the development of their child's receptive language skills by engaging them in activities like play and social routines. So, some things that might be really helpful is like pointing to objects and trying to emphasize certain words during the play activities that you're involved in. So, when you're playing with a ball, like saying, oh, look, it's a ball, you know, and kind of like labeling it, pointing to it, things like that to kind of emphasize what that word is and what you're meaning and what you're referring to in play.
Talking about things that a child's doing is very helpful for supporting receptive language development. A lot of times as speech therapists, we tell parents to narrate their daily activities because kind of thinking about putting a lot of language in helps get language out. Telling them how they can support different language concepts, which is really helpful.
So, when you're talking about like going about your day-to-day business, so when we're taking a bath, like, oh, we're watching, washing your toes, we're washing your fingers. All of that is going in and helping to help that child learn those different concepts. It's also supporting cause and effect, kind of how you mentioned before, understanding that when a child produces some sort of speech, something else happens.
So, when something is spoken for the child, they're able to understand that there's going to be some sort of response from their communication partner. We typically see children begin to recognize pretty familiar words in the beginning. They understand most words in context, like play and social routines, that typically occurs around nine to 18 months of age.
And typically, in this age range, those children are able to understand much more than they're able to express yet. They really start by understanding nouns and verbs and some basic concepts, and then they start to build some semantic networks, meaning that they understand how words are associated with each other. And they continue to learn words very quickly.
Sometimes we call this fast mapping. So, children may seem that they're gathering words, more and more words each day very quickly. This is something that we definitely want to see happen with our children.
Just we ask parents often if they feel like their child is understanding new words each day. That's one really nice marker of whether a child is on target with their receptive language development. Around age two, children really start to learn different things related to word order.
That's another marker for receptive language and grammatical markers, being able to understand that when they hear that plural S, that means there's more than one of something or past tense E-D, understanding that something happened in the past. Some of those grammatical markers start to come into play around age two. And then around age four and beyond, children are learning much more complex language, getting that understanding of more abstract meanings.
They may understand things like humor, figurative language, and things like that. And that just continues to move on as children grow.
[Dr Mike Patrick]
You know, here in Columbus, we have a pretty diverse community, which we love. You know, there's so many different languages and in a particular home, there may be more than one language that's spoken. Is there a best practice for when you have a little baby at home?
Like, should you just use one language at first and then, you know, maybe introduce the other language down the road? Or is it okay to sort of introduce both languages at the same time?
[Jamie Boster]
So that's a great question. And we are asked that very frequently as part of our job. And I will say that other research has shown that children are very capable of learning multiple languages at one time.
So, we typically encourage families to begin speaking multiple languages from the beginning. That is not something that is going to inhibit speech and language development. So very good question.
[Dr Mike Patrick]
So interesting. Now, there is also nonverbal communication that is also important. And I love the way that you put it.
You have a communication partner. And sometimes the nonverbal, in fact, a lot of times, the nonverbal cues go along with language. But sometimes, especially in little babies, before they really have a good grasp of language or good developed language, you know, that nonverbal communication can be important.
And as I think about, you know, an infant who's crying, it doesn't necessarily mean that they're in pain. It could mean any number of things. And they've just learned, hey, if I express myself in this crying way, I get what I want.
And so, is there, you know, is there a way that parents should respond to crying? And especially as we think about like colicky babies, does that nonverbal infant communication come into play at all? What should parents know about that?
[Jamie Boster]
Yeah, absolutely. That's another great question. So typically, it's nice to be able to talk to parents about being able to recognize different types of cries.
Most parents are usually able to tell a cry that's like out of hunger or out of discomfort or things like that. And one of the things we typically tell parents to do is label that kind of cry for that child. Like, oh, wow, you sound very angry.
Maybe you're upset. Maybe you're hungry. You know, talking about what you think that cry means is really helpful for receptive language development and kind of translating that and inferring meaning from things.
We do this a lot for speech therapy. So, trying to kind of label the emotion or the feeling that you think is associated with the cry to teach that vocabulary concept.
[Dr Mike Patrick]
Yeah, very, very interesting. I also loved the concept of narrating as you go about your day, like saying out loud the things that you're doing so that your infant can hear those things and actually see the actions that are happening along with that particular language. So that's really cool.
Kelsey, from the clinician standpoint. So as babies are developing and they're getting that expressive language down, they're often seeing their pediatrician or their pediatric provider very frequently. You know, two months, four months, six months, nine months, 12 months.
What should we as clinicians, you know, especially in primary care, really be on the lookout for in terms of appropriate milestones for expressive speech?
[Kelsey Schilling]
Yeah, so for expressive speech, we're looking at children being able to demonstrate that cooing that I mentioned where they're doing that exploration around four to six months and transitioning into babbling around six to seven months. And generally, we'll see that turn into words around a year, sometimes a little earlier, sometimes a little later. And then that's around the time that we start to see some of that faster mapping that Jamie mentioned, where we start to see kids start to really grab on to a lot more words.
Generally, those are going to be from an expressive language standpoint, more like nouns and verbs, things that are very easy for them to meet their basic wants and needs and communicate those with caregivers. And by two years of age, we generally see them have about 50 of those and also some two-word phrases. So, something like want cup or more ball, things like that.
From an intelligibility standpoint, we're looking for children around two years of age to be about 50 percent intelligible, meaning that their speech sound production might not be perfect. And we're going to understand about 50 percent of what they say.
[Dr Mike Patrick]
Yeah, I think that's really important for parents to understand. So that first year, we're really single words. And then between 12 months and 18 months or so, we still may just have single words.
And then around age two, they start putting two words together. And there's going to be difference among kids in terms of that development, probably both genetically and also environmentally. I would imagine those really both sort of play a role in all of this.
But I think what you said was really important for parents to realize is that even at age two, only half of what they say is going to be understandable. And that's OK. Like, that's a normal thing because there's a lot of parents like, hey, see, I don't, you know, the kid says something, the doctor's like, I don't know, you know, looks at the mom and the mom's like, I don't know what he said either.
But a lot of parents then are like, well, maybe we should be able to understand it. But in reality, it's only about 50 percent, right?
[Kelsey Schilling]
Yeah. It's generally sometimes kids, like you mentioned, will be kind of on the higher end of that and they might be perfectly intelligible at two. And then there's others who might be around 50.
I think when it's when we start to see that it's significantly unintelligible is when we start looking at, you know, normal versus disordered and looking at potential for speech therapy.
[Dr Mike Patrick]
I imagine you also get a lot of parents who compare their kids. I remember when my kids were young, my daughter, like at 18 months, like she was talking in sentences and you could really communicate and my son's still, you know, pointing and grunting at a lot of things. Is there a difference you find when you're looking at one kid versus another?
Is there a difference in the sexes? Is there a difference in like first child versus second child? Are there things that can account for differences from one child to another, even with the same mom and dad?
[Kelsey Schilling]
Every child is so different. So it is, as you mentioned, it is highly variable between like children in the same family. I think family dynamics has a lot to do with it.
If you have an older child who does a lot of the talking or parents who do a lot of the talking for a child, sometimes they just don't take ownership of that. And so, they might be a little bit more behind because everyone else is talking and they're the observer. So, it can it can definitely vary.
The research supports that sometimes girls do progress a little bit faster in some of those milestones, but that's not always the case either.
[Dr Mike Patrick]
And then if we think about speech sound errors and that they're common two years of age, when do you start to get concerned and are there particular sound errors that that lasts longer and may be more of a concern in terms of needing a referral to see a speech language pathologist?
[Kelsey Schilling]
Yeah. Kids love to make things really easy as they're learning all of this new language. So, something that we see that can be normal and it can be disordered depending on type and how long it persists is something that we call cluster reduction.
So, we'll see that a child might reduce a consonant cluster to only say one of them, such as saying like Bach for block. Assimilation is another common one where we see kids will use the same placement as another consonant in the word. So that can be like Guck for duck because the K sound is produced in the back.
So, they produce the G sound in the back as well instead of D or like another one might be tat for cat. Same thing. We're producing that those two consonant sounds in the same placement in the mouth.
Fronting. So, this is one where we actually produce a back sound as a front sound because it's a little bit easier for kids. Something like top for cup.
Stopping, which is using a short sound as a replacement for a long sound. So top for shop, substituting that T for SH. And gliding.
This is a pretty common one that often persists into disordered, which is using that W or a Y sound to replace an R and L. So, something like wabbit for rabbit. Those R's are pretty pesky.
And then final consonant deletion. So, dropping the last sound for a word. So instead of saying look a bus, we're saying look a buh and eliminating that S.
Normally these will resolve on their own in a typically developing child. And they're going to be primarily gone by the time that a child is aged three to four. But some of these, like I mentioned, that cluster reduction and gliding, those can last a little bit longer into like five or seven before we start to be concerned.
[Dr Mike Patrick]
When is a typical age that you would recommend a referral for a speech language evaluation for an individual kiddo? Like is there a particular age when that ought to happen if parents have concerns that these sound errors are persisting?
[Kelsey Schilling]
There's not necessarily a typical age. I think if there's concern, it never hurts to get an evaluation. We always tend to lean towards that because we can always identify something early and give the parents strategies to be able to maybe prevent some ongoing therapy needs in the future.
Maybe just do some quick check-ins, you know, every few months to see how they're doing. But if we wait on that, then sometimes we can find ourselves needing to do a lot more therapy just to kind of catch them up. So, the earlier, the better, honestly, if we have concerns.
[Dr Mike Patrick]
Do you take into account functional language, meaning that there may be a sound error, but as long as the communication partners can understand what it is that the child's trying to say, you can give that a little bit more time to see if it sort of works its way into normal sounds or typical sounds versus it's really interfering with our relationship and quality of life because I don't really understand what you're saying most of the time. Is that something you take into account for room to refer?
[Kelsey Schilling]
Yeah, I think that if we're seeing that there's just huge communication breakdowns because there's so many different sound errors that are occurring, we definitely would push that that is something that, you know, we get a child into therapy. If it's, you know, just one area or one sound, sometimes we can kind of wait and see or give tools and maybe do an evaluation but not bring them in for routine therapy and give the parents some strategies to help promote that sound production at home. So, yeah, I think it depends on the severity some as well.
But again, always the evaluation is great to have just so we can have a baseline to jump from.
[Dr Mike Patrick]
Yeah. Jamie, can you speak a little bit about the importance of language in terms of kids socializing with one another? So, like, as we think about language needs to be understandable so the child can communicate, it would seem then that before a child goes to, like, preschool and certainly before kindergarten, they ought to be able to communicate pretty well.
Can you just speak toward the importance of that social aspect of language?
[Jamie Boster]
Yeah, absolutely. So, there's lots of social reasons that we use language. And this is one of the things that we definitely pay attention to when we're evaluating children with speech and language impairments.
We want to think about the variety of communication functions. So, is that child using language for a variety of functions, not just, like, requesting or something like that, but are they able to use language to comment and label and protest or question people? So, are they able to use language in that flexible way to engage in a variety of things to build relationships and interact with communication partners in a really meaningful way?
We also want to think about, are children able to use language to engage in play-based activities with their peers, and are they able to do that across multiple environments and things like that successfully? When children are really young, it's actually very important that they have the opportunity to play with language with their peers. This is because peers can really provide a lot of modeling opportunities, and they really get a chance to play with language and experiment with it, with opportunities to see what works, what does not work.
And then they also have opportunities to have interactions with communication partners who are more experienced, like adults, who are able to provide things like scaffolding in terms of how words should actually go together. So, if the child says something like, car red, and the adult says, oh, yeah, the car is red, or something that is a red car, really modeling the word order and things like that as they should be. So, using language in these social interactions is actually really helpful for understanding how language works.
[Dr Mike Patrick]
Yeah, that's a really great point, because it's not only about communication, but that modeling and building a scaffold. And maybe there's elements of their language development that they're not going to get at home because there's particular vocabulary words that parents may just not use very often. But when they're in the preschool environment, maybe another child is using a particular word or the teacher is using a word that is not said at home, or your child is sharing words that others don't necessarily hear in their homes.
And so, that social aspect of development does seem really important. Kelsey and I were talking about sound errors, so really more speech issues. And when we ought to think about referring to speech-language pathology, what about a language-related concern?
So, we've said speech is a little bit different than language. What sort of language-related concerns should prompt closer evaluation?
[Jamie Boster]
Yeah, so you need to think about both expressive and receptive language when we think about whether something needs to be further evaluated. When we think about receptive language, we're thinking about, is the child having problems with understanding what is being said to them? If so, they may have receptive language delays.
And you may notice this if a child is having difficulty following simple directions. If it seems like they're unable to identify certain concepts, like if they have difficulty pointing to their eyes and ears, nose, mouth, things like that. If it seems like they may be a little confused about what you mean when you say things to them, that might be another sign of a receptive delay that needs to be addressed.
So just thinking about what that child is able to comprehend, and does it seem like they're able to gain deeper understanding as they're getting older? So, if that seems to be not happening, it's something that we would want to evaluate further. Now when we think about expressive language delays, we're thinking about, are children having difficulty expressing concepts and then using language to engage socially with others around them?
So, if they're having difficulty preparing sentences or putting words in the right order or expressing concepts to others appropriately, they may have some expressive delays. And again, you're going to think about what Kelsey was talking about, like moving from those babbling to being able to use gestures to being able to use true words around the age of 12 months and then moving to combining words and then using more advanced language. If children are not really following that progression and developing more complex language skills over time, that might be another sign that we need to evaluate further for expressive language delays.
And children can have either receptive or expressive or a combination of both delays. Yeah.
[Dr Mike Patrick]
When there are these delays occurring, is it more likely that there'll be other developmental delays that go along with that? And so, are there kids who get picked up with like autism because of their language development, for example? Which seems to me it'd be really important to refer these kiddos to try to figure out what the issue is and how can we best help them moving forward.
Is that something that you really get involved in?
[Jamie Boster]
Yeah, absolutely. So sometimes when we see receptive and expressive language delays, it may be a sign that other impairments are happening as well, sometimes intellectual impairments and difficulties with cognition. For autism, we often think about social impairments as well and being able to use social language.
So sometimes when we see these language delays, it can be a sign of other disabilities as well that we need to address. So certainly, something that we include as part of our full evaluation when we do speech and language evaluations.
[Dr Mike Patrick]
Yeah. Yeah. Kelsey, I want to bring this back to primary care providers.
As we think about the things that we've talked about in terms of sound errors and language delays, from a pediatrician standpoint, what are best practices for evaluating for speech and language when we see kids for well checkups? And I think this is important because we as practitioners, we are pulled in so many different directions, talk about so many different things, you know, like screen time and sleep and meals and all of these things. And there's only, you know, a certain amount of time that we have with each family.
What is sort of an efficient way of screening for problems?
[Kelsey Schilling]
I think those markers that I had shared earlier about, you know, expecting about 50 words around two and those intelligibility markers where we expect that a child might be about 50 percent intelligible at two. We also look at 75 percent intelligible when they're three and 100 percent intelligible when they're four. Again, that doesn't mean their speech is perfect.
It just means we can understand. Those are really great markers for a pediatrician, a pretty fast way to kind of identify if there's a problem. But I think also we see that especially in those early years when we get two to three years old and we've got kiddos who maybe have the receptive language, they understand what's going on, but they don't have that expressive language to be able to really communicate what they're understanding.
We start to see a lot of kind of behavior and frustration coming from the child because that's the only way they can communicate. And so, if the parents are reporting things like that, that is a really good indicator that there's probably something going on and maybe we can provide some support through an evaluation and some speech therapy.
[Dr Mike Patrick]
Yeah. Yeah. So not only asking questions, but also just engaging with the child and seeing, you know, what do you understand and how much of it can you not understand?
And I love that little tip there. So, 50% intelligible at age two, 75% at age three, and 100% at age four, because then that's when they're going to be going to preschool and kindergarten and we want them to be able to communicate for sure. So, we want to address that without a question.
We've not talked a lot about hearing as part of language development and speech development. I would imagine, you know, being able to hear what others are saying is going to be really important. Is a hearing evaluation part of also what you guys do?
I mean, I know there are hearing specialists, but is hearing part of your trade as well, Kelsey?
[Kelsey Schilling]
Yeah. In our outpatient clinics, we have the ability to do some hearing screenings. And then if we have any further concerns or we aren't able to do a hearing screening, we do always ask about this and we will refer on to audiology just to be sure that there's nothing going on that's, you know, impeding their ability to hear and engage with the communication and language that they're hearing in their environment in order for them to progress.
So, it's always something that we are looking for in our evaluations.
[Dr Mike Patrick]
And then as providers, what should we be telling families they can do to sort of support typical development or when there are some, you know, minor issues, but it's still early and maybe not quite time to refer yet? What are some things that families can do to help this process of language development and speech development along?
[Kelsey Schilling]
Yeah. As Jamie mentioned earlier, that interacting with their child and kind of narrating their day is really, really valuable. And it's just really talking to your kid.
I like to tell my families; pretend you're a sportscaster. And you can almost be a little bit annoying to yourself because you're talking so much, but it's great, valuable language input for the child to be able to hear all of these different words throughout the day and across different contexts so they can really start to attach meaning to what these words are. So, playing with them, narrating them, doing simple nursery rhymes together and prompting phrases when you're playing.
So, like maybe they're going down a slide and you're going to say, ready, set. And you kind of wait and see if they will fill in go. And if they don't, you can still do go.
But it's a nice way to really use simple language through play that's fun for them, but they're also learning at the same time. While you're playing, labeling items like animals or colors or making the animal sounds. Again, talking about maybe what you're eating during meals or during bath time.
It really doesn't have to be anything. It sounds so simple, but I think sometimes going through your daily routine, parents just kind of, you know, they don't do as much talking sometimes. And so just kind of having that on the forefront of your mind to really be communicating as much as you can and giving them as much language as possible is really, really helpful in helping them to learn.
[Dr Mike Patrick]
Yeah. You know, I hadn't thought of this, but a lot of parents may be on their phone, you know, scrolling and you're not talking when you're doing that. And so, in the past, you know, if we were talking to someone on the phone, your child could still at least hear your end of the conversation and is still picking up language and words.
But as we text one another, there's really less opportunity for that, right?
[Kelsey Schilling]
Yeah, definitely. And I mean, even with the use of screens, I, you know, I try to always tell my families that everything in moderation and sometimes you might need 20 minutes to unload the dishwasher and know that they're not, you know, you know that they're safe and in a safe place. But when you have the bandwidth to be able to sit and engage with your child, that's always the best thing.
[Dr Mike Patrick]
Yeah, absolutely. Jamie, as we think about referrals, are there certain red flags that really ought to result in a referral every time? Like, what are some things that really ought to get our radar up and think, oh, we really do need to send this kiddo to see speech-language pathology?
[Jamie Boster]
Sure. I think it falls back on our speech and language milestones, which are really important for us. So again, like Kelsey said, like if our patients and families are not seeing things like first words and things like that around age one, that's certainly a red flag.
We would definitely want to have a child evaluated if they are not, you know, making some vocalizations and making some babbling sounds and then making some first words attempt around, you know, 12 months of age. We definitely want to refer for a speech and language evaluation. Children are not really attending to communication partners, not turning to their, turning their head to their name, not following some basic instructions like being able to respond to the word no or come here and things like that with gestures.
We want to refer for a speech and language evaluation as well. Also, speech and language development seems to be a little inconsistent or slow. So, if it, you know, seems to have a little burst, but then go away or regress, we would want to refer for a speech and language evaluation then.
Or if it just seems that compared to typically developing children, they are a little bit delayed, that would be a major reason to go ahead and get a speech and language evaluation as well. So anytime there's concerns that a child is not meeting their milestones or just feels a little bit delayed or behind, we would want to go ahead and refer just to get it checked out to see if there's any underlying causes for that and then to see if therapy is necessary as well.
[Dr Mike Patrick]
It sounds like we're better off referring earlier if we have a question of whether we should. And then, you know, if they come to see you and you're like, well, you know, this is still normal at this age or, you know, it's a little bit of an outlier, but let's give it a bit more time and we'll reschedule a follow up in a few months sort of thing. But from the from the pediatric provider standpoint, we probably ought to refer quick, you know, fairly quickly if we are concerned and not necessarily just wait.
[Jamie Boster]
Yeah, we always want to kind of be on the safer side. It's easier for us to take a look at a child and see if they are meeting milestones and just kind of touch base with them. Sometimes we can provide some parent education as well, just of like things you can do at home to keep an eye on kids as they get older, sometimes even just providing parents and caregivers with information about milestones that their child can be achieving would be helpful for them.
Our national organization has some great resources available for parents to kind of keep on a fridge and things like that, which can be nice. Sometimes I know when I do evaluations, if even if a child isn't showing any signs of delay, I'll still print out like milestones and things like that for parents to keep an eye on. So, you know, they have like, OK, so it appears on track right now, but we might want to keep an eye on it and see if they're still meeting these milestones around age two or age three.
Sometimes that can be helpful as well. So, I think providing parents with resources, even from initial evaluations, can be very helpful just to kind of put them at ease and make sure that we aren't missing something from an early, early point.
[Dr Mike Patrick]
Yeah, so important. Finally, as we as we wrap up, are there any other little nuggets of information that pediatric clinicians ought to be keeping in mind or things we can share with families? Any other little tips or tricks?
[Jamie Boster]
I think just kind of making sure that we need to be focused on speech and language and keeping our eyes on our children and then just trying to make a big effort to engage children in lots of fun activities. Play is very helpful for language development. So, play is really how children learn language and play with language and things like that.
So that is the source of the greatest investment for children is really engaging them in those play-based activities with communication partners that are really exciting and meaningful to them. So that is something that can be very supportive of both speech and language development.
[Dr Mike Patrick]
Well, this has been a really fascinating conversation. And again, it's something that pediatric providers do see very, very often in terms of parents having concerns. Sometimes we have concerns.
It's definitely right up there front and center in terms of language and speech development, as we're seeing kids frequently during their first few years of life. So, we really appreciate you stopping by. We are going to have some resources in the show notes for everybody.
If you head over to pediacastcme.org, look for the show notes for this particular episode. We'll have a link to the American Speech Language Hearing Association. They also at their site have a page on typical speech and language development that's always good, you know, occasionally just to look that over and review it so that we really cement that in our mind, and we know the things that we should be asking and looking for at those well visits.
And then Kelsey wrote a blog post for our hospital, Speech and Communication Development, birth to three years. And that's a great resource for parents, plain language, something that families can understand. And we'll put a link to that in the show notes as well.
So once again, Jamie Boster and Kelsey Schilling, both speech language pathologists at Nationwide Children's Hospital. Thank you so much for stopping by and chatting with us today.
[Jamie Boster]
Thank you for having us, Dr. Mike. It was pleasant to talk to you about our speech and language department and give you some more information about speech and language evaluations and development for speech for kids.
[Kelsey Schilling]
Thank you, Dr. Mike. Thank you.
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[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast to CME a part of it. Really do appreciate your support. And thanks again to our guests this week, Jamie Boster and Kelsey Schilling, both with speech and language pathology at Nationwide Children's Hospital.
I also want to mention in the show notes, of course, we will have a link to speech and language pathology at Nationwide Children's Hospital. So, if you aren't sure of how you refer a patient to those folks, just head over to the show notes at PediaCast CME dot org. And if the show notes for this particular episode, we'll have a link to speech and language pathology at Nationwide Children's.
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And so even though some of those episodes may be pretty old, a lot of them may still have great relevant information for you. But the CME is only the most recent three years’ worth of episodes. Reviews are helpful wherever you get your podcasts.
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And then a third podcast that I host is a faculty development podcast. It's called fame cast. It's from the center for faculty advancement, mentoring and engagement at the Ohio state university college of medicine.
So, if you are a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you, and you can find fame cast at fame cast.org and wherever podcasts are found by searching for you got it. Fame cast. Thanks again for stopping by.
And until next time, this is Dr. Mike saying, stay informed, keep it evidence-based and take care of those kids. So long, everybody.
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