Articles
By Isa Marrs, MA CCC-SLP

How prevalent are speech and language disorders? How should you introduce new foods to your child? Who can provide speech therapy and what do you need to know before choosing a speech therapist? These questions and many more are answered here.

Does your child have frequent tantrums? Are you looking for information on Apraxia? More articles are here.

If you have other questions look for them on the FAQs page or ask Isa. Learn about evaluation and treatment options here.

Remember: Click the green words and phrases to "go to" the information.

Feeding
Developing a Healthy Feeding Relationship with Your Child - Does your angel become a devil at mealtime? Do you want to avoid having mealtimes become a struggle? This article will give you an introduction to developing a healthy feeding relationship with your child.

Feeding Milestones for Children - Should you be concerned about drooling, vomiting or constipation? When should you introduce cup drinking or solid foods? This overview will give you some guidelines about what to expect and when to be concerned with your child's feeding development.

The Speech Therapy Primer - What steps should you take to make sure you choose the right therapist for your child? What are your options for getting evaluations or therapy? What does it take to become a speech therapist? This guide will answer those questions and more.

Speech and Language Disorders Therapy - This article discusses articulation disorders. It notes some service options and gives statistics on the effectiveness of individual versus group therapy.

Speech & Language Milestones - By the time you child is three most people should be able to understand what he is saying. This is a Printable Copy of the Speech and Language Milestones that are listed in "The Importance of Being Understood".

(Printable copies require Adobe Reader. If you don't have it, click the Adobe icon on the left side of the page to get it for free.)

Developing a healthy feeding relationship between a parent and child is extremely important and begins very early on in life. Positive or negative attitudes towards food are learned early on and often will be maintained throughout adulthood. Meal times can be happy, enjoyable, and social experiences or they can be stressful and frustrating for both parents and children. Power struggles are often developed around eating and can make meal times miserable for all involved.

Ellen Satter, a nutritionist and family therapist, has written extensively on the "Division of Responsibility" when it comes to feeding children. The parent decides "what" to prepare, "when" to prepare it and "where" the meal will be served. The child is responsible for how much is eaten and if anything is eaten at all. Research has shown that children are able to regulate there own feelings of hunger and will stop eating when they are full. This however will change if they are forced to eat specific portions determined by an adult. Providing variety within a meal is important and will allow children to make choices within a controlled environment.

It is never too late to develop a healthy "feeding" relationship with your child, however the sooner the better. Within the parent's responsibility of "what", "when", and "where" here are several suggestions to incorporate. Meals should be offered at set times as should snacks. Many families have had success with three set meals a day and two planned snacks. Depending on your child's appetite this could be adjusted accordingly. Children should not be allowed to snack continuously throughout the day as this will interrupt their understanding of hunger and fullness. Depending on schedules, family meals are strongly encouraged. Children learn many things from observing adults and older siblings and eating is no different. Seeing what you eat and how you eat is extremely important.

When introducing new foods it is important to offer a familiar and preferred food at the same time. Do not be discouraged if the new food is not touched the first time, or maybe even the first few times. If children are not pressured and see others trying a food eventually they will try it. Sometimes they will try it and spit it out which does not always mean they do not like it. Keep offering it and do not force them to eat. I often recommend preparing a container of a food you want to introduce to your child and keeping it in the refrigerator or freezer and then offering small amounts at several meals. This way you will not have to keep preparing the food and end up throwing it away. Children's likes and dislikes will often change and this is normal. It is also normal for children to eat more some days and less on other days.

When it comes to feeding, sometimes you can do everything right and your child will continue to have difficulty. Some of the signs to look for in a child who may have an underlying medical condition or physical limitations are: vomiting during or after meals, choking, gagging, coughing, difficulty transitioning to solid foods, nasal regurgitation, constipation or crying and irritability after meals. If your child displays any of these symptoms it is recommended that you discuss this with your pediatrician. A speech-language pathologist who specializes in oral-motor-feeding will also be able to make appropriate referrals if deemed necessary. Other minor things to look for may be drooling, difficulty with utensils, cups, straws and mouth stuffing. These behaviors could also be appropriately assessed by a speech-language pathologist who is trained in feeding.

One of the great joys and responsibilities of parents is to feed their children. Depending on your child's health, personality and your feeding strategies, mealtime can be rewarding, frustrating or even terrifying. While some may have more obstacles to overcome than others, feeding remains a complicated issue for many. With patience, guidance and willingness to change as well as a positive attitude towards eating you can have a healthy feeding relationship with your child.

0-3 months
At 0-3 months babies are solely breast and/or bottle fed. They have oral reflexes for suckling and swallowing. It is best to feed infants at about a 45 degree angle.

4-6 months
At 4-6 months babies begin sucking and are no longer only suckling. The action of drinking a bottle or breast feeding is becoming less automatic and more voluntary. It is during this time period that many babies will be introduced to soft solid foods such as cereals and pureed fruits and vegetables. Cup drinking may also be introduced at this time (6 months) as they will practice their skills for future transition to the cup.

6-9 months
Between the ages of 6-9 months babies are able to open their mouths and wait for the spoon to enter. They are also able to use their upper lip to clean food off the spoon. At this time dissolvable soft cookies may be introduced as well as ground or lumpy solids. Many babies are able to drink from straws at 9 months.

10-12 months
Mashed or chopped table foods with noticeable lumps are introduced during the age range of 10-12 months. Babies also begin to take most of their liquids from a cup although bottle or breast feeding may continue for bedtime. Their tongue may protrude under the cup in order to add additional stability. At 12 months they also have a controlled, sustained bite and are able to bite through a soft cookie and possibly a harder one depending on the presence of teeth.

13-15 months
13-15 month olds will playfully bite on the spoon. They will also begin to bite on the cup while drinking. They will improve with their biting skills and are better able to use a controlled bite to bite through a hard cookie. Chopped table food continues to be provided and more control over the lips and tongue has developed. Most 13-15 month olds will not take a bottle and instead will use a straw or regular cup.

16-18 months
At 16-18 months children are given more challenging foods that require chewing such as most meats and many vegetables. By 18 months they are capable of chewing with their lips closed however they often will not, however when their lips are open they should not be losing any significant amount of food or liquid while eating and drinking.

19-24 months
In the 19-24 month range children will begin to gain more control of cup drinking and will bite the cup less and less. They are learning to drink in longer sequences with little to no spillage. By 2 years old children are able to manage any type of food they like as they have learned all the skills they need to eat every type of food, although they will continue to "fine tune" these skills over the next few years. (It is still recommended that foods that may be choking hazards such as grapes and hot dogs be cut in smaller pieces to avoid choking as many 2 year olds are always moving and playing placing them at risk for choking.)

Seek Qualified Professional Guidance if your child exhibits any of the following:

Vomits frequently and the vomiting is associated with pain and discomfort. Many infants "spit up" with no pain or nausea, this is not a concern. They may start "spitting up" as early as newborn and will subside between 6-18 months.

Chronic constipation or diarrhea

Choking, gagging or retching that interferes with eating and/or nutrition

Difficulty advancing to textured foods

Difficulty chewing leading to reliance on pureed foods. Both child and parent may develop anxiety around eating when child is having difficulty chewing.

Excessive mouth stuffing and/or pocketing (storing) of food in the mouth for long periods of time.

Stressful mealtimes filled with power struggles (while this is most often behavioral it can and should be addressed to make mealtimes better for everyone)

Excessive congestion, irritability, skin conditions. All these symptoms may be due to food allergies and should be explored.

Consistent and excessive drooling in the absence of nasal congestion or teething

Does not mouth toys or explore with his mouth. All babies should go through a stage of mouthing.

According to the National Institute of Deafness and Other Communication Disorders (NIDCD), approximately 8 percent of school-aged children have difficulty developing and using language. The NIDCD also reports that 10 percent of children entering the first grade have moderate to severe speech disorders. Communication is at the core of who we are and how we experience life, and thus such disorders can be devastating to a developing child both academically and socially.

There are critical distinctions between speech and language. Language can be broken into two areas: receptive language, which is the ability to understand what is being said, and expressive language, which is the ability to put words together into cohesive thoughts in order to express ideas. Speech is the actual sounds we make and the voice we use.

Speech disorders include but are not limited to stuttering, vocal nodules, and a variety of articulation disorders. According to the American Speech and Hearing Association (ASHA), articulation disorders constitute three out of five of all speech and language disorders, and are the most prevalent communication disability diagnosed in preschool and school-aged children.

An articulation disorder may be functional, meaning that is has no known cause, or it may be organic, meaning that it has a specific anatomical, physiological, or neurological cause. Severity of the disorders can range from mild to severe. A mild articulation error is the incorrect production of a specific sound, while a severe articulation disorder, such as apraxia (motor planning deficit), may result in unintelligible speech and an inability to put sounds together to form words.

Most children have some developmental articulation errors when they are learning to talk, but by the age of three, they should be easily understood by most listeners. If this is not the case, speech therapy may be warranted. Because sound production may be distorted as soon as a child begins to vocalize, children can be screened or evaluated for speech delays and disorders at any age. Parents should err on the side of caution as early detection and treatment yields excellent results. Children with articulation disorders that are left unresolved are also at risk for reading and writing disabilities, so a wait-and-see attitude is not advisable.

According to ASHA's National Outcomes Measurement System (NOMS), 70 percent of preschool-aged children who received speech therapy exhibited improved intelligibility and communication functioning. Approximately one half of the children who were unintelligible when treatment began progressed to a level where they were understandable to all listeners. The study also indicated that the amount of therapy provided had an impact on outcome; the children who achieved intelligible speech received about twice as much therapy as the children who remained unintelligible.

When comparing your child to his or her siblings or friends, remember that there is a wide range of what is considered normal speech development. Following are some of the milestones:

0-3 months
In the first month, vocalization is limited to crying to signal hunger and discomfort. In the next two months, babies may begin to laugh and make sounds in the back of their throats that sound like "goo". They recognize voices and are able to distinguish between happy and angry tones.

4-6 months
In the 4-6 month range, babies begin to use vocal play as they gain more control over their oral structures. They put vowels and consonants together and make true speech sounds. They also start to make non-speech sounds such as raspberries, yelling, and growling. They should also vocalize and practice their sounds when playing alone.

6-11 months
Babbling should begin in this range. Reduplicated babbling is the repetition of a syllable several times, such as "ba ba ba ba". Babies are now able to make several in one breath and will attempt to imitate adult sounds. Babbling is a baby's way of practicing sounds and oral motor skills that are required during actual speech. Babies who are not babbling should be evaluated, as children with speech disorders have been found not to babble as babies.

12-18 months
During this period, first words should emerge along with long strings of different syllable combinations, known as jargon. Jargon can sound like baby is using her own language, and may contain words and adult-like speech patterns. Consonants produced most often at this stage are b, m, d, and n.

18-36 months
This is when children should be learning words rapidly. Their speech may consist of developmental errors in which they are simplifying words that are difficult to say by substituting easier sounds or omitting a sound altogether. Children should be using most of these sounds: b, m, p, n, t, d, k, g, f, ng, and s. Their ability to speak clearly should improve daily as they figure out how to use sound combinations. Distortions of sounds are not typical and children with "different" sound productions should be evaluated. For example, if a child appears to be "snorting" sounds, or if sound quality is overly slushy or hoarse, these are red flags of a possible speech disorder.

3-4 years
By the age of 4, children should be using more difficult sounds such as l, r, sh, ch, y, v, z, dg, and th. Some children will have more difficulty learning these sounds than others, so their overall intelligibility should determine whether an evaluation is warranted. If a child is frustrated or unable to communicate with a variety of people (extended family, peers, teachers) there may be a delay or disorder.

The way we sound is an important part of who we are, how we see ourselves, and how we are viewed by others. While articulation disorders are the most prevalent communication disabilities diagnosed in preschool and school-aged children, they are treatable in the majority of cases. And the earlier a speech disorder is diagnosed and treated, the better the prognosis and the less likely the condition will have negative effects on the child's educational and social development. Every child deserves a chance to speak clearly and to be understood.

Only a Speech Language Pathologist must have at least a Master's degree, have passed National Boards, received national certification from the American Speech and Hearing Association (ASHA) and a state license. On the other hand a TSHH only has a bachelor's degree and a teaching certificate. A CFY has received a Master's degree but has not received a Certificate of Clinical Competency from ASHA or an SLP license. The Certificate of Clinical Competency is only received after the CFY satisfactorily completes the Clinical Fellowship Year. Teachers of the Speech and Hearing Handicapped and CFYs must work under a fully licensed Speech Language Pathologist until they receive certification and licensure. Once fully licensed, continuing education is required in order for a SLP to remain licensed.

Continuing education allows Speech Language Pathologist to become certified and specialized in a wide variety of areas and ages. Some specialize in geriatrics while others specialize in pediatrics. Some SLPs may enjoy treating people who stutter and take the extra time to receive in depth training in the area of stuttering and stay informed in the latest research and treatment strategies. Other therapists may choose to work with children who have oral motor feeding disorders and will focus their continuing education learning as much as they can about these types of disorders. The more a SLP treats a specific type of speech, language, oral-motor or feeding disorder the more experienced they get and the better they should become at treating related disorders.

Your Options
Evaluations and therapy are available through a variety of sources; we'll go over the main ones here. Private services are available for any age. However, your child's age and abilities will determine what your options are with the government funded programs. The government funded programs are broken into three main age groups: Birth to Three, Three to Five and K-12th grade.

The Early Intervention (EI) program covers ages birth to three and every child in that category is entitled to a free evaluation. If your child qualifies he or she will also be entitled to some amount of free or reduced rate services through an EI provider. Services typically take place in the home, but may also take place in the center depending on the severity of the needs. Many parents have had very positive experiences using this option, while others complain about the length of time it takes to get the process going as well as the inability to choose the therapist that best suits their child's needs. Similar opinions have been expressed by families involved in the three to five year old program (CPSE), program which is controlled by your local school district. For children who qualify, CPSE services are most often provided in their preschool setting or a center based therapy program unless otherwise requested by the family. Therapy may be individual or group according to the child's needs. A frequent complaint of CPSE center based programs is the high turnover of therapists leading to slow progress which is often very frustrating to parents.

After age five evaluations and therapy are conducted within the public school that your child attends or would attend if he or she is in a private school. Children in private schools are entitled to evaluations in their local public school even though they do not attend that school. At the grade school level almost all therapies are provided in groups of up to five children at a time depending on the number of children on the SLP's caseload. Sometimes this is a benefit if your child needs to work on social skills, however if your child's needs are related to articulation grouping is a detriment as children receive less individual attention to their specific needs. Statistics show that children receiving this type of articulation therapy progress slower and require therapy over longer amounts of time.

Private Speech Language Pathology services will offer you the most flexibility in finding a therapist with specific expertise and should provide you a significantly higher quality of service. These services may be provided in the home or center depending on the therapist, and your child's needs. Some will accept private health insurance and some will not. For those that do not, families are often able to receive reimbursement for an evaluation after submitting a claim after the evaluation is completed. Depending on the health plan parents may be able to receive reimbursement for therapy as well.

Choosing a therapist
It is possible to find a good or a bad therapist in any of the above scenarios. The more effort you put into the picking a therapist more likely you will achieve positive results.

Before doing anything else it is important to know what your main concerns are as a parent. This will help you form questions to ask the potential therapists. As noted above, therapists will specialize in different areas and you want your child treated by someone who is in expert in the area that your child is having the most difficulty.

The next step should include looking for a referral. Very likely someone you know has a child that received or receives speech therapy. Ask your friend about their therapist and experiences. You can also ask teachers, pediatricians and other healthcare professionals for referrals or visit ASHA.org. It's always good to get a referral, but it is not absolutely necessary and it is just the beginning of the process finding the right therapist.

Aside from checking availability and location, when you call a SLP one of the first questions you should ask is, "What age group do you primarily work with?" Typically SLP's will choose to work with either adults or pediatrics with the occasional exception. You do not want your child to be the occasional exception as working with children successfully requires different knowledge and skills than is required when working with adults. Even within those two main groups some therapist will specialize even further.

Next you want to ask, "Would you or someone else be seeing my child?" Ultimately you need to speak with the therapist that would be treating your child before you make a decision. Don't be afraid to ask about their qualifications, philosophy, expertise and how long they have been working as an SLP. Be as specific and inquisitive as you need to be to feel comfortable in your decision. You will also want to know what session lengths are available. The session length that is most appropriate will depend on your child's needs. You should also ask if it will be possible for you to observe the sessions.

If the services will be center-based you will want to know if your child will receive group or one-on-one therapy because this factor will affect progress. You may also want to know where you will be required to wait during the session, if siblings are able to wait comfortably and what the parking situation is.

If you are going with a private therapist you will want to know what they charge per session and if consultations, letters and referrals are included or if they will cost extra. You should ask when payment is due and what payment methods are accepted. Is insurance accepted? If not, ask if they will be willing to assist you in obtaining reimbursement.

Prior to making a final decision on a therapist, set up an initial consultation to get a better feel for the therapist and the environment. Not every personality and place is a match. Ask yourself if you feel comfortable with the facility. Observe how the therapist is interacting with your child, and how is your child responding. How are you treated in the initial visit, are you asked to wait outside? Are you welcomed in if you desire?

Speech language therapy is a commitment for both you and your child. Both of you must be comfortable in order to make the process successful. Neither of you should dread going to therapy, it should be a positive experience for all involved. While finding the right therapist for your child can feel overwhelming, if you use the information in this article it shouldn't be.

It is widely agreed that 5-10% of children have speech and/or language disorders. Speech and language are often incorrectly thought of as synonyms when in fact they are not. Language is being able to understand what is being said (receptive language) and being able to put words together into cohesive thoughts and the ability to express ones ideas (expressive language). Speech is the actual sounds we make. Expressive language may be intact but a speech disorder may impact ones ability to be understood. Speech and language disorders often coexist however they also occur on their own frequently.

Roughly 3 out of 5 speech and language disorders are related to articulation problems, according to the American Speech and Hearing Association (ASHA). When looking at articulation many speech language pathologists will differentiate between "delay" and "disorder". Many children exhibit "normal" developmental errors in their speech. Some children will have many of these errors while others will have very few. Most of these developmental errors will correct without intervention; however, this is not always the case. Some children will be "delayed" in eliminating developmental errors and will require speech therapy for a short period of time.

An articulation "disorder" consists of sounds that are produced "differently" than what would be expected for any age. The cause of the disorder may be functional (Incorrect production of a sound with no known anatomical, physiological or neurological basis) or it may be organic (due to anatomical, physiological, or neurological causes). Articulation disorders almost always require speech therapy in order to correct.

When looking for speech therapy services for your child there are several options depending on your child's age and needs. Programs are available through Westchester County such as Early Intervention (birth-3) and CPSE, a 3-5year old program through your school district. After age 5, speech and language services are provided within the school setting. Private therapy is also available for any age group. Qualified, experienced therapists are available in each of these options; however, due to numerous factors such as setting, therapist expertise and group size, the rate of progress varies greatly.

Speech language pathologists in schools often need to see children in groups due to the large number of children requiring services. These groups may or may not include children with the same type of speech/language disorder. When several children with numerous goals are in a group it decreases the amount of time in each session for an individual child. According to the National Outcomes Measurement System (NOMS), when looking at children who have articulation disorders only, who received 20-40 hours of therapy, children receiving individual therapy were much more likely to show measurable functional progress in their articulation skills than were those who received group treatment (91%-50% respectively).

Having children with speech and/or language disorders can be a long complicated road of questions, choices, and misinformation. While many will say to you "He will grow out of it", this may or may not be the case. Early detection is the key to success when it comes to an articulation disorder. The less time an incorrect sound or sounds has to become ingrained and habitual the faster therapy will go. The less time a child is self conscious or teased the better their self-esteem will be. The way we sound is a big part of who we are and how others see us. Quality speech and language services provided by a licensed speech language pathologist could make all the difference in the world.