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beandoctor, Pediatrician
Category: Pediatrics
Satisfied Customers: 334
Experience:  Board Certified; Graduated from top 20 medical school
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How do you determine if a toddler is on track with speech

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How do you determine if a toddler is on track with speech development?
My little girl is 2 yrs and 4 months. She has a good vocabulary and does speak in short sentences but also still gabbles a lot in between times. I'm sure she knows what she is talking about but we don't always except if we pick up a word or two in between, we can pick up the intent. I compare her to a couple of others maybe a month or two older and they both can recite a nursery rhyme very clearly whereas mine will say every third word of the nursery rhyme etc. On the other hand she knows all her colours (even light or dark shades) and alphabet and can count, not just recite numbers etc.

I'd love to help with your question!

From the description you provided, my gut instinct is that your daughter is normal. Let me explain why, and tell you what I think you should do.

First, as I'm sure you know, a child her age should have at least a 50 word vocabulary and the ability to make at least two-word sentences. It sounds like your daughter is clearing that bar comfortably.

Second, I'm reassured by the fact that she communicates well. Some children who seem to have a delay in language development have a bigger developmental issue for which the speech delay is just the first problem that gets noticed. For instance, parents of children with autism often go to their pediatrician with concerns about language delays - but those children usually have much bigger problems communicating their wants/needs to their parents even without language. If the rest of her development (motor skills, social skills, etc.) seem to be on track, then I don't think you need to worry about that type of thing.

The only thing that you mentioned that concerns me at all is that it seems like your daughter's expressive language is lagging behind her receptive language somewhat. Sometimes, children will have an isolated speech delay, where they have difficulty mastering the production of language (but are intellectually normal and have no unusual difficulty with processing language). This is something that can be addressed with speech therapy, and it helps to do that early on.

We do have more formal ways of testing a child's development - so probably the best advice I can give you is to talk with your daughter's pediatrician. I see that you're writing in from Australia, so I'm not sure what the customary tests are there - but in the U.S., the most commonly used ones are the PEDS Developmental Milestones (PEDS:DM; a structured questionnaire that you fill out) and the Bayley screen (which requires a trained professional to observe/assess your child).

I hope that this information is helpful to you. If I've answered your original question, please take a moment to rate the quality of my response - your feedback really does matter! And if I can help you with any more questions - now or in the future - please do not hesitate to ask!

Best wishes to you and your daughter...

Customer: replied 4 years ago.
She has had a paediatric general development assessment which did not identify any issues but this would not have identified the expressive language issue as you call it necessarily.
The other bit of info I should mention is that she has had blocked ears for which she has had grommets since January. SHe was last checked two months ago and one had dislodged and that ear had blocked again but the other one was OK. Her hearing was normal but poor localisation in the ear which was blocked again. I don't know if this would have some impact.
From here should we just go to a GP to get a referral for a speech pathologist?
Also, how common is this and will it be able to be corrected?

You are absolutely right - any amount of hearing impairment can delay language acquisition in a young child. But it sounds like her hearing is overall pretty good right now - so although poor hearing in the past might have contributed to very mild delays at this point, it seems like the hearing issue has already been appropriately addressed.

Let me first stress that I think that your daughter sounds like she's doing pretty well, and my gut feeling is that all of this is probably normal. But yes, I think that the best next step is to talk to her physician about what we've discussed. He or she should be able to offer you either a more formal evaluation or a referral to a speech therapist.

If you do have some concerns, I think that seeing a speech therapist is probably a good idea. In the U.S., insurance companies often will not cover the cost of speech therapy unless the child has severe delays, but I've cared for several patients who have paid out-of-pocket... in these cases, the therapists have seen the child for only 1-2 sessions with the goal of demonstrating exercises to the parents so that they can continue to work with the child at home. Again, I know little of the health care system in Australia, but I thought I would mention that just in case you encounter similar difficulties!

I hope that this information helps... please let me know what other questions you have!

Best wishes...

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