Children with Speech delay at Pediatric Clinic DRHC Dubai

Child with speech delay - A child is considered to have a speech delay if the child’s speech development is significantly below the normal for children of the same age.

Speech Development

Cause of Speech Delay

• Intellectual Disability
• Hearing loss
• Express language disorder
• Autism
• Elective mutism
• Receptive aphasia
• Cerebral palsy
• Bilingualism
• Maturation delay.

Indication For Referral

Any age having a lack of interest to sound; lack of interest in interaction with people and loss of previous milestones.

• 6 months – 9 months: poor sound localization
• 12 months: No verbal / failure to use mama–dada
• 15 – 18 months: No single words; poor understanding of language
• 24 months: Vocabulary less than 50 words or not 2 words phrase
• 48 months: Inability to participate in a conversation

Intellectual Disability

Kids with intellectual disabilities have a speech delay and auditory comprehension delay. The cause of 30 - 40% of children with mental retardation cannot be determined. Known cause of mental retardation includes genetic defect, intrauterine infection, maternal medication, hypoxia, kernicterus, hypothyroidism, meningitis, encephalitis, and metabolic disorders.

Hearing Loss (Conductive or Sensorineural)

Conductive hearing loss

It is commonly caused by OME (otitis media with effusion) or malformation of the middle ear structures or atresia of the external auditory canal. Sensorineural hearing loss may result from intracranial infection, hemorrhage, kernicterus, pendred syndrome, Waardenburg syndrome, Usher syndrome, meningitis, hypoxia, and toxic drugs.

Maturation Delay

In this condition, a delay occurs in the maturation of the central neurologic process, required to produce speech. It is more common in boys and there is a family history of speech delay. The prognosis is excellent; they have normal speech development by the age of school entry.

Expressive Aphasia

These children have normal intelligence, normal hearing, and skills and development. The primary defect is brain dysfunction that results in an inability to translate ideas into speech.

Bilingualism

A bilingual home environment may cause a temporary delay in the onset of both languages.

Autism

Failure to make eye contact, repetitive motor activity, and speech delay.

Selective Mutism

The child does not speak because they do not want to. They speak just when they are alone or with their parents but they don’t speak at school, in public situations, or with strangers.

Receptive Aphasia

The child responds normally to nonverbal auditory stimuli, but they have problems with comprehension of spoken language.

Cerebral Palsy

A child with cerebral palsy commonly has a speech delay because of hearing loss incoordination or spastic of the tongue muscle, and co-existing mental retardation.

Approach to The Child with Speech Delay

1. Full history of language development milestones.
2. Determine if the delay is expressive alone or receptive. Does the child follow commands?
3. Complete development history including:
   • Gross motor
   • Fine motor
   • Social
   • Cognitive
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4. The social development is critical:
   • Does the child point to objects?
   • Is the child interested in communication?
   • Does the child demonstrate reciprocity?
   • What is the nature of the child’s play?
5. Have any milestones ever been lost?
6. Result of audiology test
   • Does the child turn to sound or respond to his name
7. Medical history focusing on the factor that affects cognition (genetic disorders, prenatal exposure, prematurity, birth asphyxia, intracranial hemorrhage); hearing (meningitis, ototoxic medication, chronic otitis media) and motor development (neuromuscular disorders).
8. Family history of speech delay, learning disabilities, hearing impairment, genetic disorders.

Physical Exam

• Observe the child during encounters, including interactions with parents, interaction with strangers, and the child at play
• Assessment of the growth and dysmorphic features
• Skin exam for neurocutaneous disease
• Full neurologic exam
• External ear exam and tympanic membranes
• Mouth and pharynx exam for malformation that may impact speech

Investigation

• Formal audiology assessment
• Child with some expressive language ability may be referred for psychoeducational testing
• Karyotype or specific genetic test maybe indicated for abnormal neurologic exam
• MRI
• Iron deficiency and lead poisoning contribute to development delay

The management of a child with speech delay demands a health care team that includes a physician, speech-language pathologist, audiologist, occupational therapist, and social worker. The physician should provide the team with information about the cause of speech delay and be responsible for any medical treatment.

A speech-language pathologist plays an essential role in the treatment plan.

• For children with hearing loss, hearing aids, auditory training, lip reading, reconstruction of the external canal, and cochlear implantation may be necessary.
• Psychotherapy and behavioral therapy are indicated for children with selective mutism or when the speech is delayed caused by behavioral problems, and for autistic children.
• Most children with specific language impairment are at risk for future academic and behavioral disorder and requires regular long-term follow-up.

Dubai Pediatric Clinic at Dr Rami Hamed Center provides one of the leading pediatricians in Dubai. Please Call +97142798200 to book an appointment today with us!