Ear Infections and Language Development
When a child consistently has ear infections, or has fluid in his ears, it makes it difficult to hear sounds and words accurately. If you plug your ears with your fingers, you can appreciate the muffled quality of speech your child is experiencing. Recurrent ear infections often occur before age 3 - when a child is learning to speak. These frequent ear infections may lead to speech and language difficulties.
- Speech (articulation) is the production of sounds that make up words and sentences.
- Language refers to the use of words and sentences to convey ideas and express our wants and needs.
You may realize your child is having difficulty hearing if he says "What?" often, has trouble following instructions and / or difficulty paying attention. He may wish for the music or television volume to be turned up as well.
Conversely, you may feel that your child is hearing just fine, despite fluid in the ear or a recent ear infection. However, he may have difficulty understanding words in conversational speech and hearing certain sounds, which could make it difficult for him to learn to produce these sounds accurately. Formal hearing tests with an audiologist and attending follow-up appointments with your Pediatric ENT are crucial. It is not possible for you to determine if your child can hear accurately without having a complete audiological examination.
Ear infections are generally treated with antibiotics, but there is no good medical treatment for ear fluid without infection. When a child has frequent ear infections or when fluid persists in the ears for an extended period of time, your ENT doctor may recommend tube placement. The tubes help ventilate the ear while your child's natural ear drainage system is maturing. Most tubes stay in place for 4 months to a year, and they generally fall out on their own. By that time, your child's anatomy will likely have changed, and it will be easier for them to clear the fluid or to avoid infections. In about 15% of cases, the tubes need to be replaced.
When your child has an ear infection:
- Talk and read to your child face to face
- Eliminate background noise
- Get your child's attention before you speak
- Use a normal loudness level
- Confirm that your child is understanding what you are saying
As a seasoned speech therapist and mother of two young children with a history of chronic ear infections, I would be happy to speak with you about questions you may have about your child's speech and language development.
I provide evaluations and therapy for children with speech (articulation), language, and oral-motor difficulties. Sessions are conducted in the comfort of your Manhattan home (Upper West Side (to 96th Street), Upper East Side (to 96th Street), Midtown, Village, Soho, Tribeca, and Gramercy).
Labels: Articulation, Hearing, Language, Oral Motor, Speech, Speech Therapy
Articulation Errors
Many children make predictable developmental sound substitutions as they are learning to talk. Articulation errors may involve substituting one sound for another ("tar" for car), omitting a sound in a word ("boo" for blue), or distorting a sound.
Here are general guidelines as to when speech sounds should appear:
Age Sound
2 M, H, N, W, ING, P, B
3 F, K, G, Y (yellow), D, T
4 CH, L, S, R, V, SH
5 J (judge), Z, TH
For good articulation, we need adequate:
- Respiration (abdominal air)
- Phonation (larynx / vocal cords)
- Resonation (mouth / nose)
- Jaw, lip, tongue and abdomen strength and stability
A speech therapist can help improve your child's speech clarity. It is important for the therapist to understand why your child is having difficulty saying speech sounds. For example, is his jaw unstable? Does he not achieve adequate lip closure? When oral-motor / muscle based therapy is used along with traditional articulation techniques (e.g., practicing individual speech sounds), excellent results are often achieved.
Suckling on bottles, pacifiers and sippy cups past age one should be avoided for good articulation, as long as nutrition is not compromised. Dentition may be affected from suckling, which can also affect articulation. Thumb, finger, shirt and blanket suckling may also lead to poor speech clarity.
You may find the articulation podcast and the blog helpful. You are also welcome to ask me specific questions about your child. I am looking forward to hearing from you!
Stephanie provides evaluations and therapy for children with speech (articulation), language, and oral-motor difficulties. Sessions are conducted in the comfort of your Manhattan home ( Upper West Side (to 96th Street), Upper East Side (to 96th Street), Midtown, Village, Soho, Tribeca, and Gramercy).
Labels: Articulation, Oral Motor, Speech Therapy
Pacifiers
My 18 month old son uses a pacifier. I've heard this can be bad for his speech development. What do you think?
If you read through the information on my website and blog, you may come to the conclusion that children who have articulation delays often have habits that prevent the muscles of the jaw, lips and tongue from developing to their potential.
Pacifiers are one of these habits. When a child suckles on the pacifier, his jaw, lips and tongue are all moving as one unit. There is no dissociation / separation of the muscles, which is important for articulation. Think about how you say "buttercup". Basically, your lips come together for /B/. Next, the tip of your tongue touches the area just behind (but not touching!) your top front teeth for /T/. Next, the back of your tongue spreads out for /R/, and then immediately moves upwards for /K/. Finally, your lips come back together for /P/ ...and you realize how speech is the finest, fine motor skill we have!
When pacifier use reinforces the suckling motion, (even if the pacifier is only used during nap / nighttime) this prevents the jaw, lips and tongue from fully developing, despite efforts that may be made with oral motor exercises. Pacifier use generally negatively affects dentition as well.
I typically feel that the pacifier (and bottles, sippy cups, thumbsucking, etc.) should be eliminated before oral motor activities begin. However, each child / circumstance is different, and this must be taken into consideration.
Should you quit cold turkey? Some kids may manage to tolerate this after a few rough days. Consider WHY your child craves the pacifier in the first place! The suckling action provides deep input to the temporomandibular joint (TMJ), which is soothing. Can we try to provide this input in other ways? Absolutely! These are tricks a Speech Language Pathologist who specializes in oral motor therapy can help you with. Labels: Articulation, Oral Motor, Pacifier
From Pacifier to Thumbsucking
We finally managed to get rid of my daughter's pacifier! However, I've noticed that she is sucking on her fingers now. How can we help her?
This is a common predicament. The most important thing is to anticipate when your daughter will suck her fingers and why she will do so. Is she hungry? Bored? Tired? All three?
If she is hungry, try giving her hard, crunchy or chewy foods (e.g., vegetables cut into strips, raisins, pretzels). Encourage her to chew the food "on the side" (on the molars) to give input to her temporomandibular joint (TMJ). The TMJ was soothed by the pacifier, now we may need to make a substitution. Gum chewing, when the jaw stays in alignment, can effectively provide this input as well.
If your daughter is tired, but it's not an appropriate time to nap, turn on the music and encourage jumping jacks, toe touches, rolling on the floor, playing catch / rollie pollie, stretching, yoga, dancing, etc. The worst thing to do would be to plop your child in front of the television. This would probably encourage the finger sucking.
If she's bored, try to have art activities like these on hand - they will keep little fingers busy (please note that these suggestions contain small parts and should be used with caution / supervision only):
- Lite Brite
- Stickers
- Small Pop beads
- Magnetic Sets
- Wikki Stix
- Stringing beads or dried pasta - make a noodle necklace!
- Legos, Duplos, Quatros
- Practicing fasteners (buttons, snaps, buckles, zippers)
- Playing with playdoh, silly putty
- Gluing dry rice or macaroni - make a collage
- Cutting - make sure her thumb stays facing upwards
- Hole punchers
- Lacing cards
- Finger painting
- Stamping
There are also specific oral-sensory-motor exercises that a speech therapist can recommend based on your child's needs. These activities may include massage, vibration and resistance exercises. Labels: Articulation, Oral Motor, Pacifier, Thumbsucking
Drooling
Why does my child drool and what can I do to help him?
Drooling may occur for a variety of reasons (e.g., reflux, allergies, teething) but when it is due to weakness or low muscle tone of the mouth, it is a speech-language pathologist you should consult with. This speech therapist should specialize in oral-motor / muscle based therapy.
It is normal for children to drool prior to 18-24 months when they have not fully developed the muscles of the jaw, lips and tongue. This weakness can also affect speech intelligibility.
Low muscle tone in the mouth may result in drooling due to:
- Diminished sensation / awareness of saliva on the mouth, lips or chin
- Inability to maintain lip closure (which could be due to weakness of the jaw)
- Reduced ability to retract saliva (indicative of problems with tongue retraction)
Your child's body / trunk should be examined for low muscle tone as well, as an unstable base for the jaw, lips and tongue may make therapy efforts moot.
Before consulting with a speech therapist, here are some tricks to try:
- Eliminate the use of the bottle and the sippy cup, as long as your child's nutrition will not be compromised. This should occur around 12 months of age.
- Talk to your child about a wet face vs. a dry face and give him a dry towel to clear saliva. Terrycloth wristbands can be worn to dry the mouth / chin as well.
- Each time your child dries his face, he should close his lips and swallow (you may have to teach your child what "swallow" means).
If the problem persists after trying these techniques for one month, therapy can begin and sessions will be much more productive.
If you have additional questions about drooling, please contact me: Stephanie Sigal, Speech - Language Pathologist.
phone: 646.295.4473
email: sayandplay@yahoo.com
Serving the following neighborhoods in Manhattan: Upper West Side (to 96th Street), Upper East Side (to 96th Street), Midtown, Village, Soho, Tribeca, and Gramercy.Labels: Drooling, Oral Motor
Treating Articulation Delays
It is difficult for people who don't know my child to understand what she says. What is your approach for improving articulation problems in children? Along with traditional speech therapy techniques, I use a muscle-based (oral motor) approach to improve the muscles of the jaw, lips and tongue, which support each other in this order. When completing a muscle-based assessment, I begin at the level of the jaw, administering child appropriate exercises that a parent or caregiver may carryover for homework. Exercises for the lips or tongue may be incorporated as well, depending on your child's skill level. These exercises may include blowing horns and bubbles using specific, hierarchical, adult directed methods that target the necessary movements for effective speech production. Exercises to be completed at mealtime may also be incorporated. For example, when a child drinks from an open cup, we only want them to use their lips to take a sip, we do not want them using their teeth (jaw) on the cup. It is best to see dissociation - the jaw, lips and tongue working independently. The same is true for removing pureed food from a spoon. We want children to remove the food with their lips only. I teach children and instruct their parents / caregivers how to do this most effectively to improve muscle movements used for standard speech.
We also want to eliminate the use of pacifiers, bottles, sippy cups, etc. as the suckling action that occurs will work against all our efforts. Nutrition should never be compromised; the bottle or sippy cup should be removed when the child can drink effectively from an open cup or straw.
The recommended exercises are thoroughly discussed with parents during or at the end of each therapeutic session, and a written program plan along with detailed instructions is consistently provided. Parents are encouraged to call or email with questions about the homework in-between sessions to maximize skills.
The specific sounds your child is having difficulty producing are analyzed using a standardized test. It is then determined which, if any sounds would be appropriate to address, depending on the muscle-based results.
I have found that using a muscle based approach, along with traditional articulation therapy (targeting individual speech sounds) increases children's speech clarity in conversation, rather than simply at the word level.
Labels: Articulation, Oral Motor, Speech
PROMPT
My two year old son is currently receiving speech therapy for a language delay. I have heard about PROMPT - is this a type of treatment I should arrange for him? PROMPT involves using dynamic tactile cues (paired with verbal and visual cues) to stimulate speech production in children who have difficulty articulating specific sounds. PROMPT may also be used with children who have a motor-based speech disorder, such as developmental apraxia of speech (difficulty forming sounds into words). When I begin working with a two year old who is not speaking or has very few words, I often incorporate PROMPT techniques, along with traditional language development play therapy. We can not rule out that this child isn't speaking because of a motor-based problem, so combining PROMPT along with oral motor therapy can play an active role in facilitating language development. Oral motor treatment should be used in a hierarchical approach to develop awareness, strength, coordination and mobility of the jaw, lips and tongue. Using these three techniques simultaneously will provide a complete treatment package for your son. Ask your current speech pathologist if he / she is trained in PROMPT and if he / she has significant training and experience with oral-motor therapy. Labels: Articulation, Language, Oral Motor
Sippy Cups!!
I'm ready to wean my child from a bottle. Should I use a Sippy Cup? A Sippy cup is simply a bottle in disguise - there is nothing functionally different. Parents should pursue bottle weaning by age one, as suckling on the bottle promotes a variety of potential issues, including poor development of mouth muscles for speech. Dentition is also often affected by suckling. The shape of the Sippy cup spout and the suction / resistance that the no-spill feature provides are just as harmful as the bottle. Skip the hassle of transitioning to the Sippy cup, teach your child to drink from an open cup (you can begin when your child starts solid foods) and properly from a straw to avoid another (painful) transition down the road. I teach children on my caseload how to drink properly from a straw via the Talktools Straw Kit, created by Sara R. Johnson. Labels: Articulation, Oral Motor
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