Reader question on a toddler with just a few words, September 21, 2008

A reader sent me this question about her 16-month-old son who is saying just a few words and shows a few other behaviors that may be cause for concern:

My son is 16 months old and is not truly talking. About once a week you can get him to say mamamamama. But not really mama, as if he were directing it towards me. He grunts often and makes other noises, but no other words. He does point to things, but only sometimes does he seem to know what he is pointing at. He shakes his head no, but about 95% of the time he means yes and the other times we don't know. He does have a history of persistent ear infections, but received tubes back in February 08. They also did a hearing test at that time, and it was fine. He also does not imitate facial expressions or play peek-a-boo or patty-cake. I will demonstrate it to him and he simply smiles. I talk to him, read to him, play music and sing to him. I have a medical background and have seen speech therapy in action. I try and apply all that I learned from that. He does like to spend a considerable amount of time alone watching TV away from the family. We try to engage him and eventually he just ends us back in the room by himself. Should I be worried about any delays? Is it time for me to talk to the doctor? I just feel like something is not right.

Robert's response:

I have not met your son, so I cannot say for sure what is going on, but it does seem as if his language development is delayed and somewhat atypical. The type of babbling he is doing--repeating a single syllable over and over, like "mamamamama"--is what we call canonical babbling. Generally, we expect children to move out of this stage in their first year or so. After canonical babbling comes variegated babbling, where the child mixes up syllables like "maboodafa".

I am also concerned that he does not enjoy imitating facial expressions or engaging in interactive games like peek-a-boo. It is possible that his history of ear infections interfered with his hearing prior to his receiving tubes and contributed to his atypical speech development. However, as peek-a-boo and patty-cake are visually engaging, I would not expect a hearing loss to interfere with this sort of interaction.

Based on what you have told me, I would definitely recommend taking your son to a speech-language pathologist for an evaluation. If you need a doctor's referral, the doctor may take some convincing. Most physicians do not really understand language development and many will not recommend a speech-language evaluation until the child is quite a bit older. However, if you explain that you really want an evaluation so that you can rule out a speech disorder and have peace of mind, most doctors will agree to a referral. I have more advice and information on this in the "Getting Help" section of my site.

Thanks for your question, and best of luck to you and your son.

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