I have a beautiful grandson who I don’t get to see very often because his parents live in another state, He’s always been healthy and happy and I’ve never worried about him until now. His mother (my daughter in law) told me that Henry, who is now 20 months old, has been having tantrums. I know that’s pretty normal at this age, and I told her that I remember the frustration of that stage. Then she said that she thinks it’s because he isn’t talking yet and she thinks that once he can tell her what he wants life will be easier. I asked her if she meant that he wasn’t talking a lot, and she said, no hardly at all, just “Ma” for her and “Ba” for balls which he loves and bottles when he sees his baby sister holding one. Well, I don’t remember much from that age but I know all of my children were talking more by two than Henry. But I’m the grandmother, I’m not there, and I don’t know what I can say or do.
You are right that it’s hard for anyone outside a family unit, especially grandparents, to know what advice or opinions will be welcome. In this case, you have a small amount of information that is triggering your concern, but the information you have is certainly enough to cause you to have more questions.
There are two parts to your question: Should I worry? and “What should I do with my worries?” and I will answer each separately.
Although children develop differently, almost all children will have a burst in speech and language between 18 and 24 months of age, exactly where Henry is right now. There’s no way to pinpoint exactly what a child should be able to say at 20 months, but he should be steadily expanding what he says. So let’s start with what should be happening right now.
At this stage, a toddler should be able to understand and respond to verbal communication from others, even if he isn’t talking much. For example, Henry should be able to point to a few body parts when asked: “Show me your nose!” “Where’s my nose?” “Let’s see your foot?” He should be able to point to pictures in a book of things he’s seen in real life : “Show me the ball” “Where’s the kitten?” Although many toddlers don’t have a long attention span or the ability to sit still for long, by 20 months Henry should be interested in short toddler books such as “Where’s Spot”, “Brown Bear, Brown Bear” other books which invite engagement.
Henry should also be tuning in to conversation around him, looking at the faces of adults who are speaking to him (at least some of the time) and showing by the expression on his face that he is engaged. Some children may have difficulty maintaining consistent eye contact, but a child who does not look at faces will have trouble learning language since much of communication is non verbal.
Some children live in homes where background noise is constant, whether it is conversation among siblings or the soundtrack from a TV. Adults often tune out background noise, but toddlers don’t have the ability to discriminate what sounds are important. If you or his parents have noticed that Henry seems more able to listen to a story when the room is quiet, that’s a good clue to his need for extra help here.
Most toddlers begin using a few single words by 18 months and add more steadily. A “rule of thumb” minimum would be a dozen clear words by 18 months and 50 by age two. It sounds like Henry isn’t there yet.
Of course you will hear stories about the genius who didn’t talk until he was 4, or the younger sibling who never had to talk because his big sister always spoke for him. But how can a parent (or grandparent) predict which child is simply on his own developmental path and which child is going to wind up delayed?
The answer is that there is no definitive answer. What is important for Henry’s sake is to ask the right questions. The two critical questions right now are:
- Is Henry hearing all the words that are being said to him?
- Is Henry interested in back and forth conversation with his parents, other children and people outside his immediate family?
Why are these questions important? Because Henry is at the age when his brain is developing rapidly and everything he learns is based on what he already knows how to do. Just as a baby can’t walk until he’s already learned to sit and stand, a child can’t develop good language skills without practicing listening to words and practicing back and forth communication with others. If a child misses out on early learning he drops further and further behind while other children advance.
Now that newborns are routinely screened for congenital hearing loss, it is rare to miss the baby who is unable to hear (although in my practice I have seen children who slipped through the cracks). Hearing loss that develops later, most often secondary to ear infections, can go unnoticed because most children will continue to hear some if not all or the sounds in their environment. However, learning to talk depends on hearing all the sounds in a word and being able to repeat them A baby says “Ba” for bottle because he can’t make the rest of the sounds yet. If Henry says “Ba” for balls and bottle is it because he can’t hear the “L” sound or the “T” sound, or because he can’t make the sound? That’s why good audiological testing is the first step in evaluating any kind of speech delay.
The back and forth response between a toddler and other people around him is the other building block for speech. Some children demand a parent’s full attention, and others seem content to explore and play more independently. The latter child sometimes gets so absorbed in his own activities that he misses opportunities to practice talking. Some children get fascinated by the action of television or other screens and stop interacting with real people who might not be as continuously entertaining! Sometimes parents are tired and busy (as most are with a toddler and a baby) or there is a caregiver who does not engage in a lot of conversation with a child.
There’s no exact way to tell if Henry is getting enough interaction with language to provide a foundation for good communication. But an almost two year old is usually demanding interactive play and engagement from others, so if Henry is not he needs encouragement to do so.
If the answers to either of the questions I’ve presented is “no” then you are right to be worried. That doesn’t mean there is definitely a problem, but there might be.
So the next question is, what do you say as Grandma. The answer to that depends somewhat on how receptive your children have been to your advice up until now. If you have found that they consider your input of value, you should say something.
If they tend to discount what you say, you are in a difficult situation.
Fortunately, you don’t have to convince Henry’s parents that he has a problem. You only have to convince them to bring the issue up with Henry’s health care provider.
Almost all pediatricians know the importance of identifying language delays early and will make appropriate referrals. Keep in mind that a pediatrician can only respond to the information he or she is given. Lots of toddlers are not cooperative, talkative or playful at their well child visits. Also, the usual schedule for check ups are at 18 months, when many children are barely talking, and two years, when a child who is not talking has already fallen behind. So it is up to a parent (or grandparent) to raise concerns.
If Henry’s parents don’t want to make a call now, there is not much you can or should do. Nagging won’t help. If Henry starts talking next month then the next time you offer advice your suggestions may be unwelcome. If it turns out that Henry does have delays, it will be better if your future help is wecomed rather than tainted with the “I told you so” virus that so often contaminates parent child relationships. A four month wait isn’t ideal, but probably won’t make a difference.
One pediatrician I know who is adept at managing involved grandparents told me that he doesn’t mind when grandparents call him to express concerns. He can then use the additional information to pay extra attention to the issue when he next sees the child. Should you do this? It’s risky if you don’t know how discrete the pediatrician will be with the information you offer. At the same time, if Henry stays stalled out with words even after he turns two and his parents don’t see that as cause for concern, making a call may be advisable.
The chances are that Henry will blossom over the next few months, and if he doesn’t, your loving concern will be welcome. Language delay issues are common, and there are many resources to help children when they need help.