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Column originally published Oct 14, 2003

Severe Speech Delay Requires Urgent Investigation

Question: In our circle of friends and relatives, there is a three-year-old child who hasn’t started to talk yet. This child does not say da-da, ma-ma, or no-no, which are usually some of the first words. The child will cry, yell, or make complaining sounds. Is it too soon to be worried that this child may never talk?


No, it is not too soon to be worried. As a matter of fact, you and your friends are very late to ask for help. Let me explain to you why, and what the parents should do immediately to get help for this child.

Speech development is totally dependent on a child’s ability to hear. Simply said, if a child cannot hear, he cannot speak. The auditory system, which includes the outer ear, the ear canal, the eardrum, middle ear with three tiny bones to conduct and magnify sound, the inner ear that converts sound waves into electrical signals, and the nerve that sends these signals to the brain, is well developed even before a child is born. That is why a foetus can hear the mother’s voice as well as her heart beat. Many young infants are comforted by their mother’s voice after birth.

Normal speech development requires stimulation from the environment, whether it is spoken words from parents, or laughter from siblings. All sound waves are conducted through the auditory system and then transmitted as electrical signals to the brain. It is the richness of different sounds that helps a child to distinguish comforting voices from threatening sounds, and over time, gradually help them to develop their ability to speak.

Speech development in children come in stages. During early infancy, they make cooing sounds when they respond to pleasant stimulation. When they are hungry or uncomfortable, they would cry. Even those who are profoundly deaf would cry: this is the natural ability of all human beings. With continuous stimulation of sounds from the outside world, he will produce more frequent and complex sounds himself. Around 6 to 12 months of age, most children would start to imitate sounds, especially when they have the attention of their parents and caregivers.

As you realized, the first words most often uttered by young children are da-da and ma-ma, regardless of their ethnic origin. Between one to two years of age, children would acquire new words, sometimes more than one a day. Girls tend to have more advanced speech development than boys.

Somewhere around two years of age, many children would start to put two words together, followed closely by short phrases and then full sentences. The speed of speech development at this stage is quite variable, but it does follow a fairly steady pace. Some parents are amazed by their children’s advancing vocabulary and speech after they have been away for as little as a week.

Speech is one of the most important way that we communicate with each other. A child who cannot speak can get extremely frustrated when people around doesn’t understand what he wants. This frustration is often expressed as anger and aggression.

Research has shown that about 1 to 3/1000 children are born with severe hearing loss. This can be the result of problem conducting sound waves to the inner ear, or transmission of electrical signals to the brain, or combination of both problems. The end result is the same, these children live in a world that is very silent, they cannot even hear their own crying, let alone any sound from the environment.

These children can be completely normal at birth. They would cry like all other children. Over time, parents may wonder why their child seems to be more quiet than other children. These children may not respond to calls, although they would turn their heads if they see someone passing by. Not responding to loud noises is another clue. Unfortunately, most children with severe hearing loss are not recognized until they are two to three years of age, very similar to the child that you are describing here.

Fortunately, with improvement in medical technology, many hospitals are purchasing specialized equipments that can detect hearing loss in newborn infants. These machines are extremely accurate, children with hearing loss can be confirmed within days after birth. Once identified, they can receive help right away, often by hearing aids which can amplify sound waves. Early identification of hearing loss can prevent delay in speech development.

In your friend’s situation, the child likely has severe hearing loss which prevented him from normal speech development. He needs to be tested urgently in order to find out the cause of his problem. Once identified, a plan can be put in place to improve his hearing as well as training in speech development by specialized speech-language pathologists. His problem is very urgent. He needs immediate evaluation and intervention.

If your friend is one of those unlucky Canadians who doesn’t have a family physician, he should go to the local emergency room in order to get the proper referral. Normally emergency room should only be used for emergency problems. However, this child cannot wait another few weeks or months to see a physician, and then referred to an audiologist for hearing test. Any delay in diagnosis and treatment will have significant impact on his ability to develop normal speech. This will ultimately affect his future career opportunity and quality of life.