Speech and language impairments

What are pediatric speech and language impairments?

Speech and language impairments are delays and disorders in the development of a child’s ability to understand language, express themselves or talk. Many kids can overcome them with the right therapy and support.

Speech impairments happen when a child has a hard time producing clear sounds, words and sentences. Speech impairments can include difficulties saying particular speech sounds, difficulty with all speech sounds due to muscle weakness and difficulties with all speech sounds because of miscommunications between the mouth and the brain.

Language impairments or delays happen when a child:

• Has trouble understanding spoken or written messages coming from others (receptive language)

• Struggles to use words to communicate thoughts and feelings (expressive language)

• Has difficulty using words or language in the correct context (pragmatics)

What are the different types of pediatric speech and language impairments?

There are many types of these impairments. Some happen on their own. Some happen alongside other impairments or medication conditions.

Common types of speech impairments include:

• Articulation impairments: When a child struggles to produce sounds correctly.

• Fluency impairments: Involve the rhythm of a child’s speech. A child may have a fluency disorder if they stutter, pause frequently or spend a long time on certain sounds.

• Voice impairments: Difficulties with pitch, loudness, resonance or voice quality. Children with voice impairments can sound congested, easily lose their voice or sound raspy. Voice disorders are also called resonance disorders.

• Feeding or swallowing impairments: Affect an infant’s ability to suck for breast or bottle feeding. For older children, it can be difficult to close their mouth, chew and swallow normal amounts of food or liquid. These disorders are also called dysphagia.

The two main types of language impairments are:

• Expressive language disorder: Difficulty expressing wants, needs, thoughts, and feelings. Can be developmental or acquired.

• Receptive language disorder: Difficulty understanding spoken, signed, or written language. This disorder can be developmental or acquired.

What are the signs and symptoms of pediatric speech and language impairments?

Comprehension: For babies and toddlers, this can mean not understanding regular commands like “where is mom/dad?,” or not being able to share their wants and needs by pointing at food or reaching for a toy. As children get older, comprehension delays can be seen in struggles to read, write and/or speak.

Behavior challenges and stress: For kids who can’t express themselves, are easily frustrated or act out.

Hoarse or nasally voice: Signs of a speech impairment can be a child breathes heavily when they talk, has a hoarse or scratchy voice or sounds congested when speaking.

Inaudible speech: All kids take time to develop sounds and words. Inaudible speech can be diagnosed in babies who don’t babble or make very few sounds by 12 months. When a preschool-aged child’s verbal development pauses or doesn’t continually progress to add new words, develop phrases, or speak in full sentences.

Struggles with language: As children grow, they should mimic, observe and process how others use language. Signs of delayed understanding (receptive language) and/or problems sharing their wants and needs (expressive language) include having a hard time asking questions or following directions, struggling to put words into full sentences, learning songs or rhymes, or misusing pronouns like “she” or “they.”

Shyness or low confidence: Sometimes children talk less because they are frustrated or embarrassed about their inability to speak.

How are pediatric speech and language impairments diagnosed?

Our speech and language pathologists (SLPs) use a number of different evaluations, tools and observation techniques to make an accurate diagnosis.

Feeding and swallowing disorders: A SLP will watch how your child puts food into their mouth, chews or swallows. They will look at the position of their head, neck and the rest of their body. They will also review your child’s diet and how they get their nutrition.

Articulation, fluency and voice disorders: The SLP will put together activities and exercises to hear how your child says different sounds. They will also watch how your child breathes and holds their body. The SLP also will look at how your child moves their mouth and jaw.

Language impairments: The SLP might use some language tests and play with your child. These activities might include reading with your child, asking them questions, having them identify objects and writing and coloring together.

Complex care: The speech therapy and rehabilitation medicine team will work with you and your child’s other providers to assess their needs and abilities for babies and children with complex care needs.

What causes pediatric speech and language impairments?

Speech Impairments

Different types of speech impairments and disorders can have different causes.

Articulation disorders have an unknown cause. Feeding or swallowing disorders can have a variety of causes, including:

• Neurological conditions like a stroke, epilepsy or brain tumor

• Congenital and developmental disorders such as cerebral palsy and cleft lip or palate

• Obstruction interferences that narrow the esophagus (the tube that carries food and liquids from the mouth to the stomach)

• Muscular conditions like scleroderma or achalasia

• Head and neck injuries

Fluency disorders can be developmental or neurological. They can occur at the same time as another speech disorder and be made worse by stress. Voice disorders are caused by problems that happen when air moves from the lungs, through the vocal folds, and then through the throat, nose and mouth. These problems can be related to abnormal craniofacial development, muscular conditions, pediatric stroke learned patterns, overuse, vocal nodules and more.

Language Impairments

Language impairments often occur in children who have developmental delays or experience other health conditions, including but not limited to:

• Autism spectrum disorder

• Brain tumor

• Cerebral palsy

• Cleft lip and palate

• Craniofacial conditions

• Developmental delay

• Epilepsy

• Genetic syndromes

• Head or neck injury

• Hearing impairment

• Neuromuscular disorders

• Pediatric stroke

• Prematurity

• Tracheostomy

• Traumatic brain injury

How are pediatric speech and language impairments treated?

At Children’s Health, our team has extensive experience working with children of every age, with every type of speech and language impairment.

Some activities and tools will be things your child is very familiar with like toys and blocks. Others could appear to be more medical. For children with neurological, muscular or craniofacial disorders, the speech-language pathologist (SLP) may use tools that will help strengthen your child’s mouth, jaw and throat muscles.

Our therapists will work to help your child:

• Gain missing parts of their grammar

• Grow their understanding of words and how to use them

• Develop stronger social communication skills

• Learn to follow directions

• Improve their speaking, reading and writing