Q&A: Speech Problems and Starting Kindergarten

Dr. Gwenn O’Keeffe, a pediatrician at North Shore Children’s Hospital, writes a weekly column on child health issues.

Q: My pediatrician recommended if the 2 year old, who was born in October, did not have at least 25 words in his vocabulary and the ability to put two words together as simple as bye-bye then he should probably see a speech therapist. What are your feelings on this? I don't want to hold him back, but he knows everything that is being spoken but cannot yet speak. He has about 10 words now. – Via email.

A: There is a wide range of normal for the vocabulary of 2 year old children. Some children may only have 20-30 words but others may have hundreds. At the same time, by the time a child is 2 ½, he should be able to speak simple 2 word sentences. So, not being able to do this is a red flag that there may be a problem. The idea is to capture as many children as possible that may have a speech problem and intervene early. By design, some children will be identified as having a possible problem but in the end are just fine.

Before seeing a speech therapist, have your son’s hearing checked. According to Barbara Grizzell, a speech therapist at Salem Hospital, “If hearing is judged adequate for communication development, then a speech and language evaluation can be recommended”. A speech therapist will then evaluate not only expressive and receptive language skills but also your son’s oral motor skills and how he interacts and plays with others. Needless to say, vocabulary amount and putting sentences together is only one part of this puzzle. Better to get to the bottom of this now than to wait and possibly have a bigger speech problem down the line that could have been either avoided or lessened by intervening early. Your pediatrician can help you arrange the best hearing test for your son.

Q: My 4 year old will be starting kindergarten in the fall … I believe it would be overwhelming for him. ... The four year old has a June birthday and I'm honestly wondering if I should hold off for another year for kindergarten. –Via email.

A: I went through the same angst last year with my now kindergartner who has an August birthday and she has truly amazed us this year. Keep in mind that there is good reason that the Kindergarten cut-offs in most communities are 5 years of age by the start of school. 5 year olds are simply more socially ready than 4 year olds for the challenges they will face in elementary school. Your son is likely to be much more ready for kindergarten than you can predict today – 9 months is a huge amount of time developmentally for a child. If your son is in preschool, have a conference with your son’s teacher to discuss your concerns and learn where your son is developmentally. His teacher can give you an objective assessment of your son’s readiness for kindergarten based on the other children she has seen through this process. Also, most Public School Districts offer Kindergarten screening and have a group of educators trained who can help you. This is usually done in the Spring in most communities. You can also find out from your school district where he will fall age-wise in the class. If he is one of many early summer children in kindergarten, it is likely he will do just fine.

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