Slips of the tongue (and lips and mouth) are a normal part of toddler development: Just as a child must develop muscle strength and coordination in her legs before she can walk, she has to build up the muscles in her mouth and learn how to manage its many moving parts in order to eat, drink, and talk. While no child goes straight from uttering her first word to being ready for a speaking role on Broadway, speech delays and other mouth-related problems may be a sign of an oral-motor or motor-speech disorder. Here’s what you need to know about these developmental delays in children:
What are oral-motor disorders?
A child with an oral-motor disorder has trouble controlling her lips, tongue, and jaw muscles, which makes mouth skills — from talking to eating to sipping from a straw — tough to master. While these are physical issues, there are also speech-motor disorders, and they often have a neurological component. Two of the most common disorders are:
- Childhood apraxia of speech (CAS) — sometimes called dyspraxia of speech: Children with apraxia have trouble moving and coordinating the different parts of their mouths in order to form words.
- Articulation disorders: These include lisping, leaving out consonants when speaking, and substituting one sound for another.
What are some of the signs of oral-motor and speech-motor disorders?
A child with these disorders may:
- have a droopy, or “long” face (her mouth frequently hangs open)
- refuse to eat food that needs to be chewed
- gag frequently when eating (and not just when she’s asked to swallow her peas)
- weigh less and be shorter than other tots her age
- have trouble sticking out her tongue or moving it from side to side
- be hard to understand
- drool past the age of 18 months
- lisp excessively
- take extra time to form words while speaking
- use mostly vowel sounds after 18 months (“aah-aah” instead of “mama”)
- leave out some consonants in words at age three ( “at” instead of “cat”)
- add extra sounds to words (“animinal” instead of “animal”)
- substitute certain sounds when speaking (“wittle” instead of “little”); note that this is common in young toddlers, so if a tot who does this improves as she nears age two, she’s likely fine
- have trouble stringing together syllables in the right order (“minacin” instead of “cinnamon”)
What causes these disorders?
Experts aren’t certain, but many suspect that a neurological glitch affecting the brain’s ability to send the right signals to the mouth muscles is behind many oral-motor disorders and speech delays. Genetics, hearing problems in children, and birth defects, such as cleft palate, also contribute.
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Using the Third Person — How Toddlers Talk About Themselves
Using the Third Person — How Toddlers Talk About Themselves
How are oral-motor and speech-motor disorders diagnosed?
The earlier you get a diagnosis, the more effective treatment will be, so don’t hesitate to bring up any concerns you mayhave with your child’s doctor. The pediatrician will also be on the lookout for lags in your toddler's language development during developmental screenings, and may even recommend a hearing test to rule out some simple explanation, like fluid in the ears.Just remember: Apraxic symptoms, articulation disorders, and the like tend to become more apparent around age two and beyond. At that point, your pediatrician may refer you to a speech-language pathologist (possibly through a state early-intervention program) to get a diagnosis.
How are these disorders treated?
Children with apraxia and other oral-motor issuescan benefit greatly from speech-language therapy, which will probably be a good time for your tiny talker. For example, a therapist will lead her in fun activities — blowing bubbles, whistling, licking candy, and playing word games — to bolster her mouth muscles.
What is the prognosis for children with apraxia and other oral-motor disorders?Many can completely overcome their speech delays and feeding problems through therapy. Even toddlers with extreme apraxia can learn to express themselves in other ways,such as sign language or by pointing to pictures in a language notebook to get a message across. Regardless of how they do it, most kids will find a way to let you know what’s going on in their little heads, so don’t worry: You won’t miss a single smart, sweet, funny thing.
From the What to Expect editorial team and Heidi Murkoff, author of What to Expect the Second Year. Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff.
- American Speech-Language-Hearing Association, Orofacial Myofunctional Disorders.
- National Institutes of Health, U.S. Department of Health & Human Services, National Institute on Deafness and Other Communication Disorders (NIDCD), Apraxia of Speech, October 2017.
- Mayo Clinic, Childhood Apraxia of Speech, August 2017.
- American Speech-Language-Hearing Association, Childhood Apraxia of Speech.
- Children’s Hospital of Philadelphia, Childhood Apraxia of Speech Causes, Symptoms and Treatment.
- American Academy of Pediatrics, Healthychildren.org, Language Delays in Toddlers: Information for Parents, November 2011.
- National Institutes of Health, U.S. National Library of Medicine, MedlinePlus, Speech Disorders—Children, February 2018.
- What to Expect the Second Year, Heidi Murkoff and Sharon Mazel.
- Whattoexpect.com, Easing Childhood Ear Infections, October 2016.
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