Pediatric Speech-Language Pathology
Speech-language pathologists (SLPs) are able to provide assessment of and treatment of speech, language, social, fluency, voice, swallowing, and cognitive-communication deficits in children, adolescents, and adults. SLPs are able to determine if a child's area of concern is a delay, disorder, or if it is an area to continue to monitor. SLPs are trained to collaborate with other professionals involved in the child's care and with the child's caregivers to develop a plan of care individualized to each child's area of need.
Speech & Language Milestones
Birth - 1 year
Expect vocal play, such as:
- Cries, burps, and sneezes
- Squeals, growls, and "raspberries"
- Vowels (e.g., ooo, ah, eee)
- Consonant vowel combinations (e.g., ma, up, bah)
- Shouts to gather attention
- Produces reduplicated syllables (e.g., mama, baba, dada)
- Begins producing variegated sound combinations (e.g., ma-ba, ba-da)
- You will hear early developing consonant sounds (e.g., p, b, m, t, d, h, w, n)
- Startles/turns head to sounds
- Responds to calming/familiar voices and sounds
- Watches speaker's face when spoken to
- Demonstrates different responses to different family members
- Responds to "no"
- Responds to name
- Points to pictures of familiar toys/objects
- Copies simple actions
1 year to 18 months
- First words or approximations (e.g., "bah" for "ball") are present
- Intentional labeling of preferred toys/items
- Uses 2-6 words outside of "mama" and "dada"
- Imitates animal and environmental sounds (e.g., vroom, choo choo)
- Imitates or attempts to produce 2-word combinations (e.g., ball go, baby cry)
- Follows simple directions
- Waves hello and/or bye bye
- Engages in parallel play (e.g., playing beside another)
- Pairs gestures with words or word attempts (e.g., up, go)
- Imitates peer/adult behaviors during play
- Demonstrates simple pretend play (e.g., drinking from a toy cup, placing phone to ear)
18 months to 2 years
- Uses approximately 50 words/word approximations
- Produces consonant-vowel-consonant structured using early sounds (e.g., p, b, m, t, d, h, w, n)
- Imitates adult words and intonation
- Produced 2-word combinations
- Speech is 25-50% intelligible to an unfamiliar listener
- Understands more than s/he can express (approximately 150-300 words)
- Engages with other children during play briefly
- Engages in associative play
- Attempts to make conversational repairs when listeners show confusion
- Follows 1-2 step commands/requests
2 years to 30 months
- Uses approximately 200-300 words/word approximations
- Begins putting many different speech parts together (e.g., nouns, simple verbs, actions)
- Engages in longer conversations
- Creates conversations with others and to self during play
- Uses short phrases and simple sentences
- Holds fingers up to tell age
- Follows simple 2-step commands/requests more consistently
- Looks for missing toys
- Continues to grow in his/her understanding of words and new vocabulary
- Engages in simple group activities
30 months to 3 years
- Uses approximately 450 words with clearer productions
- Begins using simple positional words when describing (e.g., in, on, over)
- Begins to initiate simple WH-questions to seek information
- Uses early pronouns (e.g., I, me, you, mine)
- Produces 2-3 word combinations/approximations
- Begins producing later sounds (e.g., l, f, s, k, g)
- Frequently talks to self and/or engages with familiar partners/peers
- Expresses ideas and simple emotions
- Follows 2-step directions that are related, emerging for unrelated
- Takes turns during play
- Generally cooperates during structures activities and games
- Labels and understands a variety of common vocabulary used in and outside of home
Below are the optimal milestones for feeding in typically developing children. If your child has not yet developed the typical gross motor milestones or skills to manage different consistencies, please talk with your speech therapist or primary care physician before upgrading diet for greatest safety. Please use your best judgement and watch for your child's reactions. Some signs and symptoms of aversion and/or difficulty managing foods include: grimacing, excessive or large swallows, finger splaying, coughing, change in breathing/color, and excess residue following swallow. Force feeding foods is never recommended and may cause greater adverse side effects in the future.
Feeding and Oral Motor Skills
Birth to 4 months
- Sucks fingers when near mouth
- Places hands on or interacts with bottle during feeding
- Automatically recognizes nipple/bottle
- Eating breast milk or formula
4 months to 6 months
- Begins holding bottle independently
- Mouths and/or gums solid foods
- Opens mouth when presented with food
- Eats thin baby food cereals and/or breast and bottle
6 months to 8 months
- Feeds self for hand held food items
- Drinks from at open cup with help from an adult (some liquid loss expected)
- Reaches for spoon when it is presented
- Continues to prefer parent to feed
- Eats thicker baby food cereals, thin baby food puree (stage 1), breast/bottle
- Baby oatmeal, rice, or Barley cereal mixed with
- Thin purees: cereal, fruits, veggies (stage 1) (7 months)
- Thick baby food smooth (stage 1) (8 months)
- Thicker baby food cereal (8 months)
9 months to 1 year
- Holds a soft cookie to mouth (9 months) and bites through it (12 months)
- Eats lumpy, mashed food
- Rotary jaw chewing emerging
- Eats soft mashed table foods (9 months) - Cooked and mashed veggies, fruits
- Table food smooth puree (9 months) - Applesauce, pudding, yogurt, hummus, ice cream, etc.
- Hard munchables (9 months) - Raw carrot sticks, jicama, celery sticks, baby pretzels, sour patch kids, beef jerky, etc.
- Meltable hard solids (9.5 months) - Towne crackers, graham crackers, baby cookies, Cheetos, etc.
- Soft cubes (10 months) - Avocado, kiwi, bananas, cheese cubes, etc.
- Soft mechanical (single texture) (11 months) - Fruit breads, muffins, cubed lunchmeats, thin deli meats, soft pretzels, etc.
- Soft mechanical (mixed textures) (12 months) - Mac and cheese, microwavable children meals, soft chicken nuggets, fish sticks, etc.
1 year to 18 months
- Grasps a spoon with a full hand
- Brings a full spoon to mouth
- Begins to drink with a straw
- Holds a cup with two hands
- Eats soft table foods (13-14 months) - Cooked vegetables, breads (no crusts), soft cheeses, oranges, melons, etc.
- Hard mechanicals (15-18 months) - Thin pretzel sticks, Ritz Crackers, mini rice cakes, goldfish, poptarts, Fritos, bagel, fruit snacks, etc.
18 months to 3 years
- Bites through a variety of thicknesses
- Brings spoon/fork to mouth, palm up with little spillage
- Holds small/open cup in one hand with little spillage
- Chews with lips closed
- Chews with rotary chew
Articulation and Phonology
Articulation skills refer to the ability to produce individual speech sounds appropriately so that one is able to be understood when communicating with someone. Articulation errors may be the child substituting a sound for a target sound (e.g. feet to peet), distorting a sound for a target sound (e.g. seat to theat), and/or omitting a target sound (e.g. cat to ca). When a child's articulation errors follow a predictable pattern and affect more than one sound, their errors may be considered phonological and may need to be targeted by groups of sounds rather than individual sounds.
When a child has difficulty producing sounds it can make it difficult for them to be understood by unfamiliar listeners and can cause the child to become frustrated. Typically, by age 2 a child should be around 50% intelligible to an unfamiliar listener and by age 3 a child should be around 75-100% intelligible to an unfamiliar listener. Speech sounds are developed and mastered at different ages, a child is not expected to be able to produce all speech sounds when they first begin to verbally communicate.
SLP's (Speech-Language Pathologists) will work with your child to produce target age-appropriate sounds in order to increase their intelligibility. SLP's typically figure out what sounds your child can make and are stimulable for (e.g. able to make some of the time) then make a plan of care to address the sounds that they are having difficulty with at an appropriate level (e.g. sound in isolation, single word level, phrase level, etc.). SLP's can use a variety of techniques to increase awareness of target sounds. SLP's can provide visual/tactile/verbal/gesture feedback to your child about the target sound/sounds.
Receptive language skills refer to the ability of one understanding what is being said to them. Expressive language skills refer to the ability of one expressing their wants/needs/thoughts/ideas effectively with others. It is possible to have deficits in only one or both areas.
When a child has difficulty with receptive language skills it can make it difficult for them to follow directions, identify a variety of objects or actions, understand verbally presented information, and many other things. When a child has difficulty with expressive language skills it can make it difficult for them to formulate an age-appropriate sentence, label a variety of items or actions, sequence a story, and many other things.
SLP's will work with your child to target the specific areas of difficulty that your child is having and create a plan of care to assist your child in developing the target skills. Many times, this includes using sign language.
Pragmatic language skills refer to the ability to appropriately interact with others in a social context. Pragmatic language skills can also be called social skills.
When a child has difficulty with pragmatic language skills it can make it difficult for them to understand body language, tone of voice, indirect requests, how to start and/or end a conversation, conversational turn-taking, how to appropriately interject into a conversation, topic maintenance, and many other things.
SLP's will work with your child individually or in a group setting to target social skills.
Play skills refer to the ability to appropriately interact with items, objects, toys, peers, and others appropriately. Play skills have an important role in childhood development. Play facilitates cognitive, motor, speech, language, and social emotional skills. As a child grows, they go through different phases of play that help them develop these skills. The stages of play include:
Solitary Play (Birth-2 year): At this stage, a child plays alone. During solitary play a child advances their imagination and gives them a chance to explore and be creative in their play.
Spectator/Onlooker Behavior (2 years): During this stage, a child begins to watch others play but does not play with them. One way children learn is through observation. At this stage a child may watch others and how they interact with toys or within the environment and begin to imitate what they see.
Parallel Play (2+ years): At this stage, a child plays alongside or near others but does not play with them. Children at this stage are also developing symbolic play, which includes pretend play based on familiar routines and giving voices/sounds to toys that show emotion.
Associate Play (3-4 years): At this stage, a child starts to interact with other during play. Children at this stage may be participating in activities related to what their peers are doing but not directly interacting (e.g., playing on a playground). During this stage children are also developing advanced symbolic play/pretend play. Pretend play in this stage is based on events that the child has seen or heard, though has not directly experienced.
Cooperative Play (4+ years): At this stage, a child plays together with peers by interacting with both the activity and peers.
SLP's will work with your child to address play skills so that they are able to appropriately interact and learn through play.
Alternative Augmentative Communication (AAC)
Alternative augmentative communication (AAC) refers to the use of pictures, signs, gestures, or a speech generating device to convey wants/needs/ideas/feelings. When someone has difficulties with effectively conveying their wants/needs/ideas verbally, AAC may be used as an alternative mean of communication or to supplement their communication. It is possible for AAC to be temporary or permanent depending on the situation. It is possible for AAC to be low tech (e.g. printed off pictures) or high tech (e.g. speech generating device) depending on what works best for the child.
When a child has difficulty with effectively communicating their wants/needs/ideas effectively it can make it frustrating for the child and lead to communicative breakdowns, lack of communicative attempts, and/or limited communication partners (e.g. only the child's parent understands what they are trying to say).
SLP's will work with your child to trial AAC as an option and discuss potential modes of communication with families so that a plan of care can be implemented that will work best for the child and their family.
Voice refers to the ability for one to coordinate their airflow and phonation through their oral/nasal structures in an effective manner. It is possible to have deficits in only one area or all areas of voicing.
When a child has voice deficits it can make it difficult for them to produce their voice effectively whether it is from yelling too much, yelling too loud, structural abnormalities, coughing excessively, etc. A child with a voice deficit may sound hoarse, strained, breathy, have no voice, have abnormal resonance (e.g. sound nasally or sound like their nose is plugged), have abnormal pitch (e.g. too high of a voice or too low of a voice), or many other things. A child may have one of these signs or a combination of these signs.
SLP's will work with your child to educate them on how to effectively use their voice, how to take care of their voice, come up with positive alternatives to help voicing be more efficient and/or healthy (e.g. go to the other room to talk with someone rather than yelling from across the house), and many other things. In order for voice therapy to be effective, the child has to have a desire to change the way that their voice sounds or have a desire to change their voice because of how it impacts them.
Fluency refers to the disruption in the forward movement of speech. Another name for fluency disorders is stuttering. There are many different types of dysfluencies some of which are considered stuttering-like and others considered typical.
When a child has a fluency disorder it can make it difficult for them to communicate their message confidently and smoothly. Children with fluency disorders may also exhibit secondary characteristics (e.g. stomping, rapid eye blinking, body tension, etc.).
SLP's will work with your child to educate and empower them about a variety of fluency enhancing strategies and build their overall confidence in themselves.
Cognitive-communication refers to the ability to attend to a task, recall/remember information, organize information, problem solve, appropriately reason, and demonstrate a variety of other executive function skills to effectively communicate and interact.
When a child has difficulty with cognitive-communication it can be difficult to recall details from a story, sequence events of a story or event, attend to a conversation with others, effectively organize a story so that a communication partner understands what they are talking about, and many other things.
SLP's will work with your child to address specific areas of deficit so that they are able to perform activities of daily living to the best of their ability and can interact with others appropriately.
Phonological Awareness Skills
Phonological awareness skills refer to the ability to identify/produce letter sounds, identify/produce rhyming words, clap out syllables in words, identify beginning/ending sounds in words, blend sounds to produce target words (e.g. c - a - t), segment sounds in target words, and manipulate sounds in words to make new words.
When a child has difficulty with foundational phonological awareness skills it can impact their long-term academic reading, writing, and/or spelling skills.
SLP's will work with your child in developing these skills during treatment sessions and can break down the tasks into smaller pieces so that your child is successful.
Feeding refers to the ability to effectively eat a variety of foods in a reasonable amount of time. Swallowing refers to the action of someone moving their food/liquid from their mouth to their esophagus (e.g. tube that carries food into the stomach) in a safe and effective manner. It is possible for a child to have a deficit in one or both areas.
When a child has difficulty with feeding and/or swallowing, it can make it difficult for your child to safely, effectively, and/or efficiently drink/eat. A child may cough, choke, arch their back and/or stiffen during feedings, have difficulty breathing while eating or drinking, take a long time to eat, only eat certain textures of foods, spit/throw up, be unable to gain weight, have a structural abnormality (e.g. cleft lip and/or cleft palate), or many other things that impact their feeding/swallowing skills. A child may have one or multiple signs listed above along with other signs/symptoms.
SLP's will work with
your child to determine a safe diet and determine a plan of care to address
their specific area of need. SLP's may recommend for an instrumental assessment
called a Modified Barium Swallow Study to be completed so that they can see if food
or liquid is going into the child's airway.
- Feeding difficulties
- Oral Phase Dysphagia
- Pharyngeal Phase Dysphagia
- Oropharyngeal Phase Dysphagia
- Articulation delay/disorder
- Language delay
- Social/pragmatic disorder
- Oral motor deficits/dysfunction
- Fluency disorder
- Speech delay
- Mixed receptive/expressive language disorder
- Expressive language delay/disorder
- Receptive language delay/disorder
- Phonological/phonemic awareness deficits
- Voice disorders
- Augmentative and alternative communication (AAC) including: sign language, dedicated speech devices, communication apps, picture exchange, or whatever method helps give your child a voice!