As a pediatric speech-language pathologist, parents often ask me what they can do to support their child's language development. The simple answer is this: talk to your child, sing to your child, and read to your child...EVERY single day! These interactions are essential for all young language learners. 

Educational TV programs and apps, while widely popular, are less effective at helping young children develop functional communication skills (3). It is true that exposure to educational media can teach young children their letters, numbers, shapes, and colors...but  language development requires more than just learning new vocabulary words and memorizing concepts out of context. Language consists of five equally important systems:

1. The Sound System (Phonology)
2. The Meaning System (Semantics)
3. The Word Order System (Syntax)
4. The Grammar System (Morphology)
5. The Social Uses System (Pragmatics)

PHONOLOGY refers to the sound patterns that occur within a language. Young language learners must figure out which sounds are important to their language and which ones are not. In English, for example, the vowel sounds "ih" and "ee" are distinctly different (as in the words "bit" and "beet"); in Spanish, however, this vowel difference is not important (which explains why a native Spanish speaker may say, "That dog beet my son" instead of "That dog bit my son"). 

Semantics refers to the different types of words (nouns, verbs, adjectives, etc.) and the meaning of those words (vocabulary). This is the language system that can be supported with high-quality educational apps and TV programs when they are used in moderation with children over the age of 2 1/2 (there is no research that shows any developmental benefits of screen time for babies and toddlers under age 30 months). Any screen time with toddlers and preschoolers becomes more effective when the adult mediates the experience with the child (it's called co-viewing!). It is important to recognize, however, that having a large vocabulary is only one component of language development. I work with plenty of little ones who can label flashcards 'til the cows come home...but do not spontaneously use their words to communicate their wants, needs, and feelings. Labeling is not a functional communication skill!

Syntax refers to the acceptable word order in the specified language. The word order system is highly structured and rule-based. In English, for example, the adjective precedes the noun; in Spanish, the adjective follows the noun. A child who struggles with learning the rules for word order may sound a bit like Yoda from Star Wars, saying things like "Pretty are the stars" or "North America we live."

Morphology refers to how words are formed and how the different parts of words change the meaning (prefixes, suffixes, plurals). The small changes we make to words helps us explain things such as the number of objects we're referring to (one dog vs. two dogs), whether we're talking about the past or present (walked vs. walking), and how the subject agrees with the action (I eat, she eats, they eat). Like the word order system, the grammar system is also highly structured and requires children to learn not only the rules, but also the exceptions to the rules (in English we have many exceptions to the rule!).

Pragmatics refers to how we use language to socialize and interact with other people. Some of the social rules a child will need to learn include: taking turns in conversation, making eye contact with the communication partner, revising the message when there is a misunderstanding, and changing communication styles with different people (child says "mommy night-night" when speaking to her baby brother, but says "Mommy went to bed" when speaking to her father). It is virtually impossible to learn the social rules of language during screen-based activities, because there is not a responsive communication partner. 

It is also important to understand that language is not taught...language is acquired through meaningful, back-and-forth interactions with other people (2). Therefore, the way adults talk to young children matters. There are two kinds of "talk" that adults can use to enhance language and cognitive development: BUSINESS TALK and EXTRA TALK (1).
​
Business Talk is the language used to keep life moving forward and includes statements such as:

• Pick up your toys
• Finish your milk
• Sit down
• Stop it
• Go find your shoes
• Time for bed
• Let's eat
• No

Extra Talk is the spontaneous chit-chat that is used to help children learn about things in the world and includes statements such as:

• Oooohhh...look at that tiny ladybug
• I like that sparkly flower on your shirt
• You're such a big helper
• Big yawn, you must be getting sleepy
• This chocolate milk sure is yummy
• I hear the birds chirping
• I wonder when Daddy will be home
• Look...the puppy is chewing on his bone

When kiddos (who aren't teething) constantly mouth, chew, or bite on non-edibles, we describe them as having oral-seeking behaviors.  Putting fingers, toys, or other objects in the mouth provides multi-sensory input that helps to organize a dysregulated nervous system. While such behaviors may pacify the child, these oral-seeking behaviors tend to cause us adults a lot of stress! Nobody truly wants a child to chew on his shirt, lick the wall, gnaw on Lego's, or bite a board book! Another point to ponder is that if the child is chewing on the toys, that means he's not playing with them in an appropriate or expected manner. Since children learn best through play, the lack of purposeful play can contribute to developmental delays.

Let's examine some strategies to support the oral-seeking child.

Food Options

• Provide chewy foods such as gummy bears, bagels, licorice, beef jerky, chewy granola bars, fruit leather, raisins, tootsie rolls, small pieces of steak or other meat
• Try crunchy foods such as pretzel rods, Dutch pretzels, raw veggies, crunchy granola bars, sliced apples, kettle-cooked potato chips
• Offer cold or frozen foods such as Popsicles, ice chips, frozen grapes (cut in half for safety), slushies
• Try sour snacks such as sour gummy worms, oranges, lemons
• Offer carbonated beverages such as flavored sparkling water (no soda please!)
• Use sippy cups with straws instead of spouts (sucking is organizing to the nervous system)
• Try high-intensity flavors such as salsa, spicy ketchup, Hot 'n Spicy Cheez-Its, jalapeno-flavored chips, Hot Tamales, black licorice, radishes, pickles, green olives
• Encourage the child to chew gum or suck on mints (when it is developmentally appropriate)  
• Allow the child to sip milkshakes or applesauce through a straw (consider using a straw hierarchy)

​Cari's Straw Hierarchy​ (from least to most resistant)
​

Milkshake straws first (cut them in half to make the task easier)

Next offer bendy straws

After that try coffee stirrers

Finally, offer crazy straws

Non-Food Options
Try creating a "Biter Bucket" filled with a variety  of objects that are allowed to go in the mouth such as:

• A vibrating toothbrush (not to be used during teeth-brushing, but rather offered as an oral-sensory toy)

• Chewy jewelry that is designed for children with teeth (be cautious about using non-therapeutic options that are for babies whose teeth have not yet erupted)

• Chewy tubes 

• Ice maker tubing, cut into 3-4 inch pieces (this is highly resistant, food grade material that kids cannot chew through)

•  A rolled up washcloth (for kids who chew on their shirt, this will provide more resistance to the jaw)
• Mouth toys such as whistles, kazoos, harmonicas, and party blowers

​When the child puts something inappropriate in his or her mouth, block and redirect to the "Biter Bucket." Pair these non-food options with some of the food options listed above, and over time, you should start to see a decrease in the oral-seeking behaviors. 

*Note: When back molars come in around age 2, expect an increase in mouthing until those teeth erupt!

Tis the season to be anxious…FA-LA-LA-LA-LA, LA-LA-LA-LA.

Winter break, Christmas, New Year’s, decorations, a tree in the house, rearranged furniture, holiday parties, fancy clothes, school programs, church programs, family gatherings, unsolicited hugs, incessant questions, holiday music, Santa Claus, presents, family pictures, disrupted schedules, unfamiliar food, eggnog, candles, and a plethora of people — SO.MANY.PEOPLE. 

December is a much-anticipated month that brings good tidings and joy to most people. But December is notorious for bringing out the Grinch in kiddos with sensory over-responsivity. Disrupted routines and increased social demands often lead to a merry month of meltdowns. So, what can parents do to support a child who struggles during the most wonderful time of the year?

As a parent of a child with autism, apraxia, and sensory processing disorder, I assure you there are steps we can take to make the holiday season a little more blessed and a little less stressed. It is important for parents to anticipate that the chaos of the holidays will be stressful. Your sensory child needs you to advocate for his or her well-being, so make a plan and stick to it!

5.  Be honest with your family and friends about your child’s sensory needs.

• You are the only advocate your child has and most people have no idea about sensory processing disorder – so tell them (it’s called AWARENESS!)
• Don’t use the “hope and pray” approach (hope your family and friends don’t do anything to set your child off and pray your child acts like the other kids for just one day)
• Set expectations with family and friends up front:

               She probably won’t sit on Santa’s lap, and that’s okay
               He doesn’t like to be hugged, but he may give you a high-five
               She won’t sit at the table with the rest of us, but she might eat later
               He would probably like to help pass out the gifts
               We may not be able to stay very long, but we’ll at least make an appearance
               She is bothered by loud music, so we may have to step out during the sing-along

by Cari Ebert, MS, CCC-SLP

The holidays are coming so this seems like an appropriate time to start talking about the (sometimes dreaded) process of shopping for and buying toys. As a pediatric speech-language pathologist, I am passionate about this topic because toys are the tools for learning. You see, well-designed toys can enhance development and stimulate a young child's mind. As an early childhood expert, professional speaker, and toy connoisseur,  I had the privilege of meeting with the toy designers at Hasbro toys in Rhode Island to give them my two-cents worth. I provided them with my "Top 10 List" of how to buy high-quality store-bought toys. I figured if they were interested in my thoughts, you might be too. So here we go!

Tips for choosing high-quality toys:

1.  Limit the number of battery-operated, button-pushing, cause-and-effect toys. Low-tech/no-tech toys are better at enhancing a child's natural curiosity, creativity, social skills, problem-solving abilities, language, and motor skills. Think about it this way: the more the toy does, the less the child does. We want the child to provide all the power, all the imagination, and all the sound effects. We don't want battery-operated toys stealing those learning opportunities away from the child.

2.  Look for toys that encourage active play. Many battery-operated and screen-based toys keep children passively entertained. The most important thing young children need for learning and development is play-based movement! Tunnels, tents, hula hoops, balls, and self-propelled ride-on toys provide lots of opportunities for running, crawling, jumping, and climbing. Don't forget about toys that foster fine-motor development as well. Look for toys with beads and pegs, stringing toys, stacking toys, crayons, child-safe scissors, and toys with keys, hammers, and latches.

3.  Select simple, open-ended toys that can be played with in a variety of ways. Traditional toys such as blocks, nesting cups, Play-Doh, play food, dress-up clothes, a kitchen set, toy tools, toy animals, and toy vehicles (without batteries) encourage young children to use their imagination. While toys such as puzzles and shape sorters are developmentally appropriate for young children, they are rule-based and therefore don't offer the same benefits as open-ended toys. Making sure young children have opportunities to play with rule-based toys that have a definitive ending point AND open-ended toys is the adult's responsibility.

Nesting cups are one of my favorite open-ended toys. Think of all the different ways to play with them. Nesting cups can be: nested, stacked, counted, used as tea cups, used in the bathtub or water table for pouring, placed in the sensory bin with spoons for stirring dry rice or beans, paired with toy animals and used as food and water troughs, used to make stamps on Play-Doh or with paint on paper (this works because nesting cups have a raised outline of an object on the bottom of each one), or used to sort small objects by color.

4.  Provide toys that can be played with outside too. Whether blowing bubbles, drawing with sidewalk chalk, riding a tricycle, pulling a wagon, flying a kite, playing in a sandbox, or kicking a ball --- playing outside provides multi-sensory learning experiences that are important for young children with developing brains and bodies.

5.  Select toys that are safe and durable. Buy toys that are well-constructed and will hold up to lots of use. For children who are still mouthing toys, it is important NOT to buy toys from discount dollar stores. Any toy that can be purchased for a dollar is not likely constructed from materials that are safe to be put in the mouth! For children who tend to be destructive during play time, wooden toys may not be a wise choice (they become weapons when thrown). Look for light-weight plastic blocks instead of wooden blocks for children who tend to throw their toys.

6.  Choose toys that are interesting to young children but expose them to different types of toys as well. Some kiddos get "stuck" on play themes such as Thomas the Train or Disney Princesses and have difficulty being flexible in their play. For a child who likes trains, try buying ONE train along with several other different types of vehicles. Or try buying ONE train along with a train book, a train puzzle, and a train coloring book. Generic toys without characters from movies or cartoons are best at encouraging open-ended, imaginative play. When children play with character toys they tend to just repeat lines from the movie or show. This "scripting" doesn't help children learn to create their own narratives.

7.  Limit toys that force-feed academics. Play time shouldn't always be focused on teaching early academic concepts such as letters, numbers, shapes, and colors. Look for toys that allow the child to learn naturally through discovery and exploration and facilitate the development of problem-solving skills.

8.  Select toys that are developmentally appropriate (not necessarily age appropriate). All children develop at different rates. The age guidelines provided for toys is in reference to safety, not developmental expectations. We want young children to be successful during play time, while challenging their abilities just enough. Finding toys that offer the "optimum challenge point" is especially important for children who are struggling achieving their developmental milestones. Small doses of healthy frustration are expected during play time, but if the toy is too challenging, the child may give up all together. Toys that are not developmentally appropriate may simply be thrown, chewed on, or ignored.

9.  Remember, books are toys too! Board books with colorful pictures are best for very young children. Look for rhyming books, predictable books with repeating text, touch-and-feel books, and books with sturdy flaps. Books are fabulous because they can be looked at alone, with a parent, with other kids, or with a pet! They can be looked at in bed, in the highchair, in the car, at the restaurant, at church, or while snuggling on the couch.

10. Choose toys that are interesting to the adult as well. This helps to foster cross-generational play. What did you do for fun when you were a child? If you loved playing Go Fish, your child may love playing this card game with you because of the passion you bring to the table. If you loved playing with a dollhouse, then get one for your child. Action figures? Silly Putty? A Slinky? Paper dolls? A Lite Brite? Lincoln Logs? Tinker Toys? Fashion Plates? Spirograph? Toy cash register? I promise you this...your passion will be contagious!

To summarize, the more young children have to use their own minds and bodies during play time, the more they will actually benefit from the play. So...happy shopping and choose your gifts wisely! Oh, one more thing. LESS is MORE when it comes to the quantity of toys. Buying a few high-quality toys is better than buying a large quantity of poorly designed ones.

by Cari Ebert, MS, CCC-SLP

As a pediatric speech-language pathologist specializing in Early Intervention, I often hear reports from concerned parents who were advised to wait six months before making a referral for an evaluation. When a toddler is struggling with speech and language development, parents are often told:  He's a boy. He'll talk when he's ready. He has nothing to say. His older brother talks for him. Don't give him what he wants until he says the word. He's clearly smart...he's just choosing not to talk. Let's just wait and see how he's doing in six months.

Okay, time for me to get on my soapbox. I wholeheartedly disagree with the "Let's just wait and see" approach. When parents express concerns about their child's development, the knee-jerk reaction should be to refer toddlers to the state's Early Intervention program. (Every state has an Early Intervention program that is authorized under Part C of IDEA: in Missouri it's called First Steps, in Oklahoma it's called Sooner Start, in Georgia it's called Babies Can't Wait, and so on.) Why would we encourage parents to "wait and see" when there is an established program staffed with early childhood specialists (speech-language pathologists, physical therapists, occupational therapists, and early childhood special educators) whose sole purpose is to determine whether there is reason to be concerned or not? The Early Intervention evaluation is FREE and it is completed in the child's natural environment, not in a clinic. One of the most important aspects of the Early Intervention evaluation is that it MUST assess all five developmental domains (cognitive, communication, social-emotional, physical, and adaptive/self-help), which gives families information about their child's overall development.

Because the brain triples in size during the first two years of life, sooner is always better when it comes to helping children who are struggling achieving their developmental milestones. A child who hasn't spoken his first words between 15 and 18 months is officially a "late talker." It requires the skills of a pediatric speech-language pathologist, however, to determine if the late talker has a developmental delay or a disorder that requires intervention and treatment. Knowing the difference between a "delay" and a "disorder" is the essence of my job as an early interventionist. A child with a "delay" is acquiring prelinguistic milestones in the appropriate sequence, but is just behind schedule. In other words, a child with a speech/language delay communicates like a child who is chronologically younger (the child is 24-months old but speaks like an 18-month-old child). A child with a disorder, however, has scattered skills and is not acquiring prelinguistic milestones in a typical manner. Helping the child go back and pick up missed milestones so we can establish the requisite foundation skills for learning to talk is an important component of what I do as a pediatric speech-language pathologist in Early Intervention.

Because synaptic connections are created at a rapid rate through age three, we don't want to sit back and "wait and see" when it comes to young children with developing brains and bodies. Rather, we want to get services going as soon as a parental concern is reported. If the child does have a disorder, the sooner we start services, the better the child's prognosis becomes. If the child ends up having a delay, then services may be short and sweet; but why would we take a chance when it comes to something as important as child development? If a parent is concerned...make the referral. Let's move away from the "Let's just wait and see" approach and move to #let's just see.