Have you noticed that your three-month-old baby recognises your voice and smiles whenever he sees you?

By four to six months, he has started to babble, laugh, follow sounds with his eyes, and pay attention to music.

On his first birthday, he finally uttered “Ma” or “Ba” to refer specifically to you, and this created a sweet and unforgettable memory in your journey of parenthood.

In simple terms, speech is how we say sounds and words, including articulation, voice, and fluency; while language involves how we use words to exchange information, including verbal, non-verbal and written communication.

While all children reach developmental milestones at their own pace, it can be worrying if they miss their milestones by a significantly long period.

A child is said to have a speech and/or language delay when he does not acquire speech and language skills appropriate for age during early childhood.

Speech and language delays are different from, but closely linked to, speech and language disorders.

Generally, a delay is a description for a younger child during the early developmental period; however, it is said to be a disorder if it persists beyond early childhood and affects the child’s function.

A speech (sound) disorder is when a child has problems producing speech sounds properly at the expected age, making speech difficult to understand.

Meanwhile, stuttering (medically known as Childhood Onset Fluency Disorder) refers to a condition where sounds, syllables or words are repeated or prolonged, disrupting the normal speech flow.

In both conditions, the child can understand or express ideas in words and phrases, but his utterance may sound incomprehensible, especially to strangers.

Meanwhile, a language disorder is when the earlier speech and language delays do not go away as the child grows up (some children with these delays do catch up and are known as “late talkers”).

The child struggles to understand what others are saying (receptive language) or has trouble sharing his thoughts (expressive language). For example, he can pronounce words well, but is unable to make two-word phrases by 2½ years old.

It is not uncommon to see a child with a language disorder also have speech problems.

Serious signs

It can be hard for parents to distinguish if their child is just a little slow to reach a speech or language milestone, or if there is a problem that needs urgent attention.

Refer to your child’s paediatrician immediately if you are concerned or see the following signs:

Around 12-15 months

• Does not understand the name of certain common objects, e.g. “bottle”, “(toy) car”.

• Does not refer to you specifically using “ma” or “ba”.

• Does not make meaningful utterances.

Around 18-21 months

• Does not understand familiar phrases, e.g. “give me a kiss”, “hug daddy”, “stop that”.

• Does not point to body parts.

• Does not have or has very limited vocabulary, e.g. “cat”, “car”.

Around 24 months

• Does not seem to understand simple instructions or questions, e.g. “Get your shoes”, “Want a drink?” or “Where’s Daddy?’

• Does not say at least 25 different words.

• Does not combine two words together, e.g. “drink milk”, “go out”.

• Can only imitate speech and action, does not say words spontaneously.

Around 36 months

• Does not seem to understand longer instructions or questions, e.g. “Get your shoes and put them in the box” or “What do you want to eat for lunch today?”

• Does not combines words into longer phrases, e.g. “want eat biscuit”, “help me mummy”.

Red flags for speech disorder

• Sounds very immature for his age, i.e. he uses only a few speech sounds or patterns.

• Does not pronounce words the way you would expect for his age.

Red flags for stuttering

• A sound, part of a word or phrase is repeated over and over, e.g. “A a a and I want that one”, “And and and I want that one”.

• A sound is stretched out, e.g. “Aaaaaaaaaaand I want that one”.

• He tries to speak and no sound comes out.

• Eye blinking and grimacing while talking.

A speech-related problem may be caused by oral impairment due to problems with the tongue or palate.

It can also be caused by oral-motor problems whereby there is a problem in the brain area linked to speech, making it hard to coordinate the lips, tongue and jaw to produce sounds.

For language delay or disorder, it may be associated with other conditions such as brain injury and autism spectrum disorder.

In addition, speech and language problems may also be caused by hearing problems (commonly due to congenital hearing impairment, chronic ear infections or glue ear).

There is also strong evidence that excessive screen time (time spent on watching TV or gadgets) and lack of stimulation can lead to these delays.

They may also be part of developmental delay or intellectual impairment.

Early detection and early intervention is the utmost priority for speech and language delays. A wait-and-see attitude can be detrimental to the child’s future.

Dr Lim Boon Chuan is a developmental paediatrician. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please e-mail starhealth@thestar.com.my or visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.