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Hi Dr Kumar .

I am 27yrs of age, married and a mother of 2 - my eldest daughter is 5 years old and my youngest daughter is turning 3 years old in May 2013. My husband & I have a few concerns about our youngest daughters speech development. We have noticed that other kids her age (even a year younger) are speaking, their vocabulary is much bigger, they are answering & asking basic questions as well as able to state how they are feeling. Where as my daughter doesn't do any of that. All her milestones she met on time like walking, sitting, responding to her name, smiling etc.

Her vocabulary / and the way she conducts her self are as follows:

> She says / shouts "Mommy" or "Daddy" - only when she wants something and after she's gotten our attention she won't say what it is she wants & she won't ask us anything, she just calls us to get our attention and then she throws tantrums if she doesn't get what she wants;
> When she wants something to drink she will bring us her sippy cup & shove it in to our hands, we will then ask her "how must you ask?" And when she doesn't reply we then say "You must say - can I have some water please?" Then rarely she will say "open please" and then after she drinks she will say "thank you" - that is on rare occasions but mostly she will through a tantrum because we asked or told her how to ask when she needs something.
> She used to know the difference between her own name and her sisters name but until 4 months ago she seems as if she does not know the difference between the two - this appears when she calls her sister or when she tries to get her sisters attention she will use her OWN name.
> She won't say she is hungry or ask for food. She will bring us her lunch box from school and it will be the same story as the water bottle before this.
> If we ask her a question - trying to prompt her to speak or trying to engage her in a topic then it will be met with a tantrum reaction. The type of questions we will ask is "Do you want a biscuit?"; "Do you like Dora?"; "What colour is mommies dress?" etc - she will refuse to engage with us by shutting her eyes and throwing a tantrum.
> She babbles in her own langauge A LOT - she is NOT a quiet child, sometimes I can see her trying to tell us something or keep a conversation with her sister and when we can't understand her she then throws a tantrum. It breaks my heart to see this as she does try.
> She knows her colors, but her pronunciation is a bit off -
'Blue' is "Vlue; 'Pink' is "Piik" etc.
> She knows her shapes but as with the colors her pronunciation is off - 'circle' is "kirkel"; 'triangle' is "tie-kel" etc.
> She knows her body parts; how to count; sing her ABC's; certain nursery rhymes - although her pronouciation is off with these as well;
> She understands simple commands like: blow; run; press; blow kisses & dance - also when we ask her to do certain things like "pick up the toys" or "fetch the brush" she understands and listens sometimes but mostly our requests are met with a tantrum.
> She loves paging through books & pointing at stuff she knows and will  ask us "what's tis?" - when this happens we relish the opportunity and we will go through the book with her, engaging with her.
> Her favorite toys are lego building blocks, her tea-set and play dough.

We never spoke much 'baby-talk' with her. Most of the time we spoke to her like we do with everyone else. Yet she still babbles her baby-talk and we cannot understand her no matter how we try. If she is wet or if she passed stool, she wont show / point to her diaper or tell us. She would leave it there, run around, play & go about as normal she will only start moaning 30-60min later. Even through all of this, she is mostly a happy little girl. She loves play time, loves interacting with others, is very friendly to babies, kids and adults alike and babbles non stop with them. She loves bath-time, feeding herself and she concentrates fully if her favorite programs are on T.V.  She loves dancing & dressing up - even dresses her self sometimes.

She has been off the bottle since 2 years old. She is also at daycare with kids her age - the teachers says she is a lovable child - no tantrums :/ ....
Her 5 year old sister started "speaking" at 24 months.

I dont know if I have anything to worry about, but I end-up worrying nevertheless, because of seeing what other kids her age and younger are able to say & do.
I feel partly to blame for this as with my first child I was a stay at home mom until she was 3 years where as with my youngest - I started working since she was 6 months so the time I spent nurturing her is significantly less.
Majority of the time she is not in our care she is with relatives of mine (after daycare) as I work and I am not sure how they address and handle her - I am so close to leaving my Job in order to take care and raise my kids because I am convinced that I can do a better job as the mother.

So what we need to know from you Doctor is:
Is there something wrong with my toddler? Does she have a learning disability? Will this affect her later with her schooling? Do I have any reason to be concerned? Is the T.V to be blamed? & can I DO ANYTHING that can help her progress with her speech & vocabulary?

Thank you so much.
(Sorry for the LONG message)
Jameela Jones,
South Africa.

Answer
Hi Jameela,

I am so sorry for being so late in replying... Last few days were so hectic that I just couldn't manage this forum well. Sorry again.

Jameela, your younger daughter definitely has gross delay in expressive language development, although her receptive language (understanding) seems better. She definitely needs help without any further delay. Actually, any child who is not started joining two words (like "mama, come", "give ball", etc.) by TWO years of age needs further assessment.

Giving time to the child helps, but not giving much time CANNOT be the cause of such gross delay. So, don't feel guilty and, in my opinion, this should NOT be the reason to leave your job. At this stage, she needs professional help (as described below), not just your time.

Another point: "Baby talk" is normal for any toddler who is learning to speak. For example, it is difficult for a baby to learn speak "k", "g", "r" initially (thus, Triangle becomes tie-kle). We recommend that parents should not to do "baby talk", so as not to reinforce wrong pronunciation... However, please note that "baby talk" by care-givers is not the CAUSE of baby's speech in that way...

Yes, exposure to too much TV can also affect speech development (as a young toddler cannot lip-read what he/ she hears on TV: something that is essential for her to learn to speak), but cannot cause such gross delay.

We have to go for thorough evaluation in a case like this. The first step in management of any child with delayed speech development should have formal hearing test. If the child has any issue with hearing (child not hearing clearly) will obviously affect speech development.

If hearing is OK, next you should consult a speech therapist who is the best person to help her out. Follow instructions of the therapist and help your child learn to speak as taught by the therapist.

There are some clues (although not very strong) that your daughter MAY have some additional issues related to sensory integration also (the way our brain processes information that is received from various sensations)...e.g., her not bothering after she has passed stools is not normal at this age. You may have to consult a child psychologist also for comrehensive evaluation regarding such behavioral issues.

Nevertheless, I must tell you that all these things are very much manageable with efforts in the right direction. The only message I wish to strongly reiterate is that please don't adopt "wait and watch" approach at this stage....since earlier is better in such cases.

Please feel free to ask for any further clarification.

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846  

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Dr. Puneet Kumar

Expertise

I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query requiring specific diagnosis of a particular subject.

Experience

I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 15 years of experience in the field.

Organizations
Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (http://www.kumarchildclinic.com)

Publications
(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. http://www.pediatricsciences.com/issue/view/1050000010 (f) Regular column, “How do I treat” in Pediascene (www.pediascene.com) (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 (http://www.pediascene.com/page.php?cid=6&catid=9&id=132 ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

Education/Credentials
After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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