Children vary in their development of speech and language skills. Health care professionals have lists of milestones for what's normal. These milestones help figure out whether a child is on track or if he or she may need extra help. For example, a child usually has one or two words like "Hi," "dog," "Dada," or "Mama" by her first birthday.

Sometimes a delay may be caused by hearing loss. Other times it may be due to a speech or language disorder. Children who have speech disorders may have trouble making speech sounds correctly. They may hesitate or stutter when talking. Children with language disorders might have trouble understanding what others say or difficulty sharing their thoughts.

If you have concerns about your child's speech or language development, talk to your child's health care provider.

What is stuttering?

Stuttering is a speech disorder. It involves interruptions in the flow of speech. These interruptions are called disfluencies. They may involve:

• Repeating sounds, syllables, or words
• Stretching out a sound
• Suddenly stopping in the middle of a syllable or word

Sometimes, along with the stuttering, there may be nodding, rapid blinking, or trembling lips. The stuttering may be worse when you are stressed, excited, or tired.

Stuttering can be frustrating, because you know exactly what you want to say, but you have trouble saying it. It can make it difficult to communicate with people. This can cause problems with school, work, and relationships.

What causes stuttering?

There are two main types of stuttering, and they have different causes:

• Developmental stuttering is the more common type. It starts in young children while they are still learning speech and language skills. Many children stutter when they first start talking. Most of them will outgrow it. But some continue to stutter, and the exact cause is unknown. There are differences in the brains of people who continue to stutter. Genetics may also play a role, since this type of stuttering can run in families.
• Neurogenic stuttering can happen after someone has a stroke, head trauma, or other type of brain injury. Because of the injury, the brain has trouble coordinating the different parts of the brain involved in speech.

Who is at risk for stuttering?

Stuttering can affect anyone, but it is much more common in boys than girls. Younger children are most likely to stutter. About 75% of children who stutter will get better. For the rest, stuttering can continue their whole lives.

How is stuttering diagnosed?

Stuttering is usually diagnosed by a speech-language pathologist. This is a health professional who is trained to test and treat people with voice, speech, and language disorders. If you or your child stutters, your regular health care provider may give you a referral to a speech-language pathologist. Or in some cases, a child's teacher may make a referral.

To make a diagnosis, the speech-language pathologist will:

• Look at the case history, such as when the stuttering was first noticed, how often it happens, and in what situations it happens
• Listen to you or your child speak and analyze the stuttering
• Evaluate you or your child's speech and language abilities, including the ability to understand and use language
• Ask about the impact of stuttering on you or your child's life
• Ask whether stuttering runs in the family
• For a child, consider how likely it is that he or she will outgrow it

What are the treatments for stuttering?

There are different treatments that can help with stuttering. Some of these may help one person but not another. You need to work with the speech-language pathologist to figure out the best plan for you or your child.

The plan should take into account how long the stuttering has been going on and whether there are any other speech or language problems. For a child, the plan should also take into account your child's age and whether he or she is likely to outgrow the stuttering.

Younger children may not need therapy right away. Their parents and teachers can learn strategies to help the child practice speaking. That can help some children. As a parent, it's important to be calm and relaxed when your child is speaking. If your child feels pressured, it can make it harder for them to talk. The speech-language pathologist will probably want to evaluate your child regularly, to see whether treatment is needed.

Speech therapy can help children and adults minimize stuttering. Some techniques include:

• Speaking more slowly
• Controlling breathing
• Gradually working up from single-syllable responses to longer words and more complex sentences

For adults, self-help groups can help you find resources and support as you face the challenges of stuttering.

There are electronic devices to help with fluency, but more research is needed to see whether they really help over the long term. Some people have tried medicines that usually treat other health problems such as epilepsy, anxiety, or depression. But these medicines are not approved for stuttering, and they often have side effects.

Many disorders can affect our ability to speak and communicate. They range from saying sounds incorrectly to being completely unable to speak or understand speech. Causes include

• Hearing disorders and deafness
• Voice problems, such as dysphonia or those caused by cleft lip or palate
• Speech problems like stuttering
• Developmental disabilities
• Learning disorders
• Autism spectrum disorder
• Brain injury
• Stroke

Some speech and communication problems may be genetic. Often, no one knows the causes. By first grade, about 5 percent of children have noticeable speech disorders. Speech and language therapy can help.

The functions, skills, and abilities of voice, speech, and language are related. Some dictionaries and textbooks use the terms almost interchangeably. But for scientists and medical professionals, it is important to distinguish among them.

Voice

Voice (or vocalization) is the sound produced by humans and other vertebrates using the lungs and the vocal folds in the larynx, or voice box. Voice is not always produced as speech, however. Infants babble and coo; animals bark, moo, whinny, growl, and meow; and adult humans laugh, sing, and cry. Voice is generated by airflow from the lungs as the vocal folds are brought close together. When air is pushed past the vocal folds with sufficient pressure, the vocal folds vibrate. If the vocal folds in the larynx did not vibrate normally, speech could only be produced as a whisper. Your voice is as unique as your fingerprint. It helps define your personality, mood, and health.

Approximately 17.9 million adults in the United States have trouble using their voices. Disorders of the voice involve problems with pitch, loudness, and quality. Pitch is the highness or lowness of a sound based on the frequency of the sound waves. Loudness is the perceived volume (or amplitude) of the sound, while quality refers to the character or distinctive attributes of a sound. Many people who have normal speaking skills have great difficulty communicating when their vocal apparatus fails. This can occur if the nerves controlling the larynx are impaired because of an accident, a surgical procedure, a viral infection, or cancer.

Speech

Humans express thoughts, feelings, and ideas orally to one another through a series of complex movements that alter and mold the basic tone created by voice into specific, decodable sounds. Speech is produced by precisely coordinated muscle actions in the head, neck, chest, and abdomen. Speech development is a gradual process that requires years of practice. During this process, a child learns how to regulate these muscles to produce understandable speech.

However, by the first grade, roughly 5 percent of children have noticeable speech disorders; the majority of these speech disorders have no known cause. One category of speech disorder is fluency disorder, or stuttering, which is characterized by a disruption in the flow of speech. It includes repetitions of speech sounds, hesitations before and during speaking, and the prolonged emphasis of speech sounds. More than 15 million individuals in the world stutter, most of whom began stuttering at a very early age. The majority of speech sound disorders in the preschool years occur in children who are developing normally in all other areas. Speech disorders also may occur in children who have developmental disabilities.

Language

Language is the expression of human communication through which knowledge, belief, and behavior can be experienced, explained, and shared. This sharing is based on systematic, conventionally used signs, sounds, gestures, or marks that convey understood meanings within a group or community. Recent research identifies “windows of opportunity” for acquiring language—written, spoken, or signed—that exist within the first few years of life.

Between 6 and 8 million individuals in the United States have some form of language impairment. Disorders of language affect children and adults differently. For children who do not use language normally from birth, or who acquire an impairment during childhood, language may not be fully developed or acquired. Many children who are deaf in the United States use a natural sign language known as American Sign Language (ASL). ASL shares an underlying organization with spoken language and has its own syntax and grammar. Many adults acquire disorders of language because of stroke, head injury, dementia, or brain tumors. Language disorders also are found in adults who have failed to develop normal language skills because of mental retardation, autism, hearing impairment, or other congenital or acquired disorders of brain development.

As children grow older, they develop in several different ways. Child development includes physical, intellectual, social, and emotional changes.

Children grow and mature at very different rates. It's hard to say what "normal" is. There can be big differences in height, weight, and build among healthy children. Diet, exercise and genes are all factors. Some children begin puberty or are close to it before they are teenagers.

Children start to become more independent from their parents. They may rebel. They also look outward - to their friends, who are usually of the same sex. Peer approval becomes very important. Your child may try new behaviors to be part of "the group." This can also be the time that parents or teachers recognize learning disabilities or behavioral problems in children. These problems can get worse as time goes on, so it is important to get help early.

Child development describes the changes children experience as they grow older. As children grow physically, they also develop in their knowledge, skills, and behavior.

Parents and other adults, such as grandparents and child care providers, play important roles in children’s development. As a parent, you are the most important teacher in your child’s life. You also know your child best. Learning more about how children grow and develop is one way to build on what you already know and get new ideas about how to support your child’s learning and well-being.

The following table shows some of the main areas of child development.

All these areas of development are connected. We should always think about the whole child. For example, once children learn to use words, it is much easier for them to express their emotions. And once they begin to crawl, they begin to explore more and learn about other parts of the world around them.

Children develop at their own pace, so you never know exactly when your child will learn a new skill. Developmental milestones are skills that children often learn at a certain age. Developmental milestones give you an idea of the changes you can expect as your child gets older. It’s helpful to be familiar with these milestones, but remember that small variations are perfectly normal.

When we talk about a child’s growth, we often think first about height and weight. These are two important parts of your child’s physical health. Each time you visit your doctor, your child’s growth since your last visit will be measured.

Your child’s health is the foundation of all growth and development. Of course, your child’s health includes more than physical growth. Some other important parts of your child’s health include their cognitive (learning and thinking) development, social and emotional growth, and mental health. All aspects of health and development work together to form your child’s overall well-being.

You are the most important person to support and promote your child’s health and wellness, so it is important to find quality health care services and professionals. Expect professionals to answer your questions, listen to your input, and be available. You know your child best, and are his or her primary advocate.

The following table lists some of the most important parts of children's health and wellness.

Brain development (learning and thinking)

• Supporting your child’s brain development

Physical health

• Making sure that you have a medical home
• Ensuring that your child receives well-child physical exams
• Using healthy habits to prevent illness
• Managing illness

Nutrition

• Making informed decisions about breastfeeding and formula feeding
• Offering nutritious meals that meet your child’s needs and give him or her energy to learn

Social, emotional, and mental health

• Helping your child understand and learn to share his or her feelings
• Helping your child learn to have positive relationships
• Encouraging your child to explore and learn
• Learning strategies for parenting in tough times and coping with depression or other difficult feelings
• Building resilience in yourself and your child

Oral health

• Encouraging oral and dental health so children are better able to eat, speak, and focus on learning

Active living

• Providing age-appropriate amounts of physical activity in your child’s daily routines to support physical health and positive behaviors

Safety and injury prevention

• Creating and maintaining safe environments
• Educating your child on ways to avoid injuries
• Identifying and reporting suspected child abuse and neglect

Most children hear and listen from the moment they are born. They learn to talk by imitating the sounds around them and the voices of their parents and caregivers. But about 2 or 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing. More lose their hearing later during childhood.

Babies should have a hearing screening before they are a month old. If your child has a hearing loss, it is important to consider the use of hearing devices and other communication options by age 6 months. That's because children start learning speech and language long before they talk.

Hearing problems can be temporary or permanent. Sometimes, ear infections, injuries or diseases affect hearing. If your child does not hear well, get help.

Sometimes, a baby's tongue is stuck to the bottom of the mouth by a band of tissue, which means the baby can't open his or her mouth wide enough to get a good latch. Checking for tongue-tie isn't a standard newborn test in the hospital or doctor's office. If your baby isn't latching on well and doesn't seem to be gaining weight, see your baby's doctor or nurse and ask about this. Fortunately, it's a very simple fix. Once tongue-tie is treated by a medical professional, breastfeeding gets better for moms and babies.