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Ask Dr. Mom: Delayed Talker

Q. I'm worried about my 18-month-old son, who has been slow to talk. He points and whines when he wants something instead of using words. He does have names for family members and some favorite objects, but he doesn't combine words and has a limited vocabulary compared with other babies his age. He understands what I say to him, and the rest of his development seems normal. What should I do?

A. It's entirely appropriate to be concerned when your child seems to lag behind in a certain area of development. Though "slow to talk" can simply be a variation in normal development for some children, it can also point to more serious problems, such as an impaired ability to learn or acquire language, a communication disorder, or a hearing loss. You should share your observations and concerns about your son's speech with your pediatrician and ask that developmental screening tests be performed.

Normal language development proceeds in a predictable order and at a predictable rate, with characteristic spurts and plateaus. By 2 years of age, for instance, a child usually has about a 50-word vocabulary, speaks in 2-word sentences, points to pictures and body parts when prompted, listens to simple stories and rhymes, uses plurals, and follows simple commands.

It's common, however, for some toddlers  -- particularly boys  -- to have what's called expressive language delay, which sounds like what your son may have. They may comprehend what is said but have difficulty expressing themselves with words. They follow directions well but point to what they want instead of asking for it. Although most children with this type of problem eventually catch up, they are at risk for ongoing language-skill delays throughout preschool, as well as future academic learning difficulties. For this reason, early referral to a speech therapist is an important step toward helping the child speed his development.

If your pediatrician confirms that your son's speech is delayed, his hearing should be tested by an audiologist experienced in evaluating young children. If his hearing is normal, he should then have a comprehensive assessment of his language skills by a certified speech and language pathologist to determine the exact problem. I also suggest that you enroll your son in a preschool program later on, where he'll hear youngsters his own age speak their simplified language.

Meanwhile, there are lots of ways you can help stimulate your son's speech development: Read books to him, sing songs together, play interactive games ("Where are Jason's toes?"), listen patiently when he does speak, and help him express what he is trying to communicate. Most children experience a veritable explosion of language development during the third year, and you may be surprised by the progress your son makes.

Marianne Neifert, M.D. (Dr. Mom), is a pediatrician, mother of five, and the author of Dr. Mom and Dr. Mom's Parenting Guide.