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Ask Dr. Sears: Stuttering in Children

Q:  My daughter just turned 3 and she's having a problem with stuttering. I'm not sure if I should get her evaluated or not. Sometimes it's really bad and sometimes you can't tell if she's having a problem. When should I start to worry?

A: In the usual progression of learning to talk, many 3-year-olds go through a stage called normal disfluency, in which they repeat words and syllables and use fillers like "uh" or "um." Normal disfluencies tend to occur when children are tired or being rushed to speak, and they usually begin to disappear when a child is 4 or 5 years of age. If over the period of six months you gradually notice improvement, there's little reason to worry. About 5 percent of children stutter at some point on their way to becoming fluent speakers, and only 20 percent of these need speech therapy for stuttering.

In some cases, normal disfluencies can progress into stuttering. Here's how to tell the difference: With stuttering, instead of one or two repetitions of a syllable, a child may repeat it four or five times such as, "ca, ca, ca, ca, can..." or "m, m, m, m, mommy." In addition to struggling with speech, stutterers show signs of increased physical tension and often avoid speaking, in an attempt to hide their stuttering. Also, children who stutter usually develop other mannerisms such as eye blinking, tense mouth, looking to the side, and avoiding eye contact. Children often stutter more in stressful situations, such as when put on the spot to perform in front of an audience or when exposed to an unfamiliar environment.

Here's how to help your child speak comfortably and confidently:

Connect before you direct. Make eye contact with your child while addressing her. If her attention wanders, draw her back by saying, "...(name) I need your ears, I need your eyes." Your child should be comfortable looking at a person while talking.

Speak correctly to your child. Speak slowly and distinctly, and give her a chance to take in your articulations so she can mimic your speech patterns.

Listen intently. Your daughter should feel that what she is saying is important to you, so that she will talk more often. Invite her to tell familiar stories, especially those that she tells the most fluently and those that are not forced.

Identify the triggers. Keep a speech diary and notice what makes your daughter stutter. Does she stutter when she's tired, hurried, anxious, or nervous? Try to intervene in these situations.

Encourage but don't pressure. Resist the temptation to finish your child's sentences for her or to hurry her along to the end of the sentence. Let her make mistakes, as this is part of natural practice. Feeling rushed simply contributes to more stuttering. Also avoid the temptation to correct, criticize, or change the way she talks or how she pronounces the sounds of words. She won't talk as often if she thinks she's making a mistake that will lead to a lecture. Teach by imitation, not by correction.

Chart her progress. Make note of what situations trigger stuttering and which days she is most fluent. Track her progress over a six-month period. If she is stuttering less and becoming more fluent, there is no need for speech therapy. If, however, she is stuttering more and speaking less enjoyably, it would be wise to seek professional help before she begins school.

Remember that speech is a social skill you want your child to enjoy, so she should speak comfortably before speaking correctly. Children are completely unaware of quirks in speech, especially if parents don't call attention to them.