Q: My grandson living in a different country is four years old and does not speak. He pays attention, is very energetic and loves to walk and explore. At home he is an only child and is well-loved and cared for. When he does use his voice, it is to laugh, scream, etc but not to communicate. His parents are both articulate and well-educated. There are servants in the home who speak different languages. They cannot bring him to the States as they are responsible for taking care of their family there.

Can you think of anything we could do from here to help him communicate?

A: When children fail to speak at the “normal” time, parents and caregivers can become anxious and worried, assuming something is automatically wrong. However, in the majority of cases, there is no cause for alarm. Most children will begin at their own pace, particularly boys who tend to develop language skills slightly later than girls. While every child is different, there are “guidelines” set by the American Academy of Pediatrics that indicate by the end of the second year, a toddler should be able to speak in two-to-three-word sentences, follow simple instructions, and repeat words spoken by others; by the end of the third year, the child should be able to identify pictures and objects and understand most of what is said, follow instructions that may have two to three steps, and be understood by others outside the family; by the end of the fourth year, the child should master the basic rules of grammar and be speaking clearly. It should be noted, however, that many of the words may be pronounced incorrectly which is not a cause for concern; by age five, the child should be able to re-tell a story and use more than five words in a sentence.

If a child doesn’t use many words but appears to understand, there are fewer reasons to be concerned. If the child appears to comprehend what is being said and can follow commands, there is still less reason for concern. Of interest is that the number of cases of late-talking children is on the rise on our country per Marilyn Agin, MD, a developmental pediatrician in New York City and co-author of The Late Talker: What To Do If Your Child Isn’t Talking Yet. The incidence of chronic ear infections can impair hearing and may contribute to speech delays. Then there’s the thought that exposure to substances such as mercury could cause neurological damage which, in turn, might affect speech and language.

I wonder if your grandson hears his parents and those around him and can pick up on statements such as “dinner is ready” or “it’s bedtime”. What happens if someone winds a music box in his presence, or better still, can his parents “read his expression” if he winds the music box himself? If he doesn’t acknowledge individuals in his presence or a jingle on television, it may be because he has a hearing problem, a condition that should be checked by an audiologist. Hearing is essential for speech and language development. Hearing loss may be present at birth or may develop later on, perhaps because of ear infections. I feel a specialist should be consulted who can note his progress in other areas in an attempt to determine if this is a consideration. Lastly for this article only, some children exposed to more than one language early on may not speak as early as single language toddlers. In most instances, children will typically catch up in due time and do well. So if he responds to questions or comments from those around him, that’s a good sign and he’s probably just a late talker. If not, his parents should seek the help of a specialist. Early intervention works wonders, so the sooner action is taken, the better off everyone will be.