Brian is 3 years 5 months old. He hails from the slopes of Mount Kenya. When he was 5 months old, he developed convulsions which led him to being admitted in hospital several times without the cause of convulsions being clear. The convulsions went on until he was 2 years old. “The child used to stay just like that,” Rose, the mother says, “But currently the child has really improved, he eats well and plays. But he still has to support himself when walking.” While the convulsions have ceased, she still goes to the hospital for physiotherapy since the child cannot walk properly yet. It is during one of these sessions that she reported that she thinks the child cannot hear and was referred to a speech specialist.

Mr Silas Njeru, 29, a speech therapist based in Embu Level V Hospital, Kenya, handling the Brian’s case says, “These convulsions led to delay in achieving growth milestones due to brain damage hence the delay in walking and speech.” Brian is one of the many children who have difficulties in speech development.

Causes 

There are several causes of speech problems in children which include, “Genetic or inherited problems where a speech problem runs in the family. Parents may or may not have an obvious speech problem but transmit it to some of their offspring.”

“There are also acquired problems such as brain infections such as meningitis and encephalitis, and head injury in early life. These problems lead to damage in brain’s speech areas hence interference with the expressive and receptive speech areas,” he says.

Other causes of speech problems in children include pregnancy related causes such as maternal drug use and abuse. “If a pregnant woman uses some prescribed medications such as anticonvulsants, and other illegal drugs of abuse they can negatively impact the child’s brain growth hence speech problems,” he says. “Emotional disturbances in pregnant women and depression can also lead to interference with the child’s growth. Problems can also occur during birth such as birth asphyxia and fetal distress which can lead to brain damage in children.”

“Environment can negatively impact a child’s speech development,” says Njeru, “If a child is brought up by a deaf person, they may have difficulty in developing language since language is a learned skill. First born children also tend to be more affected since they lack someone to keep stimulating them with speech more so when parents are away. Equally, if the caretakers speak different languages to a child, a child can easily get confused leading to delayed speech,” he says, “hence the need to have a common language in the family.”

“Lastly there are unknown causes of speech problems,” he says. “But often the causes of speech problems are due to brain damage on the speech areas of the brain.”

Treatment

To identify speech problems in children it is important for the caretakers to be aware of the social and language development in children. “By the time the child is one year, it needs to be able to say a one word sentence such as ‘baba’ and ‘mama’, by the time they are one and a half years, a child should be able to say a two to three word sentence like ‘give me tea’ and at two years, they should be able to say a four or five word sentence,” he says.

To manage speech problems, a child is assessed for the efficiency of the speech structures. Speech structures include the tongue, lips, teeth, cheeks, palate, voice box, mouth, epiglottis. This helps to optimize the oral speech therapy. “In some cases you can find the tongue is weak, heavy and uncoordinated. Qualities of a good tongue for speech are it needs to be flexible enough, have good coordination, and have good strength,” he says. “Hearing is also assessed since it could contribute to speech difficulties like in Brian’s case.”

“Parental skill training is also essential in helping a child develop good speech,” he says, “It includes, encouraging parents to speak to a child and speak to them words they can easily understand and pronounce. Parents should do this whether the child responds or not. If a parent results in use of sign language to communicate with a child, it can negatively impact language and speech development.” 

“Social integration is another way to encourage language development. Here the caretakers are encouraged to let the child play with other children so as to encourage language stimulation from other children,” he says. “If a child reaches school going age and they cannot speak, take him to a normal school rather than a school with children with special needs.”

“Sensory stimulation is also important since it encourages normal brain development. This includes encouraging a child to sing, play, and sometimes a child is exposed toys that make specific sounds such as numbers and letters of alphabets,” he says.

“Caretakers should consult a doctor or a speech specialist anytime they notice a child has delayed speech development for further evaluation and advice,” says Njeru.