Communication Strategies for Infants and Toddlers

Your baby starts communicating with you before they take their first breath. It's true,  little Johnny and Susie are communicating even before they leave the womb. Sure, early communication seems like a lot of crying and grunting at first, but quickly becomes so much more! As you understand early communication, you will be better equipped to enhance your baby's language from infancy through adulthood.

Communication can be broken down into two fundamental categories: expressive language and receptive language. Expressive language is an individual’s ability to communicate using words, phrases, build sentences, report information, tell stories, have conversations, etc. for means of social, academic and safety needs.  Receptive language is most often a precursor to expressive language, therefore, it is essential to establish before vocalizations begin.

Expressive Language:

Around 10 months of age, your child should begin using variegated babbling, using different consonant+ vowel (CV) syllables and more sounds should begin appearing. Adult-like intonation and prosody (the up and down tones in our voice) emerges. Frequently used consonants include the following sounds /h, d, b, m, t, n, w, p/. Before your child turns one, they should have approximately 2 words in their vocabulary (i.e. mama and dada). Your child should be able to imitate CV combinations and non-speech sounds (i.e. clicks, raspberries, animal sounds). They should also begin imitating the name of familiar objects such as “ball, milk, baby”. Communication continues to grow and expand at an exponential rate. By the age of 15 months, your child should begin saying 8-10 words spontaneously and begin asking to have their needs met.After birth, vocalizations are reflexive, including crying, coughing and sneezing. As your child begins to cry, they are communicating a need (i.e. hungry, tired, dirty diaper). At two months of age, a parent is beginning to distinguish cries for different needs. As your child grows to four to six months of age, he/she is beginning to communicate by laughing, babbling CV and VC syllable sequences and vocalizing feelings through intonation. Reduplicated syllables, such as “baba” begin emerging around 7 months, as do gestures. Gestures are a precursor for verbal language skills. For example, gestures can include reaching towards a rattle, looking at their bottle, smiling when approached and spoken to, establishing eye contact, grabbing for a toy, etc.

 By 18 months your child should have approximately 50 words in his/her vocabulary and should begin asking questions (“daddy go?”). At 24 months your child should have approximately 250 words and be using new words regularly!! Your child should consistently be combining 2-3 words and should be approximately 50% intelligible (percentage of time your child is understood by an unfamiliar listener). By 36 months, your child should be able to relate recent experiences through words, begin conversing, begin counting and combing 3-4 words and be approximately 75% intelligible.

Receptive Language:

Soon after birth, your child learns to quiet to a familiar voice, shows awareness of a speaker and attends to the speaker’s mouth. Around three months of age, your child searches for you when he/she hears your voice, stops crying when spoken to and is beginning to respond to “no”. At the age of six months, your child is beginning to understand a few words and should beginning to follow simple commands, with gestures. For example, “come up” while holding your hands out. They should begin to recognize family members’ names (i.e. mommy and daddy) and wave in response to “bye-bye”.

Before reaching 12 months of age, your child should be attending to new words, giving objects upon verbal requests (“give me the ball”), understanding simple questions (“where’s sissy?”), and is beginning to identify one to two body parts on self. First early words include: family members, food, body parts, clothing, household objects, animals, toys, action words, etc.

By 18 months, your child should be understanding 200 words, identifying noun and action pictures when named. At 24 months, your child should begin following novel commands and two-step related commands. As receptive language increases, your child should begin understanding basic concepts (i.e. size, quantity concepts “give me one”, colors, qualitative “which one is big?”). By 36 months, your child will begin answering simple “wh” questions (who, what, and where), understand location phrases, answer “yes/no” questions correctly, and follow a two to three-step command.

As your child continues to grow and learn, there are many communication strategies we, as speech-language pathologists, recommend to ensure continued communicative development. I’m briefly going to discuss three communication strategies. These strategies are taken from the book More than Words: Helping Parents Promote Communication and Social Skills in Children with Autism Spectrum Disorder.

First, observe, wait and listen to your child’s body language and notice what they are looking at. Provide your child with enough time to carry out his/her own ideas and communication roles. Personally, wait time, was an extremely difficult strategy for me to use, I literally had to count 1-10 in my head. It is truly amazing how much more a child is capable of saying, when time wait is given. If your child does not respond after waiting, cue him/her through modeling, or hand-over-hand help your child make their request. Listen and pay attention to your child’s sounds and words. Do your best to NOT interrupt. When you are listening, you are letting your child know he/she is important.

During daily routines, talk to your child. Tell them what you are doing (i.e. “I’m washing my hands”). Tell your child what he/she is doing (i.e. “you must be mad, because you are yelling”). Follow your child’s lead, meaning every time your child leads an interaction, respond. Give your child information about the things that interest him/her, join in and play. Imitate, interpret and comment on your child’s play. Play is the most important aspect for a child’s communicative development. Play is how your child learns. Make communication fun and as a result, your child will develop an increase in spontaneous use of language and will also begin to establish the power of language for controlling people and getting their desires met.

The third strategy I use frequently is out of reach. Place highly preferred items in sight, but out of reach. This creates an opportunity for your child to seek out communication partners and it makes a specific request. This can be done easily by storing a specific toy in a clear box with a lid. Below is a quick list of additional tips you can use with your infant or toddler. It is important to seek a speech-language evaluation is you have any concerns with your child’s communicative development.

Infants:

• Encourage your baby to make vowel-like and consonant-vowel sounds such as "ma," "da," and "ba."
• Reinforce attempts by maintaining eye contact, responding with speech, and imitating vocalizations using different patterns and emphasis. For example, raise the pitch of your voice to indicate a question.
• Imitate your baby's laughter and facial expressions.
• Talk as you bathe, feed, and dress your child. Talk about what you are doing, where you are going, what you will do when you arrive, and who and what you will see.

Toddlers:

• Get down at your child’s eye level so he/she can see how you produce sounds clearly
• Sing songs and read books with sound and word repetitions. Music brings language to life. Popular children’s songs and rhymes: “Humpty Dumpty”, “Row, Row, Row Your Boat”, “Head and Shoulders”, “Itsy Bitsy Spider”, “If You’re Happy and You Know It”, etc. Allow for opportunities for your child to fill-in-the blank with sounds/words/phrases. Sing simple songs and recite nursery rhymes to show the rhythm and pattern of speech.
• Use environmental and vehicle noise, this will help your child produce a variety of vocal sounds and patterns
• Interpret the meaning of your child’s vocalizations and gestures into simple phrase/ Respond to your child’s sounds even if she can’t say that actual word/ Repeat mispronounced words correctly for your child to hear
• Expand his/her single words into short phrases
• Talk about the things you are doing, looking at, playing with, eating, etc.
• Respond to your child in a way that encourages further attempts to communicate/ Repeat what your child says indicating that you understand. Build and expand on what was said. "Want juice? I have juice. I have apple juice. Do you want apple juice?"
• Try to read every day. The earlier you begin to read and tell stories to your child, the sooner reading will become an important and enjoyable part of your child’s life.  It allows him/her to build knowledge they will need to learn to read.
• Identify colors/Count items throughout your day.
• Use gestures such as waving goodbye to help convey meaning.
• Acknowledge the attempt to communicate.
• Make a scrapbook of favorite or familiar things by cutting out pictures. Group them into categories, such as things to ride on, things to eat, things for dessert, fruits, things to play etc. Create silly pictures by mixing and matching pictures. Glue a picture of a dog behind the wheel of a car. Talk about what is wrong with the picture and ways to "fix" it. Count items pictured in the book.
• Place familiar objects in a container. Have your child remove the object and tell you what it is called and how to use it. "This is my ball. I bounce it. I play with it."
• Use photographs of familiar people and places, and retell what happened or make up a new story.

When speech and language interventions are implemented during a child’s daily routines, there is an increased likelihood that:

• Your child will become more independent. Teaching your child to communicate with the context of a daily routine such as mealtime will help your child to be able to function more independently
• Your child will increase their use of communication behaviors after the instruction has ended. When communication strategies are embedded within daily routines, your child has an opportunity to be rewarded as a natural consequence of their behavior.
• Your child will generalize their new skills across settings and situations.

Enjoy spending time engaging your child and helping them understand the world around them!

~Angie 

References:

      Lanza, J. R. (2009). Ls guide to communication disorders. (2009 ed.). East Moline, IL:

LinguiSystems, Inc.

      Rossetti, L. The rossetti infant-toddler language scale: A measure of communication and

interaction. LinguiSystems, Inc.

       Sussman, F. (1999). More than words: Helping parents promote communication and social skills

in young children with autism spectrum disorder. (1st ed.). Hanen Center.

"Tongue Tied"

We have probably heard of someone being “tongue tied”. What this really means is the tongue is fused to the floor of the mouth. The lingual frenulum is a mucous membrane that usually recedes after birth. 

With ankyloglossia, the medical term for “tongue tie”, the lingual frenulum stays attached to the tip of the tongue. This can cause restricted tongue movement. It appears that if we had restricted tongue movement, we would not be able to produce a number of our speech sounds; however, there has been no empirical research to indicate that “tongue tie” causes a speech delay/disorder. Wait, I just said it can cause restricted movement, how will one be able to protrude their tongue between their teeth for the productions of “th” and /l/. The “th” production can accurately be produced with limited tongue protrusion. The /l/ can be produced inside the mouth, with the tongue touching the alveolar ridge, decreasing the tongue extension. How is one going to make lingual-alveolar sounds such as /t, d, n, s, z/? In reality, we use such limited movement/elevation of our tongue during these sounds. These sound productions can be produced using compensatory strategies, such as slightly changing the position of the tongue (e.g. moving the tongue tip down instead of elevating it). With practice, little to no distortion should be heard, just practice!

According to the ASHA Leader, the oral cavity changes significantly in size and shape during the first 4 to 5 years of life. In return, the significance of ankyloglossia tends to decrease with oral growth. For example, with time the lingual frenulum can recede, stretch and at times rupture.

Being “tongue tied” can cause other functional difficulties, such as latching, sucking, and feeding. Literature primarily deals with potential difficulty with breast feeding (Nicholson, 1991; Jain, 1995; Fitz-Desorgher, 2003; Ricke et al., 2003). It was reported, that the majority of newborns with ankyloglossia do not have feeding difficulties.

To clip or not clip? The clipping of the lingual frenulum is called a frenulectomy. It is a decision solely left up to the parent. If there are feeding concerns, clipping of the tongue can be done. Most speech-language pathologists would rarely recommend a frenulectomy to increase correct sound productions, unless the child presents with a severe articulation or phonological disorder.

In conclusion, many physicians continue to think that ankyloglossia will cause a speech delay, regardless of no evidence found in literature. In the words of Agarwal and Raina (2003): "…there is enough evidence that good speech is still possible with significant tongue-tie and speech problems can be overcome without frenulectomy with speech therapy."

References:

Kummer, A. W. (2005, December 27). Ankyloglossia: To Clip or Not to Clip? That's the Question.. The ASHA Leader.

~Written by Angie