Speech Development in Children: An Interview with Speech & Language Therapist Andrea Cortes

Speech Development in Children: An Interview with Speech & Language Therapist Andrea Cortes

Amanda: Hi, today we're talking to Andrea. Andrea is a speech and language therapist who holds a master's degree in neuroscience and education from Columbia University in New York City. Additionally, she has a master's degree at human communication disorders from Universidad de las Américas in Mexico City. Andrea has worked as a teacher, a speech, language and learning therapist. She also has researched the importance of early literacy and language development and school readiness. Currently she resides in Berlin, Germany, where she lives with her loving husband and adorable son. After taking a two-year pause from her professional life to be with her family, she has just been offered a job as a teacher.

Welcome Andrea, and thank you for joining me today. First of all, would you like to tell me a little bit about your own motherhood journey?

Andrea: Sure, yeah. I can start by telling you that I was very excited when I was pregnant. I started to make big plans for my baby. My husband and I were reading a lot of books. We had the room all ready. We took a great birthing course. We definitely felt that we were prepared. We were ready for this. Then my baby was born, and I kind of knew, "I'm absolutely not at all prepared for this." The first few months were very, very trying months. I felt very tired all the time. I guess one of the easy parts for me was that I was absolutely in love with my baby, so even though I was very tired, he gave me a lot of strength.

For me that was very easy. However, there was a point when I absolutely felt like I was beginning to collapse. I was definitely so sleep deprived. That was a very, very tough moment for me at that time. That's when I realized that I had to do something about this. I found the Little Ones Program, and it gave me really quick results. My baby currently sleeps for 12 uninterrupted hours. I actually think that made me a better mother. I also think that as a result of that he's an easygoing child. He is just really fun to be around. He's mostly in a good mood. It just made being a mom very enjoyable.

Amanda: Everyone always copes better when everyone sleeps well. Right? That of course it's going to make everyone a lot happier and able to enjoy the experience.

Andrea: Yeah, for sure. I mean, even though to this day I feel like nothing can really prepare you, I mean there are definitely some great things that you can in a way handle much better once you were a bit more rested.

Amanda: Absolutely. You're a speech and language therapist. What does this entail?

Andrea: As a speech language therapist, I work with children who have either speech difficulties or language difficulties, or it could also be both. I want to start by maybe dividing them. I think it's going to be more clear this way. Speech difficulties are, for example, when a child has problems expressing or producing certain sounds in their mother tongue. Could be like in English for example, instead of saying cat, they will say Tet. Changing the K sound for a T sound. For example, they can also emit certain sounds like for example, instead of saying car they can just say cah, like omitting the the last er sound. In this case then the clarity of speech is definitely affected. That's what you would work on in therapy. Just trying to improve the clarity of speech so that other people can then understand them.

Then moving on to language. Language difficulties can be when a child has either problems understanding, for example, understanding directions. This is known as receptive language or also expressing. Expressing their needs. Maybe an anecdote. This is known as expressive language. Then of course as a therapist you would need to evaluate if you would need to work in either receptive or expressive language as well as maybe conduct an evaluation where you are determining if a child has problems in the sub areas of language, which could be for example the meaning, the structure and the use of language. For example just meaning can be like working with a child by helping him increase his vocabulary. Sometimes that is really important. The structure could be helping them simply understand the grammatical structures of their mother tongue. The use has to do more with nonverbal cues, like really important things like making eye contact when you talk to someone, taking turns when there is more than one person talking, other nonverbal things like maybe understanding jokes, understanding sarcasm for example. That is the use of language. 

Amanda: That's amazing.

Andrea:  I mean many, many things that could be definitely stimulated in language. As I said at the beginning, sometimes children can have just speech difficulties, sometimes just language difficulties. Sometimes therapy can entail a combination of both speech and language problems. If parents feel like maybe there is something that or if your child or if you feel like your child is not meeting particular language milestones, it is definitely advisable that you talk to a doctor to a language specialist but always keeping in mind that all children develop at a different speed. Never no way of getting too nervous like never comparing your child to another child. Yeah and definitely a language specialist will help you determine if there is any need this speech-language therapy.

Amanda: Yeah. I think if any parent is ever worried, my motto is always sort of just go to the professionals and you can never be... You might think you're silly, but you can always get reassured by the professional that it might just be normal or maybe there is something that you need to look into. I don't know. I'm just always of the opinion that what's the harm in going and getting it checked out if needed?

Andrea: Right. Of course. Yeah. There's a lot of information now a days that you could also access. Of course like trust your instincts. If you ever if you have read something like, "Maybe my child should be producing maybe a couple words by now, and it's not happening." I also believe that, I mean, what's the problem in asking a specialist?

Amanda: Yeah, exactly. Are there physical barriers that parents should be aware of that might be affecting their speech? For example, like lip or tongue ties and how does this affect their speech development?

Andrea: Okay. I want to start off this answer by explaining a little bit about the importance of our oral and face structures as well as the muscles around the mouth. These are actually very important structures for speech development. If a child has, for example, a lip or a tongue tie, they could definitely affect speech articulation. A tongue tie is when the child is born with a very tight or very short frenulum. This is the membrane that holds the tongue to the floor of the mouth. Like right here. If you put your finger, you would feel it. Then the problem is by having this membrane too tight, it's going to obviously affect the mobility of all these oral structures of the muscles that are definitely very important for producing certain phonemes, as I was saying at the beginning, right?

 A lip tie is very similar, now the affected part is in the upper lip. A tilt on this membrane kind of connecting your gum to your teeth. Again, it's going to impede the correct mobility of all these oral structures or your muscles. Again, impeding correct language articulation.

I guess that the good news about this is that if a child has a problem like this, most likely the mother will notice this during his first few months, like as a newborn basically. Usually mothers report that their their child is having problems breastfeeding for example. Then of course like a specialist would have to check what are the probable causes of this? Once the doctor detects this, it could either be that a very, very small cut is done to this membrane that I described, and then this will allow the child to have the correct mobility. Most likely they will just continue developing their speech as normal.

Other times this is this really small surgery is not needed absolutely at all. It could just be that the doctor refers the child even as a newborn to a speech therapist where the speech therapists could do certain exercises that helps just like release the tightness of the membrane. Then basically yes. To answer the question, yes all of these physical structures are very important for correct speech development.

Amanda: Okay, great. What would happen if, for example, they, they didn't get detected from feeding or from when their baby was a newborn? What would happen then if the child did go on to get old, grow older and couldn't speak as well? Could the surgery be done then, or is it too late, or what would happen?

Andrea: No, I mean it's never too late. Definitely the earliest intervention, the better. I mean it could still for sure happen, and then most likely if the child is now speaking, the parents would most likely notice that there are I guess, as I had said, certain sounds that they're not producing really well. Then speech therapy would definitely work very well where, again, the speech therapist would have to work with the child, teaching him a few strategies on how to produce certain sounds. Yeah. It's definitely never too late.

Amanda: Good, good. Going along from that, can dummies or pacifiers or thumb sucking also affect speech and language development?

Andrea: I would definitely agree with this. As we had mentioned, all these oral structures, the muscles near our mouth are very, very important for proper speech development. Really my advice would be that during the first few months, a child can definitely use a pacifier. Sometimes they suck their thumbs, and that's okay. It's self-soothing. I would definitely advise parents not to let this go past the age of one. During the child's first birthday is usually when a lot of oral structures begin to prepare for speech production. Of course, then dummies could definitely influence the correct development of these oral structures. Again, I would advise parents maybe to start weaning off the child, maybe around six months so that once they are one, there are definitely off the pacifier. Of course. I mean it's difficult. I guess what I could suggest is that try to maybe distract the child, like compensate by doing other activities. Maybe when the child wants a pacifier suggest, "Oh, let's read a book or let's play with your favourite toy."

Now, from personal experience, for example, my child actually never used a pacifier, but when I was weaning off the midday milk bottle, that was difficult. Gradually we always used to suggest like, "Let's play with your favourite toy. Let's read one of your favourite books." It's just like any habit. Breaking habits are tough. We were very, very consistent. I think that's key. We decided we're going to take away the bottle, the midday bottle. Just be very consistent and just like any habit, gradually, if you're consistent, it's definitely going to break. 

Amanda: Definitely. I can see how speech and language development does definitely get affected when children or babies have a physical dummy in their mouth just walking around during the day. For example, my first child did have a dummy but she was only ever allowed it for sleep. That was it. She wasn't allowed it during the day. Then the dummy fairy came. Actually as soon as we took away her dummy, her teeth and her palette changed shape almost immediately just from not having it. We have two good friends who are both dentists, and he was saying to make sure that it was gone and hopefully that her mouth shape would change just as soon as it was gone. It did. My other daughter actually sucked her thumb, and that's obviously a lot harder. She luckily for us, she sucked her thumb but only would suck it when she was holding her comforter. The comforter fairy came, and then the same thing happened. Her palette has come down, she would suck it on the side, so her teeth were going out sort of to one side. That's all straightened up.

It's amazing the difference that just a physical thing inside their mouths can change the shape of their mouth so much. I can see how that can easily affect speech development and speech.

Andrea: Right? I mean, think of these are like, these structures and muscles, well they are like any other muscle for example. If you want to work out your abs, you go to the gym, you work out, and then you have a result, right? After maybe a few months, you have a change, a physical change. It's very similar. These are muscles that are being affected by something that, so the child is sucking on either the dummy or their thumb, so then this will also change their physical structures

Interview Part 2

Amanda: So, how important is it for parents to actively encourage speech development and language development in their babies?

Andrea: Yes, exactly. I mean, this is vital. I cannot really stress enough the importance of talking to your baby, to your newborn baby. There are actually many research studies that have currently been carried out that show that speaking to your newborn will not only develop their language but it will actually increase their cognitive performance. So, in very simple terms, this means that parents who talk constantly with their children will actually raise smarter children. Yeah. So, I mean, this is really like... I cannot really stress the importance of this.

Again, speaking from personal experience, I can say that sometimes this is very hard, especially with newborns. You have this tiny, little person who you adore and what kind of conversation could you have with such a... it's a newborn in the end, right? You can tell your baby how much you love him, how adorable she is. But what kind of conversation can you really carry out? So, that's why I understand that this can be sometimes very, very difficult. But it's really one of the most important times, when they're at the newborn stage, to talk to them. I mean, you can be very exhausted. Sometimes you can even feel like you're kind of crazy, just talking and talking to the baby without getting any kind of response but really, my advice would just be to persevere. Continue having tons of conversations.

And definitely, this is something that I really also want to stress, is to avoid just putting the baby in front of a TV. Sometimes, I have seen that maybe parents who kind of fill in the silence. Sometimes it's like you have very long days with your child. Maybe you are on your own as a mother. Maybe your husband has already gone back to work, so you are the one who's there on your own. The simplest thing may be just to fill in the silence, put the child in front of the TV. This really does nothing for their development. So, I mean, possibly, maybe later when they're about 18 months old, if you want to maybe try once a week, a little bit of TV. But definitely before that, it doesn't do anything for their development.

Amanda: Right. So, talking to them and... Is there anything else that you can do? I know that with my first, I actually taught her sign language first, rather than... Well, I still spoke to her a lot, but from six months old, I started teaching her signs. So, by the time she was 18 months old, she actually knew the signs for thirty different things. And she could communicate using these signs but she couldn't necessarily say the words yet. My in-laws were actually quite worried that she would not be able to speak so much because she was signing so much. But is that a problem? For her, it actually turned out absolutely fine. My gosh, she speaks so much. It definitely did not inhibit her ability to learn speech. But I think it helped her communication. But is there anything else that we can do, for example, like that?

Andrea: Yeah, for sure. I mean, so as you said, teaching babies some sign language definitely should not affect their language development. If anything, I also believe that it can help them. It boosts their language. But definitely, I do have a few suggestions.

When the babies are newborns, I think it's very important that parents try to narrate everything that they're doing. Even, for example, when they're changing the diapers just narrate what you're doing. Try to simplify the steps.

Sequences are really, really helpful. Sequences also help a lot with language stimulation. So, like, step one, what are you doing? Step two, following, like, what happens when you use a wipe? Just really, it doesn't matter. Don't feel like you're crazy. Narrate everything that you're doing. Once you have finished, are you going now to the kitchen? What are you going to have for breakfast? Really just continue, maybe brainstorm a lot of ideas. And then you will see that from one topic, you will lead to the other so that you're constantly talking to your baby all day.

Another great suggestion, another great tool is reading, reading or using books. Maybe even forget about reading the book. Just use the book. Use the illustrations to kind of guide yourself. You can tell the story in your own words. You could also use common or popular stories maybe, like Little Red Riding Hood. Tell them the story using your own words. And you will see how you actually use a lot more vocabulary than you're used to, a lot more vocabulary than you use in your everyday language, which is also great for stimulating or increasing their vocabulary. Songs, another great tool, like singing simple repetitive songs to them 

Amanda: Nursery rhymes, things like that.

Andrea: Nursery rhymes, yeah. Sing to them as much as possible. Use these nursery rhymes. Really, at the beginning, you may think, again, that you're a little bit crazy, singing. Maybe he's not even making eye contact. But really, believe me, this will pay off. There will be a time when your child is humming the tune or going along with the tune and then gradually even putting the words to the song. So, definitely, they are absorbing. They are learning.

And literally, their brains are growing. Every time you learn, you make new neural connections, which actually you just... It expands the density of your brain.

Amanda: Excellent.

Andrea: So yeah, literally their brains are growing when they're learning all of this. And then of course, once your child grows, once maybe he/she becomes a toddler, teaching them language is actually a bit more easier, maybe even more fun. You can use any experience. When you're going out, maybe to the store, to the market, make it an adventure, like, "Oh, where are we going? What are we going to observe? Look at the cars. Look at the buses. Oh, so many people riding their bikes."

Again, kind of narrate everything, just like you did when they were newborns. Maybe now, even ask them questions. "We're going to the market, so what are we going to buy?" Try and have them make lists, things that maybe they can get at the market.

What else? Also, maybe when you're playing with them, at one point, maybe around 18 months, you will see that your child begins to develop just like free play. So, for example, my child loves to pretend that he's making a soup. He loves that. So, use these opportunities. I use this opportunity all the time. So, like, "What are the ingredients?" I ask him a lot of questions. "What are the ingredients in the soup?" So, he, for example, if he uses a tomato, he has all of these little play fruits and vegetables. So, like, "Oh, you're using a tomato. So, what colour is the tomato? What does it taste like?"

So, use these opportunities, natural opportunities, to introduce new vocabulary. So, for example, I tell him like, "Oh, we're going to stir the soup," or, "Maybe is it too hot? Do we need to let it cool down a bit?" So, just use all of these opportunities to, yeah, introduce new vocabulary, as well as to continue reinforcing, yeah, all the vocabulary. 

Amanda: Excellent. And what's some of the generalized milestones that parents should be looking out for in development of their baby's speech or language development?

Andrea: Well, yeah. When they are newborns, I think one of the first things you begin to notice, maybe around four months of age, is that they begin to, with their eyes, they begin to try and locate where certain sounds are coming from. If you're talking to them from a distance, they begin to move their eyes. Later on, you could also notice, maybe around six months, that they begin to respond when you say their names. So, if they hear their names, they're going to turn around.

So, gradually, little by little, maybe by seven months, they are babbling a lot. Well, the cooing sounds, again, this is something you should notice when they're very, very young, around seven months. A lot of babbling. A lot of just what we call "nonsense syllables." And then, of course, by the time they're one, you are going to want to hear them say a few words. And then, from this stage onwards, it's just about increasing lot of words.

Around one and a half, they should have maybe around 5 to 10 words with everyday objects, like "juice," "milk," "Mama" of course, "Dada." And then, little by little, the usage of words becomes... now, maybe they're forming very, very simple phrases.

And language, of course... I mean, this is a very, very general outline of language milestones. Language, of course, does not stop developing until a child is around five years of age.

Amanda: Right, wow, excellent. And what's some of the advice that you would give to new mothers in general?

Andrea: Well, I want to start off by saying that definitely, I love being a mom. I love just being with my little one. But I mean, having said that, I also don't want to sugarcoat motherhood. I think motherhood is... it's a very, very tough job. And I sometimes feel that no one really tells you, like really... or bluntly says like, "Yes, it's hard." I think in a way, we, all mothers are worried about being judged. But I mean, I want to tell them, I want to tell new moms or moms-to-be, you definitely should not feel like that. You shouldn't feel like you're alone. Everybody has had these feelings of inability. When you become a mom, you question yourself all the time, "Am I doing things right?" "Is this going to harm my baby?" So, of course, these feelings of incapacity that are...

Amanda: Self-doubt.

Andrea: Yeah. Of course, self-doubts that you don't love having. But yeah, as I said, you're not alone with these feelings. We have all been there. But just like with anything... maybe I'm going to compare like... it's definitely not the same but it's like having a new job, like starting out on a new job. You also have a lot of self-doubt. You don't know if what you're doing is the right thing. But again, gradually, with practice, with time, you begin to get better at it. And it's the same with being a mom. It's like there is kind of this moment where everything begins to flow. So, it will get better. 

And then, once you kind of feel like you've got this, I think that it's the best moment. It's like when you definitely feel like "I'm good at this" and then you can even enjoy it, have fun and just continue being in love with your baby. So, definitely, I would say forget about trying to be in control. I used to be a person who wanted to have a lot of things in control. This is definitely probably my biggest takeaway, is that flexibility is actually probably the key to my sanity now. Yeah, you're going to have to learn to be flexible all the time. So many variables that you cannot control. So then, yeah, again, once you kind of learn that it's okay, you will get better at this.

And I guess, from my own experience, I can say that I will now forever be tired but it's not the same as being sleep-deprived. I can say that. So, yeah, even though I'm tired, I really believe that this job is completely and totally worth it. I absolutely love being a parent. And I have so much fun every day.

Amanda: I agree. It is. It's the best job in the world.

Well, thank you so much for chatting to me today, Andrea. It's been so enlightening. And I've really loved chatting with you. And I've certainly learned a lot. And I hope everybody else has.

Andrea: You're welcome. 

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About Andrea

Andrea holds a master’s degree in Neuroscience and Education from Columbia University in the City of New York. Additionally, she has a bachelor degree in Human Communication Disorders from Universidad de las Americas in Mexico City.

Andrea has worked as a teacher, a speech-language and learning therapist. She has also researched the importance of early literacy in language development and school readiness. Currently, she resides in Berlin, Germany where she lives with her loving husband and adorable son. After taking a two-year pause from her professional life to be with her family, she has just been offered a job as a teacher