Speech therapists, speech and language therapists and speech pathologists all refer to the same scope of practice. In South Africa, we study a 4 year Bachelor of Science degree at university followed by 1 year of community service at a government hospital or health care facility. It is a requirement that we register with the Health Professionals Council of South Africa (HPCSA). Thereafter, we can work in the public or private sector. 

In the health care sector, we form an important part of the multi-disciplinary team with doctors, psychologists, physiotherapists, occupational therapists, audiologists and dieticians. Our services are essential at special needs schools and mainstream schools.

A brief summary of our profession is to provide information, conduct assessments, diagnose and conduct therapy pertaining to speech, language, communication and swallowing disorders in all ages. This means that the age range of patients we work with begins with babies who have difficulty feeding and swallowing to geriatrics who have dementia or stroke related illnesses. 

Evidence based therapy is conducted by the therapist and tailor made to suit the patient’s needs. Therapy involves family members and friends of the patient as it is a team effort. In some cases, a patient may only be able to see the therapist for 1 hour per week. Hence family members also need to collaborate with the therapist. Therapy is non pharmaceutical. There is no “magical pill” for any speech therapy related disorder.

You might be wondering what the difference between Speech, Language and Communication is. As speech therapy students, we had the same question in our minds. The distinction is quite simple. No pun intended but here’s “byte” sized summary.

• Speech: The actual sounds that emanate from the mouth. Disorders of speech can include stuttering, lisp, apraxia, dysarthria.
• Language: A system of communication made up of written text and sounds. Language is further broken down into receptive and expressive language. A child who can follow age appropriate verbal instructions but is unable to express himself verbally is said to have delayed expressive language development. In stroke patients, one or both aspects of language can be affected which is known as aphasia.
• Communication: The process we use to exchange ideas, information and needs. When we are in a foreign country and are unable to ask “Where can I purchase food?”, we may use hand gestures to communicate. Augmentative and Alternative Communication (AAC) is used in some children with autism who are non-verbal i.e. they do not use speech sounds to communicate. Not all AAC devices are electronic. A well-known method of non-verbal communication is Picture Exchange Communication System (PECS) wherein a child hands a picture of what they want to their communication partner. 

Hearing and speech development

While your baby is in utero, you may have noticed sudden movements when loud sounds emanate from the environment e.g. the sound of a door banging or a hairdryer. At three to four months, your child should turn towards sounds and voices which come from different directions. If they are bottle or breast fed, they may stop sucking and turn to look for the location of the sound or voice. 

Sounds from the environment travel through our ear canal which causes our ear drums to vibrate. These vibrations travel through the three bones of the middle ear to the inner ear which is also known as the cochlear. The cochlear is a shell like structure which is filled with fluid. The sound travels in a wave movement that causes the tiny hair cells within the cochlear to create neural signals. These signals travel to the brain via the auditory nerve. 

Disturbances of sound transmission can occur at any point. If the ear canal is filled with wax, sound cannot reach the ear drum. Similarly, if the middle ear is filled with fluid rather than air, the bones of the middle ear cannot vibrate at the appropriate speed. Middle ear infections due to various reasons are common in children under the age of five years old. 

If your child does not seem phased by the sudden banging of a door, monitor this for a few days. It is imperative that you consult an audiologist immediately. 

If a child is unable to hear correctly, the clarity of their speech will be affected. Our speech is moulded by the way we hear speech sounds. Children with high frequency hearing loss struggle to hear soft speech sounds such as /s/, /sh/ and /f/. Hearing loss leads to unclear speech which can ultimately affect a child’s literacy skills. 

Quick, Simple and Easy ways to stimulate language development in children below age 5 years

Babies can recognize different faces and voices when they are a few months old. Peek-a-boo is a game that most people enjoy playing as it elicits excitement in the child when the communication partner makes a sudden appearance. Instead of saying “where’s he, where’s he” – rather say “where’s (child’s name), where’s (child’s name). The same applies if you are a mother playing the game with your child i.e. ‘where’s mama, where’s mama’.

In their first year, babies make cooing and babbling sounds which may not be meaningful to us. However it is vital that parents engage in this “conversation” with their baby by taking turns to talk. Your baby may say aah aah – your response could be in various tones e.g. (surprised tone) Oh really! Then what happened or (excited tone) Yes! That’s a brilliant idea. What shall we do after that?

At this stage your tone of voice and facial expression are easily “understood” by your baby. If you say “You are a naughty boy” in a happy and jovial tone, your baby will smile at you. In contrary, if the same words are said in a harsh tone, your baby may start to cry. This shows the importance of facial expressions when communicating with your child. It’s only natural that if your baby is smiling and you smile to them, there’s a good chance they will smile back. 

Babies typically say their first words by their first birthday. The first consonants to develop are p/m/h/n/w/b. Therefore, the child’s first words are usually mama or baba. Although they may say mama during the babbling stage, the word mama is meaningful if it is associated correctly i.e. mama refers to mother or consistently refers to the same person or object.

By the age of 2 years, your child should be using 2 word phrases e.g. mummy come, baba gone. It is imperative that adults respond with the correct sentences. Your child may say “doggy lala”. You should respond by saying “Yes, that’s right. The dog is sleeping”. This will assist in correct language development. 

Make learning new words practical by asking your child which items s/he can identify in her/his environment e.g. where are his/her toes, how many fingers do they have.  Names of people, numbers, shapes and colours form part of basic words in a child’s vocabulary. 

Communicate with your child in simple sentences using various tones of voice. For example:

• Excited tone: Yay! Mummy is going to bake today. 
• Normal tone: Mummy is going to crack some eggs. These eggs come from chickens. 
• Serious tone: Mummy is going to use the machine and it is going to make a very loud sound. Mummy is going to put the cake in the oven. The oven is very hot.

Children love to be adventurous by opening cupboards and drawers. If they happen to peer into or get hold of something dangerous, say the word “dangerous!” in a loud and serious tone with facial expressions to match. Children will soon realize that when the word “dangerous” is used, it means that the item they have is not allowed. 

Nursery rhymes such as 1, 2 buckle my shoe, and 1,2,3,4,5 once I caught a fish alive are fun ways of teaching words and numbers to your child. Use actual objects while singing the songs so that your child can make the association between hearing the word shoe, seeing a shoe and seeing a picture of a shoe. This will create a language rich learning experience.

The nursery rhyme 10 little ducks went swimming one day is suitable for children 3 years upwards. Use pictures of ducks as counters so your child can associate between the spoken word “ten” and the numerical representation of ten objects. In this manner, your child will also learn what numbers come before and after each other.  

Place various common household items in a bag or buried in a box of sea sand e.g. spoon, cup, key, flower, pen. Have turns to dig in and find an object. Once an object is found, your child needs to name that object. Focus on correct word instead of correct pronunciation of the word. For example, if your child says “poon” instead of spoon, first say a positive statement followed by an exaggeration of the correct word e.g. “Well done! It is a ssssspoon”. Since the aim of the activity is to associate the correct word with the object, you should praise your child as their pronunciation is still developing. Be a mirror for your child by emphasizing the correct pronunciation indirectly instead of correcting them directly without offering any praise for the correct word choice. 

Point out common words visible in their environment:

• Brand names and logos which they see, eat or play with regularly. They would immediately recognize these brands in a newspaper or when they go shopping e.g. Nan – Milo – Kellogg’s – Danone – Lego
• Names of shops e.g. Spar / Edgars / Clicks
• Words and numbers on the clothing they wear, on their toothpaste e.g. labels on clothing will state 4 – 5 years
• Words and colours when travelling by road e.g. red robot, green grass, blue sky, white clouds. 

From 3 years of age, one can modify the game “I spy” by replacing the initial sound of the item with a colour or texture e.g. “I spy with my little eye, something that is blue or soft”

Reading books to your child cannot be overemphasized. It’s an easy and fun way to participate in joint attention and increases your child’s vocabulary. Books for younger children have more pictures than words. Once you have read the story to your child, making it a game by asking him/her to relate the story to you since it is now his/her turn to do so. 

Make your own story cards by assisting your child with drawings, wordings and placing the story in the correct sequence.  

Be on the same level as the child so that s/he can see how your mouth and tongue movements to form each sound of the word.If showing your child pictures, say the name of each picture slowly, with exaggerate mouth movements i.e. emphasizing the sounds within each word.

Initially focus on learning words correctly and not on clarity of the words as certain consonants develop later on. It is wise to monitor the correct development of speech sounds and consult a speech therapist sooner rather than later. Correct speech development has a direct correlation to correct spelling as a child would sound out the word when attempting to write it.

If you have any concerns about your child’s speech and language development after reading this, please consult your nearest speech therapist. Although we live in the age of information, many parents are unaware of speech developmental norms. Their concerns are often shrugged off by peers saying that ‘so-and-so’ child started talking late so your child is probably the same. If you are a concerned parent, we hope that this article has encouraged you to be proactive regarding your child’s speech and language development. Assistance is widely available. Visit www.saslha.co.za to find your nearest speech therapist and audiologist.

Disclaimer: These guidelines are not meant to diagnose or replace assessment or therapy. It is a means of gaining better insight using practical methods to boost language development in the general population.