Patient's question:
Sure, I can help with that. Please provide the content you would like me to translate.Doctor's answer:
Becoming a first-time mother, when hearing the child say the first words "" (Dad) and "" (Mom), the heart must be filled with indescribable joy and excitement. But if other babies have started talking while the child at home remains "silent," what would be the anxiety and helplessness in the mother's heart? For these children who are slow to speak, is it normal or abnormal? Should they see a doctor?When a child is two years old and still not speaking, is it normal or abnormal? Are children who speak late "duller" than those who speak early? Parents often ask such questions in clinical practice.
At what age is considered "late" to start speaking?
Children's language development follows certain patterns. Generally, the first sound a child makes is crying. In the first one or two months after birth, due to different mouth shapes, they can produce different vowels (e.g., a, o) and consonants (e.g., b, t). By 6 to 7 months, children may unconsciously call "" (Dad) and "" (Mom). At one year old, the first understandable words appear, such as "" (light-light) or "" (sugar-sugar). By two years old, they can say about 300 to 400 words and some simple phrases, like "" (eat) or "" (work). Of course, each child's language development has individual differences—some are early, and some are late. However, if a child is still not speaking at two years old or shows no communicative language at all, it is essential to take them to the hospital for evaluation.
Late speech may be a sign of a disease
Delayed language development in children may be caused by various abnormal conditions. Common diseases include:
Hearing impairments, including complete deafness and partial hearing loss, with causes or etiologies that can be either congenital or acquired.
The period from 1 to 2 years is a critical stage for language development in infants. If hearing is damaged during this stage, children will not receive any language stimuli, which will inevitably lead to language development disorders, even deafness. Generally, congenital hearing loss is more easily noticed by parents. However, many parents only realize that their child is not speaking or has unclear speech when the child is two or three years old, or even five or six, and then decide to take them to the hospital for a check-up. By then, the best treatment window may have passed, and even with hearing aids, language learning outcomes may not be ideal.
Therefore, it is still necessary to remind parents to pay attention to their children's hearing. For a newborn baby, you can gently shake a bell out of their sight to see if they react or turn their head toward the sound. If there is no reaction at all, you should consider seeing a specialist. Some children may have normal hearing at birth but later lose it due to diseases or ototoxic drugs (e.g., gentamicin), so older infants should also be monitored. If a child shows no reaction to loud noises, does not cry or fear, does not turn their head when their name is called in an inconspicuous place, or does not respond to simple instructions (e.g., nodding, shaking their head, stomping their feet, waving), you should be vigilant.
Intellectual disability refers to a group of diseases where intelligence is significantly lower than that of peers during development, accompanied by behavioral abnormalities.
The causes or etiologies of intellectual disability are diverse. Some are congenital, such as genetic metabolic diseases, congenital malformations, or prenatal maternal viral infections. Others are acquired due to environmental factors, such as asphyxia at birth, cerebral hypoxia-ischemia, brain trauma, or brain tumors. Educational factors are also important causes, such as poor education, environmental deprivation, or emotional deprivation.
Children with severe intellectual disability often have other abnormalities, such as facial or physical deformities (e.g., children with Down syndrome may have wide-set eyes, crossed eyes, a flat nose, or drooling), delayed motor development, or feeding difficulties. Language development delay is just one symptom, making it easier for parents to notice. However, mild intellectual disability may be more subtle, with symptoms like lethargy, inactivity, indifference, or feeding difficulties, which may be easily overlooked. For parents, if a child is still unable to make purposeful sounds at two years old or only makes random noises, it is essential to seek medical attention promptly.
Autism, a term that may still be unfamiliar to many parents, has seen an increasing number of children diagnosed with it in recent years.
Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder. Some people mistakenly assume that autism is caused by overly closed family environments or a lack of communication, leading to children being shy or introverted. This explanation has been proven scientifically insufficient. Currently, it is believed that autism may be related to genetics and heredity.
Children with autism often exhibit obvious behavioral abnormalities early on, such as preferring to play alone, lacking eye contact with others—even their parents, not being afraid of strangers, or showing little attachment to their parents. However, parents often first notice language-related issues, such as not speaking. Even if parents are certain that their child has normal hearing, the child remains silent and does not respond to instructions. Other children with autism may speak but often repeat words, mimic sounds, talk to themselves, or use incomprehensible "alien language," rarely using proactive language for communication. For example, they may recite long poems but cannot say simple phrases like "" (Mom, I want water). Some people vividly describe the language development characteristics of autistic children: either they don’t speak at all, or they speak nonsense.
The treatment of autism in children is a long process, requiring professionals to develop targeted treatment plans and training methods, and it demands parents' infinite love, perseverance, patience, and determination. For parents, the most basic step is to seek professional help promptly after noticing abnormalities and to follow their guidance for professional diagnosis and treatment.
It could also be normal
There is a folk saying, "" (talented people speak late), which claims that children who speak late are smarter. This claim has no basis. In clinical practice, there is a category of children with delayed speech who are not pathological and do not require special intervention—called idiopathic language delay. These children are normal in intelligence, hearing, and behavior but simply start speaking late, possibly not speaking at all by two and a half or three years old, or only being able to say simple words. Once they start speaking, it seems as if they suddenly know everything. These children may appear outwardly and behaviorally indistinguishable from normal children, with normal intelligence and comprehension. Parents can clearly feel that they understand adult speech, such as responding with nods or shakes. For these children, parents don’t need to worry too much—just focus on speaking slowly and telling stories with them. Generally, by two or three years old, the child will naturally start speaking.
It must be noted that the diagnosis of "idiopathic language delay" must be made by a professional doctor, and after all, this is only a partial case. If parents hold onto wishful thinking and consider all late-speaking children normal without seeking medical attention, it could lead to serious consequences.
The above are some common causes or etiologies of delayed language development in children. For parents, it may not be easy to determine which category their child falls into, but one thing must be clear: the period from 1 to 2 years is a critical time for language development, and most children with language disorders are identified during this stage. If your child is still not speaking at two years old or only knows a few simple words and lacks communicative language, it is essential to take them to the hospital for professional diagnosis immediately.