Chad Perlyn, MD (Host): Welcome to the For Peds Sake Podcast, a Nicklaus Children's Hospital podcast that is all about putting children at the heart of healthcare. I'm your host, Dr. Chad Perlyn, a pediatric plastic surgeon here at Nicklaus Children's and a father of two boys. And I am so excited to welcome yet another amazing guest to our show.

Today, we have Keysla Lee, one of our wonderful speech therapists and speech pathologists. Keysla, welcome to the program.

Keysla Lee, SLPD: Hello, everyone. Thank you, Dr. Perlyn, for having me here. I'm happy to talk to your listeners about speech and answer any questions that you may have.

Host: Terrific. And did I get that right? Speech therapist, speech pathologist for families to understand, same thing?

Keysla Lee, SLPD: Yes, yes. Essentially, they're the same thing. More so within the hospital setting, we kind of go by speech language pathologists. They may hear more speech therapists within the school setting or in private practices, but they both are pretty much synonymous.

Host: Perfect. Important for our families to know so they know how to get resources when they need them. Thank you.

Keysla Lee, SLPD: You're welcome.

Host: Let's talk about what I think is one of the most important things that makes us humans, the ability to communicate with words, right? How important is that? And especially for our children. So, where do we begin? When do babies start talking? Tell us about the beginning of the process.

Keysla Lee, SLPD: So, that's a very interesting question, a very good question, because communication starts before verbal language or sounds even begin. And we start at that interaction stage, the eye contact, noticing items are in the room or around them, the ability to follow their parents voice. voice or to make a sound to demonstrate displeasure or that they want some attention. So well before we start engaging in actual spoken language, it's that nonverbal language. We like to call them precursors that we look for.

Host: Got it. And am I right thinking around 12, 13 months, that's when words start becoming? Tell us about that time, please.

Keysla Lee, SLPD: So typically, around 12 and 13 months, that's when you'll start noticing a very big pivotal shift in their language development and their play. So, play and language are gonna go hand in hand. You may hear one or two word utterances, but you really should be looking at their play and interaction skills at this age.

Host: Got it. So, you know, I'm a pediatric plastic surgeon. Of course, a lot of the work we do is around cleft palate, the palate needing to be anatomical part of speech, of course. And we tend to tell parents that speech really begins around that time, 12 to even up to 18 months. In that period, what should families be looking for? Is that when words are made, when sentences are made? Tell us about that because it's so interesting.

Keysla Lee, SLPD: Sure. They should be hearing some of that spoken language, words like mama, dada, up, go, cookie. Even if it's not clear as far as the pronunciation, there should be some attempt at vocalization and some short verbal words.

Host: And is there a number? Sometimes we'll hear families ask, "Should my child be saying 10 words by this age or 20 words by this age?" Are there milestones? Is that reliable? What should families know about that?

Keysla Lee, SLPD: So typically, we look for about one to 10 words. some kids may have a lot more, and that's great. But around one to 10 should really start to pique your interest that there's some type of vocalizations, there's some type of verbal interaction that's occurring.

Host: And in what time frame? One to ten words, at what age range for parents to know?

Keysla Lee, SLPD: So between 13 and 18 months, you may notice a little bit of we call it Swiss cheese, they may have some words here, and then you may notice a big burst, maybe at 15 months, where they're starting to add more words to the vocabulary. And so, we should look for that constant incline of word production.

Host: And so, that's an interesting point. So, it sort of starts off slow, a few words here, here. And then, it bursts, to use your word, as language really kicks in.

Keysla Lee, SLPD: Yeah. So, they should start to talk about things in their environment. They see a car, hear words, say words that they hear all the time, like up, go, mama, dada. You should start seeing some of that non verbal language, some waving, some high fives, some pretending to do little household activities, maybe trying to feed you. We call it symbolic play. So you should start seeing these things coexist together.

Host: I'm laughing as we're talking about this because clearly this is unscientific, but there must be another burst around the teenage years, the reverse burst. Learned all language and then they stop talking!

Keysla Lee, SLPD: They don't tell you anything.

Host: Exactly. They don't tell you anything. But back to when they're precious and little and just learning to talk. When should families worry?

Keysla Lee, SLPD: Families should worry if you notice that there's no interaction. They tend to want to be off to themselves. They're not producing any sounds. They're not responding to their name consistently. They may not be playing appropriately. You may notice some concerns with how they're playing. Because remember, play is that precursor to language development. So when you're looking at the child, you want to look at everything and to identify certain things that just seem that they're really not picking up like they should be.

Host: And one of the things that's interesting to me in my work in pediatric plastic surgery, the difference between making words and making words incorrectly. So, speech development versus anatomical issues where the child isn't "Mama," maybe sounds "hm-hm", something like that. What should families think about those things? How can they differentiate if there's a speech issue based on delay or on word pronunciation?

Keysla Lee, SLPD: The first thing that we want to consider is that they're actually trying to attempt to produce any sounds. So, we can't actually shape the sound production unless we have some form of language output. So for our kiddos who may be a little bit more of a later talker or what we call speech delay. We like for them to have enough vocabulary at first, and then we can begin to shape the sound production. So, the first indicator would be, are they making any sounds? And then once they begin to make words, then we can scaffold back and begin to shape those sounds based on their age.

Host: So, what should families do if they are concerned? Obviously, reach out to their pediatrician, first step. But if it is identified that there is either a speech delay or a speech production issue, what would be the next step for families to get help?

Keysla Lee, SLPD: So, typically, at this stage, between the 13 and 18 months, it will most likely be a language delay because they haven't had enough words yet to focus on the speech. So, the speech is more so how they're pronouncing the words, and the language is using it to talk about their environment. So, if they notice that their child isn't producing words at all, or they're very limited in the words that they're producing, the first step is definitely to engage the pediatrician. And from there, they can get a referral to have a comprehensive speech and language evaluation.

Host: Got it. And for children who are making words, but may not be making them correctly, same thing, evaluation with the speech pathologist?

Keysla Lee, SLPD: Yes. And so for a child who's producing language, but there's a difficult time with understanding the language that they're producing, they will follow the same process, but the outcome will be different in the sense that by each age, there are certain sounds that are considered age-appropriate. So, some sounds are developed later, like maybe a four-year-old sound or a five-year-old sound that we wouldn't target as much as we would a sound that is more age-appropriate. So, we work on addressing them in the order in which they're achieved or acquired.

Host: That's really helpful to know. And I imagine like most things in pediatric care, earlier intervention is better. So occasionally, we'll hear families say, "Well, I don't need speech therapy yet because he's or she's not really talking much. So, we're going to wait. But talk us through the timing of this, and is earlier better in this case.

Keysla Lee, SLPD: So, earlier is always better, especially if once they reach that 13-month, again, the biggest indicator is going to be their play skills, that nonverbal interaction. Once we get started with that, we can always shape it. And if they don't need it, great, go off into the world and be awesome. But if you do need an extra boost or extra support, we want to be able to apply that to you and give you what you need developmentally as appropriate as possible.

Host: Got it. So, two more questions that have come to mind. Let's call them factor fiction-type type questions. Second or third siblings. I've often heard that they are later to speak because the siblings like to speak for them. True or false?

Keysla Lee, SLPD: It's both. It's both. As having two children, my first child spoke very quickly. She did everything age appropriately. My second child did not, and she did not speak for him, but he truly did have a speech delay. So, every child is different, and the order in which they acquire language is different. So to answer your question, it's false in the sense that, yes, there may be true that some kids do have a delay, and they just need more support, and it's not because the sibling is speaking.

On the other side of the coin, you have the sibling that just takes on that parental role, and they just want to mother or father their baby sibling. And so, they anticipate everything, and so the younger sibling doesn't have to use language as much, because someone's always anticipating. So, it depends on the side of the coin.

Host: But I love how you shared your personal story. And thank you. That's one of my favorite things about having this podcast when we're on as professionals, but as parents ourselves. And your story is so telling in a second child with speech delay. So, don't just think that it's because it's a second child, as you shared in your case. I hope all is well with your little one now.

Keysla Lee, SLPD: Thank you. He is. He's seven now. He's talking too much.

Host: Exactly. You're ready for that teenage reverse burst we mentioned.

Keysla Lee, SLPD: Yes.

Host: Okay. Last question. Fact or fiction. In Miami, very relevant, multilanguage homes, whether it's English and Spanish or English and Creole or all three or other languages, we often hear the same thing, that children who are raised in a home where multiple languages are spoken may speak later because to the layperson, they're trying to figure out which language they're going to speak in. True or false?

Keysla Lee, SLPD: That's false. So actually, what we want to do is if you have concerns that your child comes from a multilingual home where English is not the first language, that you want to do a speech eval to make sure that they're not disordered in what we consider their primary language. So if the home language is Spanish, we want to do an assessment in their primary language to make sure that there isn't a language disorder in their primary language before we attempt to work on filling in the gaps for both languages. Oftentimes, it's a language difference opposed to a disorder. So, we always want to rule out first in their primary language if there truly is delay or a disorder in their home language.

Host: Terrific. Any last thoughts? Last words to our families?

Keysla Lee, SLPD: I think trust your gut as caregivers and as parents. And if you feel that you know there may be a delay or something to take a further look, it doesn't hurt. And at worst case scenario, you're getting early intervention so that's going to help move the process along or everything is fine and you have ease of knowing that you've done your part. So, trust your gut.

Host: Trust your gut. I love it. Wonderful. Thank you so much.

Keysla Lee, SLPD: Thank you for having me.

Host: Of course. This concludes this episode of the For Peds Sake Podcast. We've hope you've learned some helpful tips from Keysla Lee, I said that right?

Keysla Lee, SLPD: You said it right.

Host: Perfect. Make sure to stay tuned for our next episode. And in the meantime, be sure to follow us on all social media channels. You can find Nicklaus Children's Hospital on Instagram, Facebook, TikTok, and YouTube. See you next time.