Nolan Alexander (Host): Welcome to the Live Greater podcast series, information for a Healthier You from the University of Maryland Medical System. This is an episode in a series of podcasts answering frequently asked questions about what's normal in childhood development and when parents may need to seek a specialist. I am Nolan Alexander. And today, we're diving into a topic that concerns many families, A Parent's Guide to What Is Normal: Talking and Communication. And with me today is Dr. Debbie Badawi from the University of Maryland Medical System, who will share her expertise in child development and communication.

Deborah G. Badawi, MD: I'm well. Thank you. And thank you so much for having me. This is an important topic.

Host: It certainly is. And as a parent of two young children, I'm very interested in what you have to say today, because communication is a struggle at different points in dealing with a toddler, dealing with an infant, and different ages. So, I'm really curious where we're going today. Just to set the table, kids learn to talk and communicate at different speeds, right? So, what tends to be normal?

Deborah G. Badawi, MD: So, there are some good guidelines out there about what is a normal progression of language. For instance, by nine months of age, we expect children to start saying mama and dada and then around eleven or twelve months to start to have more words that they use to label things in their environment. There is a range, but there's also what we call an upper limit of normal. There are some good guides out there as to when we should start to be concerned. If kids are approaching that upper limit for the number of words they have or how well they can respond to directions, those would be times to be concerned.

Host: And what do you factor into how much parents should rely on those milestones?

Deborah G. Badawi, MD: They can rely very well on certain of those milestone charts. The CDC actually has a great website called Learn the Signs. Act Early. There's an app on there that gives a range of what's typical for different milestones, not just communication. But the upper limit is where about 75% or three-quarters of children should have achieved a milestone. That's a reliable tool to indicate that most kids have reached this milestone by this age.

Host: And which ones do you feel matter the most when it comes to milestones, especially beyond maybe a count of words?

Deborah G. Badawi, MD: Absolutely. I think the count of words is important, but more importantly how children are using their communication. Are they just using words to label things in their environment, or are they starting to use words to get an adult's attention or to tell an adult about something that's going on? It's not just the count of words, but the quality of how a child is using their language and how they're understanding language.

Host: What do you mean by how they're understanding language?

Deborah G. Badawi, MD: Do they understand simple requests? Probably the most basic one is when you tell a child no. That can be a safety issue when toddlers are starting to walk around, and we have to tell them no so they don't get themselves into a dangerous situation. Beyond that, it's being able to follow some simple directions, like Go get your ball, and then expanding those, making those more complex directions: Go upstairs and bring your blue shirt down. We get more complex as children get older.

Host: This is an area I imagine you receive a lot of questions about. How can parents tell the difference between a child who's developing on their own timeline and one who needs extra support?

Deborah G. Badawi, MD: Those milestone ranges let us know if a child is just on their own timeline or if they're getting out of what we consider the typical timeline. For instance, if a child doesn't have a word besides mom or dad by eleven months, that may not be as much of a concern. But if they're now twelve or thirteen months and don't have a word, they're beyond the upper limit of what we consider typical. The other thing to look at is the quality of their language: are they using words to tell you things, or are they just labeling items in their environment?

Host: I've talked with other parents who notice repetition, pauses, or even stuttering. How common are those and when do they stand out?

Deborah G. Badawi, MD: Those are fairly common. About 5% of children will have some periods with repetitions or where they pause a long time before responding. That's most common in preschool children. About 1% may persist in having those challenges beyond the preschool years. Time to get concerned is if those pauses or repetitions impact a child's ability to express what they want or need, or if the child becomes very frustrated by their ability to communicate.

Host: What about hearing problems? I’ve dealt with my children getting ear tubes and noticed differences in speech. And what about stress or changes in environment affecting communication?

Deborah G. Badawi, MD: Hearing problems should be the first thing we check when a child has language delay. Many parents say, I know my child can hear, but subtle differences can impact language development. Hearing should always be checked. In terms of stress, like adults, when we are stressed it's harder to access our words. Children may be more frustrated and have difficulty expressing what's bothering them. They may regress in how they use language, for example using baby talk when a new sibling arrives. Stress impacts children’s communication similar to adults.

Host: On regression, if parents see fewer words than before, what should they do?

Deborah G. Badawi, MD: Losing words or regressing in language skills is always a concern. The first step is consulting with a pediatrician. It could be a sign of a broader neurodevelopmental diagnosis like autism or, rarely, a seizure disorder. More commonly, we see atypical quality to language or more baby talk imitation. But truly losing language skills is concerning. If the child becomes withdrawn and doesn’t interact, that’s an emotional concern. Visit the pediatrician to get more details.

Host: What are some of the best ways for parents to encourage and support their child's communication skills?

Deborah G. Badawi, MD: There are helpful ways to promote language development. One is narrating as much as possible when interacting with your child, called the radio announcer effect. For instance, playing with farm animals and saying, Oh, look, here's the bird. It's a blue bird. Reading to your child is excellent. If reading isn’t a favorite, make up stories. Letting children hear language through reading or storytelling is a fantastic way to promote development.

Host: Dr. Badawi, anything else you want to add?

Deborah G. Badawi, MD: Two important things. One, if you are concerned about your child's development, seek an evaluation with your pediatrician or the early intervention program for infants and toddlers. There’s no downside to getting an evaluation. If your child's fine, that’s great. Second, children learning two languages may get confused about which to use, but they don’t have language delay because of bilingualism.

Host: That was very informative today. I feel much more equipped as a parent in working with communication skills for both of my children. Thank you for joining us.

Deborah G. Badawi, MD: Thank you very much. It was a pleasure being here.

Host: Listen to more at umms.org/podcast, YouTube, or your favorite podcast platform. Thank you for listening to Live Greater, a Health and Wellness podcast brought to you by the University of Maryland Medical System. And don't forget to check out other topics on A Parent's Guide to What Is Normal. We look forward to you joining us again, and please share this on your social media.