Spider bite

to use at home and check back with the family in a few months to check progress.

Warning Signs

All children develop at different rates, but there are some obvious signs that a child may be developing speech problems. Parents should consult their pediatrician or a speech therapist If the child:

• is not babbling or using language by 15 to 18 months of age

• by age three is using mostly vowels or omitting the beginning sounds in words, or if other people cannot understand what the child is saying

• has not mastered all speech sounds by age eight.

At certain ages, certain speech problems are normal. For example, stuttering is common between ages three and four years, but most children grow out of the habit of repeating sounds and hesitating between words. However, if this is happening for longer than two or three months and interferes with communication, the child may be developing a stuttering problem. Parents should ignore stuttering and not correct the child, but children with a severe stuttering problem should receive speech therapy to avoid a long-term problem.

Nodules on the vocal cords can cause hoarseness; a child should be seen by a doctor if he breathes through the nose while speaking and is hoarse.

Babbling that stops after a brief period may be a sign of a hearing disorder. Frequent ear infections can affect hearing and delay speech.

By the time a child is four years old she should be able to tell a story, and by age five should be able to listen to a story and answer questions.

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