(Oct 24) Q My baby is two years old and he is still babbling. He has not said any of our names yet and I am starting to get worried.

He could sit at six months, walk at 12 months and jump at 20 months. But when it comes to talking, he runs away.

I've tried saying 'mama' face to face with him, I've read block books with him. He knows which is the pig, because I make a snorting sound; he knows to pass the ball to grandpa when we ask him to.

Is it normal for boys to pick up speech later? I have an uncle and a cousin who did not speak until they were four. Should I continue to observe and teach him or should I send him to a therapist?

A Your child's speech development is delayed if he is babbling and communicating only in jargon at two years old. You should take him to a developmental paediatrician and a speech and language therapist for a proper assessment.

In general, for a child to learn to talk properly, he needs to be able to understand language first. Therefore, he needs to be able to:

-Hear normally

-Be interested in, and attend appropriately to, the social interactions that take place around him daily

-Use his intelligence to understand and learn from social experiences, before he can translate this newly gained knowledge into his own verbal or non-verbal expressions. For instance, children with autism often have delayed speech, primarily due to their lack of social skills and sometimes poorer cognition.

In terms of expressive speech, a child will also require appropriate oro-motor planning (the oral mechanics behind sound production), coordination and motor skills to translate the desire to speak into actual speech itself.

All these areas therefore need to be assessed carefully by a developmental paediatrician and a speech and language therapist. Apart from your child's speech, social and cognitive skills, a developmental paediatrician can also evaluate his other areas of development: for example, his gross motor, fine motor and adaptive skills. Only when we have a clear picture of your child's strengths and weaknesses can we then tease out the reasons for his impediment in speech and devise ways to maximise his potential.

From your letter, I notice that your child is able to understand more than he can say. He was able to follow instructions, for example, passing the ball correctly to grandpa when asked to. This is, in a way, encouraging, as it means that your child's hearing and understanding of language is already there.

It is true that social skills and hence speech development seem to grow faster in girls than boys, and speech delay certainly runs in the family. However, this does not mean letting him 'grow out of it' is the best strategy. In fact, many studies have shown that early diagnosis and appropriate intervention is the best way to help a child with developmental issues.

Therefore, I encourage you to seek appropriate assessment and intervention for your child as early as possible. Appointments can be obtained via referral from polyclinics or private doctors, as well as directly through the respective appointment centres of the child development units at the KK Women's and Children's Hospital and the National University Hospital.

DR LIM HONG HUAY, ASSOCIATE CONSULTANT,
CHILD DEVELOPMENT UNIT, KK WOMEN'S & CHILDREN'S HOSPITAL