Every parent eagerly awaits the precious moment when their baby says their first word. They look forward to the day when they can have a conversation with their little one. It's one of the first major milestones children achieve, but for many, that milestone may be a little bumpy.

Every parent eagerly awaits the precious moment when their baby says their first word. They look forward to the day when they can have a conversation with their little one. It's one of the first major milestones children achieve, but for many, that milestone may be a little bumpy.

There are children who may need extra time and help to say their first words or sentences, and that help can come in the form of speech therapy. "Anytime there are problems, the earlier parents can get those concerns addressed, the better chances for that child to be successful and develop those age-appropriate skills," said Allana Salimbene, M.A. CCC-SLP, director of therapy at Habilitation Services.

Speech hierarchy
Typically, by the time a child is 1, they might say one word, and around 18 months they might be saying words like mama and dada. Between ages 2 and 3, they should have a vocabulary of about 50 words.

"They are going to start at the single-word level, then move on to two- or three-word sentences. Some of the initial sounds will be m, n, b, p, h, d and t. Those are pretty much the first sounds you are going to hear and that is why you get mama and dada first," said Salimbene. The early sounds come from the front of the mouth where children put their lips together and find their tongues. As the child grows, the tongue retracts back a little bit and they start making the k and g sound.

"Between 3 1/2 and 4 1/2, you expect the [letters] f and s. Between ages 4 1/2 and 5, you get to the higher level sounds like sh, j, ch, r and th. A lot of kids are
6 before they even get the th sound.

It is common for a kid not to say an r until they are 5 or older," said Rachael Weis, M.A. CCC-SLP, a private speech language pathologist in Powell.
She added that the r sound is
difficult for kids to make because it requires so much mouth strength. "They have to get their tongue to go up and back while making it fat over their teeth," said Weis. Many children will make natural substitutions for sounds, which is normal. For example, Salimbene said, before the k and g are used, kids will substitute a t and d.

For l sounds, kids will use aw, but only to about 5 to 7 years old.

If a child is not developing these speech sounds between the ages of 2 and 3, or if it is difficult for others to understand what your child is saying outside the immediate family by age 3 or 4, consider having your child evaluated by a speech language pathologist.

When problems arise
Kelly Kimmet, a mother of two year-old twin boys, Zachary and Tyler, was keenly aware her boys might have
needed extra help with their speech due to their premature birth. She became concerned when she noticed the boys were not doing the things that other children were doing around 18 months.

"I was aware they may be a little bit delayed on some things. We were assessing and watching when my pediatrician mentioned we might want to get to speech therapy," said Kimmet.

She contacted the local Help Me Grow program to do an evaluation. The program provides early intervention services for children from birth to 3.

"They were so nice and made us feel comfortable and explained things. There are so many people that have had to get help for their kids, so it made me realize that I am not the only one doing this," said Kimmet. "They gave us a report back that said [the boys] did need some speech therapy."

It was a similar story for Stacy Hathaway and her young daughter, Mia. "We first noticed Mia's speech problems at around 20 months. We adopted her from China so we knew it would take longer for her to speak, but we started wondering if she needed some help when she was only saying about two words," said Hathaway, who also
contacted the Help Me Grow program. "They came out to the house and played with her to evaluate her gross motor and speech skills. After the
evaluation, they felt she was on target developmentally, but not with speech. Therefore, they recommended speech therapy," said Hathaway.

Besides the Help Me Grow program, parents can access speech therapy services from different sources, including private practices, clinics and school-based programs. Make sure
you are seeing a speech and language pathologist (SLP) who is licensed through the American Speech-Language-Hearing Association, and
has a Council for Clinical Certification (M.A., CCC-SLP) which requires a master's degree.

Therapy and timelines
After the evaluation, the therapist will give parents a report and a recommended treatment plan for addressing the child's speech problems. Parents can schedule a time each week or two for regular one-hour speech therapy sessions.

"The length of treatment depends on the child, but a lot of it depends on the parents' ability to use the strategies with their children at home. I always try to empower parents because one hour a week of speech therapy is not what is going to make the difference. It really is going to be about giving those parents some strategies, and then you really
see quick results," said Weis.

Hathaway has noticed a big difference in Mia since she started speech therapy last October. "She only said two or three words when we started, but now she has at least 75 words in her vocabulary and is starting to use two- or three-word phrases a lot more. We are amazed every day at the words she repeats or tries to sound out."

Kimmet added, "I always tell parents not to hesitate [to contact a speech therapist] because it has really been a positive in our household. It has helped us learn how to communicate with the kids easier. It is never too early." Hathaway agrees, "As a parent, I have learned how to treat my daughter's speech issues, and talk with her simply. We have seen improvements every day. I can't imagine Mia would be talking now, had she not had the treatment from a speech therapist."

Research shows that the earlier the child gets speech therapy, the better the outcome. Weis agreed. "It gives them a better start and the brain is at a point that it benefits from therapy early and can still make significant changes. The stigma of speech therapy is long gone."