Speech therapist for children: when pronunciation is a reason to worry

It is worth seeing a speech therapist if your child is not speaking in short sentences at three, if strangers mostly cannot understand them at four, or if at five they still mispronounce several sounds. The sound R and hissing sounds such as Š, Ž and Č (sh, zh, ch) often settle only around the age of five or six, so a three-year-old who says ‘lyba’ instead of ‘ryba’ is fine. Do pay attention, though, to stuttering that lasts more than a few months, to a child who does not respond to speech, and to a child who loses words they already knew. Going early is better. The speech therapist will either reassure you or start treatment in good time.

Every child’s speech develops differently, and the differences between children of the same age can be large. So you may not be sure whether to wait or to act. This article gives an overview of what children usually manage at each age and the order in which sounds settle. You will also learn which signs should not be put off and how to reach a speech therapist in Slovakia. We have added ten games you can use to support speech at home.

What children usually manage at each age

The table is based on the overviews of the American Speech-Language-Hearing Association (ASHA). These are rough guides. If your child cannot yet do one thing on the list, it may mean nothing. If most are missing, talk to a specialist.

The order in which sounds settle

Children learn sounds gradually, from those that are easiest for the tongue and lips to the hardest. This is the approximate order in Slovak, the language your child will hear every day at a Slovak kindergarten. If your child is learning English or another language at home, the speech therapist will look at those sounds too.

If your child still cannot say a sound from a younger group when, for their age, they should, that is a good reason to get advice. An example is a five-year-old who still says T instead of K.

Signs that should not be put off

These situations are worth dealing with straight away, whatever your child’s age:

• your child does not respond to their name or to sounds, or often asks you to repeat what you said,
• they have stopped using words they already knew,
• they stutter, repeat the beginnings of words or visibly strain when speaking, and this has lasted longer than three to six months,
• air escapes through the nose when they speak, or they sound very nasal,
• they say S, Z or C with the tongue between the teeth even after the age of five,
• they get angry when speaking or avoid speaking because you do not understand them.

If you have any doubts about your child’s hearing, have it checked first. A child who does not hear well will find it hard to learn correct pronunciation.

Why not just wait for them to ‘grow out of it’

Many children really do grow out of unclear speech, but not all. If a wrongly pronounced sound becomes automatic, correcting it takes longer. It also helps to start school with correct pronunciation, because when reading and writing a child relies on how they hear and say words. If you have doubts when your child is four or five, that is the ideal time to get advice. There is still enough time for any correction before school starts.

A first visit to a speech therapist does not mean your child will need therapy. It often ends with the therapist confirming that development is on track and suggesting what to do at home.

The most common pronunciation difficulties

How to reach a speech therapist in Slovakia

1. Talk to your paediatrician. At a routine check-up or a separate appointment, describe what is worrying you. The paediatrician will assess your child’s development, may recommend a hearing test and can refer you to a clinical speech therapist (klinický logopéd).
2. Find a clinical speech therapy practice. Clinical speech therapists work in practices that have contracts with health insurance companies. With a contracted therapist, both the assessment and the therapy are covered by public health insurance. Check directly with the practice whether you need a referral and how long the waiting times are. If your family has private international insurance rather than Slovak public insurance, check what it covers.
3. Book well ahead. In Bratislava you often wait several weeks or even months for an appointment. So it is better to book as soon as you have doubts.
4. Consider a counselling centre too. Centres for Counselling and Prevention (centrá poradenstva a prevencie), which work with children in kindergartens and schools, also have speech therapists. They can help, for example, with assessing readiness for school.

What the first visit looks like

The first assessment usually takes up to an hour and is done through play. The speech therapist will first ask you about your child’s development: when they started talking, how they hear, whether anyone in the family has had speech difficulties and which languages you speak at home. Then they play with your child and show them pictures. Your child names objects, repeats words and talks about what they see. The therapist also looks at how the tongue and lips move.

If your child is growing up with two languages, tell the speech therapist right at the start. It helps them judge your child’s vocabulary properly. At the end, the therapist will tell you whether development is within the normal range or suggest therapy. With therapy you also get exercises for home, which matter as much for success as the sessions themselves.

How to prepare your child: tell them you are going to see a lady or a man who will play and talk with them. Do not say they are going ‘to the doctor because they talk badly’. Bring a favourite toy and a snack.

What to write down before the visit

The speech therapist sees your child only briefly and in an unfamiliar place, where they may be shy. It helps if you prepare:

• when your child said their first words and when they started putting words into sentences,
• which sounds or words give them trouble, with specific examples (‘says tapor instead of kapor’),
• a short video of your child talking naturally at home,
• which languages are spoken at home and at kindergarten,
• whether your child often has ear infections or a runny nose, and whether their hearing has been tested,
• what the teacher at kindergarten has noticed.

What speech therapy looks like

If the speech therapist suggests therapy, sessions are usually once every one to several weeks and short enough for your child to manage. They are done through play: your child blows, repeats, looks for pictures and tells stories. Correcting a single sound usually goes in steps:

1. preparing the tongue, lips and breathing,
2. producing the sound on its own,
3. the sound in syllables and simple words,
4. the sound in sentences and everyday speech.

The last step usually takes longest. Your child can already say the sound, but in fast speech slips back into the old habit. This is where a short exercise at home helps. Five to ten minutes a day is enough. How long correction takes varies with the child and the sound. Sometimes a few months are enough, sometimes it takes longer.

Speech during everyday activities

You do not need special materials to support speech. Most of it you can do alongside what you are doing anyway:

Ten games that support speech at home

1. Blowing: blow a feather, cotton wool, soap bubbles or through a straw into water. It practises breathing and strengthens the lips.
2. Faces in the mirror: stick out your tongue, lick your lips all the way round, touch your nose and chin with your tongue.
3. Animals: copy animal sounds. A snake hisses ‘sss’, a bee buzzes ‘zzz’, a motorbike goes ‘rrr’.
4. Clapping syllables: clap out your child’s name, then words around you (‘ta-ble-cloth’).
5. First sound: ‘What am I thinking of? It starts with M and says miaow.’
6. Rhymes: cat, hat… your child adds the next word.
7. Nursery rhymes and songs: rhythm and repetition help pronunciation and memory.
8. Telling stories from pictures: open a book, let your child say what they see and ask ‘and what happens next?’.
9. Playing shops: your child asks for things in a full sentence (‘Two rolls, please.’).
10. Phone calls: a conversation on toy phones, without gestures, makes your child put everything into words.

What helps speech most, though, is ordinary conversation. The Center on the Developing Child at Harvard University stresses the principle of ‘serve and return’. Your child says or points at something, and the adult responds, names it and builds on it. These exchanges lay the foundations of speech and learning. At meals, in the car and while getting dressed you can have dozens of them a day.

How not to correct your child

When your child says ‘lyba’, do not ask them to say the word again correctly. Respond naturally and repeat the correct form yourself: ‘Yes, that’s a big ryba.’ Your child hears the right pronunciation without feeling they made a mistake. Constant correcting can make a child start talking less.

Does growing up bilingual cause pronunciation problems?

According to research, no. Pronunciation difficulties are just as common in bilingual children as in children who speak one language. If they do appear, they usually show up in both languages. You can read more about how speech develops with two languages in Bilingual kindergarten: will my child mix up Slovak and English?

How we do it at Sovička

Once a week your child has our speech-therapy club Jazýček šikovníček at Sovička, included in the monthly fee. Through play, they exercise the tongue, lips and breathing, learn to tell sounds apart, clap syllables and find rhymes. The club does not replace therapy with a clinical speech therapist. It does help support pronunciation and notice early when your child needs more.

We follow your child’s progress through pedagogical assessment and go through it with you at an individual consultation. If we notice that a specialist’s advice would help, we will tell you. If your child is in their pre-school year, we also work on pronunciation and speech as part of getting ready for school. You can read more in Getting ready for school: what your child should manage and School readiness and deferral. Our whole programme is on the Curriculum page, and preparation for school on the Pre-school year page.

If you would like to talk about how we can support your child’s speech, book a visit with no obligation.