The parents of, 4 year old Sally are concerned about the stuttering they observed a few months ago in their daughter. The stuttering hasn’t improved despite efforts to correct and help the child overcome the stutter whenever it arises.
Language and Speech problems in the pre-school age group have become one of the most common problems we face in primary care pediatrics. There is a garden variety of potential neuro-developmental problems that may manifest as different forms of speech or language disorders. This post is intended to address one of the common concerns we’ve encountered in our experience and we caution our readership about the gross simplification introduced here since these concerns are seldom simple. We will address, Sally’s stuttering in this post.
Stuttering, typically occurs as the young child begins to make the transition from two word utterances to more complex sentences. This usually happens between ages 2 and 5 years. It is estimated that ~ 5% of all children experience stuttering at some point in childhood lasting for more than 6 months. The condition is characterized by dysfluencies within words. The medical criteria for diagnosing stuttering as a speech disorder is met when a patient like Sally has dysfluencies like “W-w-w-what is this? Or “Wwwww what is this? Affecting more than three words in a 100 word sequence. These may be accompanied with signs of increased physical tension like increased blinking and facial tension or hand movements. A family history of stuttering in a first degree relative such as a parent or sibling is often found in many cases. At least ¾ of affected patients improve spontaneously without any medical intervention within the first 12 - 24 months of symptom onset. The temptation to interrupt and “help” these children complete the words they are struggling with mid-speech has been shown to increase time pressure on them that adversely contribute to the dysfluency and reinforce the negative responses to stuttering. Parents are advised to avoid this practice. Speech therapy and audiologic evaluation may be warranted in some cases. Boys tend to be affected by stuttering more often than girls and tend to have a more severe disease course.
Children with other forms of concern accompanying their stuttering like sharp audible intakes of breath before the dysfluency occurs or facial tension or body, head or extremity movements have a moderate risk of developing anxiety as a co-morbid condition and would benefit from specialist evaluation in addition.
Female patients who develop these symptoms, especially at ages less than 4years at onset have good prognosis and we are happy to report that, Sally required no form of medical intervention and improved within a year of symptom onset with complete resolution and normal speech fluency today.
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