Ears, Nose, Throat/Speech & Hearing

Many young kids go through a stage between the ages of 2 and 5 when they stutter, repeating certain syllables, words or phrases, prolonging them, or stopping, making no sound for certain sounds and syllables. Stuttering is a form of dysfluency — an interruption in the flow of speech.

In many cases, stuttering goes away on its own by age 5; in others, it lasts longer.

There’s no cure for stuttering, but effective treatments are available and you can help your child overcome it.

What Causes Stuttering?

Experts think that a variety of factors contribute to stuttering, including:

• Genetics: About 60% of those who stutter have a close family member who stutters.
• Other speech and language problems or developmental delays.
• Differences in the brain’s processing of language: People who stutter process language in different areas of the brain. And there’s a problem with the way the brain’s messages interact with the muscles and body parts needed for speaking.
• High/increased activity level.
• Rapid rate of speech.

Early Signs of Stuttering

The first signs of stuttering tend to appear when a child is about 18-24 months old as there is a burst in vocabulary and kids are starting to put words together to form sentences. To parents, the stuttering may be upsetting and frustrating, but it is natural for kids to do some stuttering at this stage. It’s important to be as patient with your child as possible.

A child may stutter for a few weeks or several months, and the stuttering may be sporadic. Most kids who begin stuttering before the age of 5 stop without any need for interventions such as speech or language therapy.

However, if your child’s stuttering is frequent, continues to get worse, and is accompanied by body or facial movements, an evaluation by a speech-language therapist around (instead of before) age 3 is a good idea.

The School Years

Usually, stuttering drops to very low levels when kids enter elementary school and start sharpening their communication skills. A school-age child who continues to stutter is likely aware of the problem and may be embarrassed by it. Classmates and friends may draw attention to it or even tease the child.

If this happens with your child, talk to the teacher, who can address this in the classroom with the kids. The teacher also may be able to decrease the number of stressful speaking situations for your child until speech therapy begins.

When to Seek Help

If your child is 5 years old and still stuttering, talk to your doctor and, possibly, a speech-language therapist. You also may want to consult a speech therapist if:

• repetitions of whole words and phrases become excessive and consistent
• sound and syllable repetitions start happening more often
• there is an increase in the prolongations of words
• speech starts to be especially difficult or strained
• you notice increased facial tension or tightness in the speech muscles
• you notice vocal tension resulting in rising pitch or loudness
• your child tries to avoid situations that require talking
• your child changes a word for fear of stuttering
• your child has facial or body movements along with the stuttering
• you have other concerns about your child’s speech

Most schools will offer testing and appropriate therapy if you have been concerned about the stuttering for 6 months or more.

What Parents Can Do

Try these steps to help your child:

• Don’t require your child to speak precisely or correctly at all times. Allow talking to be fun and enjoyable.
• Use family meals as a conversation time. Avoid distractions such as radio or TV.
• Avoid corrections or criticisms such as “slow down,” “take your time,” or “take a deep breath.” These comments, however well-intentioned, will only make your child feel more self-conscious.
• Avoid having your child speak or read aloud when uncomfortable or when the stuttering increases. Instead, during these times encourage activities that do not require a lot of talking.
• Don’t interrupt your child or tell him or her to start over.
• Don’t tell your child to think before speaking.
• Provide a calm atmosphere in the home. Try to slow down the pace of family life.
• Speak slowly and clearly when talking to your child or others in his or her presence.
• Maintain natural eye contact with your child. Try not to look away or show signs of being upset.
• Let your child speak for himself or herself and to finish thoughts and sentences. Pause before responding to your child’s questions or comments.
• Talk slowly to your child. This takes practice! Modeling a slow rate of speech will help with your child’s fluency.

Everybody’s heard of tonsils. But not everyone knows what tonsils do or why they may need to be removed. Knowing the facts can help alleviate the fears of both parents and kids facing a tonsillectomy.

Tonsils and Tonsillitis

Tonsils are clumps of tissue on both sides of the throat that help fight infections.

Tonsils may swell when they become infected (tonsillitis). If you look down your child’s throat with a flashlight, the tonsils may be red and swollen or have a white or yellow coating on them. Other symptoms of tonsillitis can include:

• sore throat
• pain or discomfort when swallowing
• fever
• swollen glands (lymph nodes) in the neck

Enlarged tonsils without any symptoms are common among kids. Left alone, enlarged tonsils may eventually shrink on their own over the course of several years.

Don’t rely on your own guesses, though — it can be hard to judge whether tonsils are infected. If you suspect tonsillitis, contact your doctor. Recurrent sore throats and infections should also be evaluated by the doctor, who may order a throat culture to check for strep throat.

About Tonsillectomies

Doctors might recommend surgical removal of the tonsils, called a tonsillectomy, for a child who has one or more of the following:

• persistent or recurrent tonsillitis or strep infections
• swollen tonsils that make it hard to breathe, particularly during sleep
• difficulty eating meat or chewy foods
• sleep difficulty that might be affecting the child’s daily activities
• snoring and obstructive sleep apnea (when someone stops breathing for a few seconds at a time during sleep because enlarged tonsils are partially blocking the airway)

Surgery, no matter how common or simple the procedure, is often frightening for kids and parents. You can help prepare your child for surgery by talking about what to expect. During the tonsillectomy:

• Your child will receive general anesthesia. This means the surgery will be performed in an operating room so that an anesthesiologist can monitor your child. The anesthesiologist will also keep your child safely and comfortably asleep during the procedure.
• The operation will take about 20 minutes.
• The surgery is done through your child’s open mouth — without any incisions (cuts) through skin.

Your child will wake up in the recovery area. Expect to spend several hours or perhaps overnight at the hospital. Many kids go home on the same day, though some may require observation overnight. In general, kids under 3 years old and those with significant sleep problems (like apnea) will usually stay overnight for observation.

Rarely, kids may show signs of bleeding, which would require a return to the operating room.

Depending on the surgical technique, the typical recuperation after a tonsillectomy may take up to a week or more. Expect some pain and discomfort due to the exposure of the throat muscles after the tonsils are removed. This can affect your child’s ability to eat and drink and return to normal activities.

Intracapsular tonsillectomy, a variation on traditional tonsillectomy techniques, is surgery in which all involved tonsil tissue is removed but a small layer of tonsil tissue is left in place to protect the underlying throat muscles. As a result, the recovery is much faster because most kids experience less pain, don’t need as much strong pain medication, and are more willing to eat and drink. Additionally, the risk of bleeding after surgery is significantly less than with a traditional tonsillectomy. Since residual tonsil tissue remains, there is a very slight chance that it can re-enlarge or become infected and require more tonsil surgery, but this occurs in less than 1% of children who’ve had intracapsular tonsillectomy.