Q: My 2 1/2 year-old son is not talking. He is a poor eater and often packs food in his mouth without swallowing. I still have him on formula since he eats so poorly. He’s had a hearing test which showed his hearing was fine. When I teach him single words, he will eventually repeat them. Could the poor eating and delayed speech be caused by his tonsils being too large?
A: This is the second question I have received that seems to be attempting to relate dysphasia with speech or language delays. Therefore, let me define some things in order to continue.
Dysphasia is a lack of motor tone in the throat, glottis, epiglottis and esophagus that prohibits effective swallowing. This difficulty should not prohibit the accurate articulation of speech sounds.
Dysarthria is similar, but the lack of or weak motor control is located in the tongue, lips, and or velum. This difficulty will, of course, cause articulation difficulties.
Both of these are due to a lack of motor control due to varied etiologies and should be properly diagnosed by a developmental neurological specialist for children.
Apraxia is a disruption in the ability to transmit or express motor responses. The signal to move is disrupted between the brain and the muscle. There is no muscular weakness present, yet positioning and sequencing planned motor movements is absent or delayed. Apraxic patients can often execute automatic motor responses, such as blowing out a candle, but cannot position their lips into an “O” shape on demand.
All that being said, back to your questions. Stuffing food in your son’s mouth does not necessarily indicate a problem, many 2.5 year olds do this. However, it is particularly dangerous if he DOES exhibit confirmed lack of motor tone in the mouth or esophagus… choking hazards are very prevalent in these children, as you can imagine.
You mentioned that he was still on formula, which is probably not nearly enough nutritiously for a child his age. I am wondering if he is really having trouble swallowing or if he doesn’t like varied consistencies of foods. Some children with oral tactile sensitivity will only eat foods of certain textures. They can swallow solids, they just don’t like the feel of them in their mouth.
Those are all possibilities when it comes to the eating issue. Now, on to the communication issue. At this child’s age, remaining at the single word level indicates a definite language delay. It sounds as if his hearing and auditory comprehension (understanding) are appropriate, but his expressive language skills are below age expectancies. It is also worth noting whether or not the single words that he does imitate are clearly spoken.
Has the boy been diagnosed with overly large tonsils? If so, they could be contributing to poor swallowing, but they would also be likely producing multiple ear infections, sore throats and a hyponasal resonance to his speech (sounding like he always has a cold). Does the child snore loudly at night? Does he breathe through his mouth most of the time? These things are the usual indicators of enlarged adenoids.
As you can see, there are several different possibilities contributing to the difficulties your son is having. I would recommend a full evaluation from a qualified speech and language pathologist in your area. (See the phone book, children’s hospital, or local school special education department) He or she should be able to get a clearer picture of what’s going on and possibly refer you on to associated professionals. Good Luck!