Recs for speech therapist to 9 month old infant with speech delay

[Anonymous]

Anonymous wrote:For a child that age I think the DC EI programs will be better as they will do a ton of evaluations and take a holistic approach. I would do that and see what is found before pursing private therapy. Second the recommendation for the book it takes two to talk if you are desperate to do something. It has great recommendations for language development whether your child turns out to have an issue or not.

Sending a hug OP. It is super hard to hear something isn't typical about your baby. You sound like a good parent. He is doing a lot of really positive things developmentally!

Second a lot of this. Also, this isn’t definitive. It’s very early and there are lots of stories of kids who had receptive/expressive delays and then were totally fine.

[Anonymous]

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Anonymous wrote:Here are ASHA's guidelines for when to seek help. As you can see, the pediatrician's concerns align with the guidelines:

https://www.asha.org/public/developmental-milestones/communication-milestones-birth-to-1-year/

This page is not about when to seek help, it's a guide to milestones which exist in a huge range. Red flags for speech delays don't even exist before 12 months. Any experienced pediatrician would understand this.

https://www.aafp.org/pubs/afp/issues/2011/0515/p1183.html#indications-for-referral

Are you an SLP?

No but I work in pediatric healthcare and understand that the ~trade association~ of speech therapists probably isn't the place to find unbiased information about when to use speech therapists.

So who ~IS~ the appropriate source for unbiased information about milestones? Please pediatric “healthcare” worker share a more reliable source that isn’t your anonymous self.

AAP references ASHA.
NIH references ASHA.

DP. the point is that “milestones” on a professional society website are not any sort of diagnostic or even screening mechanism. The ASHA link says as much.

In this day and age pediatricians are all over the board in terms of how they assess anything developmental. Starting speech therapy at 9 months would be very, very unusual absent some known factor like the child having oral-motor issues (which you’d know from feeding) from something like having been on a feeding tube as a preemie. In this case the rational response would be for the pediatrician to start with a hearing test. For a pediatrician to suggest a 9 month old has receptive and expressive delays based on an in-office exam is surprising.

Alternatively maybe the pediatrician suspects autism but OP said the child was social. I’d be curious to know if he shows joint attention and is starting to use gestures to communicate.

Another thing I notice when I watch other people’s older babies and toddlers is that they communicate ALL the time even without words. I see this too when I look at old videos of my kid. But at the time if you asked I would say, “no, he’s not talking yet,” as I was slightly worried he wasn’t meeting the exact baby book “milestones.” (Yet he developed speech totally normally, just starting with his first word a bit later that what “they” say and talking up a storm by 18 months.)

That said, the pediatrician recommended it and I can understand why OP feels she needs to follow up. I’d book with Early Intervention (or whatever your state/county calls it) because they can do the hearing testing.

Dp. I’m the parent who posted earlier about my child who also couldn’t form verbs. At 9 months, there were no feeding issues. It wasn’t until 2, that I realized there were some feeding issues, but even then, those were mild.

I know you think you have a lot of experience being a pediatric nurse. Is that what you are? You said pediatric healthcare worker… But do you have a lot of actual experience with infants who cannot form vowels at 9 months?

I’m guessing not by your discussion on nonverbal communication. My child was signing before nine months. Forming speech sounds and eventually words is more complicated than just looking for signs of communication.

I think we’re all on the same page that Early Intervention won’t hurt to call. But fyi, Early Intervention will likely put a slp in the room during the first evaluation.

I mean obviously in restrospect if you had a kid with speech delays you’ll believe there were signs at 9 months. It sounds like your kid just had articulation issues anyway which is different from the pediatrician suggesting she can detect expressive and receptive delays at 9 months! And an overly alarmist approach absolutely does have costs, both on an individual and societal level.

It wasn’t just articulation. I had an 18 month old who still couldn’t produce most vowels, and struggled for a long time thereafter in therapy. It wasn’t a suspicion at 9 months. It wasn’t happening then either.

The pediatrician isn’t detecting anything. She’s saying there could be a problem and so you should see someone who can better determine this. I don’t doubt she (and most of us posting here on an SN board) hope there’s no issue! But apparently she values the education and experience of SLPs enough to suggest their eyes physically evaluating the child could be helpful.

But it was just articulation right? I don’t think there’s any persuasive evidence for intervening prior to the baby even being 1 yr old for articulation! That’s why OP is seeing that the list of speech therapists she has only sees older kids. Because absent something serious like cleft palate it really isn’t evidence based to treat nine month olds for articulation…

[Anonymous]

Anonymous wrote:

Anonymous wrote:For a child that age I think the DC EI programs will be better as they will do a ton of evaluations and take a holistic approach. I would do that and see what is found before pursing private therapy. Second the recommendation for the book it takes two to talk if you are desperate to do something. It has great recommendations for language development whether your child turns out to have an issue or not.

Sending a hug OP. It is super hard to hear something isn't typical about your baby. You sound like a good parent. He is doing a lot of really positive things developmentally!

Second a lot of this. Also, this isn’t definitive. It’s very early and there are lots of stories of kids who had receptive/expressive delays and then were totally fine.

again I don’t think it’s even possible to measure or detect expressive and receptive delays at 9 months … this is all premature

[Anonymous]

Use Strong Start DC, which is the DC Early Intervention program. Your EIP will be way better and more thorough than any private intervention. Also, as the law has requirements on how quickly things need to occur, your EIP SW will have an easier time getting your kid into treatments as specialists who can work with infants are limited.

DH and I are very well-off and not accustomed to relying on government programs over private programs. A developmental ped who had a months-long waiting list told us to self-refer our then-9 mos old to our EIP, and I'm so glad we did. He got evaluated for everything, in-home PT, and a strong advocate who managed his care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Here are ASHA's guidelines for when to seek help. As you can see, the pediatrician's concerns align with the guidelines:

https://www.asha.org/public/developmental-milestones/communication-milestones-birth-to-1-year/

This page is not about when to seek help, it's a guide to milestones which exist in a huge range. Red flags for speech delays don't even exist before 12 months. Any experienced pediatrician would understand this.

https://www.aafp.org/pubs/afp/issues/2011/0515/p1183.html#indications-for-referral

Are you an SLP?

No but I work in pediatric healthcare and understand that the ~trade association~ of speech therapists probably isn't the place to find unbiased information about when to use speech therapists.

So who ~IS~ the appropriate source for unbiased information about milestones? Please pediatric “healthcare” worker share a more reliable source that isn’t your anonymous self.

AAP references ASHA.
NIH references ASHA.

DP. the point is that “milestones” on a professional society website are not any sort of diagnostic or even screening mechanism. The ASHA link says as much.

In this day and age pediatricians are all over the board in terms of how they assess anything developmental. Starting speech therapy at 9 months would be very, very unusual absent some known factor like the child having oral-motor issues (which you’d know from feeding) from something like having been on a feeding tube as a preemie. In this case the rational response would be for the pediatrician to start with a hearing test. For a pediatrician to suggest a 9 month old has receptive and expressive delays based on an in-office exam is surprising.

Alternatively maybe the pediatrician suspects autism but OP said the child was social. I’d be curious to know if he shows joint attention and is starting to use gestures to communicate.

Another thing I notice when I watch other people’s older babies and toddlers is that they communicate ALL the time even without words. I see this too when I look at old videos of my kid. But at the time if you asked I would say, “no, he’s not talking yet,” as I was slightly worried he wasn’t meeting the exact baby book “milestones.” (Yet he developed speech totally normally, just starting with his first word a bit later that what “they” say and talking up a storm by 18 months.)

That said, the pediatrician recommended it and I can understand why OP feels she needs to follow up. I’d book with Early Intervention (or whatever your state/county calls it) because they can do the hearing testing.

Dp. I’m the parent who posted earlier about my child who also couldn’t form verbs. At 9 months, there were no feeding issues. It wasn’t until 2, that I realized there were some feeding issues, but even then, those were mild.

I know you think you have a lot of experience being a pediatric nurse. Is that what you are? You said pediatric healthcare worker… But do you have a lot of actual experience with infants who cannot form vowels at 9 months?

I’m guessing not by your discussion on nonverbal communication. My child was signing before nine months. Forming speech sounds and eventually words is more complicated than just looking for signs of communication.

I think we’re all on the same page that Early Intervention won’t hurt to call. But fyi, Early Intervention will likely put a slp in the room during the first evaluation.

I mean obviously in restrospect if you had a kid with speech delays you’ll believe there were signs at 9 months. It sounds like your kid just had articulation issues anyway which is different from the pediatrician suggesting she can detect expressive and receptive delays at 9 months! And an overly alarmist approach absolutely does have costs, both on an individual and societal level.

It wasn’t just articulation. I had an 18 month old who still couldn’t produce most vowels, and struggled for a long time thereafter in therapy. It wasn’t a suspicion at 9 months. It wasn’t happening then either.

The pediatrician isn’t detecting anything. She’s saying there could be a problem and so you should see someone who can better determine this. I don’t doubt she (and most of us posting here on an SN board) hope there’s no issue! But apparently she values the education and experience of SLPs enough to suggest their eyes physically evaluating the child could be helpful.

But it was just articulation right? I don’t think there’s any persuasive evidence for intervening prior to the baby even being 1 yr old for articulation! That’s why OP is seeing that the list of speech therapists she has only sees older kids. Because absent something serious like cleft palate it really isn’t evidence based to treat nine month olds for articulation…

It was not, as I said earlier. I’m going to stop responding because I’m going down a DCUM wormhole here, and have already given OP my thoughts. You clearly feel differently.

OP—best wishes. You sound like a very loving and caring mom.

[Anonymous]

Definitely start with getting hearing checked, my child had wax build up (and small ear canals) that went unnoticed by the pediatrician. Call early intervention and schedule an appointment. Make sure you are using your child's name throughout the day and use it when you are near them. Say their name, pause and wait for them to look at you. Also, try to make lots of fun sounds, like "wheeee" and "ooooohhhh" while they are looking at you so they can see your mouth make the sounds.

[Anonymous]

Hearing evaluation should be your first step.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here - DS passed the one they gave him at birth and pediatrician didn’t think he had hearing loss when she examined him. That being said if the therapist ordered it, we would happily do it.

Fwiw, my good friend has substantial congential hearing loss that wasn't picked up until kindergarten. My nephew also had issues (due to frequent infections) that weren't picked up until he started seeing an ENT. Fortunately a hearing test with an audiologist is easy/noninvasive.

+1 My young was referred to EI at 15 months with gross motor delays. At 20 months, he had a speech evaluation thru EI because of speech delays. We were late to catch the speech delays because his non verbal communication was excellent and with 2 older siblings close to his age who were very close with him, we were overlooked it.

The SLP indicated he presented as a child with hearing loss and recommended a hearing test with a audiologist. We were shock. DS was tested at birth, saw the pediatrician regularly and had no history of ear infections. Turns out, DS had unresolved fluid in his ears and needed tubes.

[Anonymous]

9 month old? Is this a typo? I’m very confused. Is it that the pedestrian thinks the sounds they make sound strange? 9 month olds really only babble, and name recognition is not at all common. To be talking expressive language delays at 9 months old is just…irresponsible. Get a second opinion. And a hearing test.

[Anonymous]

Anonymous wrote:Walking at one
Talking at two

What 9 month old is talking.. send videos. They belong in Guiness.

My mom claims I was speaking full sentences by 10 months. My kid didn’t speak until 2.5 though.

[Anonymous]

Echoing those that have said to just reach out to Infants and Toddlers/Strong Start/Child Find/ whatever it's called where you live.
Our experience with Infants and Toddlers for our kid with serious speech delays was fantastic, especially at the evaluation stage. They'll almost certainly send you to an audiologist who is used to working with babies, and then do appropriate evaluations. Even if your kid doesn't qualify for services, you'll get some helpful info.
Jumping straight to a private SLP seems a lot less effective at getting your kid the help they need.

[Anonymous]

We used the Fairfax County version of Strong Start and received weekly hour long visits from an SLP via it starting at 18 months. It processed through our insurance as in-network. They also sent us to a Fairfax County audiologist during the eval and that was free to us. The early intervention SLP suggested CAS at 28 months and then we added a CAS private specialist out of pocket to increase number of weekly sessions. Definitely recommend at least checking out the Strong Starts program. You can always drop it if you don’t like it but it was great for us and so much cheaper and more convenient than private options. We still do both public IEP provided SLP and private pay.

[Anonymous]

I think you’ve gotten very good advice to go with your early intervention program and also strongly advocate for hearing testing.
I’m not sure what age they start with but you could also contact Skills on the Hill, and maybe they would also have referrals if they don’t work with infants.
https://skillsonthehill.com/

[Anonymous]

Anonymous wrote:My DS started speech therapy at 6 months. It was for non verbal comm to start then verbal. It was a game changer. Early intervention works! Do not wait and I praise your pediatrician for recommending at 9 months. Most don't. You've got a good one. Call Stacy Fleishman. She comes to you and specializes in children under 4. She is outstanding. My child is now 14 and thriving but I believe she is still practicing.

We used Stacy for our son with CAS who is now 16. If she is still practicing, there is nobody better. She was a miracle worker!

[Anonymous]

Anonymous wrote:9 month old? Is this a typo? I’m very confused. Is it that the pedestrian thinks the sounds they make sound strange? 9 month olds really only babble, and name recognition is not at all common. To be talking expressive language delays at 9 months old is just…irresponsible. Get a second opinion. And a hearing test.

Yup, so if they aren’t babbling by 9 months it’s suggested to investigate further.