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It's the services and programs that Miami Lighthouse for the Blind and Visually Impaired offers that makes a lasting difference in the community. From music education to pre-employment service, from programs for children to adults to seniors, Miami Lighthouse works with people to help build their skillsets and abilities, strengthen their connections to others, and foster their enjoyment of life.

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Miami Lighthouse for the Blind and Visually Impaired is the oldest and largest private agency in Florida to serve people of all ages who are blind and visually impaired. To provide vision rehabilitation, eye health services and education that promote independence, to collaborate with and train professionals, and to conduct research in related fields.

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Read Aloud 15 MINUTES is a non-profit organization that is bringing together partners nationwide to make 15 minutes of daily reading aloud the new parenting standard. When every child is read aloud to for 15 minutes every day from birth, more children will be ready to learn when they enter kindergarten, more children will have the literacy skills needed to succeed in school, and more children will become lifelong readers.

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Assessment and treatment of swallowing and swallowing disorders may require the use of appropriate personal protective equipment and universal precautions.

Consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health framework (ASHA, 2023; WHO, 2001), a comprehensive assessment is conducted to identify and describe

impairments in body structure and function, including which swallowing phases are affected;

comorbid deficits or conditions, such as developmental disabilities or syndromes;

limitations in activity and participation, including the impact on overall health (including nutrition and hydration) and the child's ability to participate in routine activities;

contextual (environmental and personal) factors that serve as barriers to or facilitators of successful nutritional intake (e.g., child's food preferences, family support in implementing strategies for safe eating and drinking); and

quality of life of the child and family as it relates to feeding and swallowing impairments.

See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of assessment data consistent with the International Classification of Functioning, Disability and Health framework.

Clinicians may consider the following factors when assessing feeding and swallowing disorders in the pediatric population:

Congenital abnormalities and/or chronic conditions can affect feeding and swallowing function.

Feeding skills of premature infants will be consistent with neurodevelopmental level rather than chronological age or adjusted age.

Positioning limitations and abilities (e.g., children who use a wheelchair) may affect intake and respiration.

Infants cannot verbally describe their symptoms, and children with reduced communication skills may not be able to adequately do so. Clinicians must rely on

As infants and children grow and develop, the absolute and relative size and shape of oral and pharyngeal structures change. See figures below.

Anatomical and physiological differences include the following:

In infants, the tongue fills the oral cavity, and the velum hangs lower. The hyoid bone and the larynx are positioned higher than in adults, and the larynx elevates less than in adults during the pharyngeal phase of the swallow.

Once the infant begins eating pureed food, each swallow is discrete (as opposed to sequential swallows in bottle-fed or breastfed/chestfed infants), and the oral and pharyngeal phases are similar to those of an adult (although with less elevation of the larynx).

As the child matures, the intraoral space increases as the mandible grows down and forward, and the oral cavity elongates in the vertical dimension. The space between the tongue and the palate increases, and the larynx and the hyoid bone lower, elongating and enlarging the pharynx (Logemann, 1998).

Chewing matures as the child develops (see, e.g., Gisel, 1988; Le Révérend et al., 2014; Wilson & Green, 2009). Concurrent medical issues may affect this timeline. Foods given during the assessment should be consistent with the child's current level of chewing skills.

Clinical Evaluation

A clinical evaluation of swallowing and feeding is the first step in determining the presence or absence of a swallowing disorder.

The evaluation may address

eating,

drinking,

secretion management,

oral hygiene,

sensory status,

the ability to accept food,

the amount of diversity in their diet,

management of oral medications, and

the caregiver's behaviors while feeding their child.

SLPs conduct assessments in a manner that is sensitive and responsive to the family's cultural background, religious beliefs, dietary beliefs/practices/habits, history of disordered eating behaviors, and preferences for medical intervention. Families are encouraged to bring food and drink common to their household and utensils typically used by the child. Typical feeding practices and positioning should be used during assessment. Cultural, religious, and individual beliefs about food and eating practices may affect an individual's comfort level or willingness to participate in the assessment. Some eating habits that appear to be a sign or symptom of a feeding disorder (e.g., avoiding certain foods or refusing to eat in front of others) may, in fact, be related to cultural differences in meal habits or may be symptoms of an eating disorder (National Eating Disorders Association, n.d.).

SLPs do not diagnose or treat eating disorders such as bulimia, anorexia, and avoidant/restrictive food intake disorder; in the cases where these disorders are suspected, the SLP should refer to the appropriate behavioral health professional.

The clinical evaluation typically begins with a case history based on a comprehensive review of medical/clinical records and interviews with the family and health care professionals.

Prior to bolus delivery, the SLP may assess the following:

overall physical, social, behavioral, and communicative development

gross and fine motor development

cranial nerve function

structures of the face, jaw, lips, tongue, hard and soft palate, oral pharynx, and oral mucosa

functional use of muscles and structures used in swallowing, including

head-neck control, posture, oral and pharyngeal reflexes, and involuntary movements and responses in the context of the child's developmental level

observation of the child eating or being fed by a family member, caregiver, or classroom staff member using foods from the home and oral abilities (e.g., lip closure) related to

typically used utensils or

utensils that the child may reject or find challenging

functional swallowing ability, including, but not limited to, typical developmental skills and task components, such as

suckling and sucking in infants,

mastication in older children,

oral containment,

manipulation and transfer of the bolus, and

the ability to eat within the time allotted at school

behavioral factors, including, but not limited to,

an acceptance of the pacifier, nipple, spoon, and cup;

the range and texture of developmentally appropriate foods and liquids tolerated; and

the willingness to participate in mealtime experiences with caregivers

skill maintenance across the feeding opportunity to consider the impact of fatigue on feeding/swallowing safety

impression of airway adequacy and coordination of respiration and swallowing

developmentally appropriate secretion management, which might include frequency and adequacy of spontaneous dry swallowing and the ability to swallow voluntarily

modifications in bolus delivery and/or use of rehabilitative/habilitative or compensatory techniques on the swallow

interventions by and referrals to

Team Approach

A team approach is necessary for appropriately diagnosing and managing pediatric feeding and swallowing disorders, as the severity and complexity of these disorders vary widely in this population (McComish et al., 2016). The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting.

In addition to the SLP, team members may include

family and/or caregivers;

a registered dietitian;

a lactation consultant (infants);

a nurse;

an OT;

a physician, such as

a PT;

a school psychologist/mental health professional;

a social worker;

a classroom teacher; and/or

a classroom teaching assistant.

Additional medical and rehabilitation specialists may be included, depending on the type of facility, the professional expertise needed, and the specific population being served.

See ASHA's resources on interprofessional education/interprofessional practice (IPE/IPP), and person- and family-centered care.

Clinical Evaluation: Infants

The clinical evaluation for infants from birth to 1 year of age-including those in the NICU-includes an evaluation of prefeeding skills, an assessment of readiness for oral feeding, an evaluation of breastfeeding/chestfeeding and bottle-feeding ability, and observations of caregivers feeding the child.

SLPs should have extensive knowledge of

embryology,

prenatal and perinatal development,

medical issues common to preterm and medically fragile newborns,

typical early infant development,

neuroprotection,

neonatal care,

respiratory support,

medical comorbidities common in the NICU, and

the role of providers in the NICU.

Appropriate referrals to medical professionals should be made when anatomical or physiological abnormalities are found during the clinical evaluation. The clinical evaluation of infants typically involves

a case history, which includes

gestational and birth history and

pertinent medical history;

a physical examination, which includes

a developmental assessment,

a respiratory status assessment, and

an assessment of sucking/swallowing problems and a determination of abnormal anatomy and/or physiology that might be associated with these findings (e.g., Francis et al., 2015; Webb et al., 2013);

a determination of oral feeding readiness;

an assessment of the infant's ability to engage in non-nutritive sucking (NNS);

developmentally appropriate clinical assessments of feeding and swallowing behavior (nutritive sucking [NS]), as appropriate;

an identification of additional disorders that may have an impact on feeding and swallowing;

a determination of the optimal feeding method;

an assessment of the duration of mealtime experience, including potential effects on oxygenation (SLP may refer to the medical team, as necessary);

an assessment of issues related to fatigue and volume limitations;

an assessment of the effectiveness of parent/caregiver and infant interactions for feeding and communication; and

consideration of the infant's ability to obtain sufficient nutrition/hydration across settings (e.g., hospital, home, day care setting).

Readiness for Oral Feeding

Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. Feeding readiness in NICUs may be a unilateral decision on the part of the neonatologist or a collaborative process involving the SLP, neonatologist, and nursing staff.

Key criteria to determine readiness for oral feeding include

physiologic stability-stability of digestive, respiratory, heart rate, and oxygenation parameters;

motoric stability-stability of muscle tone, flexion, and midline movements; and

behavioral state-including the ability to become alert to a stimulus and remain alert.

Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers.

Non-Nutritive Sucking (NNS)

NNS is sucking for comfort without fluid release (e.g., with a pacifier, finger, or recently emptied breast). NNS does not determine readiness to orally feed, but it is helpful for assessment. NNS patterns can typically be evaluated with skilled observation and without the use of instrumental assessment.

A non-instrumental assessment of NNS includes an evaluation of the following:

The infant's oral structures and functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression. (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.)

The infant's ability to turn the head and open the mouth (rooting) when stimulated on the lips or cheeks and to accept a pacifier into the mouth.

The infant's ability to use both compression (positive pressure of the jaw and tongue on the pacifier) and suction (negative pressure created with tongue cupping and jaw movement).

The infant's compression and suction strength.

The infant's ability to maintain a stable physiological state (e.g., oxygen saturation, heart rate, respiratory rate) during NNS.

Nutritive Sucking (NS)

The clinician can determine the appropriateness of NS following an NNS assessment. Any loss of stability in physiologic, motoric, or behavioral state from baseline should be taken into consideration at the time of the assessment.

NS skills are assessed during breastfeeding/chestfeeding and bottle-feeding if both modes are going to be used. SLPs should be sensitive to family values, beliefs, and access regarding bottle-feeding and breastfeeding/chestfeeding and should consult with parents and collaborate with nurses, lactation consultants, and other medical professionals to help identify parent preferences.

Assessment of NS includes an evaluation of the following:

The infant's communication behaviors during feeding can be used to guide a flexible assessment. These cues can communicate the infant's ability to tolerate bolus size, the need for more postural support, and if swallowing and breathing are no longer synchronized. In turn, the caregiver can use these cues to optimize feeding by responding to the infant's needs in a dynamic fashion at any given moment (Shaker, 2013b).

Breastfeeding/Lactation/Nursing

SLPs collaborate with parents, nurses, and lactation consultants prior to assessing feeding skills when appropriate. This requires a working knowledge of nursing strategies to facilitate safe and efficient swallowing.

In addition to the clinical evaluation of infants noted above, lactation assessment typically includes an evaluation of the

infant's general health;

infant's medical comorbidities;

infant's current state, including respiratory rate and heart rate;

infant's behavior (e.g., positive rooting, willingness to suckle);

infant's position (e.g., well supported, tucked against the caregiver's body);

infant's ability to latch;

efficiency and coordination of the infant's suck/swallow/breathe pattern;

health of the caregiver's mammary tissue, if present; and

parent's behavior (e.g., comfort with lactation, confidence in handling the infant, awareness of the infant's cues during feeding).

For an example, see community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI) [PDF].

Bottle-Feeding

The assessment of bottle-feeding includes an evaluation of the

infant's general health;

infant's medical comorbidities;

infant's current state, including the respiratory rate and heart rate;

infant's behavior (willingness to accept nipple);

caregiver's behavior while feeding the infant;

efficiency and coordination of the infant's suck/swallow/breathe pattern;

nipple type and form of nutrition (breast milk or formula);

infant's position;

quantity of intake;

length of time the infant takes for one feeding; and

infant's response to attempted interventions, such as

a different nipple for flow control,

external pacing,

a different bottle to control air intake, and

different positions (e.g., side feeding).

Spoon-Feeding

The assessment of spoon-feeding includes an evaluation of the optimal spoon type and the infant's ability to

Clinical Evaluation: Toddlers and Preschool/School-Age Children

In addition to the areas of assessment noted above, the evaluation for toddlers (ages 1-3 years) and preschool/school-age children (ages 3-21 years) may include

a review of any past diagnostic test results,

a review of current programs and treatments,

an assessment of current skills and limitations at home and in other day settings,

screening of willingness to accept liquids and a variety of foods in multiple food groups to determine risk factors for avoidant/restrictive food intake disorder,

an evaluation of dependence on nutritional supplements to meet dietary needs,

an evaluation of independence and the need for supervision and assistance, and

the use of intervention probes to identify strategies that might improve function.

Clinical Evaluation: Schools

Evaluation in the school setting includes children/adults from 3 to 21 years of age. The school-based SLP and the school team (OT, PT, and school nurse) conduct the evaluation, which includes observation of the student eating a typical meal or snack. Implementation of strategies and modifications is part of the diagnostic process. Additional components of the evaluation include

parent interviews and a case history;

an assessment of oral structures and function during intake;

an assessment to determine the developmental level of feeding skills;

an assessment of issues related to fatigue and access to nutrition and hydration during school;

a determination of duration of mealtime experiences, including the ability to eat within the school's mealtime schedule;

an assessment of response to intake, including the ability to manipulate and propel the bolus, coughing, choking, or pocketing foods;

an assessment of adaptive equipment for eating and positioning by an OT and a PT; and

an assessment of behaviors that relate to the child's response to food.

Referral

The evaluation process begins with a referral to a team of professionals within the school district who are trained in the identification and treatment of feeding and swallowing disorders. The referral can be initiated by families/caregivers or school personnel.

The process of identifying the feeding and swallowing needs of students includes a review of the referral, interviews with the family/caregiver and teacher, and an observation of students during snack time or mealtime. A physician's order to evaluate is typically not required in the school setting; however, it is best practice to collaborate with the student's physician, particularly if the student is medically fragile or under the care of a physician.

The school SLP (or case manager) contacts the family to obtain consent for an evaluation if further evaluation is deemed necessary. They also discuss the evaluation process and gather information about the child's medical and health history as well as their eating habits and typical diet at home.

Parental Interview/Case History

The school SLP (or case manager) contacts the family to notify them of the school team's concerns. At that time, they

discuss the process of establishing a safe feeding plan for the student at school;

gather information about the student's medical, health, feeding, and swallowing history;

identify the current mealtime habits and diet at home; and

identify any parental or student concerns or stress regarding mealtimes.

Team Approach

The school-based feeding and swallowing team consists of parents and professionals within the school as well as professionals outside the school (e.g., physicians, dietitians, and psychologists). Members of the team include, but are not limited to, the following:

SLP

family/caregiver

classroom teacher and assistant

school nurse

OT

PT

school administrator

behavioral specialist

school psychologist

social worker

dietitian

cafeteria staff

The team works together to

inform all members of the process for identifying and treating feeding and swallowing disorders in the schools, including the roles and responsibilities of team members;

contribute to the development and implementation of the feeding and swallowing plan as well as documentation on the individualized education program and the individualized health plan; and

oversee the day-to-day implementation of the feeding and swallowing plan and any individualized education program strategies to keep the student safe from aspiration, choking, undernutrition, or dehydration while in school.

If the school team determines that a medical assessment, such as a videofluoroscopic swallowing study (VFSS), flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing, or other medical assessment, is required during the student's program, the team works with the family to seek medical consultation or referral. A written referral or order from the treating physician is required for instrumental evaluations such as VFSS or FEES.

Collaboration With Outside Medical Professionals

Best practice indicates establishing open lines of communication with the student's physician or other health care provider-either through the family or directly-with the family's permission. Any communication by the school team to an outside physician, facility, or individual requires signed parental consent.

In the school setting a physician's order or prescription is not required to perform clinical evaluations, modify diets, or to provide intervention. However, there are times when a prescription, referral, or medical clearance from the student's primary care physician or other health care provider is indicated, such as when the student

See ASHA's resources on interprofessional education/interprofessional practice (IPE/IPP) and collaboration and teaming for guidance on successful collaborative service delivery across settings.

See the treatment in the school setting section below for further information.

Instrumental Evaluation

Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. Instrumental assessments can help provide specific information about anatomy and physiology otherwise not accessible by noninstrumental evaluation. Instrumental evaluation can also help determine if swallow safety can be improved by modifying food textures, liquid consistencies, and positioning or implementing strategies.

Instrumental evaluation is completed in a medical setting. These studies are a team effort and may include the radiologist, radiology technician, and SLP. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. Please see AHSA's resource on state instrumental assessment requirements for further details.

The two most commonly used instrumental evaluations of swallowing for the pediatric population are

During an instrumental assessment of swallowing, the clinician may use information from cardiac, respiratory, and oxygen saturation monitors to monitor any changes to the physiologic or behavioral condition. Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns.

The roles of the SLP in the instrumental evaluation of swallowing and feeding disorders include

participating in decisions regarding the appropriateness of these procedures;

conducting the VFSS and FEES instrumental procedures;

interpreting and applying data from instrumental evaluations to

determine the severity and nature of the swallowing disorder and the child's potential for safe oral feeding; and

formulate feeding and swallowing treatment plans, including recommendations for optimal feeding techniques;

being familiar with and using information from diagnostic procedures performed by different medical specialists that yield information about swallowing function, which include

General Considerations for Instrumental Evaluations

Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will be best tolerated by the child. Prior to the instrumental evaluation, clinicians are encouraged to collaborate with the medical team regarding feeding schedules that will maximize feeding readiness during the evaluation.

The VFSS may be appropriate for a child who is currently NPO or has never eaten by mouth to determine whether the child has a functional swallow and which types of food they can manage. The decision to use a VFSS is made with consideration for the child's responsiveness (e.g., acceptance of oral stimulation or tastes on the lips without signs of distress) and the potential for medical complications. Careful pulmonary monitoring during a modified barium swallow is essential to help determine the child's endurance over a typical mealtime.

When conducting an instrumental evaluation, SLPs should consider the following:

Anxiety and crying may be expected reactions to any instrumental procedure. Anxiety may be reduced by using distractions (e.g., videos), allowing the child to sit on the parent's or the caregiver's lap (for FEES procedures), and decreasing the number of observers in the room.

Positioning for the VFSS depends on the size of the child and their medical condition (Arvedson & Lefton-Greif, 1998; Geyer et al., 1995). Infants under 6 months of age typically require head, neck, and trunk support.

Infants are obligate nasal breathers, and compromised breathing may result from the placement of a flexible endoscope in one nostril when a nasogastric tube is in place in the other nostril. Clinicians should discuss this with the medical team to determine options, including the temporary removal of the feeding tube and/or use of another means of swallowing assessment.

Children are positioned as they are typically fed at home and in a manner that avoids spontaneous or reflex movements that could interfere with the safety of the examination. Modifications to positioning are made as needed and are documented as part of the assessment findings.

If a natural feeding process (e.g., position, caregiver involvement, and use of familiar foods) cannot be achieved, the results may not represent typical swallow function, and the study may need to be terminated, with results interpreted with caution.

Test Environment

Procedures take place in a child-friendly environment with toys, visual distracters, rewards, and a familiar caregiver, if possible and when appropriate. Various items are available in the room to facilitate success and replicate a typical mealtime experience, including preferred foods, familiar food containers, utensil options, and seating options.

Preparing the Child

For the child who is able to understand, the clinician explains the procedure, the purpose of the procedure, and the test environment in a developmentally appropriate manner.

The clinician allows time for the child to get used to the room, the equipment, and the professionals who will be present for the procedure.

For procedures that involve presentation of a solid and/or liquid bolus, the clinician instructs the family to schedule meals and snacks so that the child will be hungry and more likely to accept foods as needed for the study.

If the child is NPO, the clinician allows time for the child to develop the ability to accept and swallow a bolus. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure.

Preparing Families

The clinician provides families and caregivers with information about dysphagia, the purpose for the study, the test procedures, and the test environment.

The clinician requests that the family provide

familiar foods of varying consistencies and tastes that are compatible with contrast material (if the facility protocol allows);

a specialized seating system from home (including car seat or specialized wheelchair), as warranted and if permitted by the facility; and

the child's familiar and preferred utensils, if appropriate.

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Dysphagia in pediatrics involves feeding (accepting and preparing food orally), and swallowing (transporting food from the mouth to the stomach).

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Browse Preschool Math Games | Education.com

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Browse Preschool Math Games. Award winning educational materials designed to help kids succeed. Start for free now!

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Fine Motor Activities to Improve Fine Motor Skill Development

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Fine Motor Activities to Improve Fine Motor Skill Development

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This page presents an overview of the development of intellectual abilities. Children are not little adults. Until they reach the age of 15 or so they are not capable of reasoning as an adult. The following information is based on the work of Jean Piaget. He was not a psychologist. He was a developmental biologist who devoted his life to closely observing and recording the intellectual abilities of infants, children and adolescents.

The stages of intellectual development formulated by Piaget appear to be related to major developments in brain growth. The human brain is not fully developed until late adolescence or in the case of males sometimes early adulthood. We often expect children to think like adults when they are not yet capable of doing so. It is important that parents know what to expect from their child as they develop and to be sure that the expectations they may have for their child at a given age are realistic.
[CLICK HERE to learn more about intellectual and cognitive development along with suggestions on how to encourage and guide your child's or teen's development]
Piaget's Stages of Cognitive Development

Primary Circular Reactions(2-4 months)
Reflexive behaviors occur in stereotyped repetition such as opening and closing fingers repetitively.

The Preoperational Period (2-7 years)

Period of Concrete Operations (7-12 years)

Characteristic Behavior:

Evidence for organized, logical thought. There is the ability to perform multiple classification tasks, order objects in a logical sequence, and comprehend the principle of conservation. thinking becomes less transductive and less egocentric. The child is capable of concrete problem-solving.

Some reversibility now possible (quantities moved can be restored such as in arithmetic:
3+4 = 7 and 7-4 = 3, etc.)

Class logic-finding bases to sort unlike objects into logical groups where previously it was on superficial perceived attribute such as color. Categorical labels such as "number" or animal" now available.

Period of Formal Operations (12 years and onwards)
Characteristic Behavior:
Thought becomes more abstract, incorporating the principles of formal logic. The ability to generate abstract propositions, multiple hypotheses and their possible outcomes is evident. Thinking becomes less tied to concrete reality.

Formal logical systems can be acquired. Can handle proportions, algebraic manipulation, other purely abstract processes. If a + b = x then a = x - b. If ma/ca = IQ = 1.00 then Ma = CA.

Prepositional logic, as-if and if-then steps. Can use aids such as axioms to transcend human

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They Learn Fast! Understand Your Kid's Intellectual Development

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This page presents an overview of the development of intellectual abilities. Children are not little adults. Until they reach the age of 15 or so they are not capable of reasoning as an adult. The following information is based on the work of Jean Piaget. He was not a psychologist.

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HOME | UM-NSU CARD | University of Miami

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The Center for Autism and Related Disabilities (CARD), a collaborative program of the University of Miami and Nova Southeastern University opened its doors in 1993 in South Florida in our community. CARD is one of seven state-funded, university-based outreach and support centers in Florida dedicated to optimizing the potential of people with autism spectrum disorders (ASD), dual sensory impairment, sensory impairments with other disabling conditions, and related disabilities.

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Florida's Early Steps | Florida Department of Health

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Early Steps honors the cultures and values of families, and we help them build on each child's individual strengths and unique needs.

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MDCPS PreK Program for Children with Disabilities

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MDCPS PreK Program for Children with Disabilities

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Prekindergarten Program for Children with Disabilities

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Miami-Dade County Public Schools site for the PreK ESE Department

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National Institute on Deafness and Other Communication Disorders

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National Institute on Deafness and Other Communication Disorders

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How do speech and language develop?

The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills. These skills develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

There appear to be critical periods for speech and language development in infants and young children when the brain is best able to absorb language. If these critical periods are allowed to pass without exposure to language, it will be more difficult to learn.

What are the milestones for speech and language development?

The first signs of communication occur when an infant learns that a cry will bring food, comfort, and companionship. Newborns also begin to recognize important sounds in their environment, such as the voice of their mother or primary caretaker. As they grow, babies begin to sort out the speech sounds that compose the words of their language. By 6 months of age, most babies recognize the basic sounds of their native language.

Children vary in their development of speech and language skills. However, they follow a natural progression or timetable for mastering the skills of language. A checklist of milestones for the normal development of speech and language skills in children from birth to 5 years of age is included below. These milestones help doctors and other health professionals determine if a child is on track or if he or she may need extra help. Sometimes a delay may be caused by hearing loss, while other times it may be due to a speech or language disorder.

What is the difference between a speech disorder and a language disorder?

Children who have trouble understanding what others say (receptive language) or difficulty sharing their thoughts (expressive language) may have a language disorder. Developmental language disorder (DLD) is a language disorder that delays the mastery of language skills. Some children with DLD may not begin to talk until their third or fourth year.

Children who have trouble producing speech sounds correctly or who hesitate or stutter when talking may have a speech disorder. Apraxia of speech is a speech disorder that makes it difficult to put sounds and syllables together in the correct order to form words.

What should I do if my child's speech or language appears to be delayed?

Talk to your child's doctor if you have any concerns. Your doctor may refer you to a speech-language pathologist, who is a health professional trained to evaluate and treat people with speech or language disorders. The speech-language pathologist will talk to you about your child's communication and general development. He or she will also use special spoken tests to evaluate your child. A hearing test is often included in the evaluation because a hearing problem can affect speech and language development. Depending on the result of the evaluation, the speech-language pathologist may suggest activities you can do at home to stimulate your child's development. They might also recommend group or individual therapy or suggest further evaluation by an audiologist (a health care professional trained to identify and measure hearing loss), or a developmental psychologist (a health care professional with special expertise in the psychological development of infants and children).

What research is being conducted on developmental speech and language problems?

The National Institute on Deafness and Other Communication Disorders (NIDCD) sponsors a broad range of research to better understand the development of speech and language disorders, improve diagnostic capabilities, and fine-tune more effective treatments. An ongoing area of study is the search for better ways to diagnose and differentiate among the various types of speech delay. A large study following approximately 4,000 children is gathering data as the children grow to establish reliable signs and symptoms for specific speech disorders, which can then be used to develop accurate diagnostic tests. Additional genetic studies are looking for matches between different genetic variations and specific speech deficits.

Researchers sponsored by the NIDCD have discovered one genetic variant, in particular, that is linked to developmental language disorder (DLD), a disorder that delays children's use of words and slows their mastery of language skills throughout their school years. The finding is the first to tie the presence of a distinct genetic mutation to any kind of inherited language impairment. Further research is exploring the role this genetic variant may also play in dyslexia, autism, and speech-sound disorders.

A long-term study looking at how deafness impacts the brain is exploring how the brain "rewires" itself to accommodate deafness. So far, the research has shown that adults who are deaf react faster and more accurately than hearing adults when they observe objects in motion. This ongoing research continues to explore the concept of "brain plasticity"-the ways in which the brain is influenced by health conditions or life experiences-and how it can be used to develop learning strategies that encourage healthy language and speech development in early childhood.

A recent workshop convened by the NIDCD drew together a group of experts to explore issues related to a subgroup of children with autism spectrum disorders who do not have functional verbal language by the age of 5. Because these children are so different from one another, with no set of defining characteristics or patterns of cognitive strengths or weaknesses, development of standard assessment tests or effective treatments has been difficult. The workshop featured a series of presentations to familiarize participants with the challenges facing these children and helped them to identify a number of research gaps and opportunities that could be addressed in future research studies.

What are voice, speech, and language?

Voice, speech, and language are the tools we use to communicate with each other.

Voice is the sound we make as air from our lungs is pushed between vocal folds in our larynx, causing them to vibrate.

Speech is talking, which is one way to express language. It involves the precisely coordinated muscle actions of the tongue, lips, jaw, and vocal tract to produce the recognizable sounds that make up language.

Language is a set of shared rules that allow people to express their ideas in a meaningful way. Language may be expressed verbally or by writing, signing, or making other gestures, such as eye blinking or mouth movements.

Your baby's hearing and communicative development checklist

Birth to 3 Months

4 to 6 Months

7 Months to 1 Year

1 to 2 Years

2 to 3 Years

3 to 4 Years

4 to 5 Years

This checklist is based upon How Does Your Child Hear and Talk?, courtesy of the American Speech-Language-Hearing Association.

Where can I find additional information about speech and language developmental milestones?

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on speech and language development:

For more information, contact us at:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Email: nidcdinfo@nidcd.nih.gov

NIH Publication No. 00-4781
September 2010

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Speech and Language Developmental Milestones

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How do speech and language develop? The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills. These skills develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

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The SAG-AFTRA Foundation's Daytime Emmy-nominated, Storyline Online, features celebrated actors reading children's books to inspire a love of reading in millions of children worldwide.

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Harvard University

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Center on the Developing Child at Harvard University

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Executive function and self-regulation (EF/SR) skills provide critical supports for learning and development, and while we aren't born with these skills, we are born with the potential to develop them through interactions and practice.

This 16-page guide (available for download, below), describes a variety of activities and games that represent age-appropriate ways for adults to support and strengthen various components of EF/SR in children.

Each chapter of this guide contains activities suitable for a different age group, from infants to teenagers. The guide may be read in its entirety (which includes the introduction and references) or in discrete sections geared to specific age groups.

Suggested citation: Center on the Developing Child at Harvard University (2014). Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence. Retrieved from www.developingchild.harvard.edu.

Download PDF

Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence

An activities guide for building executive function

Download PDF

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Activities Guide: Enhancing & Practicing Executive Function Skills

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Download free guides of executive functioning activities to support and strengthen skills, available for children ages six months through adolescence.

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English and Spanish

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Florida was one of the first states in the country to offer free prekindergarten to all 4-year-olds. Children must live in Florida and be 4 years old on or before Sept. 1 of the current school year to be eligible. If their fourth birthday falls Feb. 2 through Sept. 1 in a calendar year, parents can postpone enrolling their child in VPK that year and wait until the following year when their child is 5.

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Florida was one of the first states in the country to offer free prekindergarten to all 4-year-olds. Children must live in Florida and be 4 years old on or before Sept. 1 of the current school year to be eligible. If their fourth birthday falls Feb. 2 through Sept.

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In order for a toddler to be successfully potty trained, she needs to be able to sense the urge to go, be able to understand what the feeling means, and then be able to verbalize that she needs your help to make it to the toilet and actually go. Waiting until your child is truly ready will make the experience much faster and more pleasant for everyone involved.

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In order for a toddler to be successfully potty trained, she needs to be able to sense the urge to go, be able to understand what the feeling means, and then be able to verbalize that she needs your help to make it to the toilet and actually go.

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English and Spanish

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Early Steps is Florida's early intervention system that offers services to eligible infants and toddlers, age birth to 36 months, who have or are at-risk for developmental disabilities or delays. Early intervention supports families and caregivers to increase their child's participation in daily activities and routines that are important to the family

Positive early learning experiences are crucial for later success in school, the workplace, and the community. Research shows that children's earliest experiences play a critical role in brain development.

15 Local Early Steps (LES) throughout the state receive referrals from various primary referral sources. Infants and toddlers are assessed in the following developmental domains to determine eligibility: physical, cognitive, communication, social-emotional and adaptive.

Each child receives an Individualized Family Support Plan (IFSP) that meets his or her unique needs. Families also receive support to develop the skills and confidence needed in helping their child learn and develop.

Services will support children in their communities where they live, learn and play.

There is no income requirement to qualify for the program and although families may choose to allow access to insurance or Medicaid benefits, families are not charged for services.
For more information visit our website. To make a referral to Early Steps, contact the Local Early Steps program serving your area or call (800) 218-0001.
State Systemic Improvement Plan (SSIP)

Early Intervention programs nationally are required to develop a State Systemic Improvement Plan (SSIP). This is a multi-year plan that began July 2013 and will continue through June 2019. The purpose of the Florida Early Steps SSIP plan is to implement effective, sustainable policies and practices at the state and local levels to positively impact social-emotional development for infants and toddlers with disabilities ages 0 to 36 months.
SSIP Fact Sheet
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Early Steps, within Children's Medical Services, serves families with infants and toddlers, birth to 36 months of age, who have developmental delays or an established condition likely to result in a developmental delay. Each child receives an Individualized Family Support Plan (IFSP) that meets his or her needs.

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Español

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A Comprehensive Digital Library at Your Fingertips

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More than 1,500 professionally voiced titles

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Unlimited access to 1,000+ books. Anytime. Anywhere.

100% safe and kid-friendly environment

Popular titles and characters that children know and love

Guided Reading and Lexile® levels available for 1,000+ books

Accessible on computers, tablets, and smartphones

All titles carefully curated for readers 12 and under

Book recommendations for every child based on his or her level

Up to 3 children per account

Ability to monitor your child's progress

Ability to preview the content your child is exploring

More than 1,500 professionally voiced titles

From Reading Experts:

"Children who read more than 10 pages per day score 10% higher in reading proficiency."
Source: National Assessment of Education Progress (NAEP), (2000). The Nation's Report Card-Fourth Grade Reading Highlights.

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From Reading Experts:

"Reading for just 10 minutes per day increases the number of words a child reads in a year by more than half a million."
Source: Adams, M. J. (2006). The promise of automatic speech recognition for fostering literacy growth in children and adults. In M.C. McKenna, L.D. Labbo, R. D. Kieffer, & D. Reinking (Eds.), International Handbook of Literacy and Technology, Volume 2. Mahwah, NJ: Lawrence Erlbaum Associates.

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ReadingIQ: 1,000+ Digital Books for Kids 2-12

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ReadingIQ helps kids ages 2-12, learn to read with 1,000+ digital books. Adventure & mysteries, fables & fairytales, animals & plants, and more.

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No cost Eye Exams & Glasses for Children 

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No cost Eye Exams & Glasses for Children 