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Speech and Language Birth to 3 years

Birth to 3 Years

Bonding With Baby: Baby’s introduction to communication.

  • Holding, talking, singing, rocking, cuddling, and other nurturing interactions between you and your baby are bonding experiences. Not only do these interactions form an intense emotional connection, it also strengthens babies’ learning connections and ability to communicate.  Forming a secure bond will provide life-long benefits to both baby and caregiver.

Here are some tips for deepening the bond between you and your baby:

  • Provide your baby with plenty of face-to-face interaction. Bring your face close to your baby’s and gaze into each other’s eyes. Your baby prefers familiar smiling faces, changing expressions, and a loving voice.
  • Soft touches nourish your baby’s emotional development and improve sensory awareness.  While feeding, changing diapers, dressing and bathing, take the time to lovingly touch your baby.
  • Massage is one of the most nurturing gifts that you can give your baby. It is a language of love between parent and child. It relaxes, reduces stress, and helps your baby sleep.
  • Skin-to-skin contact is soothing and comforting for both you and your baby. Hold your baby against your chest and breathe slowly. The warmth of your body, the smell of your skin, and the beating of your heart are very reassuring.  Skin-to-skin contact also helps increase milk production if you are breastfeeding or pumping.


  • Talk to your baby.  Even though your baby cannot talk to you at first, they are listening to everything you say.  Involve him in your activities by talking about everything that you do. Once your baby starts cooing and making sounds, respond to his growing vocabulary by repeating those sounds back to him.


  • Sing to your baby.  Even if you think your singing is not the best, it’s the best for your baby. Don’t limit yourself to lullabies or nursery rhymes–sing whatever makes you happy.


  • Reading is a great way to bond with your baby while developing language skills. Start with large books that have simple bold illustrations. Cradle your baby in your arms and let him experience the closeness that reading a book provides.

Factors That May Affect Bonding

  • Your baby may look different than you thought.  You may have formed a mental picture of baby having certain physical and emotional traits before he or she was born.  When you meet your baby, either at birth or after an adoption, you may need to adjust how you thought he or she might look.  Because a baby’s face is the primary tool of communication, it plays a critical role in bonding and attachment.  This might be why we miss our babies’ wide smiles so much after surgeries- we bonded with baby just how they were.


  • Sometimes mothers have difficulty bonding with their babies if they have postpartum depression. Bonding can also be delayed if a mom is exhausted and in pain following delivery.


  • If your baby spends some time in intensive care, bonding may be delayed or difficult.  Bonding with your baby is still important!  The hospital staff can help you hold and handle your baby and will encourage you to spend time watching, touching, and talking with your baby. Your baby will recognize you and respond to your voice and touch.


  • Forming a secure bond to baby is important for future relationships.  A child with insecure attachment or an attachment disorder doesn’t have the skills necessary to build meaningful relationships throughout their lifetime. The earlier attachment issues are recognized, the easier they are to resolve.  It is never too late to seek help if you feel like you are having a difficult time bonding with your baby.

Possible Speech and Language Problems:

  • Over half of children born with cleft palate will require speech therapy.  Regular evaluations by the speech-language pathologist on your child’s cleft team will help you decide if speech therapy services or other types of interventions are needed.  The speech-language pathologist will be able to assess your child’s speech production and language development and make appropriate therapy recommendations.


  • Language delay is common in children with cleft lip/palate.  A delay can occur because of a child’s inability to produce certain sounds due to the structure of the mouth. Compensatory speech patterns can develop and be very difficult for adults to understand. This in turn affects the child’s interaction with adults and children.  Language delay can also occur because children may not be able to hear well or at all.


  • Articulation can also be affected by the cleft palate if the soft palate cannot make contact with the pharyngeal walls (wall at the back of the throat). Airflow will leak through the nose during speech (hypernasal speech). This can affect consonant sounds “p”, “b”, “t”, “d”, “s”, “sh”, “ch”, and “f” if the seal cannot be maintained. As the air escapes, the sounds will become distorted.


  • Before the palate is repaired, there is no separation between the nasal cavity and the mouth.  This means that the child cannot build up air pressure in the mouth because air escapes out of the nose.  There might also be less tissue on the roof of the mouth for the tongue to touch.  Both of these problems can make it difficult for the child to learn how to make some sounds.


  • When speech is produced correctly, the soft palate lifts and moves toward the back of the throat, separating the nasal cavity from the mouth so that air and sound can be directed out of the mouth.  The inability to close off the nasal cavity from the mouth is called velopharyngeal inadequacy/insufficiency. It may sound like they are “talking through their noses.”  This problem occurs because when the soft palate cannot close off the nose from the mouth, air and sound can escape through the nose during speech, possibly resulting in hypernasality and nasal emission of air.

  • Dental issues such as the early and/or late eruption of teeth and/or the collapse of the upper jaw can further complicate the child’s ability to develop speech and language skills.


  • Whether you suspect a problem or not, your child’s ears and hearing need to be checked on a regular basis.  Children with cleft palate are more susceptible to otitis media (ear infections) than children without clefts.  Multiple ear infections can cause hearing loss, language delays, and speech problems.

Early Intervention

  • It is common for there to be a delay in both the onset of speech and the development of speech sounds during the first 9-24 months of age in children born with cleft palate.  Once the palate has been repaired, your child may be able to learn more consonant sounds and say more words, but speech may still be delayed.


  • If you are concerned about your child reaching his or her speech and language milestones, you may want to speak with your child’s pediatrician and/or team to set up an evaluation with the speech and language pathologist.


  • A speech and language evaluation will determine if the child’s speech, expressive language, and receptive language skills are at age level or below age level. If the child demonstrates below-age-level skills in any area, intervention may be needed.  Additionally, a speech-language pathologist can provide helpful suggestions on how to help a child gain language during everyday activities.


  • A speech-language pathologist can also teach parents how to expand, imitate and model words, phrases and sentences for their child.
    • Expanding is completing the child’s phrase i.e the child says ”milk” and the parent says “you’d like milk?”
    • Imitating is repeating what the child says stressing correct and incorrect sounds i.e the child says “baba” and parent says “bottle.” When imitating the child’s speech and language, it is important that the child is not forced to repeat after you.
    • Modeling is adding new information to a child’s utterances ie the child says “car go” and the parent or caregiver can say “That’s right, the car is going!  Bye-bye car.”


  • Children with a language delay will sometimes show frustration by crying, biting, or throwing temper tantrums.  Once they understand that using language is an effective way of communicating, these behaviors often get better.


  • It is also important to remember that some children, with or without a cleft palate, may simply develop speech more slowly than others.


How do parents pay for speech therapy?

  • Insurance may pay for speech therapy for children born with cleft lip and palate, though they may limit the number of physician’s letter.  Consult with your insurance provider to obtain the necessary information.


  • State Funded Programs may be available.  Check with your team as well as the resources page provided by The Cleft Lip and Palate Foundation of Smiles to see what services are available in your state. State Resources


  • Your school district is also obligated to evaluate and treat your child if he or she qualifies for the school program and has reached the age of three.  Contact your school system’s special education department to inquire about these services. Also check out Our IDEA and IEP Program and Support


Responses to Speech and Sounds: What to look for:

  • Newborn: Is startled by a loud noise, turns heads to look in the direction of a sound, is calmed by the sound of a voice, and prefers mom’s voice to a stranger’s, discriminates many of the sounds used in speech.

  • 1-2 mos.: Smiles when spoken to.

  • 3-7 mos.: Responds differently to various intonations (ie friendly or angry).

  • 8-12 mos.: Responds to name, responds to ”no” (but doesn’t always obey), recognizes phrases from games (ie peekaboo), recognizes words from routines (ie waves to bye-bye), recognizes some words.

Activities to Encourage Speech and Language Development

  • Encourage your baby to make vowel-like and consonant-vowel sounds such as “ma,” “da,” and “ba.”  “Ma” and “da” are usually easy to encourage because they lead to “mama” and “dada!”


  • Reinforce attempts by maintaining eye contact, responding with speech, and imitate baby by using different patterns and emphasis. For example, raise the pitch of your voice to indicate a question.


  • Imitate your baby’s laughter and facial expressions.


  • Teach your baby to imitate your actions.  Clapping you hands, blowing kisses, and playing games such as pat-a-cake, peek-a-boo, and the itsy-bitsy-spider are great ways to encourage them it’s fun at the same time.


  • Talk, talk, talk! Talk as you bathe, feed, and dress your baby. Talk about what you are doing, where you are going, what you will do when you arrive, and who and what you will see.


  • Identify colors, things around the house, familiar people, etc.


  • Count anything and everything.


  • Use gestures such as waving goodbye to help convey meaning.


  • Introduce animal sounds to associate a sound with a specific meaning: “That’s a doggie, doggies say woof.”


  • Acknowledge attempts to communicate in a positive way.  Smile at your child and repeat what they’ve said or done to show that you are interested and understand what they’re trying to tell you.  Encourage them and say “Yes, that’s right!  Doggie says woof!” (even if it sounded nothing like woof!).


  • Expand on single words your child uses (ie. mama or baby): “Here is Mama. Mama loves you.” Or “Where is baby? Here is baby!”


  • Read to your child.  Sometimes reading is simply describing the pictures in a book without following the written words.  Ask your child, “What’s this?” Also encourage naming and pointing to familiar objects in the book.


  • Teach your baby or young child sign language.  Finding a way to effectively communicate will help keep frustration down and give them a way to tell you what they need or want.

Speech and Language Development

Speech: The production of articulated sounds and syllables.  Articulation refers to all of the parts (tongue, palate, lips, etc.) that move to make a particular speech sound.

Language: There are two components of language, expressive and receptive. Expressive language refers to the child’s ability to verbally express his needs, wants, feelings, etc. Receptive language is the ability to understand language.

Infant Speech Production: What to look for:

  • Birth-1 month: Reflexive vocalizations such as crying, fussing, coughing, sneezing and burping.  Speech-like sounds are rare. 

  • 2-3 months: Look for non-reflexive vocalizations to start, such as cooing and gooing. 

  • 4-6 months: Look for baby to start squealing, growling, yelling, and making raspberries.  Baby may start to have vowel-like elements in vocalizations.  It is normal for baby’s vocalizations to vary daily or weekly.  Baby may just start to babble—Examples: ba, ma, da.

  • 7-9months: Look for baby to expand babbling to baba, mama, dada, tata, kaka, etc. 

Although babies typically start to say mama and dada, they are not used with true intention yet                           (the dog or a toy can be mama).

  • 10 months to about the first year: You might hear baby say things likes “madaga”, “putika”, and “tikadi.” 
    • Around their first birthday, babies’ intonation patterns can start to sound adult-like.  Their sounds may resemble real statements, questions, and exclamations, but don’t typically contain real words (but can!).

  • 12 Months +: A typically developing child first acquires single words between the ages of 12 to 18 months. 
    • It is normal for babbling and meaningful speech production to overlap for a few weeks to several months during this time.
    • Emergence of Protowords. Protowords are invented “words” consistently used by children.  Though these “words” may not resemble the adult form, they carry meaning (ie the dog is always “Kiki”). 
    • It is normal to hear your child use protowords, true words, and/or babble in the same sentence.
    • At 12 months of age, a child should recognize his/her name and understand “no.”

  • 18 Months +: A child may have approximately 3 to 20 words by 18 months.
    • Between 18 and 24 months of age, two-word combinations emerge. Some examples of words and phrases that may be used at this age level are “no”, “more”, “mine”, “want up”, “that’s mine”, “all gone.”
    • At 18 months of age, a child may recognize pictures of family members and objects. The child may also understand the concepts of “in” and “out.”

  • 24 Months +: A child will typically have 50 words by 24 months.
    • Children may use two- to three-word utterances by the age of 24 months. Examples of phrases at this age may include those with negation such as, “not go”, “no want.”
    • At 24 months of age, a child understands simple questions and commands.


36 Months +: At the age of 36 months, children may begin to expand upon simple sentences and ask questions.  The average length of these sentences is approximately three to fours words.

  • A child who is 36 months of age is able to follow simple directions and understands basic location concepts of “under,” “in front of,” and “behind.”

Work Cited

Josephine K. Chen, M.S., CCC, LLC (2004-2011).  Center for Speech and Language Pathology (online).  Available: www.speechtherapyct.com.  (January 20, 2011).

American Speech-Language-Hearing Association (1997-2011).  Activities to Encourage Speech and Language Development (online).  Available: http://www.asha.org/public/speech/development/parent-stim-activities.htm.  (January 21, 2011).

Suanne Armstrong (1997-2008).  Smiles (online).  Available: www.cleft.org/group.htm 2001.  (January 21, 2011).

Cleft Palate Foundation (2006-2011).  Cleftline (online).  Available:  www.cleftline.org .  (January 21, 2011).

Kids Health For Nemours (1995-2011).  Bonding With Your Baby (online).  Available:  http://kidshealth.org/parent/pregnancy_newborn/communicating/bonding.html#

Babies Online (1997-2008).  Bonding With Your Baby: Ten Tips That Work (online).  Available: http://www.babiesonline.com/articles/baby/bondingwithbaby.asp. (January 21, 2011).

Hegde, M.N., Pena-Brooks, Adriana.  Assessment and Treatment of Articulation and Phonological Disorders in Children. Austin, Texas:  Pro-Ed, 2007.  Print.

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