Dear Doctor, Is it normal that my four year old son can’t speak well yet most kids in his class do? He seems to have a stammer but I am not sure yet because he rarely talks. Is this a stammering issue? What causes it? Lydia

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Dear Lydia,

Stuttering is a speech disorder, where the individual cannot articulate words and sentences clearly and without pausing. It is not an uncommon problem. Some children outgrow it, as they get older. But some continue to stammer even as teenagers or adults.

A child stuttering often becomes a target of ridicule. Even if nobody mocks him, he hesitates to speak, because he realises the difference between himself and other friends. Thus he loses his self-esteem.

The exact cause of stuttering is not known. But there are many theories for it.

Many experts agree that stuttering has a genetic component. 60 per cent of people who stutter have a blood relative who stutters as well.

Many young kids go through a phase of stuttering during development of their speech and vocabulary from around 18 months to two years of age. But this subsides as they grow. In some children, it is postulated that stuttering may be due to some problem in the brain. The way language is transmitted through the brain, may not be normal.

However, there are certain risk factors that predispose a child for stuttering. The risk is higher, if a close family member has the same problem. A child beginning to stutter before the age of 3 is more likely to overgrow it. If the problem lasts for more than six months, there is a risk of it lasting longer. Boys are three to four times more likely to stutter as compared to girls. This difference in gender is also not understood clearly.

If the child has associated other problems of speech and or understanding, it is unlikely that he will overgrow stuttering.

It is important to support a child who stutters emotionally, as well as physically in his speech. A parent should be very calm and patient. In no way should the child be interrupted or scolded when he speaks with a stutter. Encourage the child to speak slowly and with emphasis on each word. Thus, he should to try to speak each word clearly.  Counsel other people interacting with him to do the same. This would include other family members, other elders and children of neighbourhood, teachers in school. Gradually, his stutter may disappear over time.

It is also important to keep the atmosphere of the house peaceful and serene all the time. This would keep the child cheerful and calm and prevent stuttering to some extent. If the child is mentally disturbed due to any reason like fights in the house, he may stutter more.

Apart from these efforts at home, help of a professional speech therapist can be taken to help improve the child’s speech.

Dr. Rachna   Pande is a specialist in internal medicine.