Stuttering In Young Kids: When To Be Concerned

When you see your child all-of-a-sudden struggling to get words out, it can be concerning.  This is especially true if your child, who previously had no difficulty speaking, is now stuttering out of the blue.  Fortunately, about 75% of children who show signs of early stuttering will recover by late childhood.

As a parent, how do you know when to accept stuttering as a normal part of development and when to be more concerned?

When children are learning how to communicate, some will exhibit developmental disfluency, or normal interruptions in speech, between ages 2-5. This stage happens when children are acquiring the skills to talk.  It is thought that they are having difficulty coordinating their muscles for speaking as their language skills are blossoming and they begin talking in longer, more complex utterances.   The child’s speech system may also be stressed from the development of other skills, such as walking or potty training.

When determining when to be concerned about your child’s speech, knowing the difference between typical/developmental disfluency and true stuttering can be helpful.

Examples of typical/developmental disfluency:

  • Hesitations between words (“I want some …. milk”)
  • Interjections, such as “um,”“uh,” “well,  or “like”
  • Revisions within utterances (“The dog is – the dogs are playing”)
  • Repetitions of phrases (“I want to … I want to go”)

Examples of stuttering, or atypical disfluency, which can fall into the more concerning category:

  • Repetitions of words (“I I I … I want a banana”)
  • Repetitions of sounds (“M-my”) or syllables (“Ba-baby”)
  • Sound prolongations (“I— (prolonging sound) I live in C—-Cincinnati.”)
  • Vocal blocks in which no sound comes out (“M {block} my name is {block} … M Max.”)

Emotional Reactions to Stuttering:

In addition to taking note of how atypical disfluencies sound, it is also very important to be aware of any emotional reactions that your child may demonstrate in response to his or her stuttering.  The following reactions may be a cause for concern:

  • Awareness of difficulty with speaking (saying, “I can’t say it.”)
  • Frustration from stuttering
  • Shame or embarrassment with talking
  • Refusal to talk to strangers due to a fear of stuttering
  • Escape or avoidance behaviors (e.g. abnormal movements during speech such as jerking or forceful eye blinking, head nodding, or using of many filler words, such as “um”)

When Stuttering Persists

Although many children do tend to recover from stuttering, other children may persist.  Some children who begin with typical developmental disfluency may evolve into children who stutter.  Determining the difference between a child who is truly stuttering and a child who is simply passing through the developmental disfluency stage can be confusing. Here are some factors, which may indicate your child is at-risk for continued stuttering:

  • Family history of stuttering
  • Age at onset (if your child began stuttering after age 3 ½ years)
  • Time since onset (if you child has stuttered for longer than 1 year)
  • Gender (males are 3 to 4 times more likely than females to persist in stuttering)
  • Speech is difficult to understand with many speech sound errors
  • High frequency of disfluencies (more than 10 stutters per 100 words)
  • Higher percentage of atypical stuttering-like disfluencies (atypical stutters comprise more than 50% of total disfluencies); these include:
    • Repetitions of sounds, syllables, and one syllable words
    • Tense pauses accompanied by muscular tension in the jaw and/or mouth
    • Prolongations (elongating a sound or syllable)
    • Silent blocks (voice stops)
    • Higher number of times a word or sound is repeated – often more than two times
    • Increased degree of tension during speech
    • Higher sensitivity to stress

Variability in Stuttering

It is important to remember that stuttering is highly variable in its nature and frequency among children and even within the same child.  A common saying is, “The only constant with stuttering is its variability.”  Furthermore, stuttering is not black and white.  There is actually much overlap between a young child who is truly stuttering and one that is passing through the developmental disfluency period.  One area of overlap is the impact of environmental influences on fluency.

Both children with developmental disfluency and children who persist in stuttering are more likely to have difficulty speaking smoothly when they are: interrupting; commanding or directing another person; responding to a request to change their own activity.

Also, children often exhibit more disfluency due to excitement, such as during vacations, holidays, and visits from relatives.  Similarly, disfluency increases when the child is exposed to psychological stress such as a birth of a sibling, moving homes, divorce, or other events that disrupt the normal life routine.

When to Seek Help

Your child should be evaluated by a speech-language pathologist who specializes in stuttering if you have a concern about your child’s speech and he or she:

  • Stutters for longer than 6 months and it occurs frequently during the day
  • Shows tension, facial grimaces, or struggle behaviors during talking
  • Avoids situations in which he or she will have to talk
  • Expresses concerns about speech
  • Avoids saying certain words or sounds

Getting Your Child Help

Diagnosing stuttering can be difficult as stuttering is a complex disorder and no one child stutters in the same way.  For children that do continue to stutter, early treatment can substantially reduce and sometimes eliminate their stuttering.

Speech therapy is the most effective treatment, and there are different kinds available, depending on each child and family.  In addition to working on a child’s speech skills, therapy can also help build the child’s confidence in communicating.  Families and patients are counseled and given support throughout the therapy process.

To learn more about our division of Speech-Language Pathology, call 513-636-4341 or email speech.pathology@cchmc.org.

Katrina Zeit Purcell

About the Author: Katrina Zeit Purcell

Katrina Zeit Purcell, MHA, MA, CCC-SLP, is a speech-language pathologist at Cincinnati Children's and coordinates the speech pathology division’s public relations projects. Katrina is a member of the fluency team, specializing in evaluating and treating preschool, school-age, and adolescent stuttering. Additionally, she served as a final editor for Language in My Life, an interactive guide for caregivers that offers practical, easy-to-follow and fun suggestions for stimulating a child’s speech and language development at home.

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Comments

  1. Mokwena Sbongile February 26, 12:59
    Hey Katrina, hope to find you well. Can I briefly ask if you understand the concept of Atypical dysfluencies vs atypical fluencies. Thank you. Sbongile Mokwena, South africa
    • Katrina Zeit Purcell
      Katrina Zeit Purcell Author March 05, 10:26
      Hi Mokwena, I think what you might be asking is “What is the difference between atypical and typical disfluencies?” As children learn to communicate, some will exhibit developmental disfluency, or normal interruptions in speech, typically between the ages of 2-5 years. However, as children get older, they may develop atypical disfluencies. Additionally, some young children may produce atypical disfluencies from onset. Examples of atypical disfluencies are described in the paragraph above and are defined as repetition of words, repetition of sounds, sound prolongations and vocal blocks.
  2. Cassie December 31, 15:52
    Hey Katrina, I have a question, My son is almost 11 and has had a continuous stuttering issue. And in the past 4 months it has gotten extremely bad. There is no family history of it, and he had no issues growing up til now. Is it typical for late childhood on set of stuttering?
    • Katrina Zeit Purcell
      Katrina Zeit Purcell Author January 11, 15:43
      Hi Cassie, The short answer is that onset of stuttering in late childhood is more rare, however, it does occur. Stuttering is a complex issue and I would need more background information, such as how long he's been stuttering, when you first noticed it, any medications he's started/stopped, and if the stuttering is impacting his interactions with others.
  3. Kel September 04, 03:30
    I have been reading and reading. After 6 months of treatment from my 4 year old i see no changes and it breaks my heart. I am waiting for him to “grow out of it” but i feel this is unrealistic. Any advise for a distraught mother? I get so frustrated at his lack of progress.
    • Katrina Zeit Purcell
      Katrina Zeit Purcell Author September 06, 13:23
      Hi Kel, I am sorry to hear about your frustrations related to your son’s stuttering, a situation which can be difficult and stressful for the entire family. It would be hard for me to offer you advice in this format, without knowing your child’s history, treatment plan, and any incremental progress. If you haven’t already, I recommend relaying your thoughts to your child’s speech pathologist, and if you’re still having concerns, a second opinion is never a bad idea.
  4. Rob Schneider February 27, 06:36
    This is very clever and very helpful.
  5. Dr.Brian March 02, 17:56
    great article full of helpful information Dr.Brian McKay
  6. Bobby March 15, 21:38
    Respectfully I think title to this article puts an unnecessary negative twist on stuttering. I do believe that some good points are made and I encourage you to all that you can to help your child with this challenge. As someone that has dealt with a stutter their entire life, the impactful people that influenced me were people that didn't acknowledge but accepted my stutter as apart of me. Instead of being ashamed, I embraced it and worked thru it. Not seeing it as a weakness, but just part of me. I used it as a character builder. I was a leader in my high school, I have done public speaking, lead as manager of 300 people, currently operate a small business, and succeed in many ways of my life. Yes, I sometimes get aggravated, sometimes I have to start over, but I never let this get the best of me. I'm sure we all have hurdles that we must overcome. I consider myself a successful extroverted, talkative person. I don't even use Stutting to define any part of me and I'm sure most people who know me wouldn't either. Children that have a speech impediment are very tuned into "special treatment" and it shapes them. Allow your children to define their speech impediment or any struggle, don't make it define them. Let them tell you what they need help with and stand behind them and support them. Give them the information and let them make decisions as it makes sense to. I am a product of defining the stutter and not letting it define me. You can find peace with any struggle if you look at other areas of your life it improves. I realize that in some ways I am the opposite of a normal Stuttering person, but I believe with the correct influences and support that I could be the norm. Reguardless on if there is a "cure" or not, you can have a life that is not defined by a stutter even if it stays with you. Never be concerned about your child having a stutter, simply know that just as with other children, you are helping them shape who they are! Help them just as you would other kids, don't coddle them and protect them from life. Instead prepare them and give them the confidence to be Great!
    • KJ July 07, 03:42
      As a mother with a child that stutters, this comment is beautiful and I agree with it 100%. Thank you for voicing your personal journey with stuttering and making it known that it certainly should never define you.
  7. […] Cincinnati Children’s Blog […]
  8. thelovelysummer March 06, 18:58
    Can someone define Atypical Disfluencies?
    • Katrina Zeit Purcell
      Katrina Zeit Purcell Author March 13, 11:46
      Atypical disfluencies, or stutters, are more likely to be produced by children who are truly stuttering: EXAMPLES OF STUTTERING, OR ATYPICAL DISFLUENCY, WHICH CAN FALL INTO THE MORE CONCERNING CATEGORY: Repetitions of words (“I I I … I want a banana”) Repetitions of sounds (“M-my”) or syllables (“Ba-baby”) Sound prolongations (“I— (prolonging sound) I live in C—-Cincinnati.”) Vocal blocks in which no sound comes out (“M {block} my name is {block} … M Max.”) Children who are exhibiting revisions, multisyllabic whole-word repetitions, and interjections may be experiencing normal disfluency or developmental stuttering
  9. Imran July 19, 06:49
    Hi Katrina, Hope you are doing well! I am looking forward for your advise for my son who is 2 and half year old. Till last week he was one most talkative child and was very clear on his talks. But from last week out of no where he started stuttering and it is mostly the starting alphabet of word for example :- mmmmother or nnnaugty.What I have noticed he is mostly struggling with the word starting from alphabet "M" and "N". From yesterday he try to cover his face when stuck in his sentence. One of the point I would also like to mention that we move in to a new house recently(15 to 20 days).Earlier we used to live with grand parents and other family member but now we have to move to different city .Now in the day time he use to live with his mother only. But I have not noticed anything like that he is not liking here. He seems to be playing whole day and seems happy too. Please advise if there is something we can do overcome this situation for our child.Thanks!!
    • Katrina Zeit Purcell
      Katrina Zeit Purcell Author July 30, 12:54
      Thank you for reaching out. First, don’t panic. Many children go through a period of stuttering during their preschool years as they are developing their speech and language skills. Sometimes, the stuttering emerges following a change or disruption in their normal routine, such as moving to a new home. The vast majority of children recover from their stuttering independently. We recommend that parents create a helpful, fluency-enhancing environment to aid the child in his recovery. Things you can do include: - Talk in a slow, easy relaxed way to your child, pausing frequently - Let your child know that you are listening by giving him eye contact - Do not interrupt your child or finish his words for him - Pause after your child says something before you respond to slow down the pace of the conversation - Repeat back some of your child’s stuttered utterances in a smooth, slow way - Let your child know that talking can be tricky. Once in a while, reassure him after a severe stutter that it is ok and that sometimes speech can be bumpy when children are learning to talk. If your son continues to stutter for 4-6 months, seek an evaluation from a licensed speech-language pathologist. The number one risk factor for the stuttering to persist is family history of stuttering. Please go to https://www.cincinnatichildrens.org/health/s/stuttering for more information.
  10. Elizabeth November 15, 09:50
    Hi, I have a question about my son. I look forward to your feedback. It took him a little longer to begin talking than average and he still has a hard time saying some sounds. The letter f and s are particular difficult and he would leave off the first letter of many words when he began talking. But he did not have any kind of stutter (that I noticed). He is now 4.5 years and he suddenly Monday morning woke up and is stuttering. It's usually the beginning of the sentence and sometimes in the middle. "Mmm-mommy can I have..." "I- I I I want to ggg-o...."
    • Rachel Camper
      Rachel Camper November 15, 12:56
      Hi Elizabeth, I would be happy to help facilitate an answer to a question. What are you specifically looking to have answered?
      • Elizabeth November 15, 21:59
        I think it cut off some of my post earlier. Just advice of what to do, I read the above article to give him time to slow down conversations, etc. And I will do that. Is this something that is common to start and stop quickly? Also when should I think about getting a speech therapist? And is there something that could have triggered it to start? (We haven't moved and we have a 1 year old but no new siblings) Also we find it so strange that he went from normal to this overnight, does it usually happen like that? Sorry for so many questions ! And thank you
        • Katrina Zeit Purcell
          Katrina Zeit Purcell Author November 26, 05:49
          Thank you for reaching out to us about your concerns. I am sure that the unexpectedness of your child’s stuttering has left you wondering what might have caused this to happen and what you might do now to help. It is not unusual for some children to suddenly begin stuttering overnight. In fact, we now know that a fairly large proportion of children who do begin to stutter do so in that manner. That, in and of itself can be very disconcerting to a parent given the abruptness of the onset. You should also know that this particular type of onset does not necessarily predict the course of stuttering or recovery probabilities. In addition, it is also important to understand that a recovery period for a child who has begun stuttering may last for a while in some cases. While there are some who appear to improve and recover relatively quickly, others may take a bit longer and during that time, experience a lot of variability moving from more stuttering to less stuttering for weeks or months at a time. Inasmuch as the stuttering has just begun recently, there is probably no immediate need to have your child evaluated right away. Of importance, however, is to monitor how you child reacts when he is stuttering or whether he even is aware of the behavior at all. Reactions may take the form of frustration, upset or obvious struggling to get the word out. On the other hand, he may not even notice the changes in his speech apart from just taking a bit longer to get his words out. Allowing him ample time to get his words out is most appropriate now as is a relaxed, non-emotional response to the behavior itself. A phone consultation with a qualified professional may be the most appropriate next step inasmuch as you mentioned some concerns about speech sound difficulties and late talking as well. A professional can also ask you some additional questions that may help determine next steps for helping you to better manage this at home or possibly making an appointment. Visit the Stuttering Foundation’s website to find a speech-language pathologist in your vicinity who specializes in stuttering at: https://stutteringhelp.org/referrals-information Thank you again for contacting us. Best of luck in helping your son.
      • jaanu November 16, 03:53
        Hi, I have a question about my 12yrs old daughter , she often says she is having chest pain on the left side while breathing would like to know what could be the reason * she didn't get hurt anywhere. when i took her to pediatrician he advised due to puberty attaining age , due to hormonal changes in the body and tissues may get stretch may be that is the cause. but am worried about my child's condition some times she is not able to breathe normally , she breathes through her mouth. kindly suggest what to do further.
        • Rachel Camper
          Rachel Camper November 17, 05:21
          Hi Jaanu, I am sorry to hear that your daughter is experiencing chest pain. If you haven't already, please read this blog post and view the video, which may help you determine which symptoms are worrisome, as well as next steps: https://blog.cincinnatichildrens.org/healthy-living/6-questions-to-ask-when-your-child-complains-of-chest-pain/