murmurs


Phoebe’s last doctor’s appointment was a while ago now. Her 18 month appointment. (She’s now 21 months old.)

For those of you who haven’t taken a baby on a well visit to the doctor, they tend to follow a predictable pattern, at least in our experience. You go into a room strip the baby down. A nurse weighs the baby, and measures the baby’s length and head circumference. Then you wait a bit and the pediatrician comes in. She looks over the measurements, and pokes and prods the baby. Looks in ears and mouth, listens to lungs and heart. Asks questions about development. How much milk does she drink? Does she still drink from a bottle? Eating solid foods? Using a spoon? Is she babbling? Yodling? Falling asleep on her own? Crawling? Walking? Dancing?

We answer the questions, and it being us, we joke around a bit with the doctor. Happily, she has a sense of humor and understands when we are joking. The visit goes pretty uneventfully, typically. We learn that Phoebe is big and tall for her age. We rattle off some of her accomplishments. Things are all smooth sailing till the doctor leaves and the nurse comes in to give the shots. And then it’s over till next time.

But this last time there were a couple of things that caught me by surprise. One was that the doctor heard a heart murmur. And the other was that she thought that Phoebe’s speech was lagging.

After the visit, we got the referral for the cardiologist to check on the murmur. We weren’t too worried, as the doctor didn’t think it was likely to be a troublesome murmur. But of course we followed through. We wouldn’t take risks with Phoebe’s heart. We sought the expert opinion. And the cardiologist confirmed that the murmur is completely benign.

The speech part of the story is ongoing.

Phoebe is a quiet child, for the most part. She takes after her parents. She started saying a few words at around 12 months old, and over the following months added quite a lot of words. But the thing is, she would use a word for a day or two, and then move on to the next word. We wouldn’t hear the word again in most cases. Turtle was a favorite word for quite a while, and then yellow, and then uh-oh. And there would be all sorts of other words she’d use only once or twice, often carefully articulating. Shoe. Puzzle. Rubberband. She spent a whole day working on getting the production of hat just right, getting the /h/, and the vowel and fully released /t/ out there in a careful sequence.

So when the doctor asked for a list of words that Phoebe used regularly and consistently, we didn’t really have much of a list to offer. That wasn’t what Phoebe was doing. We could remember maybe 2 or 3 words. Ball. Uh-oh. No. There were a couple of signs and gestures, too.

What’s funny is that I have studied language development in classes, and have read a textbook or two, and attended lots of conference talks on the subject. But up to that visit, I hadn’t really given much thought to whether Phoebe’s development was on schedule. I had noticed that Phoebe was not doing the things the textbooks had described, but I figured that intro textbooks tend to overgeneralize, and that individual babies have different patterns. Actually, I still think this is the case. Phoebe was using language productively, and showing remarkable comprehension of even quite complex sentences and structures. It hadn’t occurred to me to worry. So when the doctor mentioned that she thought Phoebe was behind in her speech, and that she recommended that we get an evaluation for early intervention, I was quite startled. My first first reaction was that this wasn’t necessary. But I agreed that we would take the information and consider it before the next well visit, which wouldn’t be till Phoebe turns two.

The doctor said that at 18 months, a child should be using at least 5 or 6 words consistently. I thought our list wasn’t that far off, especially as we drove home from that visit. I remembered a few more words here and there. I realized that had I been more fully prepared, I could have presented a list of 6 or so words. And perhaps the doctor would have just taken the list as adequate to meet the criteria of her checklist.

John was a late talker. His mother doesn’t remember the details of when he started talking, but remembers that she had a sign up over his bed saying that Einstein didn’t talk till he was 4 years old, or some such. John’s family says that once he started talking, he was using complete sentences. So it doesn’t seem too surprising that Phoebe is taking after her father. She has been a cautious child, much like John was, I’m told.

But the truth is, I’ve had murmurs of doubt. I know that children do vary a lot in their paths through language development. I’ve seen that other kids were much more verbal at Phoebe’s age, and even younger. A baby who lives next door to John’s parents was producing about 60 words consistently by the time she was 14 months. A friend’s daughter was saying all kinds of words when I’d seen her when she was 16 months, making requests, chattering away. I don’t necessarily think Phoebe needs to be as verbal as those other kids, but I sometimes wonder.

She does a lot of pointing. We do a lot of 20 questions, trying to figure out what she wants. We communicate quite a lot, and things go quite smoothly most of the time. She makes observations. She names objects. She responds to questions. She’s produced a few two-word combinations. There are times when she says fairly long things which we can mostly decipher, though other times when we have no idea. She has lately even gotten better at producing words on request, as in answering “what’s that?” or “what does a dog say?” And she’ll say “please,” now, on request. Which is so freakin’ cute I can’t even tell you.

She’ll say “more” if she wants something, and point, but beyond that it’s as if she hasn’t fully figured out that she can use words to make requests. She’s been getting better at this, though. But still, every once in a while, she gets frustrated. I can’t tell what she’s pointing at. Or guess what she wants to do.

I sometimes read about the verbal progress of kids Phoebe’s age, or younger, and I feel little pangs. I know she’ll be talking soon enough. But I do sometimes get impatient to reach that next stage. And I would really love it if she called me something. She knows I’m Mommy, but she never calls me that. She doesn’t call for me. For a while she called me Ada, which I realized came from “other.” (Maybe I’ll share the story some time.) She has said Daddy for a while, but there was a stretch when she’d use it to mean “good-bye.” She’s now started to say “bye,” but may have stopped saying Daddy.

Anyhow, the upshot is that we are having the early intervention evaluation. I realized that even though I know quite a bit about language development, I am not an expert, and I certainly don’t have a clinical background. I didn’t feel like the suggestion that we see a cardiologist was somehow a criticism of us or our parenting abilities, so it shouldn’t be any different for this. I still have this nagging feeling that they’ll tell us we’re doing something wrong, or that they’ll tell us we’re overreacting. And while I have decided that I am 85% sure that they will think that Phoebe is on track, I have realized that I don’t want to withhold from Phoebe anything that might be beneficial to her, such as early intervention services. Certainly not out of some sense of pride.

So some people are coming over to our house bright and early tomorrow morning. (Or this morning, if you want to get technical, since it’s after midnight.) Which means I should be cleaning, and not writing this. Because I can’t quite get over the feeling that they will be evaluating us, and not just Phoebe’s language.

23 thoughts on “murmurs

  1. Oy. I think you’ll probably find what you suspect– she’s a slow talker but plenty smart, and the “benchmarks” are just not applicable to her. I can’t imagine that you’re doing anything “wrong,” and while the experts may have some suggestions at drawing out more words, I am sure that the two of you are raising a whipsmart little one. Good luck.

  2. I didn’t realise Phoebe was so close in age to my Nephew, who has just gone 22 months. Most of what you’re saying here is pretty reminiscent of how my neph was talking about a month ago, but lately, he’s really started to open up and say heaps. He loves large earth-movers, diggers, and when he sees one in the car he points and says ‘Big dig-dig!’ and does this characteristic hand sign. He’s also been saying things like ‘more juds’ (more juice), ‘I eat-it’ and ‘Out (from inside the car)! – I want it!’.

    His enunciation is surprisingly quite good, except when he says my name, but I sense that he mispronounces it on purpose, as he always has – ‘Uggen’. The other day, he rapped his fists on my door and yelled “I wake Uggen up!” which struck me as quite advanced; a phrasal verb disjoined by an intrusive object, but I suspect it was primed by someone telling him to ‘wake Uggen up’.

    He also apparently said the other day, while waiting for his mum to pick him up, “Later – my mummy come”. Again, this is quite amazing to me, since it involves three levels of syntax; a noun inside a possessive forming a noun phrase.

    In contrast with your experience of not dwelling so much on Phoebe’s language development, I never studied language acquisition and I think about it with my nephew often!

  3. My first thought is that I hope my post this morning didn’t give you pangs. Now that we’ve got the world revolving around me out of the way, a couple more thoughts:

    1. From the moment you become pregnant, you begin worrying about how you are raising your child. Other people often exacerbate this, but a lot of it is in your head. You are a great mother. You are doing nothing wrong.

    2. Children who are spoken to in two or more languages tend to take longer to begin talking than monolingual children. You might not be speaking two languages to Phoebe, but you’re probably giving her a great deal more linguistic stimulus than some other children receive. This is not a criticism; it’s praise. It might take her longer to process your input into fluent productive language, but when she does, I bet she is going to be quite the verbal genius.

    3. My sister began speaking ridiculously early. She spoke in clear, adult-like sentences by the time she was 18 months old. So you can imagine our surprise when she was diagnosed with Asperger’s syndrome. Her written and verbal language is excellent to this day, but she still misses a lot in social interactions. At the age of nearly 25, after a party or other event, she always needs to debrief with me to check she acted OK and to try and analyse what other people’s expressions and tones of voice meant. My point in mentioning this is that verbal ability is not necessarily indicative of ability in other important aspects of life.

    Anyway, you have professionals coming tomorrow, so enough with my amateur diagnoses. I look forward to hearing the outcome and I applaud you for making the decision to get Phoebe’s speech checked out.

  4. I hope it goes well. And, they don’t care about your dust bunnies.

    Your description of John sounded like me – I was the first child and my mother thought I was retarded because I didn’t talk. And then, when I did, I talked in paragraphs.

    And of course, there’s this:

    Once there was a child who didn’t say a word for 8 years. The mother and father were distraught, took him to speech therapists and doctors who tried their best but couldn’t help or diagnose the problem. Then one day, just after the child’s 8th birthday, the child was eating dinner when he suddenly said “ugh, the soup’s too cold”. His mother and father were stunned and relieved. The boy’s mother said “you can talk! you can talk! If you can talk, why haven’t you said anything all this time?” The child responded, “well, up until now, everything has been satisfactory.”

  5. My boys would say a few words here and there as well. All of a sudden one day, my youngest (who was 2 in Sept.) just started talking. Seriously, like words we had no clue he knew. I think that they are so overwhelmed at this age that they really just sit and take it all in. And since we did the 20 questions thing, too, he only said what he had to, and pointed for the rest. I think they’ll find Phoebe is just fine and isn’t ready to talk yet.

    My girlfriend’s son was almost 3 before he started really talking – and then he started with big words and complete sentences!

    Glad the heart murmur isn’t really a worry!!

  6. FWIW, my brother didn’t start talking until he was 23 months old. This freaked us (my parents and me, the elder sister) out for a while. We even started wondering whether my brother was deaf as he would often ignore people when they tried to talk to him.

    Then, out of the blue one day, my brother spoke his first word. In a moving car. While my mother was driving. That the first word he ever uttered was the Chinese word for “breasts” made it all the more shocking. I swear that it’s a miracle my mother didn’t drive smack into another car.

    Needless to say, my brother — who’s now 26 years of age! — is neither deaf nor dumb. Oh, and he’s not a sex maniac either.

    And yeah, like Phoebe, he was into a lot of finger pointing. In retrospect, we figured that he was happy and got what he want without having to talk. So that’s why he didn’t, for a time… ;S

  7. I wish I could say something that could ease your mind. All I can say is that kids have this tendency to do things in their own time. Kind of like us, but in smaller packages.

  8. My KayTar has been in therapy with ECI for over a year now. DT, OT, PT, ST. Whew. Lots of letters around here. ;) It has been wonderful for her and helped so much. Whether Phoebe needs a little help or not, it will be okay. The therapists come in and play with them and it is actually quite enjoyable.

    And for the record, YOU have not done anything wrong, either way. There is no parental flaw that causes speech delays. Kids are kids and they take it at their own pace.

  9. BLC-
    Thanks for the encouragement. And for the use of the word whipsmart.

    Jangari/Uggen-
    That quick a change, huh? Interesting. And it’s not that I haven’t given much thought to Phoebe’s language development, I just haven’t been comparing her too much to the textbook timelines. It is pretty cool stuff. Your nephew’s syntax does sound quite complex. It will be fun once Phoebe starts producing longer utterances.

    Stella-
    Thanks for all those comments. 1. I know what you mean, and thanks for the encouragement. 2. Interesting thoughts. I bet studies about the type, quality and quantity of the input on language acquisition would be interesting. 3. That’s really interesting about your sister. I admit that I have a bit of fascination with Asperger’s.

    maggie-
    So you were like John, huh? I wish we had more details on John’s early language. It’s funny to think that these days, he would have most likely been flagged for services. I guess you would have, too. (And thanks for sharing the funny 8-year-old story.

    pgoodness-
    Thanks for your thoughts, and for sharing those stories. It’s that sort of story that’s made me not so worried about Phoebe, since I know there is so much variation.

    YTSL-
    Thanks for sharing that story, too. (I think you mentioned it briefly in a post once, right?) I can see how it would have been worrisome to not get any speech at all till almost 2. I’m glad things turned out well in the end! (And what a funny first word. Phoebe’s first word was “duck.” Which is kind of funny, but perhaps less startling.)

    flutter-
    Thanks for the support and encouragement. I like the idea of the smaller packages. It has amazed me right from the start how much personality Phoebe had.

    Kyla-
    That is a whole lot of letters. It’s good to hear that you’ve had such positive experiences with the therapy. (It looks like we will be having some.) And thanks for the affirmation that we have not done anything wrong. I know that in my head, but my insecurites (in whichever organ they reside) still nag. So it’s good to quiet them.

  10. My mother recently told me the story of my neighbor, who was about ten years older than me. His parents were quite concerned that he hadn’t started talking, and were discussing it in the car, with him in the back seat.

    His mother said, “This kid, I don’t know. He doesn’t say beans.” (They were transplanted NY city-ites, so imagine a thick Brooklyn accent.)

    Suddenly, from the back seat, a small voice piped up, “Beans!”

    And after that humble beginning, he never stopped.

  11. we were warned several times that once MQ started talking she would never stop. how right they were.

    and she started YOUNG.

    (but worry not. Pheobe? she sounds to me like a girl who just chooses her word carefully)

  12. Wasn’t it Tennyson who didn’t say a word till he was four or five. At that point, his nanny accidentally dropped a pot of hot water on his foot. She ran to get some ointment and when she returned he looked her in the eye and said his first words:
    “You may desist in your efforts. The pain has now considerably abated.”

  13. My first child was talking rather early and quite eloquently, my second was way slow and still he has problems pronouncing some letters. ‘Twill out in time, I guess.

  14. yep, like most of your commenters here, i’m sure it’s going to be hunky mcdory. my baby brother babbled along like the stereotypical infant, but my baby sister didn’t start talking until rather “late”. of course, he never did come up with much interesting to say, but she busted out into fully-formed sentences and hasn’t looked back.

  15. 1) Zachary gets his murmur checked on Friday, and I am trying not to think about the fact that I am taking my 3 year old to a cardiologist.
    2) At 18 months, he seemed a late talker. That was about when he FINALLY acknowledged that his MOTHER had a name (Mama). At 2o months, he had maybe 50 words, most of them not consistent (in the way you describe) and a good chunk of them animal sounds (“meow”). But, by 2, he was putting 5 and 6 words together. Now he won’t shut up. He was just waiting till he got it all down before he started talking. I suspect you will find the same thing.

  16. Hi again Alejna —

    Yeah, I think I told the story of my brother on my blog — though not in so much detail as on this comments thread! :)

  17. jwbates-
    I love the “beans” story.

    painted-
    Yes, Phoebe will likely choose her words carefully. She’s definitely a cautious individual. If she continues to be like her father, she won’t likely be a chatterbox. (I do look forward to chatting with her, though.)

    raincoaster-
    I hadn’t heard that story. I love it.

    denguy-
    All part of the variation, it would seem. It’s interesting to see the variation across siblings, too.

    fireweaver-
    Perhaps Phoebe will be like your sister, then. I swear today she said “I did it.” Which is not only a sentence, but has pronouns and tense. (Actually, she first said what sounded like “I didded it,” an over-regularization which I wouldn’t expect from her age. So perhaps we will get some more sentences soon.)

    Emily-
    I hope that the cardiologist visit goes easily for you all. It does sound scary, but I hope that your case turns out like ours.
    Interesting about Zachary’s language development. I find that is what I expect Phoebe to do. Just jump right to multi-word combinations, like her father did. But time will tell.

    YTSL-
    Well, at least you know I’ve paid attention!

  18. What you’ve described sounds very normal/encouraging to me. She understands you and she can communicate using gestures. The words will come – and when they get there (in my experience) the wait means that it really never seems like the child is talking too much.

  19. I know I’m late chiming in here….playing catch-up with everyone.

    I’m wondering how the Eval. went.
    And my stepmom & I were speaking the other day (she is an audiologist/audiological specialist in a school district in our state). The numbers are rising much like that of autism in regards to speech “delays” and auditory processing disorder. what the reasons are for this, we just don’t know. in my ten years as a preschool teacher, i have seen the numbers rise astronomically in regards to cases of speech delays. and these are “over”privileged children who have perfectly fit parents who spend time with their children and are simply wonderful.

    whenever something like this comes up with our kids, we are always so quick to question ourselves, aren’t we? it’s like a tick or something.

    good on the doc. for acting on this so early. she may be jumping the gun, but she truly has Phoebe’s best interest at heart. many doc’s are much more reluctant and valuable time is lost.

    i hope i’m not sounding to preachy or anything. but i bet the slp who comes to do the eval. will only be left thinking that your little Phoebe has a lot of wonderful, fantastic adults around who are only looking out for her best interest :)

    best of luck and i hope all is well.

  20. bubandpie-
    Thanks for the encouragement. It’s certainly not too surprising that she’s on the quiet side, considering her parents.

    Tabba-
    Thanks so much for chiming in! It’s never too late. And I appreciate your encouragement and insight. The eval went well, though Phoebe does qualify for services. She’s at age level or advanced for everything but expressive language, and there she has a 5 month delay.
    It is unsettling that there is such a dramatic increase in speech delays recently. At the same time, I wonder how much was just not caught in past decades. I think John (as in Phoebe’s daddy) would definitely have been considered “delayed.”

  21. I’m really late popping by on this, but I just wanted to say I’m having very similar feelings right now. My Peanut just went for her 12-month follow up clinic (she was a preemie) where there was much hemming and hawing and whispered consultations before it was announced that her fine motor skills are behind as is her speech. I ended up writing a post about it, as I turned over the words in my head.

    I believe that both Phoebe and Peanut will be fine, and are going to get there in their own time. But right now, it does feel just a little like my parenting, as shown by Peanut’s “results”, is being judged. It’s a tough place to be.

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