Q: I am an SLP and cannot figure out how to remediate my own 20-month-old daughter’s speech problem.  She is very expressive, has unlimited vocabulary, is speaking in 4-word sentences, and has above average articulation.  She recently developed a cold which is now gone but as a result she is now producing L in place of N in all word positions. She is saying “Lo for “no” and “Bel” for “Ben.” She had this correct before. How should I correct and should I take her to an ENT?

I have to be very honest here and say that I think you are overly concerned about a very minor problem. Your child is only 20 months old! Less than two years! Her speech and language skills already are far beyond most kids — some quite normal kids have not even begun to speak at this age.

Research has shown that toddlers in this age range speak fewer than 50 words, they produce unintelligible jargon, the two-word combinations they produce are just emerging, and phonological errors abound.  In a summary of the literature, Vihman (2000a and b) explained that phonological development does not settle into adult-like patterns until children are three years of age.  Therefore your daughter has at least a year and a half of development before this should be any kind of concern.  That is her age times two!

If she were my child, I would leave this completely alone for one full year.  Give her time to work it out.  She does not need therapy to fix this.  She also doesn’t need an ENT visit to prove that toddlers make articulation errors.  (If you think her ears are still clogged up, take her to your physician.  If necessary he/she will refer to the ENT.)

The most I would do in terms of remediation is play with minimal pair words: Bell and Ben, for example.  Most children her age do not understand the humor of minimal pairs, but I bet your child can.  Make a picture of a bell and a picture of Ben, and have fun comparing and contrasting the two.  I would make this be auditory work, and I personally would not correct her error.  We do not want fluency to become an issue over pressure to speak perfectly, do we?

If I may be so presumptuous, my guess is that this advice to back off might help you in other aspects of her development, too. One does not have to teach normal children to be normal.  Leave them alone and they turn out normal 🙂  You have already proven that a mom who has excellent speech and language stimulation skills can turn out a child with superior skills in these areas.  Now let it go.  Be her mom first and her teacher or therapist a distant second.

References

• Vihman, M. M. (2000a) Early phonological development. In Bernthal, J. E., and Bankson, N. W. Articulation and phonological disorders. Boston: Pearson. Pp. 63-104.
• Vihman, M. M. (2000b) Later phonological development. In Bernthal, J. E., and Bankson, N. W. Articulation and phonological disorders. Boston: Pearson. Pp. 105-138.