Dr. Gwenn Schurgin O'Keeffe, MD, FAAP

Dear Dr. Gwenn,

We adopted our now 22 month old daughter from Guatemala last year. She was in an orphanage until 4 months old and then transferred to a foster home with a mom and dad and another 3 year old child for the last 3 months of her stay until we brought her to her "forever home."

She was 7 months old when she arrived. Her speech is not great. I hear her saying a handful of words that I can understand (about 10). She had tubes put in for recurrent OM about 4 months ago. I know she can hear me just fine (there is alot of selective hearing too).

When do I become concerned about her lack of words and speech?

Signed,
Julie

Dear Julie:

This is a very common question about adopted kids as well as 22 month olds in general. Kids this age often have receptive language skills that are more developed than expressive language skills. Many kids don't talk well until they are closer to 2 to 2 1/2 years old and some closer to 3.

If you look at language charts, your daughter "should" have more worlds:

Delayed Speech or Language Development
Speech and Language Delays and Disorders
Your adopted child's speech and language development
Health & Development Issues in Newly Adopted Children

However, her ear problems and early life experiences play no small role in being a bit behind. Talk to your pediatrician about a game plan. It may be worth considering a speech evaluation over the next few months if your daughter doesn't start using more words. So many kids without ear tubes and who were not adopted have only a handful of words at 22 months that I'm not sure I'd get a referral yet but over the next few months I would if she doesn't start to come out of her shell.

Best,
Dr. Gwenn

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About the Author
Pediatrician, Dr. Gwenn Schurgin O'Keeffe, MD, is a board-certified pediatrician and Fellow of the American Academy of Pediatrics. Dr. Gwenn is an experienced columnist, educator, and practicing pediatrician. Dr. Gwenn strives to write as if she were talking to a parent. As a parent herself, she knows how important it is to obtain information but also understand how precious little time parents have to find that information on the internet. Pediatrics Now was developed to fill that gap and provide a bridge between the parenting and pediatrics worlds.

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