Welcome to the first installment of "Healthy Children," a regular column on Wakfield Patch where Dr. Tien Lan Chang, chief of pediatrics at Melrose-Wakefield Hospital, will answer your questions about children's health and parenting. To submit a question, e-mail Wakefield Patch Editor Sara Jacobi at sara.jacobi@patch.com. Please include your first name. Your email address and any other identifying information will remain confidential.

Here's this week's question:

Dr. Chang,

For about the past 6-8 months, my 3-year-old grandson has had difficulty beginning sentences, especially ones that start with W or Y. He gets hung on the first letter and carries it out as though he can't make the transition to the rest of the word. Example: Wh-wh-wh-wh-wh-wh-why...., or Yo-yo-yo-yo-yo-yo-yo-you......., and it seems to be getting more pronounced. It sounds like classic stuttering to me. If so, what should the first step towards correction be? My understanding is that if not corrected early, it can become permanent.

—Jim

Dear Jim,

Your description of your grandchild's speech pattern does fit with stuttering.  

What is stuttering?
Stuttering is defined as a lack of fluency in the speech, as marked by a repetition of either a word or a syllable in the beginning of a word.   It is common in children as they learn to speak in sentences, thus typically presenting in children (about 5%) between the ages of 2 to 5 years.   Most children who have stuttering in this age range will clear this hurdle of development, but some (30%) will continue to experience this difficulty in speech later on in life, i.e. approximately 1% of adults stutter.  Imaging studies of the brain in children who stutter have found evidence of decreased gray matter volume and reduced white matter integrity in areas that are important for speech, compared to children who do not stutter.   Stuttering also appears to run in families.  Mutations in certain genes have been associated in patients with a family history of stuttering.

What can be done?
Stuttering can be exacerbated by tension or anxiety.   It may also affect a person's self esteem, as children who stutter are more likely to be teased or bullied by their peers.   It is no wonder that parents want help for their stuttering child. 

 However, because 70% of children who stutter will eventually stop stuttering, it is difficult to demonstrate that a particular treatment is truly effective in this age group.   There are speech therapists who deal with this condition and may provide some guidance that are age appropriate.    

Before 3 years of age, a child with any speech difficulty can be evaluated and treated by the Early Intervention Program.  After 3 years of age, the public school system should provide speech therapy for a child with a speech impediment.    There are also hospital-based or community speech therapists who your pediatrician may refer to for consultation.  There is also a national support group, National Stuttering Association (www.nsastutter.org), from which one can obtain more helpful information.