I have a nephew who will be two in September. I love him with all my heart, and we are extremely close. I take care of him every day while my sister and brother-in-law work. The problem is he won't talk! He follows directions and responds to his name and understands very well. I've tried not giving him things until he speaks; but that only makes him mad. My sister is concerned; but I don't think she's as concerned as I am. All my other nieces and nephews talk, and he understands them when together. I know that he hears well; but can there be something else wrong? I'm starting to get concerned.

[answer]
When it comes to questions of development, I know it can be hard to decide whether you are under- or overreacting.

It sounds to me like your nephew’s receptive language skills (understanding of language) are progressing well, and you're not concerned about this. Your worries, however, are focused around your nephew’s expressive language skills (words used to communicate). Children in the age range that your nephew is in (18 to 24 months) are usually in the phase when they are acquiring new vocabulary words. They are beginning to combine these new words into two-word combinations, especially as they near their second birthday. Since normal development falls within a range, it is also important to pay attention to how your nephew is communicating. Is he pointing, using gestures or making sounds to let you know what he wants or needs? Has he begun to produce word approximations, such as saying “bah” for bottle or meaningful vocalizations such as animal sounds?  Or is he totally silent?

If you and your sister remain concerned or your nephew does not begin to use words over the next few months, I would suggest you contact a speech and language pathologist to see if your nephew would benefit from early intervention services. You can check with his pediatrician or call your state’s “Child Find” office (http://www.childfindidea.org)  to find your local Early Intervention Program to provide a speech and language assessment. This might also ease the fears you and your nephew's mom are feeling.

In the meantime, continue to do what you are doing: providing language models and playing together to facilitate language. It can also be helpful to begin to keep a running list of his new words as you hear them. It's useful to note progress and this can give you information about how your nephew's expressive language is developing.

Please keep us posted,

Rhonda

Rhonda Davis is a speech and language pathologist with a private practice in New York City.