What Causes Delayed Communication Development In A Child?

Question: Hello Doctor, I am a mom 2.4 year old. We are XXXXXXX who live in Canada. Currently i am a stay home mom. I have concern about my son's language development.

Mainly,
1. He does speak a lot but does not really communicate as such verbally.
2. Though he has lots and lots of vocabulary and can also say 2-3 word phrases, rhymes etc, he is still not saying mommy, Baba(Dad). Doesn't respond 'yes' 'no'
3. He is not 'pointing' yet but he is good with collective attention.
4. He is eating card board sometimes.

I am 'sometimes' worried about Autism, Thanks to the 'too much' information that is available online. But he is not showing any symptoms/red flags from the list( I know I am not the one to decide, I am just describing what I feel). I am also guilty of this thought.

My husband, son and I live in an apartment as a happy family. My son knows all the names of main animals, shapes, colors, alphabets, numbers till 20, Fruits, vegetables, animal sounds. He watches rhymes on TV and picked up 60% from TV 40% from me. However He is not much into sentences. Its 2 way, I seem to be making mistakes as well as he is taking me for granted and not learning much. All well until 18 months he was picking all the new words in just one or 2 attempts. When i am speaking sentences, he kinda was not that fast. May be I had to speak more. and more. Also, for the longest time, I used to give him food and milk, water without asking him, just by seeing the cues. Its when he was turned 2, now I 'ask' him more. He does watch bit too much of tv, He likes musical rhymes. First we thought he is enjoying. Now I reduced his screen times to just 2-3 hours. I stay home, giving him Tv seems the only way I can get things done. I am not proud of it. Another mistake was we used to speak to each other in Hindi, but spoke to son in English. When he turned 2, we also speak English with each other for improving receptive language. I thought teaching English will help him better in playschool. But it was a mistake we spoke different language. he was born when I was 35 years old, because I got married late and planned baby late.

He says "Lets go" "What is this" "Bye bye See you soon" " Hi Five'' "Its a monkey" "shoes, socks" "its a flower" a appropriately in a situation. He adds "Its a..." to everything appropriately. he understands "give me" "take this" " few more things. He knows ALL (most) the names of the day to day objects. Now a days can sing couple of rhymes in full. He loves questions like "What does the lion say?" " What shape" What alphabet is this? " Can answer perfect. More confident about what he learnt from TV. Also, he is not iking non musical programs on TV. He just turns off the Tv or doesnt watch. Sometimes when there is a Halloween rhymes, he is not liking scary thing, he will turn off the Tv

BUT If I ask him, "Do you want milk(loves milk)?" No answer. No answer to any question that he understands. He looks at me and just goes away or if he is hungry he will just come and stand at the microwave or fridge where I warm milk. These days He repeats the word if he likes to eat. " Do you want pasta? I ask..He says "pasta pasta(yes)" if he doesn't want, he would look at me and turn his eyes away. He does not call us mom and Baba too. Every evening when my husband comes home, son hears the sound of the door, and runs( since he started walking), I always said, "baba has come" But my son never says 'baba'. I used to always show him our family picture and refer mommy and baba. But he doesn't care but he does know who is who.He will follow " Give tea to Baba" "Give kiss to Baba" etc he has no phonetic problem.

When he was turning 2, he was not able to follow what I am pointing at, now he is lot better. HE does not point at things himself, If I ask sometimes, ' do you like this rhyme, or this on tv? pointing, he just keeps looking at it. But I do confess, I have not made significant attempts to make the situation better.

For 4 months now, occasionally he is biting and chewing card board or few wooden toys( At the time of wooden toy, it felt like teething). His board books are mostly the victims. He also eats toilet paper when I am in washroom, laughs and spits it. more like an attention seeking thing. When we say 'No' to something he would laugh and repeat. Sometimes he will even repeat things if he thinks we find it cute.

Its often worrying to me, why he doesn't address us as mom, dad. More worrying is he is refusing to say yes/no. because he is old enough. He can answer to 'What is this?" very well Its a car, its a red car etc. I am always with him, around him. My husband goes to work, comes back. But he never actually does any communication with my son. Its a big issue for me. But if my son goes and plays with him, he will just reciprocate. Loves his son, but he seems to find nothing to talk to my son. Except showing affection. 2 months ago, we started play school for couple of hours a week. He loves it though he would cry first 5 minutes when I drop. He makes eye contact to teachers and says 'bye' while coming back. Gives hugs too if ask.

Son is excellent with pretend play, imagination. relating things, quite social, Loves cuddles, good appetite and everything like a normal toddler. ( I was reading the lists online, helplessly many times) He sounds very normal. No meltdowns. Its sometimes times when we meet friends families we see he can do more things than we know His play school is 5 minutes away by walk, I was surprised recently that he knows the way to come back home. Dad drops in car, me and son come back walking in stroller together.

I am also finding it difficult to teach him questions like "where are you going" I often get dumbstruck how to start a conversation with my son with regard to teaching new sentence. I think I am expecting positive outcome. Kid is sometimes busy to focus on my long sentences. I do not want to take him to any evaluation( Developmental problems/speech therapy), yet. Its going to leave me and him some stress. i am planning to wait couple of more months.

Please give me suggestion. Thank you for patiently reading this.

Hi Doctor, thanks for the reply. I have taken Mchat multiple times and he is at low risk. I will paste the Mchat answers below this email.

He is 'LOOKS' quite NORMAL. except, he does not 'point' say 'yes/no' answers. Mom and Baba.

I have a family doctor and evaluation is actually free BUT I was actually needing a second opinion from you. I am sad and disappointed you came back with a Brief and Detailed answer which is very same and GENERIC. I want to DISCUSS the matter. My family doctor gave a questionnaire for his one year and 18 months check up and he is all good. For example, He may not say mom, dad, but he says 100 other words or more. He may not say yes/no but he says 'Its a house' etc And runs when I say' lets go to park'. I WANT TO KNOW WHAT MIGHT BE THE REASON HE DOESN'T FEEL THE NEED TO SAY YES/NO ANSWERS.

He doesn't point but if he wants a cookie, he will hold my hand and take me there. If he is hungry, he will come and cry, i would soon give what he wants because i just know what he needs. He always share his happiness, shows his toys. Looks for and loves compliments.

Also what can we do to make sure he does not have 'pica' because he occasionally eats cardboard. If its a nutritional issue, how bad can it get? Do you think i should get his iron checked?

Also Doctor, please read my first question, take time and imagine our home setting. a 2.4 year old 'normal child' always home with mommy. Dad comes evening. Does not talk but gives him attention. Kid doesn't get to interact with anyone except mom dad. Unless we occasionally meet friends.

He is enjoying playschool, I stayed with him in school for a week, I have not seen any visible difference with other kids. I asked some questions to other kids of his age, they can say 'yeah' my son wont. but my son can count how many oranges and tomatoes. He can recognize colors and shapes. Can sing rhymes.Reads alphabets. I am confused why he cant say mom.

Getting appointments is tough here. I have appointment with family doctor after a month. We have an excellent pediatrician but I cant go without her reference. She is a well wisher. She is just not serious about these 'silly' questions. she always in hurry. Just about 2 minutes to finish.

All XXXXXXX women here say he is just fine. But we are all not doctors. As I said he is cuddly, affectionate, excellent pretend play, hand eye coordination, imagination, etc. Until 3, I dont think we can actually predict any problem. Because doctors are so brief, I have to read online and guess. I would go for intervention. But not now. I have just some concerns, my husband who is an IITian, with a foreign PhD degree and what not doesn't feel the necessity to communicate with kid, unfortunately. Kid actually goes himself and tries to play with dad. he too think my son is fine and will catch up. Child gets all the love attention he could. Its just me speaking to him. may be a set of sentences. repeatedly. I am always with him.

Dear Doctor, please give me suggestion or advise on how to make him say yes/no. When is the sensitive age for kids to regress and get into developmental problems. is it a big issue that he is not saying 'mom and Baba'?

Thank you, Here is the Mchat. Its just the questions 6 and 7. He does not point, but holds my hand and take me there where he wants snack. Or he will hold me and make me sit in sofa so that he can drink bottle milk in my lap. He knows how to get around. now a days 50% of the time he can follow where I am pointing. But he wont point. he will look at the aeroplane in the sky and look at me to show it. But will not POINT. Result: Low Risk
Question 1.

If you point at something across the room, does your child look at it? (FOR EXAMPLE, if you point at a toy or an animal, does your child look at the toy or animal?)

You Answered: Yes
Question 2.

Have you ever wondered if your child might be deaf?

You Answered: No
Question 3.

Does your child play pretend or make-believe? (FOR EXAMPLE, pretend to drink from an empty cup, pretend to talk on a phone, or pretend to feed a doll or stuffed animal?)

You Answered: Yes
Question 4.

Does your child like climbing on things? (FOR EXAMPLE, furniture, playground equipment, or stairs)

You Answered: Yes
Question 5.

Does your child make unusual finger movements near his or her eyes? (FOR EXAMPLE, does your child wiggle his or her fingers close to his or her eyes?)

You Answered: No
*Question 6.

Does your child point with one finger to ask for something or to get help? (FOR EXAMPLE, pointing to a snack or toy that is out of reach)

You Answered: No
*Question 7.

Does your child point with one finger to show you something interesting? (FOR EXAMPLE, pointing to an airplane in the sky or a big truck in the road. This is different from your child pointing to ASK for something [Question #6.])

You Answered: No
Question 8.

Is your child interested in other children? (FOR EXAMPLE, does your child watch other children, smile at them, or go to them?)

You Answered: Yes
Question 9.

Does your child show you things by bringing them to you or holding them up for you to see - not to get help, but just to share? (FOR EXAMPLE, showing you a flower, a stuffed animal, or a toy truck)

You Answered: Yes
Question 10.

Does your child respond when you call his or her name? (FOR EXAMPLE, does he or she look up, talk or babble, or stop what he or she is doing when you call his or her name?)

You Answered: Yes
Question 11.

When you smile at your child, does he or she smile back at you?

You Answered: Yes
Question 12.

Does your child get upset by everyday noises? (FOR EXAMPLE, does your child scream or cry to noise such as a vacuum cleaner or loud music?)

You Answered: No
Question 13.

Does your child walk?

You Answered: Yes
Question 14.

Does your child look you in the eye when you are talking to him or her, playing with him or her, or dressing him or her?

You Answered: Yes
Question 15.

Does your child try to copy what you do? (FOR EXAMPLE, wave bye-bye, clap, or make a funny noise when you do)

You Answered: Yes
Question 16.

If you turn your head to look at something, does your child look around to see what you are looking at?

You Answered: Yes
Question 17.

Does your child try to get you to watch him or her? (FOR EXAMPLE, does your child look at you for praise, or say "look" or "watch me"?)

You Answered: Yes
Question 18.

Does your child understand when you tell him or her to do something? (FOR EXAMPLE, if you don't point, can your child understand "put the book on the chair" or "bring me the blanket"?)

You Answered: Yes
Question 19.

If something new happens, does your child look at your face to see how you feel about it? (FOR EXAMPLE, if he or she hears a strange or funny noise, or sees a new toy, will he or she look at your face?)

You Answered: Yes
Question 20.

Does your child like movement activities? (FOR EXAMPLE, being swung or bounced on your knee)

You Answered: Yes

Hi Doctor,

Thank you. He also likes to eat cardboard occasionally. He chews it and bites the leftover. Or licks his hard covered kid books. Likes to bite and spit Toilet paper and laugh when I say no. I would rule out teething. He has all the teeth already.

I have read online that it is 'pica'
Shall i leave it as a toddler fun or I have to check for iron or any other deficiency.
Please give me an answer which is more specific than what is available on internet forums. I have read all of them. I want some advanced advise.