School Problems and the Family physician - Part I

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A. History : In children > 3 years of age - ask
  • Whether he or she talks spontaneously and if speech is intelligible.
  • If she/he becomes frustrated when asked questions and/or fails to ask questions spontaneously.
  • Whether dislikes listening to stories, had difficulty in understanding stories, and cannot relate events correctly.
  • Cannot learn simple song or nursery rhymes
  • Has difficulty in playing with peers
    In children < 3 years ask,
  • How many words spoken
  • Able to follow small instructions (comprehension)
  • Also ask for family history of disorder of hearing, language, attention deficit, learning articulation and stuttering.

B. Physical Examination
Perform pneumatic otoscopy to identify otitis and middle ear effusion.
Note signs of neurologic disorder, especially altered, generalized muscle tone, abnormal reflexes and abnormality of muscle movements related to speaking, chewing, sucking or swallowing. Note abnormalities of palate and oral structures (tongue tie, cleft palate)

C. Audiological evaluation
This is mandatory in all cases of language disorders.


D. Identify hearing loss and congenital syndromes.
In many congenital disorders, hearing loss is associated with mental retardation and produces marked language problems. Wherever possible treat hearing loss (eg) Downs syndrome, Treacher Collins, Congenital infections.

E.The Diagnostic criteria for developmental language disorders in children is when the problem causes interference with home and educational activities in the absence of global developmental delay, hearing loss and neurologic disorders.

F. Repetition of words and phrases is common for children of 2 to 5 years of age. A small proportion of these children progress to chronic stuttering. The features that indicate a persistent problem include part-word repetition rather than full word or phrase, multiple rather than single repetitions and irregular, abrupt (jerky) repetitions. The children with obvious problem exhibit struggle and avoidance behaviour. They avoid speaking to strangers. Children should be referred to speech therapist if the problem inhibits the child or continues longer than 6 months.

G. The effect of mild to moderate conductive hearing impairment related to persistent or recurrent otitis media on language development makes it important to do an otological examination of any child with language disorder.

H. The home environment. Inadequate stimulation at home can be a result of insufficient care and attention or overprotection, especially from siblings who do and get everything of a younger child. Children living in multilingual environment is simultaneously hearing more than one language may have transient delay.

Speech and language disorders are contributors to poor school performance.The role of Family Physician in children with language disorder is to identify rectifiable causes such as hearing loss, otitis media, anatomical defects (cleft-palate, tongue tie); assess for underlying neurologic problem, mental subnormality or lack of stimulation and appropriately refer conditions such as stuttering for speech therapy.

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Please check on the references of the above statements. Most of it is not correct.

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