Infants emerge from the womb as multi talented and communicative individuals. New born infants have a whole host of communicative aptitudes. These include musical and literacy preferences, the ability to identify their mother’s voice, copy facial expressions and express contentment and displeasure.
Speech, language and communication development (SL&CD) and health inequalities from 0-3 years
The development of good speech, language and communication abilities in infants rests upon positive interactions with parents, especially during the first year of life.
Health and social inequalities experienced by families can affect positive interaction and speech, language and communication development and lead to further inequalities later in life.
Quick links:
- What are health inequalities?
- Policy context
- What do we mean by SL&CD in 0-3 year olds?
- How do inequalities relate to speech, language and communication development in 0-3s?
- Communication support needs (CSN) of parents
- Identifying those at risk
- Indicators of problematic speech, language and communications development
What are health inequalities?
The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups."
For a general discussion of health inequalities and the early years, please see Inequalities in the early years.
Policy context
Activity in this area is consistent with commitments and priorities detailed in the Early Years Framework and the National Parenting Strategy, Equally Well, Achieving our Potential, a range of NHS Scotland's Quality Indicators and is relevant to Scotland's national practice model for child-centered services - Getting it Right for Every Child (all external links).
Under the terms of the Disability Discrimination Act, public sector service providers must discharge their Disability Equality Duty to promote equality of opportunity for people with disabilities, including those with communication support needs or communication disabilities.
What do we mean by SL&CD in 0-3 year olds?
It's important that parents (and other adults) speak to their babies as soon as they are born in order that they gain familiarity with speech sounds and begin to learn words and language patterns.
See Developing communication skills in infants.
How much a child is spoken to (Hart and Risely, 1995) and the number of different words a child hears (Pan et al. 2005) directly affects its speech and language development.
Before they can speak, babies are still able to communicate their needs and feelings and respond to what goes on around them.
Positive responses by adults to these cues - e.g. offering food when the 'hungry' cry is heard - build connections in the brain that are the foundations for more complex communication in future.
As speech begins to emerge, parents and other adults can support further development by continued positive, sensitive and consistent responses, through play, and by reading and giving access to books.
A 2011 longitudinal study for the Department for Education in England, Investigating the role of language in children’s early educational outcomes (external link), found that children's language development at two years predicts their performance on entry to primary school and:
"The children’s communication environment influences language development. The number of books available to the child, the frequency of visits to the library, parents teaching a range of activities and the number of toys available are all important predictors of the child’s expressive vocabulary at 2 years.
The amount of television on in the home is also a predictor; as this time increased, so the child’s score* at school entry decreased." (Page 3).
Both the above report and a review of evidence by NHS Health Scotland found that the home learning environment is of more importance for intellectual and social development than parental occupation, education or income (p27, Evidence summary: Interventions to support parents, their infants and children in the early years (pregnancy to 5 years (external link)).
*Defined as early language skills, reading, writing, and maths that they need to help them in school.
How do inequalities relate to speech, language and communication development in 0-3s?
Anything which diminishes the ability of parents to communicate with and bond with babies and young children may affect their development of speech, language and communication abilities.
Emotional availability is required if parents are to respond to their child in positive ways. This can all be affected by health and other inequalities.
For factors associated with an increased risk of experiencing difficulties in social, emotional and cognitive development, please see Evidence Summary: Interventions to support parents, their infants and children in the early years (pregnancy to 5 years) (page 32) (exernal link).
Not speaking English as a first language is not in itself a risk associated with delayed speech, language and communication development.
Children who develop good communication skills via any language are generally able to transfer those abilities to other languages and those living in bi-lingual homes may find it easier to learn new languages.
Communication support needs (CSN) of parents
Communication Support Needs include learning disability, sensory impairments and English not being spoken as the first language.
Parents with CSN may be less able to access additional supports and information that could assist with their child's development.
For a detailed discussion on issues around assisting parents with communication support needs, please see Communication Support Needs (CSN) and inequalities in pregnancy.
Identifying those at risk
Because those at risk can be difficult to identify, it's important to link with other professionals who may know more about the family and their circumstances, e.g. Speech and Language Therapists, carers, GPs, social workers, health visitors, nursery school and other childcare staff, and voluntary sector agencies.
Specific factors relating to physical health should also be taken into account, including:
- Frequent catarrhal colds - child may experience undiagnosed but repeated, transient conductive hearing loss due to blockage of the Eustachian tube, leading to developmental delay.
- Frequent illness or hospital admission - child may be too tired or unwell to learn and develop at the usual rate.
For a fuller discussion of inequalities risk factors, see Inequalities in the early years.
A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.
Indicators of problematic speech, language and communications development
For a checklist of normal interaction development indicators for infants 0-12 months (including summary guidance for carers) please see Development of Interaction Checklist 0-12 Months (PDF Download - 66Kb).
The following are indicators of potential problems any age:
- Parental concern about child’s speech and language
- Child whose play or social interaction seems inappropriate
- Child has difficulty chewing and swallowing
- Child is heard to stammer or if parent reports hearing this
- Child has a hoarse voice or abnormal voice quality.
For further, age-specific indicators, please see:
Lothian guidelines for referral to SLT (MSWord Download - 116Kb) or, for this age group alone, Speech and language development - what to expect 1-3 years.
