Child Speech & Language

When should I refer my child to the Speech and Language Therapist?

There is no simple answer to this question, as facial palsy has many different presentations and causes.

What are the main causes of facial palsy in babies and young children?

  • Child with Moebius syndrome

    Child with Moebius syndrome

    Damage to the facial nerve during delivery which may recover fully or partially.

  • Congenital Facial Palsy – due to under development of the facial nerve/s or complete absence of the facial nerve. This may occur as part of a syndrome with other associated growth, health and developmental issues, (e.g. Moebius Syndrome and more rarely CHARGE syndrome).
  • Neurofibromatosis Type 2
  • Other tumours of the facial nerve
  • Trauma, (e.g. head injury)
  • Bell’s Palsy/Ramsay Hunt syndrome – of which most will make a full recovery but a small percentage of children will have long term symptoms.
  • Tumours which affect the brain itself
  • Stroke during the delivery period or as a young child.

What is the difference between a stroke/tumours which affect the brain and the other conditions listed above?

  • A stroke or tumour within the brain itself can cause damage to areas of the brain which affect learning, language development and movement, (upper motor neurone). The needs of these children will therefore be different. Early contact with the speech and language therapist is recommended for advice and help in the early months of language development.
  • All the other conditions tend to affect the facial nerve itself as it exits the brain and branches out into the facial muscles, (lower motor neurone).

How will facial palsy affect my child’s speech?

  • The speech sounds which are most likely to be affected are P, B, M, F and V. These sounds are made with the lips which may be weak and lack movement.
  • The earliest sounds to develop are usually p, b and m, as they are the most easy to see and copy.
  • In some instances of facial palsy the child may have problems with tongue movement but this is normally restricted to those born with facial palsy and diagnosed with Moebius syndrome.
  • Children with bilateral facial palsy are more at risk of developing speech difficulties due to the lack of compensation available from the normal side of the face. They should seek help and general advice from a speech and language therapist as soon as possible. In the first instance help will be in the form of advice and support. Later as the baby matures more direct speech work will be necessary.

Does the age of onset of Facial Palsy matter?

  • Children who acquire facial palsy after the age of 6 or 7 will already have a full inventory of speech sounds and language appropriate to their age. A facial weakness affecting the lip and cheek at this point may change their speech slightly but speech should still be easy to understand.
  • Children born with a facial palsy may need more specialist help at an early age depending on the diagnosis.
  • Parents of children who have had a stroke or tumour within their brain should be vigilant about the affect this has on speaking and understanding, listening and attention.

How important is hearing for speech?

The importance of normal hearing for the development of speech and language should not be under estimated. Many children without facial palsy develop speech problems because they have mild to moderate temporary hearing loss. A child must have good hearing in order to be able to learn the differences between sounds. The child must be able to discriminate one sound from another before they can reproduce that sound in words.

When should your child start speaking and communicating?

Below is a brief outline of the milestones for the development of speech and language.

Birth – 6 months

  • Crying relieves stress
  • Eye to eye contact is the first social communication and occurs from 2 – 3 weeks onwards
  • Social smiling develops in response to communication at approximately 4 – 6 weeks
  • Chuckles and laughs at 3 months
  • Tuneful noises to self and others when pleased
  • May shout to attract attention at 5 -6 months

6 – 12 months

  • Babbles in long strings for self amusement as well as to other people, (7 months onwards)
  • Adults’ actions with speech may be imitated and repeated, (e.g. Pat-a-Cake).
  • At 10 – 12 months the baby will respond to own name and may recognise one or two others
  • Is affectionate towards familiar others
  • Starts to point to interesting things or events

12 – 18 months

  • Able to produce continuous, loud, tuneful “conversation-like” jargon to self and others
  • At approximately 14 months may produce a few single words in the correct context
  • Starts to communicate needs by pointing to desired objects, (e.g. bottle, dolly).
  • May hand adult a common object on request, (e.g. a cup, ball, bottle or spoon).
  • Identifies common objects by use, (e.g. picks up comb and tries to comb hair).

18 – 24 months

  • Understands most simple language addressed to him/her.
  • At approximately 21 months is able to put 2 or 3 words together to form a meaningful sentence
  • Enjoys nursery rhymes and tries to join in
  • Hands and names familiar objects on request

30 – 36 months

  • Can use approximately 200 recognisable words but speech is still infantile
  • Asks questions “what/who”.
  • Stuttering in eagerness is common and part of normal language development at this age
  • Speech shows a range of loudness and pitch variation
  • Large vocabulary which can be understood by strangers
  • Speech still infantile with immature sounds
  • By 3 years knows several nursery rhymes

4 years

  • Correct grammar in speech and easily understood by strangers
  • Shows some immature substitutions
  • May be able to count to 20 by rote
  • Listens to and tells long stories

5 years

  • Speech is fluent, grammatically correct according to the speaking styles of those around them and the child can use a full mature sound system except perhaps for “s”, “f” and “th”.

When should I ask to see a speech and language therapist?

You should ask for a referral to your GP or contact your Health Visitor if you are concerned about any of the warning signs below.

  • Any concerns about the child’s ability to hear or is known to be at risk of deafness
  • Any suspicion on the parents’ part that the child is not hearing normally
  • Not responding to nearby voices or everyday sounds by 8 weeks of age
  • Not showing ordinary interest in people and for playthings by 3 – 4 months
  • Not using frequent, tuneful, repetitive babble to self and others by 10 months
  • Not speaking single words by 21 months
  • Not putting 2 – 3 words together in sentences by 30 months
  • Not using intelligible speech by 4 years (average 30 – 36 months)
  • Not using appropriate grammar by 5 years
  • Still demonstrating problems with articulation (speech sounds) by 6 and a half years

Always take your child for their health visitor checks as many screening assessments are carried out during these appointments. This enables the Health Visitor to establish whether a referral to the GP, Audiologist or Speech and Language Therapist should be instigated.

Information for parents and carers about communicating with a child with facial palsy

Oxford Craniofacial Unit GuideOxford Craniofacial Unit have produced this excellent guide for parents and carers which includes activity songs to sing to encourage alternative forms of expression. Download here

Please follow the link below for further advice on how to help your child communicate:

NHS: Helping your child’s speech

For adults see our Adult Speech & Talking Patient Guide


From Birth to Five Years: Children’s Developmental Progress – Mary D Sheridan

Externally Linked Articles:

Communicating with a child with facial palsy (Ext. Link - opens in new window)

Oxford University Hospitals guide written by Principal Speech and Language Therapist Sarah Kilcoyne about communicating with a child with facial palsy.

Parents & Carers Facebook Group (Ext. Link - opens in new window)

Private Facebook support group for parents and carers of children with facial palsy, operated by Facial Palsy UK.

NHS Choices – Helping your child’s speech (Ext. Link - opens in new window)

Last reviewed: 16-02-2020    ||    Next review due: 16-02-2022