We have an extremely verbal twenty-six-month-old son. We have noticed he is beginning to stutter. Is this a normal speech pattern? Will it pass? Is this something we should be concerned about?

When a child stutters, parents are often told to relax, that the stuttering is a phase which will soon be outgrown, and that nothing need be done. This advice can be unfortunate.

Treatment of stuttering is more effective the earlier it is begun. By needlessly delaying evaluation, parents can miss an important window of time when their child's stuttering is most treatable. On the other hand, many children go through a developmental stage of speech disfluency that is often confused with true stuttering. This normal disfluency does disappear over time without need for treatment.

If a two year old begins to repeat syllables, short words, or phrases (su-su-such as this, or such as...such as such as this) about once every 10 sentences, and begins to use more filler words (um, with uh pauses or er hesitations), is this normal disfluency or stuttering?

Children with true stuttering tend to repeat syllables four or more times (a-a-a-a-as opposed to once or twice for normal disfluency). They mmmmmay also occasionally prolong sounds. Children with stuttering show signs of reacting to their stuttering -- blinking the eyes, looking to the side, raising the pitch of the voice. True stuttering is frequent -- at least 3% of the child's speech. While normal disfluency is especially noticeable when the child is tired, anxious, or excited, true stuttering is noticeable most of the time. Children with true stuttering are usually concerned, frustrated, or embarrassed by the difficulty.

About 4% of all children will have true stuttering for at least 6 months, most commonly between the ages of 2 and 5. Most of these will recover by late childhood, but about a quarter of them will develop severe, chronic stuttering. Whenever parents suspect that their child has true stuttering, it is important to bring it to their pediatrician's attention -- it is easily treatable, unless you miss the window of time when treatment is so effective.

In general, you should seek an evaluation by an expert, such as a speech and language pathologist, if:

1. There are 3 or more+ stuttering-like episodes in every 100 syllables uttered.
2. Your child displays avoidance or escape reactions when talking, such as pauses, “uhs”, “ums”, other interjections, eye blinks, or head nods.
3. Your child seems tense or uncomfortable when talking.
4. You and/or your doctor have any doubts about your child’s speech.

When children stutter, a combination of exercises done with parents at home along with therapy with a speech and language pathologist often results in considerable improvements.