Stuttering and Speech Disfluency


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.
Robin Karp – Hillsborough, California

Dr. Greene's Answer

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

Treatment 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 a true stutter. 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 a stutter?

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 a stutter 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+ stutter-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.

May 1, 2008
Published on: December 17, 1996
About the Author
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Dr. Greene,

My family and I are in a unique situation. I am currently stationed in Germany with the Air Force and we have a 2.5 year old baby girl with an extremely extensive vocabulary. She has been verbal since 9 months and talking in extremely fluid appropriate sentences for about 1 year. As mentioned before, I am currently stationed in Germany and my daughter has been picking up some German here and there. She knows her alphabet, can count to 20, etc.. She has not until recently given us any reason to question her development. She has occasionally showed some trouble stuttering, once in a while, usually when extremely tired, overwhelmed, etc. You can see the frustration on her face when it does occur.

The past week however has been different, and very hard on all of us. My daughter started the week by not being able to get the words out, and now has almost completed reverted to speaking nonsensical gibberish. We are not sure what to do and at what point we should call the pediatrics dept., especially knowing what is available here on base in Germany. Please help. It is such a sad sight to see, a generally super happy child with a heavy frustrated heart. Thanks, Amanda