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Am Fam Physician. 2019;100(9):online

See related article on stuttering

What is childhood-onset stuttering?

Speech is one of the hardest things that people learn. Most preschoolers have some trouble learning to speak normally (fluency). They may repeat entire groups of words or add extra sounds, like “um.” This is called disfluency. Most disfluencies are normal and will go away in time. But, some preschoolers have disfluencies that can cause problems with communication. The most common cause of these more severe disfluencies is called stuttering.

When someone stutters, a word or part of a word is often repeated. They may have trouble saying a word or say it in a choppy way. As stuttering continues, the person might develop poor habits to try to force the word out, such as tightening the muscles of the face and throat.

Some children start speaking normally as their brains develop. Speech therapy can still help these children.

The speech part of the brain stops developing by about age seven. If a child is still stuttering at seven years of age, it is less likely that the stuttering will completely go away. This is called persistent stuttering. About 1% of people have persistent stuttering. Speech therapy can still be helpful.

What causes stuttering?

Studies show that stuttering happens when the part of the brain that controls speech doesn't develop correctly. It is not the fault of the person who stutters, their families, or the environment. It is not caused by someone's personality.

What other problems can stuttering lead to?

Overall, people who stutter are no more anxious or shy than others. But, stuttering can make people become anxious about socializing, because they appear different from others and can be viewed as not as smart. It may cause poor self-esteem and depression. If this starts to affect how they cope with life, it needs to be treated.

Stuttering can lead to discrimination. This is illegal under the Americans with Disabilities Act. It should be combatted by educating others. It may require filing a formal complaint.

When is treatment in young children needed?

Therapy is needed when the disfluency is keeping the child from learning to speak clearly and develop good social skills. Therapy is especially needed if the disfluency hasn't changed for more than 12 months or is getting worse. A referral to a specialist in speech problems, called a speech-language pathologist (or SLP for short), is needed to confirm the diagnosis of stuttering and to decide on the best therapy.

How can I help my young child?

Parents and other caregivers can help young children stutter less by doing these things:

  • Encourage the child to speak freely. Make the speaking environment relaxed.

  • Listen patiently to the child without interruption. Do not finish the child's sentences.

  • Encourage family members to take turns when speaking.

  • Never punish the child for stuttering.

  • Treat stuttering as normal speech unless the child is in a speech therapy session.

How is persistent stuttering treated?

The goal of therapy may not be complete fluency. Instead, goals may focus on stuttering less or not as badly and accepting that it is okay to stutter. The SLP can help with these goals.

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