I have a 2.5 year old son who has a great vocabulary, appears to be meeting all the appropriate milestones, but has muffled speech. I understand 95% of what he says. I think a stranger may understand 75% of what he says. He had chronic ear infections as an infant and had tubes put in at 9 months. We just had his adenoids checked and discovered they are blocked and quite large. My oldest son had muffled speech at the same age, and also had large adenoids. My oldest son’s adenoids were removed and his speech improved dramatically. We hate to put him under again, but wonder if the muffled speech is related to the enlarged adenoids. Could he just need some articulation exercises to improve the quality of his speech?
As therapists, we don’t begin to look at the actual articulation/intelligibility of speech until a child reaches the age of three. Since you describe your son as currently being 95% intelligible to you and 75% intelligible to strangers, this indicates that at age 2.5 he is within the norm for his articulation skills. Children with chronic ear infections do sometimes have articulation errors because when they had the fluid in their ears they had a temporary conductive hearing loss and during that time they pronounced words as they heard them, perhaps substituting a “th” sound for an “s” during that time. They may still continue to pronounce words that way even when the fluid is alleviated because that is the way they learned them and it became a pattern. Having said that, since your son received his tubes at age 9 months, well before he probably began using too many single words, this probably has no bearing on his speech unless he continued to have problems with his ears after he received the tubes.
Also, many two year old and older children continue to have articulation errors that are expected and considered “normal” since production of speech sounds is developmental in nature and many children continue to work on more difficult sounds and blends up until age 8. Enlarged adenoids often cause nasal blockage and in turn children will mouth breathe excessively, often snore at night and may have trouble smelling or even breathing properly. Enlarged adenoids and tonsils can even be related to sleep apnea in some cases. Because of the nasal blockage, enlarged adenoids can cause children’s speech to sound as if they have a cold all the time, which could be why your son’s speech is sounding “muffled” since you went through this experience with your other child. I would definitely discuss your options with your physician, mention your concern about his speech and see what he/she recommends. If you do not have his adenoids removed or even if you do and you still have concerns about your son’s articulation skills at age 3, then you might choose to contact your local preschool early intervention provider or a local speech clinic to have your son’s articulation skills assessed. You can check our speech and language page for what is typical for a child of 2.5. This is also a link for a 0-3 Early Intervention Program in your area if you choose to contact someone before your son turns 3.
In the meantime you and your family can continue to be good speech models for your son by pronouncing words correctly for him. Don’t draw attention when he mispronounces a word, but simply pronounce it correctly for him in a sentence back to him so he hears it correctly i.e., “Yes, you are eating SPAghetti”. You can exaggerate initial sounds for him or make silly games of making sounds back and forth such as “PA, PA PA”, “TI, TI, TI”, or the snakes goes “ssssssss” etc. You can use his books or cut out pictures from magazines to make matching games of pictures with similar sounds. Blowing bubbles is a great oral motor strengthening activity and if you are using sipper cups, switch to a straw cup whenever possible, since sucking through a straw is a much more mature oral motor movement than suckling through a sipper spout (which is more like a bottle).