Have toddler evaluated for delayed speech

Question: My 28-month-old son, Michael, has a vocabulary of about 50 words. However, he has not started putting words together. He often pronounces only the first syllable of a word.

I am very concerned about his expressive language. In large groups, he tends to keep to himself. He does a little better in small groups and smiles at other children (and adults) a lot.

Michael's receptive language is excellent. He follows directions and appears to understand everything I tell him. When I name objects, he can point to them correctly.

The doctors have found nothing wrong with him physically at checkups. My mother-in-law says that my husband did not start talking until age 3, and my father did not start talking until age 3. Both of them have science-related professions.

Do you recommend that Michael receive a speech evaluation or some other form of intervention? Should I check for any physiological disorder? My husband thinks he is normal and will start talking on his own. -- A.J., Fairfax, Va.

Answer: There are many late talkers, as you've found in your own family. Perhaps your child is one of them. But I think you would be wise to respect your own instincts and get a speech evaluation for your son by someone who understands small children.

I'm not sure that Michael is in trouble, but the evaluation might put your mind at ease. And if there is a delay to attend to, you could approach it with more direction -- and with less worry.

You have made important observations about your son: He has receptive language and expresses himself with his behavior language.

Has his hearing been thoroughly checked out? These days, with so many young children experiencing recurrent or chronic ear infections, hearing can be a real barrier to learning to speak. Even when a child hears well enough to understand, he may not hear well enough to learn to reproduce the sounds he hears.

Your pediatrician can help you sort through this possibility and make a hearing-test referral if needed.

The symptom you tell me about that worries me most is that your son is keeping to himself in large groups. Is he hypersensitive and easily overwhelmed, or unable in some way to keep up with other children? Be sure to share these questions and your observations as you pursue an evaluation for your son.

Question: At what age should a child be expected to stay dry at night? Our almost-4-year-old daughter is potty-trained but still wears a pull-up to bed. It is wet every morning.

She sometimes asks to sleep in underwear, but I tell her she can't do that until she wakes up with a dry pull-up.

Do you have any suggestions for helping her learn to do this? -- D.G., New York, N.Y.

Answer: Most pediatricians don't start thinking of bedwetting as a problem until a child is 5 years old, unless a child who had been completely dry at night for several months starts wetting anew. I'd prefer not to worry about bedwetting until 6 years of age, because I think the pressure that can result can only make it worse.

In your case, it sounds as if you and your daughter are already upset about it, so I would urge you to take the pressure off her. The biggest danger is that she will lose self-esteem.

I like your message about "when you are in a dry pull-up," but be sure she doesn't take it as criticism or as a punishment. Just say to her: "It's too early for you or me to worry about you staying dry at night. You'll get there one day."

I'm sure you've tried rousing her from sleep to go to the bathroom before you go to bed at night. Another idea is to put a potty right next to her bed. For other suggestions, see our book "Touchpoints Three to Six" (Perseus (2001).

But mainly, I'd suggest that you don't make too big a deal of it. It's not. And her self-image is.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 122 E. 42nd St., New York, N.Y. 10168. Questions may also be sent by e-mail to: nytsyn- families@nytimes.com. Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually. Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider.

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