If your chid has difficulty speaking and tends to repeat certain syllables, words, or phrases, he may have a stuttering problem. But he simply may be going through periods of normal nonfluency that most children experience as they learn to speak. This instruction sheet will help you understand the difference between stuttering and normal language development.

The normally nonfluent child
1. The normally nonfluent child repeats syllables or words once or twice, li-li-like this. Nonfluencies may also include hesitancies and the use of fillers such as "uh."
2. Nonfluencies occur most often between ages 1 and 1/2 through 6, and they tend to come and go. They are usually signs that a child is learning to use language in new ways. If nonfluencies disappear for several weeks, then return, the child may just be going through another stage of learning,
3. Try not to correct your child for nonfluencies; they will fade away in time. They may persist, however, if you make a big issue of them.
4. If nonfluencies occur very frequently at certain times — for example, when your child is excited or when he is under stress — try to model a slow and easy style of speaking. Don't ask the child to slow down. Giving him an example of slow speech will be more effective.

The child with mild stuttering
1. A child with mild stuttering repeats sounds more than twice, li-li-li-li-like this. Tension and struggle may be evident in the facial muscles, especially around the mouth.
2. The pitch of the voice may rise with repetitions, and occasionally the child will experience a "block" — no airflow or voice for several seconds.
3. Try to model slow and easy speech when talking with your child, and encourage other family members to do the same. Don't speak so slowly that it sounds abnormal, but keep it unhurried, with many pauses. Television's Mr. Rogers was a good example of this style of speech.
4. Slow and relaxed speech can be most effective when combined with some time each day for the child to have one parent's undivided attention. A few minutes can be set aside at a regular time when you are doing nothing else but listening to your child talk about whatever is on his mind.
5. Try not to be upset or annoyed when stuttering increases. Your child is doing his best, as he copes with learning many new skills all at the same time. Your patient, accepting attitude will help him immensely.
6. Effortless repetitions or prolongations of sounds are the healthiest form of stuttering, Anything that helps your child stutter like this instead of stuttering tensely or avoiding words is helping.
7. If your child is frustrated or upset at times when his stuttering is worse, give him reassurance. Some children respond well to hearing, "I know it's hard to talk at times ... but lots of people get stuck on words . .. it's okay." Other children are most reassured by a touch or a hug when they are frustrated.

The child with severe stuttering
1. If your child stutters on more than 10% of his speech, stutters with considerable effort and tension, or avoids stuttering by changing words and using extra sounds to get started, he needs speech therapy. For the severe stutterer, complete "blocks" of speech are more common than repetitions or prolongations.
2. You can call your local school department and ask about an Early Intervention speech evaluation. This is the best place to start as most health insurance plans do not cover speech therapy beyond the initial evaluation. If your child is not eligible for school speech therapy, ask the school speech therapist for the name of a speech and language pathologist who is experienced in working with stutterers. You can also contact the Speech-Hearing-Language Foundation of America, and they can provide you with a referral to a stuttering specialist in your area.
3. The suggestions for parents of a child with mild stuttering are also appropriate when the child has a severe problem. Use a relatively slow, relaxed rate in your own conversational speech, but do not speak at an unnaturally slow pace. Remember, slowing and relaxing your own speaking style is far more helpful than telling the child to slow down.
4. Encourage your child to talk to you about his stuttering. Show patience and acceptance as you discuss it. Overcoming stuttering is more a matter of losing fear of stuttering than a matter of trying harder.

When talking to a child who stutters
1. Listen to what the child is saying. Respond to that, rather than the stuttering.
2. Give appropriate nonverbal feedback to the content, such as head nods and "uh-huhs."
3. Keep natural eye contact when the child is talking,
4. Don't rush the child by interrupting or finishing words for him. Don't let others rush or tease the child.
5. Use a relatively slow, relaxed rate in your own conversational speech, but do not speak at an unnaturally slow pace.

Adapted from Contemporary Pediatrics, February 1988.