Symptoms:

Most children have problems pronouncing words early on while their speech is developing.

However, by age 3, at least half of what a child says should be understood (intelligible) by a stranger.

By age 5, a child's speech should be mostly intelligible.

• The child should make most sounds correctly by age 4 or 5, except for a few sounds such as l,s, r, v, z, ch, sh, and th.
• Some of the more difficult sounds may not be completely correct, even by age 7 or 8.

Children with phonological disorder will substitute, leave off, or change sounds. These errors may make it hard for other people to understand the child. Only family members may be able to understand a child who has a more severe phonological speech disorder.

Commonly, children with this disorder have:

• Problems with words that begin with two consonants. "Friend" becomes "fiend" and "spoon" becomes "soon."
• Problems with words that have a certain sound, such as words with "k," "g," or "r." The child may either leave out these sounds, not pronounce them clearly, or use a different sound in their place. (Examples include: "boo" for "book," "wabbit" for "rabbit," "nana" for "banana," "wed" for "red," and making the "s" sound with a whistle.)

Signs and tests:

Children should be examined for disorders such as:

• Cognitive problems (such as mental retardation)
• Hearing impairment
• Neurological conditions (such as cerebral palsy)
• Physical problems (such as cleft palate)

The health care provider should ask about issues, such as whether more than one language or a certain dialect is spoken at home.