A: Diana, it's good you're so concerned about your grandson's early development. Recent research has underscored how a child's development in the first few years of life lays the foundation for lifetime development and learning. It's important for your grandson to develop his speech and language abilities so he can better understand his world, express his thoughts and feelings, and interact well with other children and adults.

Approximately one in ten children have speech and language delays. They are commonly caused by repeated ear infections, as your grandson had, which can cause temporary hearing loss during the period of ear infections and even permanent hearing loss.

It sounds like you've noticed some signs that your grandson's speech may be delayed. At age 3½, children typically follow simple directions, engage in simple conversations, speak in 3-4 word sentences, and have fairly clear tone and pronunciation so that most adults can understand them. It's okay for children at this age to still have difficulty pronouncing some letters (e.g., t, r, l, s, sh, ch, and th) and to stutter sometimes. But if you've noticed that your grandson has difficulty listening or understanding, doesn't speak as much as most children his age, doesn't engage in conversations, has an unusual sound to his voice (e.g., hoarse, stuffy, flat, very loud, or very soft), or is difficult to understand, then he might have a speech and language delay.

Knowing that your grandson has a 10% hearing loss in both ears and that you've noticed signs of speech problems, it's very important that he get a thorough assessment of his speech and language. When children with hearing and speech problems get help in their first 5 years, they have a far better chance of doing well in school, both academically and socially.

Make a note of your observations about your grandson's speech and language, and talk with your daughter about this. It might be a difficult issue to discuss, but it is very important. Often parents don't recognize there might be a problem because they can understand their own child's speech. Encourage your daughter to share your observations with the doctor and request a referral for a full developmental evaluation, with special attention to speech and language. Your daughter can also contact the local school district to request a free evaluation under the Individuals with Disabilities Education Act (IDEA) which extends special education assessment and services to preschool-age children with developmental or health impairments (including hearing, speech and language problems) that can affect their educational abilities. Remember, it can't hurt to get the evaluation—you might find that your grandson's development and speech are on-track, which would be great; or you might find that your grandson has certain delays, which could benefit greatly from therapy—the earlier the better.