Q: Dear Dr. Theriot-
I have a 19 month old son who had tubes placed in both ears when he was 16 months old. He says "mama" and "dada" and just recently I heard him say "bye". I know he understands what I am saying because he can follow simple commands like "throw in the trash", or "shut the door".
He is a very active 19 month old, except for his speech. He is in daycare and constantly has a runny nose and has drainage from his ears. Should I have him tested for hearing problems, or is it too early to tell?
Concerned but not alarmed,
Tracey in Arkansas
A: There are two major issues that your question addresses. The first deals with what is the normal or expected speech for a 19 month old? From what you have indicated, it sounds as if your son is right where he should be developmentally. Most children can say a "few" words by 15-18 months. Boys generally develop language skills more slowly than girls. What is important however, is that their receptive speech is intact by this age. In other words, it is not uncommon for a 19 month old boy to have only a few audible words (mama, dada, bye etc.) as long as he understands simple commands as you have indicated. You can be sure that their hearing is intact if they can respond to things like, "Where's your nose?", "Go get your shoes", or "Where's the kitty?". The speech should come with time, and the first words will probably include names of familiar people, pets, body parts and favorite possessions. In some cases it seems as if the speech "explodes overnight". By two years of age, a child should be able to use two to four word sentences such as "more milk please", or "go bye-bye car".
The second portion of your question is a bit more concerning. This has to do with his constant runny nose and ear drainage. First of all, it is not uncommon for an infant or toddler who is in daycare for the first time to seem to get one upper respiratory tract infection after another. Their immune system hasn't been "primed" to protect them from all of the new viruses and bacteria that they are exposed to. It would be concerning however, if he constantly had a runny nose or congestion that didn't clear. Although this could be explained by infections, one would want to be certain that you are not dealing with allergies. You might want to discuss this possibility with his doctor.
Lastly, you mentioned that your son "constantly" has drainage from his ears. This suggests to me that in spite of the tubes, he is still getting ear infections. If the tubes are in place, and he gets an ear infection, the fluid will drain through the tubes into the ear canal and out the ear. This can be caused by getting water in the ears during a bath or swimming (without ear plugs). Chronic ear drainage when the tubes are in place can be the tip-off of a more deep-seated infection of the mastoid bone which sits behind the ear. Your son should definitely see his doctor to sort out these possibilities if you haven't done so already.
I hope this answers your question to your satisfaction. Thank you for your support of The Informed Parent.