Peter R. Ramig, Ph.D.
Dept. of Communication Disorders and Speech Science
University of Colorado
Box 409
Boulder, Colorado 80309 (303) 492-3049


The following pages contain guidelines, suggestions, and general information for parents or other significant adults (e.g. day care providers) who have or know a young child who repeats, blocks, or hesitates when he/she speaks. It is important to realize that learning to speak is a complex task and repetitions and hesitations occur frequently during the developmental stage of speech (2 - 7 years). For most children, those "errors" are only normal nonfluencies. For some children, however, they can be the beginning signs of stuttering. Below is a list of danger or warning signs to look for in any child's speech. These signs can occur randomly; however, frequent and consistent appearance of one or more of them should be brought to the attention of a speech-language pathologist.


1. Multiple part-word repetitions -- Repeating the first letter or syllable of a word, such as t-t-t-table or ta-ta-ta-table.

2. Prolongation -- Stretching out a sound, such as r------abbit.

3. 'Schwa vowel' -- Use of the weak (schwa in German) vowel. For example, instead of saying bay-bay-bay-baby, the child substitutes buh-buh-buh-baby.

4. Struggle and tension -- The child struggles and forces in his attempt to say a word. For example, the child may exhibit eye blinks or facial grimaces when having difficulty speaking.

5. Pitch and loudness rise -- As the child repeats and prolongs, the pitch and loudness of his voice increase.

6. Tremors -- Uncontrolled quivering of the lips or tongue may occur as the child repeats or prolongs sounds or syllables.

7. Avoidance -- An unusual number of pauses; substitutions of words; interjection of extraneous sounds, words, or phrases; avoidance of talking.

8. Fear -- As the child approaches a word that gives him/her trouble, he/she may display an expression of fear.

9. Difficulty in starting and/or sustaining airflow or voicing for speech This is heard most often when the child begins sentences or phrases. Breathing may be irregular and speech may occur in spurts as the child struggles to keep his/her airflow and voice flowing.

The following ideas are suggested to help parents better understand the disorder of stuttering.

1. There are many fallacies we hear regarding the cause(s) of stuttering in children. The fact is, experts on stuttering openly acknowledge that the cause(s) of stuttering are unknown and are probably multidimensional in nature. Much of the recent research, however, supports a possible weakness of some kind in the neurophysical or neuromuscular systems. Few specialists of stuttering support or prescribe to a psychological cause or base for stuttering. However, there is little doubt that stress created from feelings of embarrassment, inadequacy, shame, and frustration caused by stuttering increase and maintain it. There is no respected research evidence that targets parents as the cause of stuttering.

2. Stuttering can become an embarrassing and frustrating problem for the child and may influence his/her behavior, academic performance, and self-esteem and confidence.

3. Stuttering can be changed and possibly eliminated in younger children if professional help is sought before excessive struggle and tension develop.


1. The child may have inadequate attending behaviors that may include hyperactivity, distractibility, and difficulty attending to tasks.

2. The child may have oral motor difficulties evidenced by misarticulation of sounds and/or inability to rapidly coordinate tongue and/or lips.

3. The child may have perfectionistic tendencies and he/she may appear to be exceptionally sensitive.


1. Some children may display nonfluencies or stuttering as soon as they begin combining words, but most do not start until approximately one year later.

2. Stuttering often begins gradually and its progression can be episodic, containing oscillations in severity across communicative tasks and time.

3. Repetitions of syllables which occur on the initial words of an utterance are the most frequent type of nonfluency occurring in beginning stuttering.


The following guidelines are appropriate when talking and/or listening to any child, but are especially important when a child is exhibiting some of the danger signs of stuttering.

1. Speak clearly so that each sound is pronounced clearly and words do not run into one another. Use the appropriate names or words for objects and events. Use sentences and vocabulary appropriate for the child's age. This is important so that the child is not frustrated because he/she may be unable to repeat or imitate more complex words, phrases, or sentences.

2. Beginning at a very young age, associate talking with pleasant activities. Use a pleasant voice when speaking to the child. For example, while rocking or holding the child, talk about pleasant daily activities or events.

3. Talk about people, objects and events that are meaningful to the child.

4. Promote spontaneous conversation on the part of the child by waiting silently for the child to initiate the conversation during free play. Reinforce the child's responses with smiles and praise and by touching.

5. Provide a variety of entertaining language experiences, such as trips to the zoo, amusement park, museum, circus, etc. Talk about each experience with the child.

6. Read to the child in a relaxed manner that is slightly slower than normal and has a natural rhythm. After you have read a story, discuss what happened with the child. Let him/her finish sentences in familiar stories or tell them in his/her own words. Let him/her do as much talking as he/she wants; again, calmly allow the child to complete statements. Tell stories about events in your own life and when he/she was smaller; use familiar pictures. Avoid frightening stories because they may be disturbing to the child even if he/she appears to enjoy them.

7. Help the child express his/her feelings, both verbally and nonverbally, by doing so yourself. Tell him you love him/her and like him/her, with words as well as by caressing him/her, smiling at him/her, etc.

8. Listen to the child when he/she is expressing rage, anger, or frustration. Discuss what caused these feelings.

9. Pay attention to his/her nonverbal communication: Is he/she asking you something because he/she really wants to know the answer, or is he/she really asking for attention and/or physical contact?

10. Consider the child's feelings. Adults do not like to be ridiculed for speaking poorly, or to frequently be told "no," or to be reprimanded for something that is insignificant, or to seldom receive praise. Neither do children.

(Taken from How to Talk so Kids will Listen and Listen so Kids will Talk, Adele Faber and Elaine Mazlish, 1980, Avon Books, New York, New York.)

11. When the child is nonfluent, any of the following behaviors may only make him/her feel that you are dissatisfied with him/her and with him/her way of communicating. They may make him/her feel that nonfluencies are "bad", resulting in his/her attempt to avoid being nonfluent. When avoidance develops, the problem of stuttering often worsens.



CAUTION: This approach ("f" above) should be used only on those occasions when the child exhibits real distress over his speech failures.

For more assistance, refer to Stuttering and Your Child: Ouestions and Answers. Stuttering Foundation of America, 1989.

12. When you ask the child a question, use "close-ended" queries like "Did you have a good time at school today? What did you do that you liked best?" These sorts of questions are far more likely to elicit short, simple responses as compared to a directive such as "Tell me about school today." Short, simple responses are more desirable on days the child is especially nonfluent because they are more likely to be produced fluently.

13.When the child wants to talk to you and you are busy doing something, if you can, stop and give him/her your full attention. If you cannot do this immediately:

(These suggestions about how to react to nonfluencies are from Zwitman, The Disfluent Child, A Management Program, 1978.

14. Everyone should take turns talking.

15. If possible avoid using the word "stuttering" to describe the child's speech when talking to him/her. Instead, use descriptive words -- "gets stuck," "bumpy speech," "hard talking," etc.; however, if the child is well aware of his/her nonfluencies and refers to them as stuttering, it would be unnatural for everyone else to avoid using the word.

16. Do not place demands on the child to perform in front of people (asking him to say the alphabet, recite nursery rhymes, etc.). If he/she wants to and initiates this type of activity, then it is okay.

17. Avoid extensive questioning of the child, especially about details or about the past.

18. Do not request the child to speak excessively on days when he/she is extremely nonfluent.

19. After a nonfluent utterance you might repeat back the content of what the child said. This will help you make sure you are attending to the content of what is said, and help to reduce his memory of the nonfluency. In addition, you are showing the child that you are listening to him/her. (Child: "I went I went shopping." Parent: "So you went shopping.")

20. Be careful not to convey a sense of time pressure on talking. Behaviors can purposely be modeled to reduce this sense of time pressure by speaking more slowly. Speech should be evenly paced and not contain fast rushes followed by long pauses. "Brisk" turn taking and frequent interruptions also convey a sense of time pressure and should be minimized.

21. Talk openly with the child about stuttering, if he/she expresses a desire to do so, but do not make a big issue out of it.

22. A child usually develops his attitudes about talking by observing his parents' behaviors. Take advantage of everyday opportunities to see that the child experiences some form of success and praise.


In addition to how you talk and listen to the child, the child's home and school environment can have an impact on his/her speech. The following suggestions pertain to the home and school environment. For more information, the following brochures are available:

The Child who Stutters at School: Notes to the Teacher, The Stuttering Foundation of America, Memphis TN.
Stuttering and Your Child: Questions and Answers, The Stuttering Foundation of America, Memphis TN.


Research indicates that some parents of nonfluent children do not cause stuttering but unrealistic expectations can maintain or increase existing or developing stuttering. For example, the parents may expect their child to:

Some parents of nonfluent children speak rapidly or hurriedly. In turn, their children may speak quickly. Because speech and language is a very complex motor and cognitive act, rapid speech may cause the child to make mistakes such as hesitating, repeating, prolonging or mispronouncing sounds or words. Such mistakes may lead to even more mistakes because the child becomes frustrated, tense, self-conscious, etc.

If parents speak rapidly or act rushed, the home environment may become more stressful. Hurrying becomes a way of life. An environment such as this may not be conducive to good speech development, normal parent-child interaction, or normal parent-parent interaction. The parents should provide a good model by speaking calmly and reducing their rate. This is more effective than telling the child to slow down. If any of the above examples are characteristic of you or your home environment, it is suggested changes be made.

Putting this information practice is difficult. Lena Rustin describes a task called "Talking Time" in which the parents complete a home assignment involving a commitment to spend three, four or five minutes; four, five or six times per week playing with their child. "Talking Time" is structured accordingly:

(Rustin, Lena, 1991. Parent, Families and The Stuttering Child, Singular Publishing Group, Inc., San Diego, CA, pg. 63-64.)


The following suggestions (1-5) regarding discipline are taken from Zwitman (1978) and are appropriate for any child, whether or not he/she is nonfluent:

1. Establish a noninjurious discipline system for the child's misbehaviors. This system should be consistent from day to day and from child to child.

2. When the child unintentionally annoys you:

3. When the child intentionally annoys you, and you are sure that he/she knows his behavior is wrong, we suggest the following:


When considering the effects the general environment has on his speech, it is important to realize that the parents themselves serve as models to the child. Many of the child's behaviors, feelings, and attitudes are directly influenced by the behaviors, feelings, and attitudes of the parent.

1. Some behaviors are modeled directly; however, indirect influences of the parents and other adults important to the child are very powerful.

2. The nonfluent child may adopt the parent's feelings about stuttering. As a result, parents might ask themselves the following:


{document revised 9/10/93}


The Child Who Stutters at School: Notes to the Teacher, Stuttering Foundation of America, P.O Box 11749, Memphis, TN, 38111-0749.

Conture, Edward G., Stuttering. Prentice-Hall, Englewood Cliffs, New Jersey, 1990.

Faber, Adele and Elaine Mazlish, How to Talk So Kids will Listen and Listen So Kids will Talk, Avon Books, New York, New York, 1980.

Ramig, Peter, "Parent-Clinician-Child Partnership in the Therapeutic Process of the Preschool-and Elementary-Aged Child who Stutters". Seminars in Speech and Language, vol. 14, #3, 1993.

Rustin, Lena, Parents, Families and the Stuttering Child, Singular Publishing Group, Inc., San Diego, CA 1991. Stuttering and Your Child: Questions and Answers, Stuttering Foundation of America, P.O. Box 11749, Memphis, TN, 38111-0749.

Zwitman, Daniel H., The Disfluent Child, A Management Program, 1978, University Park Press, Baltimore, MD.

added December 15, 1995, with permission (JAK)