Speech development in children | Session with Speech Therapist Merzia Maskati

0:00 Welcome, Mazia. Welcome to Get Set Parents with Pallavi, our parenting channel. And we have, you know, thousands of eager parents here to meet you today because I think the topic we're touching on today affects every parent at some point or the other. So, dear parents, today we have an expert with us who's going to answer all your questions on speech. You know, so when is my child going to speak? Why is my child not speaking? Which language?

0:31 All of that. So, Mazia is going to talk about loads of, you know, issues with us. But let me take this opportunity to introduce our expert speech therapist today. Mazia Miss Khati Shivramani is the founder of the Speech Dysphagia Language Clinic in Mumbai. She consults at the Breach Candy Hospital. And she treats a lot of speech disorders in children, including children in the autism spectrum, those with social communication disorders, and something interesting caught my eye, fussy picky eaters. This is also one of those things which we're going to touch upon apart from the speech bit. She's certified by the best institutes in the world across the US and Australia and India. Mazia, what a pleasure to have you. Thank you so much for joining us.

1:26 Thank you so much for having me, Pallavi. Love. So, yeah. Okay. So, I'm Mazia. I'm a speech therapist and I get this a lot of what is speech therapy then. So, speech therapy is essentially it's a paramedical course. So, it's similar to physical therapy, occupational therapy. And basically what speech therapy does is the overall goal of speech therapy is to improve the communication of that person. So, to make sure that they have some sort of effective communication system so that they can be understood and you know, express themselves with everyone who's close to them.

2:15 So, speech therapists work through the entire age group right from zero till, you know, old age. I won't get in Yeah, I won't get into the adult bit of it. But the pediatric bit, what speech therapists work on are we work on, so starting from zero, what speech therapists work on is we work on feeding difficulties. So, you know, for kids who are born pre-term, for kids who have any sort of issue early on, who are in the NICU, speech therapists work on the sucking, the swallowing, you know, all of that bit in the NICU. And then as a child grows older, you know, speech therapists continue to work on feeding. So, like I said, picky and fussy eaters. So, sometimes there are kids who have only certain textures and refuse to move from, say, like a pureed texture to having solid food.

3:15 Sometimes they may want to pick out things in their food and not have that. And again, I mean, all kids are a little picky, but if this was excessive, then it's something that can be worked on. You know, and then the obvious ones are kids who speak late, you know, kids who are late talkers, kids who are unclear, you know, very commonly in India we say totla. So, kids who are unclear. Kids who stammer. Then sometimes kids have voice problems, you know, when they Some kids are more prone to if they shout a lot or scream a lot, they lose their voice very easily.

3:52 So, we work on voice exercises. Let's start from the beginning. Let's start right from the beginning in terms of, you know, once a baby is born, what is the typical trajectory which, you know, you know, when we talk about correct development, when you talk about in speech, you know, in the speech parameters, what should be the ideal milestones or the, you know, normal flow that parents should expect? So, around two to four months of age, you should expect your child to be like smiling. That's social smile.

4:28 All Then by six months you expect the child to be smiling at you, laughing, you know, a little bit of cooing like we say they make some sounds back and forth and some babbling starts emerging. All right. By around eight months or so you expect the babbling to become like like we say ba ba ba, ma ma ma, reduplicated. And then by around a year you expect a child to be at least word approximating, which is saying even part of a word.

4:59 So, even if it's ba for ball. Or, you know, da for dog or da for down. Even part of a word. So, by around a year you expect that along with some pointing, waving. So, those are the social milestones also that you expect. Okay. So, this is this common for both boys and girls or is there a difference here? So, there's actually no difference. Actually, boys and girls develop speech at the same time. Really? Yes.

5:34 I think I think you know, one has been hearing that girls are ahead in their milestones, you know, physical milestones and all developmental milestones. This is okay. So, you're saying for speech they develop equally. They do develop equally. You know, and then I around two or three girls tend to become a lot more verbal. Whereas All right. So, majority of the girls tend to become more verbal. Whereas boys it's not a majority of them.

6:04 All right. But there's no difference in the beginning when they pick up speech. Okay. So, you're saying by the age of one they should be able to, you know, put together small words. And by about So, sentence formation by the by what age could they string basic, you know, I want water or, you know, I want to go to mom or such sentences? By what age should they be able to string? So, by one and a half, by 18 months you expect them to join two to words. So, even if it's a word and an action, so like mama and this. So, like mama bye.

6:42 So, even if it's a word and an action. So, by 18 and then between 18 to 24 is when you start seeing the, you know, sentences coming in, the small phrases, the small sentences. So, by like two you expect those to really increase. Okay. I'm just getting some comments. Guys, audience, I hope you're able to hear us. I'm just seeing some comments saying you can't hear me or Mazia. I'm not sure who you can't hear.

7:13 Just Just tell me you can hear both of us so we'll, you know, be rest assured on that front. Anybody, guys? I think there's a lag. Okay, they can hear. I can see. Yes, audible. Yes. So, so a lot of lot of parents start getting very concerned when, you know, by three or four children are still not talking. Especially, I don't know if if lockdown and, you know, children not being able to go out has had any effect. But is there a cause of worry if children don't start talking by three or four, you know, three plus, four plus? And what should What should parents do?

7:59 So, by Is there a concern there? By three and four plus, absolutely it's definitely an area of concern. The reason being is that sometimes even if there's nothing else So, the thing that therapists screen for is are there any red flags of any sort of developmental it still has to be looked at because the thing is that one, sometimes I get a lot of calls where they say my child is understanding everything.

8:33 So, if your child is understanding everything and they're not giving you that much output, by three they start getting extremely frustrated. That they are getting in so much and they're not able to get out so much. So, then they start developing aggressiveness and other behaviors because they're not communicating. So, that's one reason why we don't leave it. And the other reason also is kids who speak late are known, you know, known to be at a higher risk for having reading and writing difficulties.

9:05 Because if we leave the speech to catch up, then the academics start and then the kids are at a disadvantage. Right. So, these are the two reasons why we shouldn't leave delayed speech because earlier people used to say they'll talk. They'll talk. Let it be. Yeah. Yeah. Tell me, are there things during, you know, first just looking at the two-year mark, the two to three-year mark? Are there things parents can do consciously to encourage their children to speak or is it a complete natural process that, you know, some children do and some children don't? What can the parents do?

9:43 So, the parents can definitely do a lot to encourage speech early on. So, from the time your child is a baby, forget even one, even when they're a baby, one is definitely keep talking to them. So, keep talking especially during routines. You know, diaper changes, baths, you know, meals, things like that. You keep talking to them. Tell them what you're doing. You know, I'm You know, now I'm going to feed you. Now I'm going to do this. Now I'm going to do that. So, you keep talking. You're exposing them to that language.

10:20 Even when you keep talking, you don't talk as like you know, as a cricket commentator. You kind of you pause. Keep your sentences short and simple. They don't have to be really lengthy. You don't have to use baby words, but keep it short and simple. So, like something like diaper on on. Oh, oh, it's heavy. Time to change it. You know, so short and simple things. a bit of tone, changing tones and expressions helps. Yes.

10:50 Absolutely. So, being expressive, you know, having a little like intonational change. Always looking Always having your child look at you. Yeah. So, very important to be at your child's level. So, again, if they're little and they're on the floor, you sit on the floor. Or you put them on the table so that they're looking at you. Especially when you're reading also to them. And read a lot. Read a lot. Correct. So, I think you know, eye contact, your auditory tones, they even look at the way you pronounce, your enunciations. All of those make a huge difference during the first couple of years, right?

11:27 Absolutely. So, I I get this question a lot, Mazia. Maybe you can help us answer that. When the child is frustrated and not able to speak or when the child is not speaking at two or three, parents feel that you know, we preempt what the child is doing, hence the child is not speaking. So, we should ignore some of the signs, you know, the sign language. And you know, allow the child to struggle a little bit and communicate. What are your thoughts on that?

11:58 Yeah. So, I get this a lot, too. And the thing is that talking is absolutely the easiest thing that anyone can do. So, if the child could talk, they would talk. So, no child is being lazy. No child is being you know, difficult or acting out by not talking. If they could do it, they would do it. AND THEY AND NO CHILD IS DOING it just TO IRRITATE YOU, FIRST OF ALL.

12:28 SO, the fact that they can't do it, it's a struggle for them. They can't do it. So, you can't ignore their communication efforts. So, whether they point, whether they sign, you have to give it. The thing though that we do tell parents, if we have a child who has you know, a slight delay or whatever is don't don't preempt. So, you don't don't make life difficult and not give it. But also don't give everything without any input from the child.

13:01 So, so you create opportunities for the child to communicate. So, for example, like if you were to give a a biscuit don't just hand over the whole thing. Give a little piece. Let them do something to ask you for more. Then you give another piece. Yeah, exactly. But don't frustrate them so much that you know, on top of the frustration of lack of communication, they're also not getting anything from you. Right. Right. And you know, moving ahead on these toddler years, right? So, you know, once we've parents have come out of this, the whole two to four when you know, a lot of sounds.

13:41 Here is where you do the questions. Raw being pronounced as law. So, you know, make al me jaata hoon for a car. And you know, a lot of these sounds get you know, the totla-ness that you spoke about. Yeah. Yeah. What about that? Some children go through it and some don't. And those who do, what do we do about that? So, it depends again on what sound at what age. So, you know, if you like you can my website or even if you look up online, you'll always find a table that tells you what sound is expected at what age.

14:18 So, by like three, if a child is not saying like if they're saying tar for car, which is a very common thing kids do. The cur becomes tur. I see. before three, that's fine. We don't do anything about it. After three, if it stays, then we'll work on it. So, similarly, each sound has a different age. So, like raw comes after five. If by five Raw comes after five. After five. So, if by five a child is not saying it, we'll work on it.

14:50 Okay. So, it And there are children who are in the beginning not very clear. But that doesn't mean That doesn't mean that like every child's every sound has to be corrected at two. But Mazia, tell me, so many children in the country go through these phases of you know, mispronunciation, delayed speeches. Do all parents have to look for a speech therapist and go for sessions? Or is it something that will you know, typically just bolte hai, correct ho jayega. It will they'll outgrow it. It will self-correct. Is there a conscious intervention needed?

15:26 Or you know, what what should parents do about it? So, the thing is in this it's There are very um I I don't think every child requires intervention at all. And sometimes you know, you do you can wait. But the point is whether to know whether you can wait or no is hard for a parent to judge. That has to So, you need to check in and make sure that it's okay to wait. You know, the same with the stammer, right? Between two and a half and I get this also a lot. Between two and a half to three and a half or many kids go through this stammering like phase.

16:07 And it's called It's called normal non-fluency. And by after three and a half 85% of kids outgrow it spontaneously. Okay. So, which is a huge percentage. So, so we don't see a child for therapy for stammering before three and a half. Okay. Okay. But it's good to check in and at least see. You know, because each speech issue has a different age.

16:39 Right. Right. Yeah, this is this is a learning for me because you know, what you're saying, every sound, the the the cut-off point Yeah, is different. And these are things sometimes you know, you know, even our pediatricians are not experts in this. So, sometimes you know, you need to go to you know, the super specialist on this. Stammering and stuttering, is it an emotional issue? Could there be emotion triggers, emotional triggers? Or is it purely speech?

17:14 So, it's purely a speech issue. What happens is that it So, there's no known cause for it. It happens due to an incoordination between breathing and speaking. It's more common in boys than in girls. And it tends to run in family. Um Ah. But what happens is that any emotional stressor whether happy or sad. So, like whether it's a child's birthday or whether the kid is you know, moving to a new school or has new friends or Ah. you know, has exams or whatever, any emotional stressor will make it more noticeable.

17:56 Okay. very often then people link it to being caused by the emotion. It's already there. It's just that the emotional bit brings it to the forefront. So, could a child who was speaking completely normally suddenly start stammering at seven or nine or 10 because of a of some trigger? Or that is not likely to happen? So, it usually starts after around three, three and a half. Okay. What happens is sometimes it tends to be very very mild.

18:27 Hm. So, parents don't notice it. And then say when a child is six, seven, you know, it's Going to school and you know, speaking in school. Exactly. And then that's when they reach out. Okay. Okay. So, yeah. So, and and what about lisp? The whole you know, school Like that. Yes. Yeah. Yeah. Yeah. Yeah. Correct. After about four, four and a half, we don't correct it before that.

18:58 Okay. Okay. So, it's it's basically a simplification of how kids say it. All right. say you know, the sur just a little bit of a little extra air. Okay. Okay. I you know, one of the FAQs which keep you know, I keep say I I also have small children. So, I've gone through this. You know, on also on on on the handle, we get so many of these questions. Hm. Is there any connect to breastfeeding, bottle feeding, thumb sucking, sucking on a blanket in the early years which could cause speech delays later?

19:40 So, um No. Oh. Breastfeeding, bottle feeding, thumb sucking, all of that. Uh if thumb The thing that thumb sucking, a pacifier, and a bottle. Pacifier too, yes, I forgot. That's a big one. Correct. Correct. The thing that all these three do is that they push the the teeth forward. Okay. So, if they're used beyond age three, Mhm. your alignment is going off.

20:16 Now, if your alignment goes off, your dental alignment, then you're more prone to a lisp. And having trouble saying turn all of that. Um but if after three, again with a pacifier, the thing is if a child has it in their mouth all the time, then they it's it's hard for them to they have to keep removing it to talk. So, um Yeah. Yeah. That's that's when it becomes an issue, but otherwise, no, it doesn't cause a delay.

20:47 So, do you feel that the use of pacifiers and bottles to a later age has increased in India, or do you feel it's come down over the years? I don't think pacifiers are that widely used, um but bottles bottles, yes. Bottles, I think are Yeah. are you know going way beyond Way beyond. I struggled in fact with my little one. He was three and just wouldn't give it up, and it is a real struggle for parents, you know, getting rid of the bottle because the child is crying and then you're like you just take it.

21:24 But, um Yeah. I mean, the parents are torn between the right thing and the and the issue at hand at that point, right? It's very hard because with both my kids, after the bottle after I left the bottle, the milk stopped. So, they don't drink it. They don't drink milk. You know, last lockdown when my son was three, we got a puppy, you know, because of the lockdown. So, in front of him, I gave the bottle to the puppy, and that puppy was all over the bottle, AND HE SAID, "I'M NOT GOING TO THE BOTTLE AGAIN."

21:58 SO, I GUESS IT'S A test of creativity also sometimes what you do to stop that. Absolutely. So, so is there a dental connection? Should parents visit dentist to get, you know, a check done at two or three, you know, for speech related? So, the for a tongue tie, um For a tongue tie or lisp, yeah, I mean, So, if you do have a tongue tie, uh definitely, you know, and that's something pediatricians do see early on.

22:32 Uh you know, you should visit a dentist at some point to see if that's if your child has any clarity issues. Okay. Okay. Um you know, but not otherwise. Okay. All right. Um also, you mentioned somewhere, you know, a point about genetics. So, um if if you have late speech in the family, is is that also genetic? Uh like stammering, I mean, Yes, late talking does tend to run in the family, too.

23:06 Um you know, Okay. Yeah. Not clarity issues. Not clarity issues. No. No. So, Marzia, I want to come to a point about very, you know, uh it's it's come up in the national education policy also, a massive one on languages, right? So, today today parents are confused. Should we be introducing the mother tongue? Should we be speaking English so that, you know, by the age of three when the child goes to preschool, the child is confident?

23:38 Can we introduce two three languages at the same time? You know, you have the extreme uh on this end, and you're also like French me karado, Spanish me karado, local state ka language, five six languages. What is your take on absorption of languages in children because cognitively in early learning theory, you know, we do say that children absorb languages very fast. But from a speech point of view, what is your take on languages? So, it exactly like the early learning theory, you the younger they are, the more languages you expose them to, the more they pick up, which is great. Okay.

24:14 When a child has a speech delay, and then there are multiple languages, what we always say is that then let the person speaking the language be consistent. So, it's okay if the child is exposed to three or four languages as long as they're three or four different people speaking those languages. And it's not a person switching. I see. I see. And again, only when there's a delay.

24:45 In case of a delay, if the mom is speaking English, father is speaking Hindi, grandmother is speaking something, the person I mean, it's a man to man thing on language rather than Okay. Exactly. Exactly. Because otherwise, then it becomes a lot And kids who don't have this issue of you know, speech delays, then no issue in introducing multiple languages. But are there transliteration issues, grammatical issues, all of these things I presume can be corrected later?

25:18 And the thing is the child will always pick one core language. Like that will be their building block. Right. That will be the one they think in, and then everything else will build will build on that. Yeah. Yeah. So, So, dear parents, please drop your questions. You know, we've touched on a lot of topics, but I do want to open it up to parents to talk about their issues. One of the questions that Marzia, I'm seeing a lot is uh children who are nine and 10 and don't want to talk. Teacher is asking a question, don't want to reply.

25:59 Knows how to talk, doesn't want to. Uh stage fright, all I mean, I I this is all in the vicinity of older children, you know, seven plus, not wanting to talk. Yeah. What would you have to say about that? That is that age. I think there's just that you know, that's the age of I'm going You get them to talk till they're 20 now. YOU HAVE TO EXPLAIN. OKAY. OKAY.

26:30 SCREEN TIME. That's what I mean. What about screen time and speech delays? Is there a correlation, and what is your uh advice to parents on toddlers, zero to two, I mean, you know, infants zero to two, two to five. What is the recommended, you know, there are of course the WHO guidelines pre-COVID, but now during COVID, everything is online. Correct. And you know, but what are your recommendations on screen time, and does it have a an effect on speech?

27:04 Delays. It does. Um so, the thing with the thing with screen time is it's not that it doesn't have an the the way it has an impact is um I think it's just become an easier alternative for, you know, everyone to do instead of sing. Um It just takes away from that much interaction time that you could have with your child. It's not the same. So, hearing, you know, whatever, Twinkle Twinkle is not the same as singing it and making the actions. And your child seeing your expressions, seeing your mouth moves, seeing the actions, it's not the same when they're watching it on a screen or even hearing it through like a device. Um so, that's one, and the other thing that it really impacts screen time is attention.

27:55 Um because what happens is the more and more kids watch things, especially in the early years, and because things move so quickly and are so brightly colored, when they switch to normal life, it's hard to focus because that's too boring uh compared to what's going on. So, it's this draw of always then going back to the screen. A lot of parents tell me that they put on, you know, Peppa Pig and Ben and Holly's, or even nursery rhymes, and their kids are able to pick up English well from these videos as well.

28:32 So, is it's a little bit of a It is. Right now, I mean, Pro and con. It is. It is. It absolutely is. But the other thing is also, I get a lot of, you know, it's one thing to learn English, but the other thing I get a lot is also that parents say that they put on these videos and kids pick up, you know, shapes, colors, letters, numbers, all of those things. Yeah. But coming back to that academic language, and that's not the language we use to communicate. So, I always emphasize always always focus on if your child is young, first teach functional language, things that they need to get their day by. They don't need colors, shapes, and numbers.

29:11 They need, you know, the hi, bye, up, more, in, on. Communicating Yeah, I mean, getting what you are doing. Yeah. Yeah. Exactly. So, Okay. Yes. So, Marzia, another question on picky eaters. I'm sure this is a huge you know, problem area for a And you know, somewhere I do see connections of really picky eaters and delays in speech. Is there a connection, and what do you do about picky eaters, you know, um, sucking issues, um, you know, insist on, you know, being liquid feed, all a lot of these eating issues. Right.

29:57 What do you What do you think of that? Yeah. So, a lot of picky eating, um, is sensory based. It's actually the the body's system kind of overreacting to, uh, the, you know, change in texture or to the change in, you know, whatever in the food. So, basically, kids develop certain With picky eaters, they develop certain comfort foods. Uh, and then everything else to them is very like intrusive, and they want to not touch it or get rid of it. Um, so, you kind of work on desensitization. You help on desensitizing the mouth. You first start with desensitizing the body, then desensitize the mouth. So, we do a lot of sensory play and things like that, and then get to eating. Okay.

30:42 So, I see. And with the sucking and all that, we actually work on the muscles, you know, so we do like oral motor exercises, um, things like that to work on sucking cuz sometimes there can be weakness, sometimes there can be incoordination. Um, Until what age can these be corrected? Till what age? The picky eating one need to do with this? Picky eating, sucking, uh, all of that. so the sucking and all we work on early, like, by, you know, before one.

31:11 Uh, sometimes Before one? Yeah, sometimes if kids have, you know, any sort of, uh, developmental issue, they have cerebral palsy or, you know, things like that, then we're working on it later as well. Um, and picky eating, ideally, before five is good because by after that, they just become too set in their ways. Uh, to to to change the eating habits. Absolutely. So, Yeah. So, Marzia, what about What about, uh, you know, children on the autism spectrum or, you know, like you spoke about children with uh, other developmental issues which have been identified? What about, you know, so we do have a lot of parents, uh, you know, who are struggling with, uh, children in, you know, with those disorders as well. Um, can you talk a little bit about what what all, uh, what all happen What are the different kind of disorders where speech becomes an impediment?

32:07 So, I mean, so kids on the autism spectrum, um, kids with any sort of syndrome, uh, you know, any, uh, Down syndrome, there's Angelman syndrome, there are lots of different syndromes, kids with cerebral palsy, all these kids tend to have, uh, you know, and kids with learning disabilities tend to have, you know, speech and language difficulties. Um, sometimes kids are nonverbal, and, you know, that was bring me back to a setting up a communication system. So, a lot of what we do is set up alternative ways then to communicate. So, we use a lot of technology, we use a lot of assistive apps, um, so that a kid can use something else to communicate if not their speech.

32:51 Um, Um, so, and and these things What should parents do, Marzia, right now in the lockdown? You know, there's so much of a struggle getting to a, you know, an expert and book appointments. What should they do? What should they do? Um, are there Are there any I mean, maybe your website? They can visit your website for some information. There's a lot of tips for parents on what they can do at home to encourage speech and language. Uh, you know, a lot of what I've explained, um, and, uh, yeah, that's what they can do at home with toddlers.

33:26 All right. All right. Okay. So, okay, there's one quick question. Sippy cup or straw cup? Is there any preference? Straw. Graduating from a bottle? Straw. I'd go straight to a straw. Yes. Okay. Uh, All right. So, last, we'll take a few more questions. Please enlighten about tongue tie. Um, so, the tongue tie, like I said, you know, you There are many kids who have a tongue tie. Uh, Okay.

34:04 depends on where the tongue tie actually is. So, there are many different kinds of tongue ties. Um, but, uh, if it's very severe, it will impact the child's feeding. They will have trouble sucking, they will be drooling, uh, they may have trouble chewing. So, you know, with that significant a tongue tie, the pediatrician is going to point it out and tell, you know, the parent to do something about it. Okay. Um, the the less obvious tongue ties, okay, sometimes, later, a child may have trouble saying certain sounds.

34:36 Um, and it's a very distinct speech pattern. Then you know, okay, it's not, uh, you know, it's not due to, uh, simplification of the sound. It's They're They're genuinely having trouble getting their muscles to move to say it. I see. I see. Um, All right. And then in which case the tongue tie should be corrected. So, all of these issues we spoke about, are they all 100% treatable? And do they need, you know, consistent intervention or, uh, you know, is there a magic pill? You do one thing and you sort it. How does it work?

35:14 So, sound errors, when a child is speaking totla or what, you know, not saying certain sounds clearly, those are completely correctable. Um, when kids stammer, that's, uh, you know, it's something that can be managed. You teach the child how to control it through therapy. Um, it's it's something that's, you know, stammering, like I always say, it's not a disease, it's a condition. It stays with you. Um, so, it's something that, you know, you learn how to control, you learn how to manage, and still at times when emotions are very high, you still may have a slight stammer.

35:48 Uh, Okay. So, that kind of stays. And then, you know, with everything else, like for kids who have a delay and all, yes, all those things can definitely be, you know, worked on. And the earlier they're worked on, the faster they get worked on. Um, and then with other things, you know, if there is, you know, a developmental issue, then therapy tends to kind of be more long term. It's okay. So, when you say long term, I mean, how how How much could therapy So, last? So, I I mean, ideally, you should, if you start it early, do it till school going So, usually, how we progress is if we're working with a child that's going to go into like a mainstream school, you work with the child until they kind of hit school age, after which they may then require some academic help.

36:44 Uh, you know, so they may may require like a special educator or something. They may. They may not. Um, if they were going to go into a mainstream school. Uh, if you work with a child who is not able to go into a mainstream school, then you work on like life skills, and you get, you know, as functional as the child and as independent as the child can get in their daily functioning. And then you kind of wean off therapy.

37:11 Okay. Okay. All right. Dear parents, lot of you are asking about correct pronunciation and grammar. So, that is that's beyond, uh, speech, right? That is something through reading good books, talking correctly, exposing children to, you know, good language. That is something over the years children will pick up, and those are not really speech defects or speech issues. Right. So, you know, I think, you know, parents, you know, please do differentiate between, uh, having a problem speaking and, you know, your language proficiency, as it were, or fluency, which is a different thing.

37:51 Um, and, uh, you know, finally, I think the red flags are something, you know, what happens is most parents, we we develop I think when you live in at home, you know, there are blind spots that we all develop. Developmental delays, whether it's speech or non-speech, I think, uh, you know, parents, if you're able to spot it earlier, that's how the therapists are also able to help uh, solve, uh, you know, these issues because like Marzia told us that there are these bench you know, these milestones and cutoffs. So, you know, all of you who have children in that age group and have concerns, do maybe read up about it, visit, uh, Marzia's site, which is the Marzia, can you tell us your site and again and where they can check out all the information? It's sdlc.co.in.

38:48 sdlc.co.in. I'll just put it in the chat. Um, I'll again add it into the post copy later. So, you know, they can read up, and I think the important thing is to understand those points and then Yeah. Yeah. Yeah. Marzia, this was absolutely lovely. So many questions, and you know, you are so crystal clear with, you know, what what needs to be done. No wonder you're one of the best in the country today. Um, what are your parting words to all our parents, uh, you know, who have who have been doing a fantastic job last 1 and 1/2 years with their children? Your advice, your freewheeling thoughts to our parents.

39:37 Um, okay. The the My last parting words would be for toddlers especially have fun with your child, play with your child. That's when they learn the most language. Don't worry about teaching them. Don't teach and don't tell them to say it. Just have fun and they will start repeating after you. Um so yeah, otherwise it becomes very stressful. You know, parents feel like we have to keep teaching. Um but you don't.

40:09 Yeah. But yeah. Toddlers learn the way they learn is play. Yeah. The method of learning for toddlers is through play. Of course, you know, parents are struggling with writing and all of that which is a completely different issue. Yes. Yes. Yeah, that is that is in fact three plus. Three plus, you know, they they get into a little bit of a rigor and you know what schools expect and all of that. But Mazia, this was really really helpful. So many of these, you know, they play on parents' minds, you know, the stammer, the list, the delay, not talking, you know, two plus ho gaya, four plus ho gaya, they're not talking.

40:47 What can we do? The frustration of the parent and the frustration of the parent transfers onto the child as well. And you know, and then there's this whole social stigma within the family. Ye bacha baat kar raha hai, ye abhi tak nahi baat kar raha hai. All of those. So Absolutely. So thank you so much, Mazia. I'm so many messages saying this is one of the best sessions and so so useful. You know, um thank you so much again. I'm going to uh you know, all parents, I'm going to tag SDALC and their contact numbers where you can call their clinic for consultations or any uh you know, you want to get into in touch with them.

41:33 So you can do that and see you soon, dear parents. Take care. Stay safe. Unlock is on, but you need to continue to be safe. Right, much love. Thanks, Mazia. Talk to you soon. you. Thank you. Bye.