When your child's speech delay is a red flag

Dear doctor,

My three-year-old boy has delayed speech. He also likes focusing on one object and gets angry when one takes it away. In case he is denied what he wants, he hits his head on the wall and I am worried that he could sustain injuries. Could he be autistic? Also, how can I help him develop speech?

Dear parent,

First, all children develop differently, and a delay is not always an indicator of a problem. Secondly, because of differences in personalities, children have different likes and dislikes, and different behaviours. It is also normal for toddlers to express their frustrations through tantrums, especially because they may not be able to express their emotions well. However, when you are concerned, it is best to have the child assessed so that you are aware exactly what is going on and the best way to deal with it.

It is advisable for your son to be assessed. This is best done by a team that comprises a paediatrician, a developmental specialist, a psychologist, a teacher and the parent. The parent, the teacher or the doctor may be the first person to raise a concern. The boy can be reviewed by a paediatrician, who will also get information from you and the teacher (if the child goes to school) so as to have a more comprehensive view of the child’s abilities, challenges, strengths and weakness. There are different assessment tools that may be used to assess for autism and any other disorders. The child can also be assessed for free or at low cost at the Kenya Institute of Special Education.

In the meantime, here are some considerations in addressing the current concerns:

- Frequent communication - Talk to him in the course of daily activities and describe activities, items and emotions as much as possible. Use gestures in addition to words, ask him questions and as much as possible, be at the same level with him and look at him when talking, and when he is communicating, give him time to express himself and ask questions to clarify. Also play together, sing with him and read to him. Interacting with children his age will also stimulate communication.

- Consistency – provide as much structure as possible and accommodate the child’s needs like activity, learning, sleep, hunger, fatigue, among others. Changes in routine or discomfort with the physical surroundings ( such as noise, light) or social surroundings can cause disruptions and lead to a tantrum.

- Behaviour management - You can anticipate and prevent (or reduce) negative behaviour for example by providing small alternatives or distractions or small choices such as choosing between two toys of interest, or whether to brush teeth before or after showering. You can also give prior warning before a change, for instance, saying that it will be time to stop playing five minutes in advance, with a reminder after two minutes and then following through when it is time. Reward good behaviour with praise, attention or a pat, or any other reward. Avoid rewarding negative behaviour such as giving a lot of attention or giving in to his demands as a result of negative behaviour.

- Managing tantrums – maintain your cool, move the child to a safe space and give them time to calm down. Afterwards, depending on the child’s developmental capacity, you can talk to him about what happened and how to avoid it next time. Developing the ability to communicate can significantly reduce the number and severity of the tantrums. Also, address any other underlying issues like hunger, fatigue and environmental change.

- Screen time – it is advisable for children to have limited screen time. This can be scheduled, for instance having access for only 30 minutes a day, or during specific time periods over the weekend. You can also regulate what the child watches - some devices have a time-out feature. You can also make the screen time more interactive by watching together and discussing during and after.

Hi doc,

For about three weeks now, I have been having pimples, which are hard to pop, on my pubic area all the way down to my rectum. At first I thought they were aftershave bumps and would disappear with time but that hasn't been the case. The bumps are, however, not painful, apart from one that I popped yesterday. Please help. I am now getting scared and concerned.

Dear reader,

The pimples in the pubic region may be due to several causes. One is folliculitis, where there is inflammation of the hair follicles. The other possible cause is contact dermatitis, caused by allergic skin reaction to irritants like hygiene products, detergents, personal lubricants and body fluids. It may also be due to hidradenitis suppurativa, a chronic inflammatory skin condition, usually occurring in areas where there’s friction due to skin rubbing together. Other possible causes of pimples in the pubic region are infections like genital warts and genital herpes.

It is advisable for you to be reviewed by a health care worker for examination and diagnosis. Maintain good hygiene, avoid any irritants and avoid popping the pimples. Depending on the identified underlying cause, you may be given oral and/or topical medication. If the underlying cause is a sexually transmitted infection such as genital warts and genital herpes, it is advisable for your sexual contacts to also be treated, and also to avoid transmission by practising abstinence during treatment.

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