My seven-year-old can’t speak fluently. Is it normal?

Dr Flo,
My seven-year-old son does not speak fluently; he only says some words in Kiswahili. I have been told this delay is normal. He is also very forgetful. His teacher has a problem with this since he is falling behind in class work. What is the problem? Please advise me on the way forward.
Mwikali

Dear Mwikali,
By four years, a child should have more words in their vocabulary than what can be counted (more than a thousand). He should also be able to tell a story, and make sentences with four to five words, identify colours and shapes, name some body parts and ask questions. At seven years, he should be able to read and write and tell time.
Delays in development of speech could be due to oral-motor problems (structural problems in the mouth) like cleft lip and palate, or tongue-tie, which would impair word formation. It could also be due to hearing problems or due to neurological problems like cerebral palsy, brain injury, among others. It can also be due to developmental disorders like autism spectrum disorder and mental retardation. It could also be due to other disorders like auditory processing disorder (where there is a problem with understanding speech sounds) or speech apraxia (difficulty in carrying out speech movements). Another cause of speech delay is severe environmental deprivation – no one talks to the child for prolonged periods of time, or the child is neglected or abused. Forgetting easily may be due to a problem with understanding, paying attention or being easily distracted.
Since your son has only a few words, he is behind his peers and he also forgets easily, he needs to be evaluated by a paediatrician, ENT specialist and by a paediatric psychiatrist so as to find out the exact cause of the problem. Depending on what the diagnosis is, you will be advised on the best course of action. He may also benefit from working with a speech therapist.
At home, spend a lot of time communicating with your child. Talk to him, play games with him, read to him, sing with him, use gestures together with words; describe activities, items, and feelings. Look at him when talking to him and when he is communicating back, give him a lot of time to respond. Ask him questions and also encourage him to tell stories. Let him interact with other children his age.

Dr Flo,
I have lower abdominal pain and it has been two months since my last period. What could be the problem?
M K

Dear M K,
The menstrual cycle is different for every woman, but menses can occur every 21 to 42 days, and can last from two to eight days. A period is considered to have been missed if it has been more than 42 days since your last one. The menstrual cycle occurs due to changes in the levels of the hormones oestrogen and progesterone, causing the different phases of the cycle. If something causes a problem with these hormones, then there is a hormonal imbalance and the cycle is disturbed.
The most common cause of missing periods, and possibly low abdominal pain, is pregnancy. Other possible causes include breastfeeding, using hormonal medication, stress, too much exercise, severe weight change (losing or adding a lot of weight), thyroid disease or polycystic ovarian syndrome.
You need to visit a gynaecologist so that you can be examined and some tests such as hormone levels and a pelvic ultrasound, will be done. These will help to figure out the exact cause of the missed periods, so that you can be treated appropriately. If you are pregnant, it would also be good to know the exact location of the pregnancy, since an ectopic pregnancy can be life threatening and is a medical emergency.

Dr Flo,
I have been hearing some type of noise from my ears. The noises are louder when I am sleeping. What should I do?
Edwin

Dear Edwin,
Hearing sounds within the ear is referred to as tinnitus. The sound may be ringing, buzzing, humming, hissing or even beating in time with your heart (pulsatile tinnitus). In many cases, it is mild and disappears on its own. In severe cases however, it may be accompanied by hearing loss, dizziness and poor concentration.
Tinnitus can be caused by an outer ear infection, or by a buildup of wax in the ears. You need to see a doctor to get examined, so that in case of an infection, it will be treated, and if there is wax, it will be cleaned out.
Tinnitus can also result from exposure to loud sounds and you may notice your ears ringing or buzzing after you leave a concert, after alighting from a matatu that had very loud music or when you remove ear/headphones after listening to music at a high volume. Sometimes repeated exposure to loud sounds causes damage to the inner ear and recurrent tinnitus.
It can also occur due to advancing age with hearing loss, especially after 60. This type of hearing loss is called presbycusis. It may also be due to inner ear cell damage, a middle ear infection (otitis media), ear injury and other diseases like otosclerosis, Meniere’s disease, thyroid disease, heart and blood vessel problems, brain tumours, nerve problems, and some medication.
Wear ear protection if you are in an area with loud sounds and turn down the volume, especially if you use headphones. It would be good for you to see an ENT specialist for further investigation.
Manage stress, avoid noisy environments, and also avoid coffee and smoking. Playing soft music or radio static when you are in a quiet environment or when you are sleeping may help to mask the noise. Also, reduce alcohol consumption because alcohol increases blood flow, especially in the inner ear. If you have high blood pressure or other blood disorders, they should be properly managed. You may benefit from some medication prescribed by a doctor to reduce the symptoms. A masking device can also be given to reduce the discomfort.

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