INTRODUCTION
Speech and language delay in children is a common presentation to primary care either directly to the GP or through the health visitor, affecting approximately 6% of pre-school children.1 Young children, particularly those with speech delay, can be difficult to examine. Differentiation between an isolated pathology and those with concurrent global developmental delay is crucial. This article presents an example of a common case, considers the learning points, and highlights management principles.
CASE HISTORY
A 2-year-old boy presented to primary care with fewer words than his peers, and with difficulty in non-family members understanding him. On closer questioning he had <10 words of speech. He was born at 39 weeks by normal delivery, not requiring special care baby unit, and passed his newborn hearing screening. Review of his Personal Child Health Record (red book) showed consistent growth along centile lines, and other developmental milestones attained. In the consultation room he played appropriately, made good eye contact, and followed instructions: identifying his nose and ears when asked. On examination, he had normal facies, and otoscopy revealed bilateral dull tympanic membranes.
Referral to audiology was made and age- appropriate free-field hearing testing with tympanometry performed. He had hearing thresholds of >40 dB (mild-to-moderate hearing loss) with flat tympanograms indicating a conductive loss in keeping with otitis media …
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