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What Health Care Providers Need
to Know
When health care providers and their young patients don't speak the same
language, assessing language development is, of course, more difficult.
The way that expressive language develops in bilingual children may vary
from that in monolingual children. Children whose primary language is
not English are more frequently misdiagnosed with cognitive delay or
learning disabilities, and more likely to receive inappropriate
interventions or educational placement.
Health care providers need to know:
Language development in bilingual children A child who is born into a family in which adults speak different
languages (for example, if the mother speaks English and the father
speaks Chinese) often simultaneously learns more than one language from
the day they are born. Another bilingual child may learn one language
first, in the home, and another later on when the family moves to a new
country. Whether language acquisition is simultaneous (as in the first
example) or sequential (as in the second) will affect the child's early
expressive language development.
An infant's receptive language development typically starts with
responding to noise, then to names, and then to simple requests (Look! Sshh. No!).
Early expressive language milestones are typically babbling, cooing,
laughter. Next, the child begins to use words. Typically, children begin
with single words, and then combine them to make phrases and simple
sentences. Research into early bilingual exposure Research suggests that, contrary to folk wisdom, exposure to more than
one language in early life provides a number of advantages, and doesn't
confuse or otherwise negatively affect a child's overall cognitive or
language development. Research has also demonstrated that the way the
brain processes language depends upon how old a child is when learning
that language. The development of expressive language in children who
learn two languages before they are three years old differs from that of
children who acquire a second language when they are older than three.
The development of receptive language, however, appears to be the same
for both groups. Simultaneous bilingualism. A child younger than three who is
simultaneously learning two languages may, at first, mix the elements of
the two languages together: "Deseo little perro, Mommy." Over time, the
child will separate the two sets of language codes, and will use each
language appropriately. This separation process usually takes place
early in the child's language development, and will depend in part on
how the two languages are used in the home. Sometimes during the period when the young child is making the
transition to the separation of language codes, an apparent, slight
delay in expressive (but not receptive) language may be noticed. This is
not true delay, but cases exist where this has led to a misdiagnosis of
overall language delay. Sequential bilingualism. Although language development varies, children
who are introduced to a second language later in childhood typically
follow this pattern:
Phase 1 - Child uses only the primary language.
Phase 2 - Non-verbal period; child rarely speaks in either language;
mimicry, frustration, and non-verbal communication occur.
Phase 3 - Child quickly acquires the second language, and uses both
languages. Again, during the non-verbal phase, a child may be misdiagnosed as
having overall language delay. If a health care provider has concerns
regarding speech-language delay, they should refer the child to a speech
and language pathologist who has experience evaluating bilingual
children. Your local Area Education Agency can direct you to a qualified
speech-language pathologist. Requesting that ESL (English as a Second
Language) staff participate in an assessment may also be helpful.
Screening language development In a health care setting, the screening of language development in
bilingual children should begin with gathering a full health history.
Using a translator is often very important at this stage. Factors that
are especially relevant to assessing language development include:
Psychosocial aspects of bilingualism It is important that children be proud of themselves and their culture;
language is often a key component of a child's cultural identity. For
families who would like their children to be bilingual, the health care
provider can assist by encouraging the parents to: Use both languages at home. Parents and caregivers may also welcome information about adult
education in English for themselves, to prevent language issues from
separating older and younger generations. Resources Other valuable resources include:
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