ISELIN, N.J. — Little Charlie Kanter wanted the puzzle.
The 2-year-old smiled from under his mop of blond hair and leaned forward in his chair. But his toddler arms couldn’t stretch far enough across the wooden table to reach the colorful farm animal pieces.
So Charlie, born in March 2020, had to do something that should be easy for a boy his age.
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Speak in a full sentence.
“I,” began Diane Manahan, Charlie’s speech therapist.
“I,” Charlie shouted back.
“Want,” Manahan said, leaning closer to show how her lips moved with each sound.
“Mutt,” Charlie said, trying his best to mimic her.
“Puzzle,” Manahan finished.
“Puzz-lllllllllllllllllle,” Charlie said gleefully.
As Charlie celebrated during his speech therapy session earlier this year, Nancy Polow fretted in her office down the hall. The South Orange boy, who was barely speaking at 18 months, is part of an alarming trend in children born during or shortly before the coronavirus pandemic, she told NJ Advance Media.
“I have never seen such an influx of infants and toddlers unable to communicate,” said Polow, a Millburn-based speech pathologist with more than 45 years of experience. “We call these children COVID babies.”
The pandemic’s staggering toll on the physical and mental health of adults has long been clear. But its lingering impact on our youngest is only beginning to come into focus.
Babies born during the pandemic are talking later and saying fewer words, according to a growing body of academic research. Speech problems are also cropping up in preschoolers whose early social needs were put on the back burner during the chaos and fear generated by COVID-19, speech and health experts told NJ Advance Media.
“The crucial stages of early brain development rely on a lot of social interaction and a lot of stimulation,” said Janice Prontnicki, director of developmental and behavioral pediatrics at Rutgers New Jersey Medical School. “With COVID, a lot of that was just knocked out.”
Speech is only one area where children are lagging since the pandemic. Verbal delays are often the first sign of broader developmental issues. Yet Polow says she’s working with an increasing number of young children who are hitting every developmental milestone except for one — talking.
“There’s not anything else wrong, other than they lost out on the socialization,” she said of kids like Charlie, who are pouring into the Suburban Speech Center, the office she runs above a Millburn strip mall.
The children are showing the consequences of closed day cares, overwhelmed parents juggling remote work and months without visits from grandma and grandpa, Polow said.
“Parents do feel guilty, and I think their biggest question that they are asking is, ‘Should I have come sooner?’” she said.
As worried parents sought help, they quickly learned the pandemic created new barriers to high-quality speech therapy. Masking restrictions. Fear of in-person therapy. The challenge of telehealth for cranky, disinterested toddlers. And, in some cases, more competition for a scarcer supply of appointments.
The state’s early intervention program, which provides free or low-cost services for children under 3, was flooded in late 2021 with a 20% increase in monthly referrals as babies born at the outset of the pandemic began turning 18 months old.
“It’s scary. It’s sad,” said Jennifer Kuhta of Basking Ridge, whose daughter was 5 months old when the pandemic hurled their lives into disarray. “You want them to progress.”
Many families turned to private therapy, which can cost more than $1,000 a month. But low-income families have fewer options and struggled to overcome roadblocks to get help, said Ediza Lahoz Valentino, a social worker at the Jane H. Booker Family Health Center in Neptune.
“Some of them don’t have access to a computer or a tablet or a smartphone to be able to access therapy virtually,” Lahoz Valentino said. “That in itself was challenging.”
Born into isolation
When Emma Tessier and Luke Kanter were expecting, everyone had the same advice: It takes a village.
The couple planned to hire a nanny to help with Charlie, their first child. Tessier’s mom was going to fly in from Iowa for extra support.
But three days after Charlie was born, the World Health Organization declared the novel coronavirus outbreak a pandemic. Society shut down. Charlie’s parents holed up inside their Brooklyn apartment as the weeks turned to months.
“Outside of us, he had no interaction with anybody,” said Tessier, who was on leave from her job in marketing.
Charlie’s other grandmother, who lives in Princeton, held him for the first time when he was 3 months old. But even after the family moved to South Orange in August 2020, the happy, blue-eyed boy practically lived in a bubble.
At Charlie’s 1-year checkup, the pediatrician said the toddler should be saying at least five or six words.
He said zero, unless you count “uh-oh.”
“He never had to learn, like, ‘hello’ and ‘goodbye,’” Tessier said, “because he was always with us.”
Charlie’s parents decided to wait another six months — his next scheduled pediatrician visit — to see if he would catch up.
Charlie is far from alone, according to research published earlier this year. Children born nine months into the pandemic produced “fewer coos, grunts, babbles, and other precursors to speech,” according to a study from the LENA Foundation, a nonprofit that works to accelerate language development in toddlers.
A Brown University study also found children born during the pandemic had weaker verbal skills. Both teams discovered children from lower socioeconomic families fared the worst.
The reason for speech delays? Fewer interactions with adults, researchers suggest.
Babies born during the pandemic or shortly before faced unprecedented challenges in developing speech, said Prontnicki, who evaluates children with developmental conditions through the Rutgers New Jersey Medical School’s faculty practice.
Some day care centers for infants and toddlers were closed for an extended period, limiting interaction with teachers and other children. Masking, a key safety measure to prevent the spread of COVID-19, blocked children from seeing facial expressions and learning how to mimic words and sounds, she said.
Parents were stressed by an unprecedented crisis. Priorities shifted to vying for toilet paper. Disinfecting groceries. Doomscrolling social media for news from the outside world. As they juggled work and virtual school for their older children, their babies’ social needs receded to the background.
“Realistically, a lot more children under the age of 1 were sitting in front of screens for a longer period of time,” Prontnicki said. (The CDC recommends no screen time at all for children under 2.)
Autism and many other conditions affecting speech typically aren’t diagnosed until children are older. It created an agonizing guessing game for families. Is their child behind because of the pandemic? Are other developmental factors at play? How long should parents wait for words to come before getting worried?
For some toddlers, the pandemic may have exacerbated speech problems that likely already existed.
Kuhta’s daughter, Sofia, was the center of her world when she was born in October 2019.
But when the pandemic hit, Kuhta suddenly had her twin first graders home for virtual school. The stay-at-home mom bounced from one room to the next, trying to help the boys stay on task, she said.
Sofia was in a crucial stage for learning speech and language skills. But Kuhta couldn’t give her daughter the attention she deserved, she said.
“She would always have a pacifier because I would have her quiet a lot,” Kuhta said. “Kids are supposed to start making sounds at 1 … And I noticed she just wasn’t doing all that.”
Kuhta put Sofia, a tall, blonde girl with a big personality, in speech therapy at the Suburban Speech Center shortly after she turned 2. Sofia was later diagnosed with apraxia of speech, a neurological disorder that affects the brain’s ability to plan and sequence sounds.
Approaching her 3rd birthday, Sofia is repeating short sentences, such as “I want baby,” and mastering words such as “mommy,” more complicated alternatives to words that repeat the same sound twice, like “mama.”
Kuhta feels fortunate.
What if she had waited longer to get help? What if she hadn’t insisted on in-person, maskless therapy sessions?
“I don’t think she’d be anywhere (close to) where she is right now,” Kuhta said.
Barriers to help
When Charlie was still struggling to express himself at 18 months, his parents turned to early intervention.
Like many children needing help during the pandemic, Charlie participated in a virtual screening. But his parents immediately questioned how much anyone could learn about their son from his ability to interact through a screen.
So he didn’t play virtual peekaboo with a stranger? Is that an indictment of the child or the system itself, they wondered.
“It just didn’t sit well with me,” Tessier said.
At its best, early intervention is a lifesaver for families who need special services, helping nearly 30,000 children a year. But the pandemic rocked the program in 2020 and then stretched it to its limits in 2021.
The service went virtual between mid-March and September 2020. The move to telehealth was designed to help contain the spread of COVID-19, but left some families feeling abandoned.
Laura Slyfield’s twins, Thaddeus and Magnus, had just turned 1 when the pandemic hit. Slyfield, a special education teacher, knew they were behind and needed speech therapy.
“I’m sure anybody who’s had a 1-year-old before is like, ‘I’m not going to have my 1-year-old do Zoom speech therapy, because it’s just not going to work for them,’” the Montville mother said.
She enrolled her children in private therapy instead at the Suburban Speech Center.
Referrals to early intervention dropped during the initial stages of the pandemic, said Nancy Kearney, a spokeswoman for the state Department of Health.
Demand gradually returned to normal in early 2021 and then spiked as more babies born near the outset of the crisis hit 18 months old. Between November 2021 and April 2022, the statewide program saw a surge that added about 100 child referrals per month over pre-pandemic levels, Kearney said.
Requests for screenings soared at the regional office at Rutgers University-Newark, including from many families who said their children hadn’t been going to the grocery store or library, seeing neighbors or interacting with other children at day care, according to program manager Doreen Glut.
“This past year is probably the highest that I have seen in years,” she said.
New Jersey allowed in-person speech therapy to resume through early intervention in the fall of 2020, but trepidation lingered on both sides. Between September 2020 and March 2021, about 80% of early intervention services were provided via telehealth, Kearney said.
Twins Sam and Max Toplansky-Hoenig started virtual speech therapy through early intervention in March 2020, when they had just turned 1, according to their mother, Debbie Toplansky. They weren’t offered in-person therapy until February 2021 at the earliest, the Union Township mother said.
The therapist tried hard to help the “tiny human tornadoes” on the computer screen, Toplansky said. But progress was minimal after one year of online therapy. She turned to private, in-person sessions at the Suburban Speech Center.
“We made more progress in one day at our first in-person session than we had basically in the whole year,” Toplansky said.
Other barriers hampered families.
Masking requirements remained in place until March 2022. Many therapists wore clear masks or face shields, Kearney said, but the concept of masks during speech therapy was a turnoff to some families.
Early intervention is typically “phenomenal,” said Lahoz Valentino, the licensed social worker. But she watched many low-income families struggle to get timely help in 2021.
Some families had to wait longer than usual to get started, likely due to higher demand. But there were additional challenges for families whose children do not speak English as their first language or lacked technology for telehealth. And some parents still didn’t feel comfortable inviting someone into their home to work with their unvaccinated children.
The early intervention program has a lending library to help families access telehealth, Kearney said. But families faced “a lot of layers of challenges and barriers,” said Lahoz Valentino, who’s embedded in the Neptune pediatrician’s office through HealthySteps, a grant-funded program run by Hackensack Meridian Health.
Few pediatrician’s offices in New Jersey — or beyond — are equipped with a social worker. Many of the families Lahoz Valentino worked with might not have stuck it out if she weren’t involved in the process, she said.
And private therapy, either in-person or virtual, simply wasn’t an option for the patients Lahoz Valentino supported.
“They don’t have the resources to pay for thousands of dollars worth of therapy,” she said.
So those families slogged through telehealth for months while others turned to private, in-person therapy.
Sofia’s twice-weekly sessions cost $165 each and are partially reimbursed by insurance, Kuhta said. But her share of the bill isn’t always the same — it’s based on a fair market value calculation — and the price adds up.
“Financially, it’s a burden,” Kuhta said. “I’m not gonna lie.”
But not enough to slow demand.
Facing an influx of clients under 3, Polow hired three new therapists. She started opening 30 minutes earlier and closing 90 minutes later.
She even added Saturday hours for families who couldn’t get an appointment during the week.
“We have never been so busy,” Polow said.
Charlie now speaks in full sentences, asks and answers questions and greets strangers with an enthusiastic “Hi!”
After 10 months of speech therapy, he is about to graduate out of his sessions because he meets all the developmental milestones for children his age.
“He’s a talking little boy,” Kanter, who works in tech, said proudly. “It’s going really well.”
The early intervention program has largely returned to its pre-pandemic operations, Kearney said. About 80% of services are face to face and offered in homes.
In virtual therapy, parents are trained in strategies to help their children, such as imitating another person’s enunciation and learning to have back-and-forth exchanges in conversation, Kearney said.
It doesn’t take long for a child to catch up if they have no other developmental delays, Polow said.
She predicted in April that Charlie would be back on track within a few months. By summer, he was — like many of the other “COVID babies” whose families sought help.
“If we get them young enough, then they become age appropriate,” Polow said. “Then they reach their milestones.”
But experts agree many other children slipped through the cracks, not only with speech delays but autism and other developmental issues.
Babies were spending less time around grandparents and child care providers, who might have noticed a delay or confirmed a parent’s fears, Prontnicki said. Many families put off seeking help for a variety of reasons related to the pandemic.
“We were missing kids that should have been picked up sooner,” she said.
The Suburban Speech Center is still seeing “lots and lots” of COVID babies, Polow said. It’s also seeing an increase in what she called “COVID children.”
They are kids who missed two years of preschool or spent their entire kindergarten year in virtual learning. When the masks came off and they returned to in-person learning, they struggled to differentiate speech sounds, which weakened their reading and spelling, Polow said.
Now, they’re in elementary school and still saying “wellow” instead of “yellow” and struggling with articulation, she said.
Before 2020, you might see this with children who sucked their thumbs, suffered hearing loss or were diagnosed with apraxia.
“But now we’re getting children coming in just because of COVID,” Polow said. “There was nothing else we could find.”
© 2022 Advance Local Media LLC
Distributed by Tribune Content Agency, LLC
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