I have a new student (age 4) on my caseload with nasal emission only on the /dz/ (like Joe) in the initial position. I don’t know if that warrants a referral to the primary care physician (who would refer to an ENT if concerned) or not, since it’s just the one sound in one position. I also don’t know where to start with therapy (assuming its habitual and not medical).
To Refer:
If nasal emission is phoneme-specific and the child is able to say other sounds without nasal emission, then it is probably an articulation problem only. If it were me, I would probably try therapy first and if there was no progress after a while, refer to primary care or ENT.
How to Treat:
- Find the closest sound that the child can do without using nasal emission (“ge” like in beige, “sh”, “s”, or /t/)
- If he can do, “ge”, get him to put his tongue up like he’s going to say the /d/ sound and then push it out
- If he can only do “sh”, try to turn on voicing for the “ge” and then do the above step
- If he can only do /s/, work on moving the tongue back or rolling the tongue tip down to go from /s/ to “sh”
- If he can only do /t/, get the /s/ sound using the “exploding /t/ technique”
