Developmental and Behavioural issues in Children

Child Health

By Dr Shan Narayanan

In the past one year, I have been writing mainly on medical issues in children. Beginning this month, I will be focusing on Developmental and Behavioural issues in Children. In this article I introduce, briefly, two topics, Speech and Language Delay/Disorder and School Refusal. I will write in detail in coming articles.


Speech is the sound of the actual spoken language. It involves articulation and phonology, voice and fluency.

Articulation is the making of sounds. Phonology is the sound system of the language and the rule of sound sequences that make up words. Voice is the quality, pitch or loudness of the sound. Fluency is the rate and rhythm of the flow of speech.

Language is used to communicate. It is a system of verbal, written and gestured symbols that enables communication. Language can be divided into content (meaning of message), form (grammar and syntax) and use (use of both verbal and non-verbal language).

Speech and Language develop in a sequence. When the sequence is right but late, it is called delay. When the sequence is abnormal, it is then called disorder.

About 5% of preschool children have some form of speech and language delay. When there are concerns of a child’s speech and language, parents should consult a Paediatrician and a Speech and Language Pathologist. As a support to parents and caregivers, we are organising the following workshop:

By Ms Farah Azlina Mohd Alkaf, Speech & Language Pathologist
Date & Time:  8th November 2014 from 2pm to 6pm
Venue:  Conference Room, Hospital Fatimah
Fees:  RM80 per person or RM140 per couple
Contact:  Ms Santha 05 546 1345


School attendance is mandated by law. School refusal is a behavioural disorder. It is characterised by a child’s refusal to go to school on a regular basis or has problems  staying in school due to emotional distress.

The prevalence of school refusal in western countries is about 1 to 5% of school aged children.

School refusal behaviour can be due to:

Avoidance of fear/anxiety producing situation at school.

Presence of underlying anxiety disorder, depression, sleep disorder, panic disorder or separation anxiety


Attention seeking from parents or others important to the student.

Avoiding lessons, presentation and tests.

When children refuse school, immediate attention is necessary to avoid negative academic, social and psychological consequences to the child and his family.

As a support for Parents, Caregivers and Teachers we are organising the following seminar:

By Mr David Hong, Family Therapist
Date & Time:  5th November 2014, 7pm to 9.30pm
Venue:  Conference Room Hospital Fatimah
Fee:  Free.    Contact:  Ms Susan Lim 05 545 5777
For more information, call Dr Shan’s clinic at Hospital Fatimah 05 546 1345 or email
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