Learning to connect thoughts with words can be a difficult process. Children often stumble over words, or say "uh," "um" and "er." Sometimes the problem develops into something more serious, such as a stuttering problem.

Ellen Kelly, an associate professor of speech and language pathology at Purdue University, says parents should be aware of certain signs which may indicate a stuttering problem.

"If you hear things like, 'la-la-la-la-like that,' or 'I-I-I-I-I-I,' or 'm-m-m-m-mommy,' keep an eye on it. Even if it's very mild, just keep an eye on it," she says.

Parents also should look for facial grimaces, because children feel like the words are getting stuck in their throat or mouth when they stutter. Kelly says some kids say they have a frog in their throat when they stutter.

When and Why Does It Happen?
During childhood development, an estimated five to 10 percent of all children will go through a stuttering stage. This stage usually occurs during the ages of 2 and 5. The onset could occur well after the preschool years, up to age 7.

"The average age of onset is 4, and it tends to be earlier in girls than in boys," Kelly says. "This could be because girls develop language earlier than boys."

According to the Stuttering Foundation of America, stuttering affects four times as many males as females. But researchers, after years of testing, do not know what causes stuttering. They do believe that stuttering results from a combination of genetic and environmental factors.

"We think there is something inherited," Kelly says. "In at least 50 percent of people who stutter there is a strong family history of stuttering, especially in those people for whom it becomes chronic or long term."

Many people believe that a traumatic event or high stress can cause stuttering. Although it is unlikely, a traumatic event or stress could cause stuttering. "It is rare for stuttering to be caused by stress or trauma but certainly that can trigger and exacerbate the stuttering," Kelly says.

The stress can be positive or negative. For example, positive stress like the excitement of a birthday party, people coming to visit or a vacation can trigger stuttering. Negative stress like a parent losing his job also can trigger stuttering.

Andrea Cook, 19, stuttered as a child. Her stuttering did not stem from a traumatic experience but worsened under stress.

"Stress causes the stuttering to become worse," she says. "Even now when I become nervous, stressed or upset, I begin to stutter."

There are some children who will stutter no matter how calm the surrounding environment is and others who will not stutter no matter how chaotic their environment may be. Fortunately, 80 percent of children who experience developmental stuttering recover, Kelly says, noting that girls recover sooner than boys do.

Cook recovered before entering kindergarten with the help of a family friend who was a college student studying speech disorders. He made Cook talk while he patiently listened to her. "I remember he talked to me as if I was an adult, and I was on his level," she says.

How To Handle It
Experts at the Stuttering Foundation or America recommend that parents listen to what their child is saying and respond to the child -- not to the stuttering. They also recommend that parents use a relaxed rate of conversation, make affirming responses like smiling or saying "uh-huh," make eye contact with the child and allow the child to finish the word. Parents should also avoid saying things like, "stop that," or, "say it right." The child is already frustrated and that frustration should be acknowledged.

Most importantly, a parent should not tease the child or respond negatively. "Parents should not imitate the child, tease the child or allow others to do that, even in a good-natured way," Kelly says. Cook remembers not only being frustrated but also being "worried about what others thought of me."

For most young children, stuttering resolves spontaneously in the first 12 to 18 months after they start stuttering. Cook says she naturally outgrew stuttering and learned to control it by speaking slower and thinking before she spoke.

If the problem has not resolved after 18 to 24 months, the child is more likely to have a chronic stuttering problem.

"Intervention is more successful the earlier it occurs, for preschooler or early school-age kids, before they've developed a lot of negative reactions," Kelly says.

Learning techniques to resolve stuttering takes between one to two months and then several more months to learn techniques for every day situations. Re-evaluations and checkups are necessary steps in resolving stuttering.

Learning these techniques in a clinic is easier than learning them at home, according to Kelly. Even if treatment is sought in a clinic, Kelly recommends that the family get involved. "It's good to involve parents, siblings and peers so the child has an advocate outside the clinic."

Other Effects of Stuttering
A decreased rate of conversation is not the only possible effect of stuttering. Depending on the child's personality and temperament, a child might experience mood changes.

"Children who are very shy already may refuse to talk or become very shy about it," Kelly says. "Kids who are more assertive or outgoing may just push the stuttering out no matter what and keep going."

Stuttering can also make school difficult. The child may be teased and taunted.

"Other children will imitate or call the child names," Kelly says. "It's an unusual enough problem that when a child is having a problem with fluency it will be recognized."

Once kids get into school, information is available to help teachers handle various situations, but stuttering becomes an extremely difficult problem as teenager with dating and social interaction. If a parent discovers that their child has a stuttering problem, she should seek an evaluation -- the sooner the better.

"We like to see children early because we can give parents an idea if this is typical development or something to worry about," Kelly says.