If the family code-switches multiple times within one conversation, the child will also learn that pattern and recognize that two different languages are being used. He then develops the ability to alternate language, using a specific language to communicate in a specific context. The child may learn to associate each language with a specific person (parent vs. The second stage occurs when a child begins to differentiate the two language systems, using each one as a separate system for distinct purposes. For example, the child may know an object's name in one language but not the other or use words from both languages in a single sentence (language mixing), or use word stems of one language with prefixes and suffixes from another language (language blend). The same developmental processes that occur in a monolingual child—single words, increased vocabulary, emergence of two-word combinations, use of verb tenses, and so on—also occur in this undifferentiated stage of simultaneous bilingualism the main difference is that two languages are involved. The first stage is an undifferentiated, "single-language" system composed of elements from both languages. TABLE 1 Simultaneous acquisition of two languages In general, however, these children appear to go through two stages of bilingual language development (Table 1). Not much is known about the process by which a very young child simultaneously learns two languages. For older children and adults, acquiring a second language is a conscious rather than subconscious process, more appropriately termed language learning rather than language acquisition. Preschoolers may differ qualitatively from school-age children in their ability to develop a second language. A bilingual child generally follows one of two language acquisition patterns: simultaneous bilingualism, in which the child acquires two languages at the same time before the age of 3 years, and sequential bilingualism, in which the child acquires a second language by age 3 after having acquired the primary language. Language development is a complex, dynamic process influenced by the child's age, language exposure, and social interactions. For simplicity's sake, we use "bilingual" to mean exposure to, rather than fluency in, two languages. ![]() In this article, we review patterns of bilingual language development, offer general advice about raising a child bilingual, and discuss common questions raised by parents and teachers. What should families be told about raising a bilingual child?.How does one know whether the language development of a bilingual child is normal or a possible developmental language disorder?.How does a bilingual child acquire language?. Does learning two languages "confuse" the child and thereby slow language development?.Questions that commonly confront primary care providers include: Screening for language development in a child exposed to two or more languages can be challenging. As a result, pediatric providers will need to become familiar with normal patterns of bilingual language acquisition and be able to identify abnormal language development in a bilingual child. 1 This number is expected to rise over the next few decades. In 1990, more than six million children between the ages of 5 and 17 (representing 13.9% of children in this age range) spoke a non-English language at home. ![]() The above vignette portrays an increasingly common scenario: parents concerned about language development in their bilingual child. Jorge's parents want to know what they should do. She has suggested that the family speak only English so that Jorge will do better once he starts school. His English-speaking day-care provider has told the parents that Jorge is confused by being exposed to two languages. His parents speak a mixture of Spanish and English at home, as do his older siblings. He was born in Puerto Rico and came to the United States when he was 12 months old. Jorge is able to say fewer than 10 words, some in Spanish, some in English. As you examine him, his parents express concern about his language development. You are seeing Jorge for his 2-year-old well-child visit. Pediatricians need to know how to screen for normal language development in these children, what advice to offer parents about bilingual child-rearing, and how to answer common questions raised by families and teachers. The number of children in the United States who are exposed to two languages is growing. Developing bilingualism Abnormal development of bilingual language General advice for parents Responding to concerns Embracing bilingualism By Victoria Fierro-Cobas, MD, and Eugenia Chan, MD
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