Babies start communicating the moment they let out their first bloodcurdling cries at birth. Every day they continue to cry on and off, and then just when mommy and daddy are draining the bottom of the barrel for the last bit of sanity that may be left, baby smiles. Regardless of whether this smile is due to gas or is a true social smile, to see baby’s face light up with something more than just contentment for her current situation is unimaginable.

Plenty more communication happens after that, including coos, which turn into babbling, which later combine with pointing and eventually crawling and cruising toward a desired thing or person, all to culminate in that first true declaration of “mama” and “dada.”

But if your child has a developmental delay, you know you’re going to be waiting some extra time for these milestones, and while you’re waiting, your baby is likely growing frustrated over his or her inability to express a need or want—it’s up to you to read your baby’s mind. For now.

The use of “total communication”—which in a nutshell for a hearing child combines oral speech, natural gestures, sign language, written words, and pictures—from an early age is a fantastic approach to assisting our children in communicating their needs and wants. Whether we like it or not, we know there will be a delay of months to years between receptive communication (the child’s ability to comprehend) and expressive communication (the child’s ability to outwardly communicate their thoughts). Without knowing which of these modes will work best for the child, the “total” approach covers it all, just as the name suggests.

Talking to Hope (i.e., oral speech) has always been very easy, especially as a stay-at-home mom with few adults to talk with during the day. And I’m from New Jersey, so as the stereotype goes, I already speak with my hands (i.e., natural gestures). But communicating with a baby using sign language, written words, and pictures takes a little more creativity.

Sign Language

The commitment to using sign language with baby is pretty big and can be slightly disruptive to your attempt to blend in among a crowd. We use sign language at every meal, when reading, during music class, and especially when Hope is getting fussy during the day, wherever or whenever that may be. We always combine oral speech with signing, and we always follow up a sign with an action (e.g., sign/say: more; action: give more to baby).

What I hadn’t realized when we introduced sign language seven months ago was that without some more advanced motor control, signing would be a serious challenge, even with the allowances afforded a typically developing baby. For example, the sign for “more” brings the fingertips of both hands together, and the allowance for a baby is just to bring the hands together at the appropriate time, understanding that the finer control will come later. But if baby hasn’t mastered the coordination required for bringing her hands together, the sign for “more” just can’t emerge.

So back to that important concept of commitment: If you use sign language reliably throughout the day, even mold baby’s hands for a tactile imprint of the sign, the expressive communication will happen. It will! Just be patient and consistent.

Hope decided the two most important ideas to communicate were “all done” and “dog.” I find this to be an absolutely beautiful insight into what’s going on in her mind and something we would not have experienced had we not introduced sign language. The first place she signed “all done” was at the table, but she quickly learned she could use it in other situations as well, including to attempt to end a therapy session, while feeling frustrated alone in the backseat of the car, and during many a diaper change. And regarding “dog,” Hope is working through the difference between cats and dogs, but I’m certain that with practice, she will soon learn to differentiate the two.

Written Words and Pictures

Flashcards. Flashcards, flashcards, flashcards. Don’t question yourself. Don’t read up on whether the effort to make or use them will pay off. Don’t stop using them because baby isn’t yet gesturing toward them. Don’t make them out of something you wouldn’t want your baby gnawing on. And may I repeat: don’t question yourself.

Flashcards feel cumbersome in a digital world, and at first they may seem far too advanced to introduce to an infant. But there is tons of research to suggest that children with DS learn to read best by “sight-word reading,” meaning they build a vocabulary on recognizing words as if they were symbols as opposed to sounding out the words phonetically. (Sight-word reading is commonly taught in early literacy regardless of disability status.) So if your baby can theoretically recognize a picture of a dog or a cow, why couldn’t he or she also recognize the difference between the written words “eat” and “water”? By using flashcards, you may be building a bridge between recognizing an image and the actual reading of words.

I knew about the use of flashcards, but it wasn’t until Hope’s first birthday in December when we received some homemade, personalized versions from a friend that we decided to introduce them. Here’s what a few look like:

Using a flashcard is simple:

1. Show the card to baby so that she can take in the image.
2. Point to the word while sounding it out.
3. Optional: Sign the word if you know the sign and plan on using it.
4. Follow through on whatever the card suggests.

When your child becomes more advanced in gesturing toward a flashcard, you can offer two at a time, having baby choose between items (e.g., ball or dog) or activities (e.g., play or eat), following through on what the card suggests, to further reinforce the card’s meaning.

As a parent introducing total communication, it’s up to you to figure out what makes the most sense for your family. And if your child learns to communicate using sign language or flashcards in a world where these two modes aren’t understood? You’ll figure out how to teach your child’s caretakers and teachers and friends how to play along until your child is ready for oral speech. I’ll let you know when we reach that day!