Sergio was part of an early intervention program that my city offered to low-income children with learning problems, and he had both an occupational therapist and a speech therapist who came to the school to work with him regularly. I already had seventeen other students, and so it was with grave apprehension that I prepared to welcome Sergio, his fleet of therapists, and the disruption he would surely bring to my classroom. Nevertheless, I made him a cubby and labeled a hook for his coat, and explained to my students that we were getting a new classmate, and that he didn’t talk, and that we’d all have to be very kind and help him feel safe in our class. If I’d had any choice, I would’ve said no. But in the end, I’m really glad I didn’t. 

 

Sergio arrived without much fanfare. He didn’t cry or seem particularly fearful of his new environment. I showed him around the room, speaking to him as if he could understand, since I had no proof that he couldn’t. Finally I settled him at a table with some of the calmer children, and he immediately took up a puzzle and began to work on it. I decided to stand back and observe him, until I could gain a clear understanding of what his limitations were and how I could best help him.

 

He was a physically beautiful child, with long lashes and silky dark curls. His beauty was marred, however, as soon as he smiled: he had a mouthful of stainless steel crowns. Having “metal teeth” did not particularly cause him to stand out in our classroom; there were a number of students with one or more metal crowns, although few had as many as Sergio. All of my students were low-income, and all of them qualified for free dental care through my state’s Medicaid program. If one didn’t know better, one might conclude that the poor had terrible oral hygiene. I was poor as well (“preschool teacher” is a euphemism for daycare worker, and daycare workers make approximately the same wages as McDonald’s employees) but I certainly wasn’t sporting a mouthful of metal teeth… possibly because I hadn’t been to a dentist in several decades. Other than that, Sergio had a charming smile. It was so wide and spontaneous that it crinkled up his entire face. He didn’t seem self-conscious about his teeth. I had noticed that the metal crowns tended to bother the girls more than the boys. I recalled one little girl who’d been in my class a few years prior. She had a habit of covering her mouth with her hand every time she laughed or spoke, hiding her metal teeth. Even at four years old, she knew that Disney Princesses (or whoever represented “beauty” to her, at that age) did not have a mouthful of stainless steel crowns.

 

Sergio flourished in my class. The other children were unexpectedly kind and accepting of his inability to speak, and fought for the privilege of being Sergio’s “helper”. I had to remind them that Sergio wasn’t a baby and could do things for himself. The more I observed Sergio, the more I came to the conclusion that he possessed an intellect within the normal range. He built elaborate constructions out of legos and blocks. He could put together the most difficult puzzles I had in my classroom, the twenty-four piece ones that few of his classmates could manage. He was not physically aggressive, as nonverbal children sometimes are. His eyes were watchful and intelligent. I began to think we’d done him a disservice by retaining him in the toddler room for so long. He was keenly interested in his same-age peers, eager to observe and mimic everything they did. 

 

I asked my director for more information about Sergio’s condition. I’d been led to believe he had cognitive disabilities, but now I was pretty sure this wasn’t the case. He seemed neither intellectually impaired nor hearing impaired. He responded to verbal directions and requests. I wondered if there was some physical problem with his mouth or throat which prevented him from speaking. My director assured me that his pediatrician had already ruled that out. Perhaps he was autistic, she suggested. I was no expert, but I’d worked with a few children on the autism spectrum, and I didn’t observe anything in Sergio’s behavior that suggested autism to me. 

 

His silence remained an enigma. His therapists visited him several times a week, causing no disruption at all to my classroom routine. They simply pulled him out of class and worked with him individually, either on the playground or in a seldom-used storage area near the director’s office. I badly wanted to ask the therapists what was wrong with Sergio, what I should be doing to help him, but for some reason I couldn’t bring myself to speak to them beyond the most banal pleasantries, these professional people with college degrees. I was a glorified babysitter. What if they told me it was none of my business? What if they told me there was nothing I could do that would be helpful? Logically, I doubted they’d do either of these things, but even so, some complicated pride or shame rendered me as mute as Sergio in their presence. 

 

Weeks passed. Handprint turkeys replaced painted jack-o-lanterns and autumn leaves. Sergio became increasingly attached to me, forcing himself into my lap while I read books on the circle rug, coming up behind me and clutching me hard around the neck, launching himself at me for hugs at unexpected times, head-butting me in the stomach, or whacking his head on my hipbone, bruising us both. He was never aggressive with the other children, but there was something violent in his love for me. 

 

“Gentle,” I reminded him. “Gentle hugs. Soft hands.”

 

I stroked his forearm gently to illustrate the point. He stroked my forearm as well, his face crinkling into a blissful smile, stainless steel teeth flashing. 

 

It was a few weeks before Christmas when Sergio uttered his first word. Words, I should say. We were sitting on the circle rug, which was composed of pie-shaped wedges of different colors. 

 

“Red,” I told him, pointing to the red section. It was a familiar ritual. “Red is rojo. Apples are red. Fire trucks are red.”

 

Smiling, Sergio pointed to the red section of the rug.

 

“Yes, red.” I affirmed. “And yellow. Yellow is amarillo. Bananas are yellow. Where is yellow?”

 

Sergio wasn’t looking at yellow. He was still pointing to the red section of the carpet. 

 

“Red.” he announced, in a clear, conversational tone. My mouth fell open. But Sergio wasn’t finished. “Yellow, green, blue. Red.”

 

So it began. I boasted to my director and everyone else that would listen that I’d gotten Sergio to speak. So far, it was only colors. But he continued to identify colors correctly throughout the day. At the lego table, I asked him, “What color is this lego?”

 

“Blue!” he responded. 

 

On the playground, “Sergio, what color is the leaf?”

 

“Green!”

 

It was late in the day when Sergio’s mother arrived to pick him up. She was often late. She didn’t have a car, and had to take the bus. I tried to tell her that Sergio had spoken. She smiled politely and nodded. She was very young, and her English was shaky. Maybe she hadn’t understood me, I thought. Maybe she didn’t believe me. Maybe Sergio spoke at home, and she’d just neglected to tell us. Determined to share my excitement, I repeated myself: Sergio was saying words today in class. It was the first time any of us had heard him say words. Again, she just nodded. She was dressed in a disheveled Burger King uniform, and looked very tired, standing on the porch in the gathering dark. Tired, and impatient to be on her way.

 

She thanked me in her heavily accented English, shouldered Sergio’s backpack, and reached for his hand. Sergio was staring, transfixed, at the twinkling multicolored Christmas lights we’d hung on the porch railing. Suddenly, he broke into a face-crinkling smile, pointed at the lights, and cried, “Red! Yellow! Green! Blue!”

 

There was a dull thud: his backpack, sliding off his mother’s shoulder and landing on the wooden porch. She covered her face with her hands and let out a gasping sob. I knew then, without a doubt, that she was hearing her son speak for the first time, and I also knew that she’d been afraid he never would. She reached for him, lifted him up, crushed him in an embrace, laughing and crying, the Christmas lights reflecting off her wet cheeks.

 

 “Yellow!” Sergio exclaimed happily. “Red, blue, green!” He grinned, and his metal smile reflected the twinkling colors as well. 

 

After that, Sergio never stopped talking. He cheerfully identified colors throughout the school day. Within a week, he was identifying other objects. “Tree! Bird! Bike! Chair!”

His speech therapist was thrilled. She suggested that associating with other verbal children had facilitated this rapid progress. I agreed, to a point. He’d been held back, stuck with nonverbal toddlers, for years. He was keenly interested in his current, older classmates and eager to copy everything they did. But I also secretly believed that I had played a role. My repetition of the colors on the circle rug had triggered the utterance of his first words. I was very proud of whatever role I’d played in this apparent miracle. It reinforced the rightness of my decision to do this job, instead of looking for something that might pay a few dollars more. 

 

As we entered the long, dreary month of January- drab wet days, twinkling lights packed away in storage- Sergio continued to add new words to his vocabulary: “Book! Snack! Boy! Table!”

He even began to combine two words: “Blanket, blue.” “Ball, green.”

He always put the adjective after the noun, and I would respond, “Yes, a blue blanket, a green ball. The ball is green.”

I didn’t worry about the order of the words, since I knew that Sergio came from a bilingual household, and in Spanish his format was correct: the adjective comes after the noun.  

I did begin to worry, however, about the fact that he knew so many words, but was still not really communicating. He was not trying to make complete sentences, not really attempting to express himself. He was simply identifying objects. If this was all he ever did, even if he was able to identify every object in the world, he would be labeled autistic or mentally disabled, and he would never live a full and independent life. I wanted more for him. I wanted as much as he was capable of, and I suspected he was capable of more.

 

One cold, rainy day in February, I sat on the pillows in the reading center with Sergio. I had a board book open in my lap. It was meant for much younger children, infants or toddlers. Each page had a photograph of a child engaged in some sort of physical activity, and a single word of descriptive text. We had looked at this book together many times before.

 

“Look here, what is he doing?” I asked, rather listlessly. It was late in the day, and I was bored and tired. “Jumping. He’s jumping.”

 

I turned the cardboard page. 

 

“Climbing. The girl is climbing.”

 

Another page. “Sitting. The children are sitting.”

 

The final page. “What’s he doing? Running. He’s running.”

 

Sergio peered intently at the book. The boy in the picture had dark curls and looked a bit like him.

 

“Boy.” he stated, pointing at the picture.

 

“Yes, that’s a boy.”

 

“Boy.” He repeated. “Boy running.”

 

There it was. A noun. A verb. He had spoken his first complete sentence.

 

“That’s good, that’s really good.” I whispered into his hair, hugging him tight. 

 

Spring comes early in my state. As the days warmed and the leaves and grass made their annual reappearance, Sergio’s speech took off. 

 

“Birds flying!” He squealed in delight, chasing them into flight. “Friends digging. Squirrel! Squirrel running. Squirrel climbing!”

 

His sentences grew in frequency and complexity, although they never became terribly complex. By summer, he could hold what I considered an age-appropriate conversation.

 

“I want more snack.” 

 

“He took my toy.”

 

“Teacher. I love you, teacher.”

 

Words to obtain the things he wanted. Words to resolve problems. Words to express his feelings to the people he cared about. 

 

Sergio said all of these things, and many more, and then it was August, and he was gone. He started public school, a special education class where he could continue speech therapy, with a plan to mainstream him to a normal classroom for first grade. 

 

I never heard from him again, but I expect he’s doing fine. I doubt he will graduate valedictorian or receive a scholarship to an Ivy League college, but I suspect he will be able to communicate well enough to get by, to work a job and live independently, to leave his mark on the world. And that’s all any of us can expect, really. 

 

I consider this a triumph of early childhood intervention. It’s fortunate that those services were available, and that Sergio’s mother was able to access them. I have no doubt that the therapists that came to work with him individually are largely responsible for his gaining the ability to speak. I’m sure that, as his therapist suggested, the example set by the other children also helped. And I’d like to believe that I played some small role as well. It is well-documented that there is a “window” for language learning. If a child doesn’t speak by age six, odds are he will never speak much. That’s why early intervention is so critical in cases of children with speech delay.

 

If that’s all there was to this story, this would be the happy ending. Unfortunately, there’s more. I believe it is important for people to know what I am about to write, so please bear with me.

The year after I taught Sergio, I read an article in a reputable national paper. It was an expose about Medicaid and the dental care it provides to low-income children (in my state, nearly half of all children qualify for Medicaid). This article described how children’s dentistry franchises have proliferated in certain states, including mine; chain offices that cater exclusively to Medicaid patients. These dentists receive about a hundred dollars in Medicaid reimbursement for filling a small cavity, but they receive about 350 dollars for fitting the tooth with a stainless steel crown. One has only to visit any low-income school to see the result: small children with a dozen or more metal teeth. Children like Sergio. 

 

It gets worse. Most of us have areas of weakened enamel on our teeth. This is considered normal. These are not cavities, but could eventually become cavities. A private-pay dentist will take a watch and wait approach to these spots. There is no reason to treat them, especially not when they appear on a child’s baby teeth. But these unethical Medicaid dentists redefined these benign areas of weakened enamel as “lesions”, and- you guessed it- began fitting these normal, cavity-free baby teeth with unnecessary stainless steel crowns. The dentists justify using stainless steel crowns rather than fillings or watchful waiting by claiming that the patients are “unlikely to maintain proper oral hygiene”. And our tax dollars pay for this travesty.

 

It gets worse still. The metal crowns these dentists install in the mouths of low-income children are often ill-fitting as well as unnecessary, allowing bacteria to enter and rot the previously healthy tooth beneath the crown, causing unspeakable pain. And that brings us back to Sergio. One cause- albeit a rare cause- of mutism in children is trauma to the mouth. A child who, at a formative age, gets hit in the mouth by a swing, requiring stitches, may become afraid to speak. A child who, at a formative age, is taken to a franchise Medicaid dental establishment and tortured by an unethical dentist who forces a dozen unnecessary stainless steel crowns onto the child’s previously normal, healthy teeth… may also become mute. After I read this article, I immediately thought of Sergio, and I believed in my heart that this is what happened to him. I can’t prove it, and I wouldn’t even if I could. How would it make his mother feel, to know that the dental care she sought for her precious son with the best of intentions probably traumatized him into muteness?

 

State and government agencies have since cracked down on these sinister dentistry practices, and today I see fewer children with metal smiles than I did ten years ago. 

The lengths to which people will go to get rich is appalling. I think not only of Sergio and the pain he must’ve endured, but of the little girl who covered her mouth with her hand when she spoke, hiding the ugliness that had been inflicted upon her, and perhaps subconsciously protecting herself from further pain. 

Knowing what unethical people do to get rich and stay rich, I’m proud to live, work, and count myself among the poor.