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Delayed Speech or Language Development

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As with other skills and milestones, the age at which kids learn language and start talking can vary. Many babies happily babble "mama" and "dada" well before their first birthday, and most toddlers can say about 20 words by the time they're 18 months old. But what if a 2-year-old isn't really talking yet or only puts two words together?

Knowing what's "normal" and what's not in speech and language development can help parents figure out if there's cause for concern or if their child is right on schedule.

How Are Speech and Language Different?

  • Speech is the verbal expression of language and includes articulation (the way sounds and words are formed).
  • Language is the entire system of giving and getting information in a meaningful way. It's understanding and being understood through communication — verbal, nonverbal, and written.

What Are Speech or Language Delays?

Speech and language problems differ, but often overlap. For example:

  • A child with a language delay might pronounce words well but only be able to put two words together.
  • A child with a speech delay might use words and phrases to express ideas but be difficult to understand.

When Do Kids Develop Speech and Language Skills?

The stages of speech and language development are the same for all kids, but the age at which kids develop them can vary a lot.

During routine well-child checkups, doctors look to see if kids have reached developmental milestones at these ages:

Before 12 Months

By the first birthday, babies should be using their voices to relate to their environment. Cooing and babbling are early stages of speech development. At around 9 months, babies begin to string sounds together, use different tones of speech, and say words like "mama" and "dada" (without really understanding what those words mean).

Before 12 months of age, babies also should be paying attention to sound and starting to recognize names of common objects (bottle, binky, etc.). Babies who watch intently but don't react to sound could be showing signs of hearing loss.

By 12 to 15 Months

Kids this age should have a wide range of speech sounds in their babbling (like p, b, m, d, or n), begin to imitate sounds and words they hear, and often say one or more words (not including "mama" and "dada"). Nouns usually come first, like "baby" and "ball." They also should be able to understand and follow simple one-step directions ("Please give me the toy," etc.).

From 18 to 24 Months

Most (but not all) toddlers can say about 20 words by 18 months and 50 or more words by the time they turn 2. By age 2, kids are starting to combine two words to make simple sentences, such as "baby crying" or "Daddy big." A 2-year-old should be able to identify common objects (in person and in pictures); point to eyes, ears, or nose when asked; and follow two-step commands ("Please pick up the toy and give it to me," for example).

From 2 to 3 Years

Parents often see huge gains in their child's speech. A toddler's vocabulary should increase (to too many words to count) and he or she should routinely combine three or more words into sentences.

Comprehension also should increase — by age 3, a child should begin to understand what it means to "put it on the table" or "put it under the bed." Kids also should begin to identify colors and understand descriptive concepts (big versus little, for example).

What Are the Signs of a Speech or Language Delay?

A baby who doesn't respond to sound or who isn't vocalizing should be seen by a doctor right away. But often, it's hard for parents to know if their child is just taking a little longer to reach a speech or language milestone, or if there's a problem that needs medical attention.

Here are some things to watch for. Call your doctor if your child:

  • by 12 months: isn't using gestures, such as pointing or waving bye-bye
  • by 18 months: prefers gestures over vocalizations to communicate
  • by 18 months: has trouble imitating sounds
  • has trouble understanding simple verbal requests
  • by 2 years: can only imitate speech or actions and doesn't produce words or phrases spontaneously
  • by 2 years: says only certain sounds or words repeatedly and can't use oral language to communicate more than his or her immediate needs
  • by 2 years: can't follow simple directions
  • by 2 years: has an unusual tone of voice (such as raspy or nasal sounding)
  • is more difficult to understand than expected for his or her age:
    • Parents and regular caregivers should understand about half of a child's speech at 2 years and about three quarters at 3 years.
    • By 4 years old, a child should be mostly understood, even by people who don't know the child.

What Causes Speech or Language Delays?

A speech delay in an otherwise normally developing child might be due to an oral impairment, like problems with the tongue or palate (the roof of the mouth). And a short frenulum (the fold beneath the tongue) can limit tongue movement for speech production.

Many kids with speech delays have oral-motor problems. These happen when there's a problem in the areas of the brain responsible for speech, making it hard to coordinate the lips, tongue, and jaw to produce speech sounds. These kids also might have other oral-motor problems, such as feeding difficulties.

Hearing problems are also commonly related to delayed speech. That's why an audiologist should test a child's hearing whenever there's a speech concern. Kids who have trouble hearing may have trouble articulating as well as understanding, imitating, and using language.

Ear infections, especially chronic infections, can affect hearing. Simple ear infections that have been treated, though, should not affect speech. And, as long as there is normal hearing in at least one ear, speech and language will develop normally.

How Are Speech or Language Delays Diagnosed?

If you or your doctor think that your child might have a problem, it's important to get an early evaluation by a speech-language pathologist. You can find a speech-language pathologist on your own, or ask your health care provider to refer you to one.

The speech-language pathologist will evaluate your child's speech and language skills within the context of total development. The pathologist will do standardized tests and look for milestones in speech and language development.

The speech-language pathologist will also assess:

  • what your child understands (called receptive language)
  • what your child can say (called expressive language)
  • if your child is attempting to communicate in other ways, such as pointing, head shaking, gesturing, etc.
  • sound development and clarity of speech
  • your child's oral-motor status (how the mouth, tongue, palate, etc., work together for speech as well as eating and swallowing)

Based on the test results, the speech-language pathologist might recommend speech therapy for your child.

How Does Speech Therapy Help?

The speech therapist will work with your child to improve speech and language skills, and show you what to do at home to help your child.

What Can Parents Do?

Parental involvement is an important part of helping kids who have a speech or language problem.

Here are a few ways to encourage speech development at home:

  • Spend a lot of time communicating with your child. Even during infancy — talk, sing, and encourage imitation of sounds and gestures.
  • Read to your child. Start reading when your child is a baby. Look for age-appropriate soft or board books or picture books that encourage kids to look while you name the pictures. Try starting with a classic book (such as Pat the Bunny, in which your child imitates the patting motion) or books with textures that kids can touch. Later, let your child point to recognizable pictures and try to name them. Then move on to nursery rhymes, which have rhythmic appeal. Progress to predictable books (such as Brown Bear, Brown Bear, What Do You See?) that let kids anticipate what happens. Your little one may even start to memorize favorite stories.
  • Use everyday situations. To reinforce your child's speech and language, talk your way through the day. For example, name foods at the grocery store, explain what you're doing as you cook a meal or clean a room, point out objects around the house, and as you drive, point out sounds you hear. Ask questions and acknowledge your child's responses (even when they're hard to understand). Keep things simple, but avoid "baby talk."

Recognizing and treating speech and language delays early on is the best approach. With proper therapy and time, your child will be better able to communicate with you and the rest of the world.

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

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