Delayed Speech or Language Development

As with other skills and milestones, the age at which kids learn language and start talking can vary. Knowing a bit about speech and language development can help parents figure out if there's cause for concern.

How Do Speech and Language Differ?

• Speech is the verbal expression of language and includes articulation (the way we form sounds and words).
• Language is giving and getting information. 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 say 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 hard to understand.

What Are the Signs of a Speech or Language Delay?

A baby who doesn't respond to sound or vocalize should be checked by a doctor right away. But often, it's hard for parents to know if their child is taking a bit longer to reach a speech or language milestone, or if there's a problem.

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 some sounds or words repeatedly and can't use oral language to communicate more than their 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)

Also call the doctor if your child’s speech is harder to understand than expected for their age:

• Parents and regular caregivers should understand about 50% of a child's speech at 2 years and 75% of it 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 might be due to:

• an oral impairment, like problems with the tongue or palate (the roof of the mouth)
• a short frenulum (the fold beneath the tongue), which can limit tongue movement

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. This makes it hard to coordinate the lips, tongue, and jaw to make speech sounds. These kids also might have other oral-motor problems, such as feeding problems.

Hearing problems also can affect speech. So an audiologist should test a child's hearing whenever there's a speech concern. Kids who have trouble hearing may have trouble saying, understanding, imitating, and using language.

Ear infections, especially chronic infections, can affect hearing. But as long as there is normal hearing in one ear, speech and language will develop normally.

How Are Speech or Language Delays Diagnosed?

If your child might have a problem, it's important to see a speech-language pathologist (SLP) right away. You can find a speech-language pathologist on your own, or ask your health care provider to refer you to one.

The SLP (or speech therapist) will check your child's speech and language skills. The pathologist will do standardized tests and look for milestones in speech and language development.

The SLP also will check:

• what your child understands (called receptive language)
• what your child can say (called expressive language)
• 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.

How Can Parents Help?

Parents are an important part of helping kids who have a speech or language problem.

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

• Focus on communication. Talk with your baby, 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.
• Use everyday situations. To build on your child's speech and language, talk your way through the day. Name foods at the grocery store, explain what you're doing as you cook a meal or clean a room, and point out objects around the house. Keep things simple, but avoid "baby talk."

Recognizing and treating speech and language delays early on is the best approach. Call your doctor if you have any concerns about your child’s speech or language development.