When to Worry About Speech Delay (or not)

Parents of young children are often concerned about their child meeting growth and developmental milestones. Is my baby sitting up when she should be? Is my little boy walking too late? How late do children ordinarily begin talking, as a rule? Should I be worried if my toddler can run everywhere but still hasn’t said a single word?

Children may develop differently, to a degree, and there is no need to panic if a child is not giving long speeches at a very young age. But there are expected ages by which a child should have learned to do certain things. When there is a significant speech delay, or motor delay, parents and caregivers may reasonably begin to worry about their child.

When exactly should my child start speaking?

Babies begin communicating right at the beginning of their lives, with cries, smiles, coos, and other responses. As time passes, certain speech and language development milestones should be reached within specified age ranges. Bearing that in mind, there is no reason to worry if your child does reach milestones slightly later than you would expect, but within the normal range.

By 1 year, most babies can:

  • Locate the source of a sound
  • Answer to their name when called by a parent or caregiver
  • Wave their hands goodbye or hello
  • Follow your cue when you point and tell them to look at something
  • Babble in a sing-song that rises and falls, mimicking sentences
  • Take turns in a conversation: listen when their caregivers speaks, and continue babbling afterwards
  • Make sounds like “ma ma” or “da da” when talking to the specific parent
  • Say at least one word
  • Point to items out of reach, or make sounds and point to something they want

Between 1-2 years, most toddlers typically can:

  • Follow simple commands. This will first start with following a word or words and a gesture or pointing. Later, the child should be able to follow words only.
  • Retrieve objects from another room if asked to do so
  • Point to more than one body part if asked
  • Point to things to get a parent or caregiver to look at them
  • Bring things to show a parent or caregiver
  • Point to objects so that the parent or caregiver will name them
  • Name some common things and pictures if asked
  • Play “pretend” with gestures and words, sometimes with a doll or toy
  • Learn about one new word a week between1.5 and 2 years of age

By 2 years, most toddlers typically can:

  • Point to many parts of the body
  • Point to common objects
  • Point to some pictures in books
  • Follow simple instructions without a hand gesture (like “put your blankie on the bed”)
  • Say between 50-100 words
  • Use a few two-word phrases, like “Mommy here,” “Ball mine,” or “All done.”
  • Possibly say some three-word sentences, such as “I want water” or “We go swings.”
  • Be fairly clearly understood by adults approximately half the time

By 3 years, most toddlers typically can:

  • Use about 1000 words
  • Call themselves by name
  • Call others by their name
  • Make three or four word sentences using nouns, adjectives and verbs (“The horse ate grass.”)
  • Make words in plural form
  • Ask questions (or sometimes, not stop asking questions)
  • Tell a story, sing a song, and repeat childhood rhymes

Parents and caregivers who spend the most time with the child will tend to understand them the best. Between 50-90% of three year old’s speak well enough for strangers to understand what they are saying most of the time.

Questions for your doctor about speech delay worries

Consider writing down questions and concerns about your child’s speech delay ahead of your visit. Try asking your doctor or healthcare professional:

  • When should I begin to worry about speech delay?
  • Why is my child not talking yet, or not talking more?
  • Should my child be talking more than they are?
  • Should I speak with my child more, to help them figure out how to talk?
  • I don’t think my child understands what I say: could they have hearing loss?
  • I don’t think my child understands what I say: could there be another problem?
  • Does my child have a developmental disability?
  • What can I do that will help my child speak better, or better understand me?
  • Will my child be able to attend school?
  • Should my child attend an early intervention program, if available?

Can speech delay be treated?

There may be no treatment necessary at all. It could be the case that your child is just taking their time talking and will have normal speech development as time goes on. However, it depends on what is causing your child’s speech delay.

Your doctor may refer you to several specialists for a variety of testing and treatment options. These could include:

  • Speech and language pathologist: to help your child talk more, speak better, listen, and sometimes lip read
  • Psychologist: to examine, diagnose, and potentially treat behavioral problems
  • Occupational therapist: to help your child learn to perform daily tasks
  • Social worker: to help with family and home environment problems
  • Programs in your area such as Early Intervention

How do I know if my speech-delayed child needs further testing?

Speech delay can be related to a variety of genetic disorders, including intellectual disability, autism spectrum disorder (ASD), and an array of other possible conditions, some very mild, some severe. Your doctor or healthcare provider may refer you for genetic testing, if your child shows certain delays or symptoms that could be related to a specific disorder, or if you have a family history of genetic disorders or related symptoms. This could help pinpoint the source of a speech or motor delay, relating it to a genetic disease. The benefit of such a diagnosis is a better understanding of the problem, and the ability to plan ahead for your child’s future development.

If you simply have a gut feeling that your child could benefit from diagnosis and treatment, it is worth looking into your options. Pediatric genetic testing may be covered by your healthcare system. If not, or if it is your choice to look into further genetic testing aside from any that has been recommended for you, there are private genetic testing options available.


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