Speech Delay in Toddlers: When is Delayed Speech a Concern?
Parents often wonder what their little one’s first words will be and when they will start talking and sharing with them what they’re thinking and feeling.
Sometimes, it takes a little while for children to begin speaking. If you have a toddler between the ages of 2 to 4, you may be concerned if they haven’t begun talking yet or if they very rarely speak.
How do you know when it is considered a speech delay or normal development?
This article will provide you with the most current research and information to answer what a speech delay in toddlers is, provide some common reasons why it may occur, explain what the typical language and speech development milestones are for kids, and when delayed speech is an issue to address.
What is a Speech Delay?
In terms of the ability to speak, there are two areas of focus: speech and language. Speech refers to how we form words and sounds and is the ability to verbally express language and articulate ourselves.
Language refers to how we communicate information between ourselves and others, ensuring we are being understood and that we understand what is being communicated. Language includes verbal, nonverbal and written communication.
A speech delay is when a child has an issue using words and phrases to verbally express themselves and their speech isn’t developing at an expected rate. They may be hard to understand.
It is estimated that 3 to 10 percent of children have a speech delay and it is more common in boys than girls.
At what age is speech considered delayed?
It can be difficult to know whether your toddler is taking longer than expected to reach their developmental milestones for speech.
According to the American Academy of Family Physicians, the normal pattern of speech development for age and achievements is the following:
- 1 to 6 months: Coos in response to voice
- 6 to 9 months: Babbling
- 10 to 11 months: Imitation of speech sounds; says “mama/dada” without meaning
- 12 months: Says “mama/dada” with meaning; often imitates two- and three-syllable words
- 13 to 15 months: Vocabulary of four to seven words in addition to jargon; < 20% of speech understood by strangers
- 16 to 18 months: Vocabulary of 10 words; some echolalia and extensive jargon; 20% to 25% of speech understood by strangers
- 19 to 21 months: Vocabulary of 20 words; 50% of speech understood by strangers
- 22 to 24 months: Vocabulary > 50 words; two-word phrases; dropping out of jargon; 60% to 70% of speech understood by strangers
- 2 to 2 and a half years of age: Vocabulary of 400 words, including names; two- to three-word phrases; use of pronouns; diminishing echolalia; 75% of speech understood by strangers
- 2 and a half to 3 years of age: Use of plurals and past tense; knows age and sex; counts three objects correctly; three to five words per sentence; 80% to 90% of speech understood by strangers
- 3 to 4 years of age: Three to six words per sentence; asks questions, converses, relates experiences, tells stories; almost all speech understood by strangers
- 4 to 5 years of age: Six to eight words per sentence; names four colors; counts 10 pennies correctly
What causes speech delay in toddlers?
It’s understandable for parents who have a toddler who has not begun to talk yet to worry about their child. Children do not all speak at the same time, but there are definite periods during which certain sounds and combinations of sounds should be produced.
The most common causes of speech delay in toddlers include the following:
When your child was an infant, they should have had their hearing tested to determine if they are developing normally and healthily. Hearing loss can have an impact on learning to speak.
Therefore, it’s important to have your child’s hearing checked regularly. A child who has difficulty hearing may have trouble talking, understanding, imitating and using language. Ear infections, especially persistent ones, can also affect hearing.
Your pediatrician should also assess whether the parts of your child’s mouth and throat that are necessary for speech are physically intact and functional. They can assess whether your child has an oral impairment such as issues with the roof of the mouth.
The child may also have difficulty moving their tongue if they have a short frenulum (the fold beneath the tongue). Checks like these ensure your child is physically capable of making sounds. For instance, as infants, they should respond to noise, make baby sounds, babble and vocalize concerns.
Some other causes that can cause speech delays in toddlers include the following:
- Development disorders: Neurological and developmental disorders such as autism spectrum disorder, Down Syndrome or cerebral palsy can cause speech delay.
- Maturation delay: This is also known as developmental language delay and refers to the parts of the brain that is required to produce speech maturing at a later time.
- Bilingualism: A child who is raised in a bilingual home may have a temporary delay in using two languages. Their language skills are developing normally; however, they aren’t able to communicate in both languages proficiently until the age of 5.
- Psychosocial deprivation: Children who grow up with psychosocial deprivation are more likely to have problems with speech development. Some examples include poverty, poor housing, malnutrition, abuse, emotional stress, neglect, and a lack of exposure to a variety of sounds and conversations.
- Elective Mutism: This is when a child has the ability to speak but chooses not to. They may speak with their friends and sometimes with their parents or when they are alone; however, they do not talk at school, in public places or with people they do not know well.
- Developmental Apraxia: This is a condition in which the child is unable to move the muscles involved in speech.
Lastly, there are some other, less serious explanations for speech delays in early childhood. Some children in big families don’t talk a lot because they don’t really have to.
Older brothers and sisters (or even the kids in a daycare center) may be hovering over them, doing all the talking for them. Sometimes adults give things to children too quickly and don’t give them a chance to ask for things.
When should I worry about toddler speech delay?
Some common signs and symptoms of a speech delay in young children may include the following:
- 12 months: Does not use gestures such as waving bye-bye or pointing
- 18 months: Gestures significantly more than vocalizing; has difficulty imitating sounds and understanding simple verbal requests
- 2 years: Cannot follow simple instructions; can only vocalize some words or says words repeatedly; can only imitate actions or speech; doesn’t say words or phrases spontaneously, without prompting; unable to use oral language to express more than their immediate needs; has an unusual tone of voice such as nasally or raspy sounding; caregivers understand less than 50% of what their child is saying.
- 3 years: Parents and caregivers understand less than 75% of what their child is saying
- 4 years: Those who interact with the child cannot understand mostly what they are saying.
When should you bring kids to speech therapy?
It’s important for parents to speak with their pediatrician if they have any concerns about their child’s development. Early intervention for speech and language problems is critical and can be very effective.
If your child shows any of the signs or symptoms, you can take them to see a speech and language clinic at a children’s hospital. A speech therapist will have the latest equipment and more experience with lots of children with speech and language delays. The speech-language pathologists and neurologists there can also help you determine whether any other conditions might be causing language developmental delays.
How to help toddlers talk more and improve speech development
Parents want the best for their children. Although it can be frustrating to watch your child’s speech delay, it’s important to remain positive, supportive and patient.
Try not to compare your child’s speech development to another child’s, even a sibling’s. Everyone develops at their own pace. The constant comparisons may make your child feel inadequate and negatively affect their self-esteem. In addition, your child may have an underlying condition that requires medical treatment.
Do not force your child to speak, criticize or get angry with them if they aren’t responding to you. Do not threaten them by removing privileges or verbally abusing them. These actions are harmful and detrimental to a child’s development.
There are several ways to encourage your child to talk.
Read to your child
Take time every day to sit together and read. While you’re reading, be sure to point at pictures and verbalize what is going on so they can connect what they see with what they hear.
Lead by example
Talk to your child frequently and demonstrate good communication skills. Use simple words and phrases. Give eye contact. Use body language and facial expressions to communicate.
Narrate your actions and describe what is going on at the moment. For instance, if you’re putting on your jacket, say, “I’m about to go outside. I’m putting on this green rain jacket because it is cold.”
Be patient and compassionate
Encourage your child’s language development skills by asking them to imitate you or taking turns asking and answering questions. Give them time and space to respond. Don’t jump in immediately or interrupt them by saying the words or phrases for them. Be sure to praise their efforts.
Ask an Expert: Why is My Child’s Speech Delayed?
To understand more about how to address language delays in young children, one parent wrote to expert, Jerome Schultz, the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges.
Q: Hi, my name is Sandra. I have two children with speech delays. My son is three and only says a few words. My daughter is two and she does not say a single word.
Both of them had their ears checked; no problem with them. My son has seen a speech therapist for over one year now. She helps him, but I am still feeling very hopeless because his progress is been very slow and I don't know what else I can do to help them. As far as I know, they don't have any other problems. Their doctor says they are very normal children with only a speech delay.
I want to know why a problem like this happens with children like mine. Can this be genetic?
A: Significant language delays, and certainly the absence of speech are reasons to be concerned. You have done the right thing by having the children's ears checked since hearing problems can definitely have an impact on learning to speak.
Have any other children in your extended family, in this or other generations, exhibited speech problems or language delays? If so, share this information with your pediatrician, so he or she can rule out any genetic causes.
It's also good that your son is being seen by a speech therapist. What does she think the cause of the problem is? Does she tell you that he is making acceptable progress, or does she feel that he should be improving at a more rapid rate?
You can ask your pediatrician to refer you to an early intervention program that will help determine whether there are any identifiable reasons for the language delays.
Children do not all speak at the same time, but there are definite periods during which certain sounds and combinations of sounds should be produced. Your daughter should be seen by a specialist in speech and language pathology.
Leung, A. K. C., & Kao, C. P. (1999). Evaluation and Management of the Child with Speech Delay. American Family Physician, 59(11), 3121–3128. https://www.aafp.org/pubs/afp/issues/1999/0601/p3121.html#:~:text=A%20delay%20in%20speech%20development
Mayo Clinic. (2017). Childhood apraxia of speech — Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045
Speech and Language Problems in Children. (2019). Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/speechandlanguageproblemsinchildren.html
What if Your 2-Year-Old is Not Talking But Understands You? (n.d.). Connected Speech Pathology. Retrieved February 28, 2023, from https://connectedspeechpathology.com/blog/what-if-your-2-year-old-is-not-talking-but-understands-you
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