Language and Speech Delays in Toddlers

Speech is the physical act of producing sounds and saying words. A toddler with a speech delay may try but have trouble forming the correct sounds to make words. A speech delay doesn’t involve comprehension or nonverbal communication.

It’s also possible for your child to have a language delay, which involves understanding and communicating, both verbally and nonverbally. A toddler with a language delay may make the correct sounds and pronounce some words, but they can’t form phrases or sentences that make sense. They may have difficulty understanding others.

Children can have a speech delay or a language delay, but the two conditions sometimes overlap.

If you don’t know which one your child may have, don’t worry. It’s unnecessary to make a distinction between having an evaluation and starting treatment.

Speech and language skills begin with the cooing of an infant. As the months pass, seemingly meaningless babbling progresses into the first understandable word.

A speech delay is when a toddler hasn’t met typical speech milestones. Children progress on their own timeline. Being a little late with a conversation doesn’t necessarily mean there’s a serious problem.

Age 0-1

Language typically begins to develop around 4-6 months of age. Around this time, your baby should be making babbling sounds and showing understanding of their environment with things like laughing. If a baby isn’t cooing or making other sounds at two months, it could be the earliest sign of a speech delay.

From seven months onwards, they should be visibly reacting to sounds and understanding basic words like “cup,” “shoe,” or “juice.” They should continue babbling while using hand gestures, and by around age 1, they should be able to say 1-2 words. This is often “mama” or “dada.”

Age 1-2

Within the second year of life, a child should be able to understand basic body parts, as well as simple commands and questions. They should be noticeably learning new words and start to use some two-word combinations.

You should also see them react to things like pictures, stories, or songs. They’ll also begin to ask simple questions.

Age 2-3

By the third year of life, a toddler should be starting to use 2-3 word combinations with more regularity.

A typical 3-year-old can use about 1,000 words. They should have enough vocabulary to name most things around them by this point. You should be able to understand their speech, but it’s okay if people who don’t know them as well don’t. People who spend the most time with toddlers tend to understand them best.

In addition, by age 3, they typically can:

• call themselves by name, call others by name
• use nouns, adjectives, and verbs in three- and four-word sentences
• form plurals
• ask questions
• tell a story, repeat a nursery rhyme, sing a song

Signs that an older toddler is missing their speech milestones:

• Age 2: uses less than 50 words
• Age 2 1/2: doesn’t use unique two-word phrases or noun-verb combinations
• Age 3: doesn’t use at least 200 words, doesn’t ask for things by name, hard to understand even if you live with them
• Any age: unable to say previously learned words

A speech delay may mean that their timetable is a little different, and they’ll catch up. But speech or language delays can also tell something about overall physical and intellectual development. Here are some examples.

Problems with the mouth

A speech delay can indicate an issue with the mouth, tongue, or palate. In a condition called ankyloglossia (tongue-tie), which affects 4-10% of the population, the tongue is connected to the floor of the mouth. This can make it difficult to create certain sounds, particularly:

• D
• L
• R
• S
• T
• Z
• th

Tongue-tie can also make it hard for infants to nurse.

Speech and language disorders

A 3-year-old who can comprehend and nonverbally communicate but can’t say many words may have a speech delay. One who can say a few words but can’t put them into understandable phrases may have a language delay.

Some speech and language disorders involve brain function and may indicate a learning disability. One cause of speech, language, and other developmental delays is premature birth.

Childhood apraxia of speech is a physical disorder that makes it hard to form sounds in the right sequence to form words. It doesn’t affect nonverbal communication or language comprehension.

Hearing loss

A toddler who can’t hear well, or hears distorted speech, is likely to have difficulty forming words.

One sign of hearing loss is that your child doesn’t acknowledge a person or object when you name them but does if you use gestures.

However, signs of hearing loss may be very subtle. Sometimes a speech or language delay may be the only noticeable sign.

Lack of stimulation

We learn to speak to get in on the conversation. It’s hard to pick up on speech if no one engages with you.

Environment plays a crucial role in speech and language development. Abuse, neglect, or lack of verbal stimulation can keep a child from reaching developmental milestones.

This is likely to affect all types of language development, including speech development itself, as well as the ability to understand and express concepts and learn how to communicate socially.

Autism spectrum disorder

Speech and language problems are very often seen with autism spectrum disorder. Other signs may include:

• repeating phrases (echolalia) instead of creating phrases
• repetitive behaviors
• impaired verbal and nonverbal communication
• impaired social interaction
• speech and language regression

Neurological problems

Certain neurological disorders can affect muscles necessary for speech. These include:

• cerebral palsy
• muscular dystrophy
• traumatic brain injury

In the case of cerebral palsy, hearing loss or other developmental disabilities can also affect speech.

Intellectual disabilities

Speech can be delayed due to an intellectual disability. If your child isn’t speaking, it may be a cognitive issue rather than an inability to form words.

The American Academy of Pediatrics (AAP) recommends that children be evaluated for their overall development at 9, 18, and 30 months of age.

This is usually done as a routine step in your child’s well appointments, at which your pediatrician should identify a problem with speech or language, if there is one, and refer you further for developmental testing.

That said, if you think your child is showing a speech delay, or have any concerns at any other point, bring them up with your doctor because there earlier your child can get an intervention, the easier it will be to overcome a delay, depending, of course, on the cause.

Diagnosing a speech delay

Because toddlers progress differently, it can be a challenge to distinguish between a delay and a speech or language disorder.

Between 10-20% of 2-year-olds are late to develop language, with males three times more likely to fall into this group. Most don’t have a speech or language disorder and are caught up by age 3.

Your pediatrician will ask questions about your toddler’s speech and language capabilities as well as other developmental milestones and behaviors.

They’ll examine your child’s mouth, palate, and tongue. They may also want to have your toddler’s hearing checked. Even if your child seems responsive to sound, there could be hearing loss that makes words sound muddled.

If your doctor refers you to further testing, this may include:

• audiologist
• speech-language pathologist
• neurologist
• early intervention services

Speech-language therapy

The first line of treatment is speech-language therapy. If speech is the only developmental delay, this may be the only treatment needed.

It offers an excellent outlook. With early intervention, your child may have typical speech by the time they enter school.

Speech-language therapy can also be effective in the overall treatment plan when there’s another diagnosis. The speech-language therapist will work directly with your child as well as instruct you on how to help.

Early intervention services

Research suggests that when speech delay isn’t treated early, it can persist in 40-60% of children, who have a higher chance of developing various social, emotional, behavioral, and cognitive problems in adulthood.

With a doctor’s diagnosis, your 3-year-old may qualify for early intervention services before they start school.

Treating the underlying condition

When speech delay is connected to an underlying condition or occurs with a coexisting disorder, it’s important also to address those issues. This may include:

• help with hearing problems
• correcting physical problems with the mouth or tongue
• occupational therapy
• physical therapy
• applied behavior analysis (ABA) therapy
• management of neurological disorders

Here are some ways you can encourage your toddler’s speech:

• Talk directly to your toddler, even if just to narrate what you’re doing.
• Use gestures and point to objects as you say the corresponding words. You can do this with body parts, people, toys, colors, or things you see on a walk around the block.
• Read to your toddler. Talk about the pictures as you go.
• Sing simple songs that are easy to repeat.
• Give your full attention when talking to them. Be patient when your toddler tries to talk to you.
• When someone asks them a question, don’t answer for them.
• Even if you anticipate their needs, give them a chance to say it themselves.
• Repeat the words correctly rather than directly criticizing errors.
• Let your toddler interact with children who have good language skills.
• Ask questions and give choices, allowing plenty of time for response.

It may very well be that there’s nothing wrong, and your child will get there in their own time. But sometimes, a speech delay could signal other problems, such as hearing loss or other developmental delays.

When that’s the case, early intervention is best. If your child isn’t meeting speech milestones, make an appointment with your pediatrician.

In the meantime, keep talking, reading, and singing to encourage your toddler’s speech.

At what age is a toddler considered speech-delayed?

Signs of first speech begin to appear around six months, so if you’re not seeing the signs at any time from then onwards, a speech delay is possible. That said, not all children develop at the same pace, so only an evaluation by a doctor can tell you whether there’s a legitimate delay.

Can a toddler have a speech delay and not be autistic?

Autism Spectrum Disorder can cause problems with speech, though not always. It’s also not the only possible cause. Many things can cause a speech delay in young children.

At what age do late talkers talk?

Typically late talkers are considered children who don’t begin to show signs of speech until around age two or later.

Can toddlers recover from speech delay?

Depending on the cause, early recognition of a speech delay is crucial so that the child can receive treatment and recover as much as possible. This is why early screening and access to early intervention is so important.

A speech delay for a toddler means they haven’t reached the milestone for speech for a particular age.

Sometimes a speech delay is due to an underlying condition that needs treatment. In these cases, speech or language therapy can be used in conjunction with other therapies.

Many toddlers speak earlier or later than average, so it’s not always a cause for concern. If you have questions about your child’s speech or language abilities, see their pediatrician. Depending on their findings, they can refer you to the appropriate resources.

Early intervention for speech delay may get your 3-year-old caught up in time to start school.