Slow to speak? When to worry

Your daughter is two-years-old and still isn’t saying much outside of “no” and “baba”. And compared to the kids in playgroup who are blurting out sentences and the rate at which her older brother spoke, you think she’s way behind. Hoping she’ll catch up, you forgo talking to the pediatrician, telling yourself “some kids are early walkers and some are early talkers.” Nothing to worry about…right?

This scenario is common among parents of kids who are slow to speak. Some may excuse the lack of talking by reassuring themselves that “he’ll outgrow it” or “she’s just more interested in physical things.” And unless they observe other areas of delayed early development, parents may wonder what’s age appropriate and when it’s time to seek advice.

Before worrying, or heading to the doctor, speech pathologist Jayme Boyle says you need to understand the distinction between speech and language. “Speech is the verbal expression of language and includes articulation, which is the way words are formed,” she says. Language is much broader. “Language refers to the entire process of giving and receiving information in an exchange that’s meaningful.” 

Many things can cause delays in speech or language development. “Oral impairments like problems with the tongue or palate can cause speech delays,” says Boyle. Oral-motor problems can also cause speech delays. “This occurs when there’s inefficient communication in the areas of the brain responsible for speech production so a child has trouble using the lips, tongue and jaw to produce speech sounds,” Boyle says.

Hearing problems are also commonly related to delayed speech, which is why a child’s hearing should be tested by an audiologist whenever there’s a speech concern. A child who has trouble hearing may have trouble understanding, imitating and using language. “Ear infections are big culprits of speech delay,” says Boyle.

What’s the schedule

Although no two children speak at precisely the same age, or utter the same “first word” experts say most should follow this approximate schedule:

Before 12 months

Kids this age are really only using their voice to relate to their environment. They coo when they’re happy and babble while playing. Around nine months old, babies begin adding sounds (they hear and those they realize they’re able to make) together.  Those sounds are a baby’s first words and although they’re meaningful to parents (since they’re often “mama” and “dada”) are often said without the baby understanding their meaning. 

12 to 15 months

By now, kids should have a broad repertoire of daily sounds. They should also be saying one or two “real” words (beyond “mama” and “dada”). These first “real” words are usually nouns and are often things that are constant in a child’s life like “dog” or “ball”. Because communication truly is a two-way street, at this stage your child should also be able to understand and follow single directions like “Please give me the ball”.

From 18 to 24 months

This is the stage where experts say a child’s vocabulary will begin to take off. By 18 months a child should have command of about 20 words and be saying at least 50 more partial words by their second birthday. Some will be saying more or speaking more clearly than others, but this is 20 recognizable words and 50 partial ones is what experts say everyone should have. To assess how your child’s doing, ask them to speak to a neighbor or adult they don’t see everyday day. “This is because you can decipher what your child is trying to say,” says Boyle. “Someone who isn’t around your child every day will give you a clearer picture of your child’s verbal clarity.” By age two kids should also be able to follow two-step commands like “Please come here and sit down.”

From 2 to 3 years

This stage will spark what Boyle calls “a verbal explosion.”  “A child’s vocabulary should increase to where it’s hard to count the number of words,” she says. Sentences also come into play now and a child should be routinely combining two to three words into phrases and sentences. With his growing grasp of communicating and sentences, a child this age should also be able to understand what it means to “put this on the bed” or “sit down at the table”. He should also be identifying colors and vague concepts like “big” versus “little”.

If you’re concerned about your child’s speech and language development, Boyle says watch for these things:

• An infant who doesn’t respond to sound or vocal particular concern for sound.
• A child who isn’t using gestures, such as pointing or waving bye-bye by 12 months.
• Preference for gestures over vocalizations to communicate by 18 months.
• Trouble imitating sounds by 18 months.
• Difficulty understanding simple verbal requests. 

Gina Roberts-Grey is a freelance writer from Baldwinsville, NY.