Slow to Speak? What’s Normal and When Should You Worry?

When Michelle Tanner's daughter was 2 years old, she didn't says much outside of "no" and "baba." "Compared to her sister, and the kids in playgroup who are blurting out sentences, I started thinking her speech was delayed," the mom of two says.
Hoping her daughter would "catch up," Tanner put off talking to the pediatrician. "I told myself "some kids are early walkers and some are early talkers, and this was nothing to worry about."

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, caused by physical issues such as problems with the tongue or palate, can cause speech delays. Oral-motor problems (i.e., processing disorders) 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, as was the case with the Tanners. "Once we had her hearing tested by an audiologist, we learned Kenya was having residual issues due to chronic ear infections," Tanner says. "A few months after having tubes put in, her speaking took off." Boyle says this is common because a child who has trouble hearing may have trouble understanding, imitating and using language. "Ear infections are big culprits of speech delay."

The role of the speech pathologist

Boyle says if you or your doctor suspect your child has a problem, early evaluation by a speech-language pathologist is crucial. “An evaluation can also ease your fears,” she says.

Your child’s doctor or insurance company should be able to refer you to a speech pathologist. “Once you’re there, the pathologist will perform an evaluation of your child’s speech and language skills,” Boyle notes. “She’ll conduct standardized tests, and look for milestones in speech and language development.”

The speech-language pathologist will assess:

What your child understands (receptive language)
What your child can say (expressive language)
If your child is attempting to communicate in other ways, such as pointing, head shaking, gesturing, etc.
Sound development and clarity of speech.
Your child's oral-motor status (how a child's mouth, tongue, palate, etc., work together for speech as well as eating and swallowing)

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 together (those they hear and those they realize they're able to make). 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. Experts say that at 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. 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 as a parent 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 stimulus, or who doesn't show 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

Writer Gina Roberts-Grey specializes in health & consumer issues. When she's not busy writing, or serving as chauffer to her teenage son, Gina enjoys curling up with her family's two Bichon Frise puppies and reading.