The ability to communicate verbally opens a new world of learning and socialization for children. Toddler speech gradually evolves into proper and sophisticated use of language. But, how do we know if our kids are evolving or if they are suffering from speech delay?

The early speech and language milestones are very important in child development because they pave the way for future language acquisition.

Every family exuberantly celebrates the first words spoken by a child. Similarly, if parents feel that their child is falling behind in developing speech, they become concerned.

Having an insight into typical developmental patterns of speech and language can help parents better understand if their child is developing at an age-appropriate level or there seems to be any delay.

Words are tools of thinking. – Daniel C. Dennett

The difference between speech, language, and communication

We commonly use the terms “speech” and “language” interchangeably. However, it’s important to understand that when it comes to communication skills, speech, language, and communication have their distinct meanings.

Speech

It refers to the way we produce different sounds. Speech is basically concerned with pronunciation and involves articulators, such as the lips, jaws, and tongue.

You might have heard children producing certain sounds incorrectly or replacing some sounds with others. The types of speech errors include:

• A child pronounces |cat| as |tat| or |mango| as |mando|.
• Some children might omit certain sounds, for example, say |cartoon| as |catoon| or |pink| as |pin|.
• In some cases, a child might utter certain sounds improperly, make longer pauses, or repeat some sounds. This condition is called stuttering, which interferes with speech fluency.

Language

Language has to do with what we speak. It includes vocabulary, syntax (arranging words and phrases to form sentences), and grammar. Children are born with the ability to learn languages, but it takes some time to learn the language(s) spoken around them.

Language development is broadly classified into 2 categories:

• Receptive language: This is the ability to understand the meaning of spoken words and sentences. A child facing problems with receptive language might struggle with understanding simple concepts (big, small, near, open, long, etc.). Challenges with receptive language also make it difficult for the child to follow simple instructions (put it there, bring that to me, sit there, etc.).
• Expressive language: This refers to the ability to use words, phrases, and sentences to correctly communicate needs, thoughts, and feelings. To clarify, children who experience difficulties in developing expressive language might not be able to remember the names of objects, put words in the correct order to form a sentence, or use the appropriate verb forms.

Communication

Communication is a broader term compared to language and speech. It involves both verbal (spoken words and sounds) and non-verbal (gestures, facial expressions, signs) aspects used to communicate.

Children learn to communicate non-verbally even before developing proper speech. For example, they reach for familiar adults and objects, point towards things they need, and maintain eye contact to indicate their desire to communicate with others.

Some children with delayed speech only have difficulty with verbal communication. Children with neurodevelopmental disabilities—for example, autism spectrum disorder (ASD)— might struggle with communicating both verbally and non-verbally.

Statistics on speech delay

Almost 5% of children in the US have a significant speech problem by the time they reach grade 1. Young children at risk of developing a special need have a higher prevalence (27%) of speech delays.

Research also indicates that children who have delayed speech at 2.5 to 5 years of age tend to face many challenges in developing reading skills in elementary school.

If not managed promptly, speech and language delays can lead to speech or language problems. According to NIH (National Institutes of Health), about 1 out of 12 children aged 3-17 have some speech or language problem. Almost 8% of children have communication problems, 5% have speech disorders, and 3.3% have language problems.

Given these statistics, it becomes crucial to identify language delays and provide the required support to the child to avoid further complications in the future.

What causes speech delays in children?

There can be various causes for speech and language delays in children.

1. Hearing impairment and speech delay

Children learn to speak by copying the words others say. Hearing impairments deny children the auditory stimulus, leading to delay in their language development.

Generally, children with hearing impairment reach the normal milestones of cooing and crying but don’t develop meaningful speech.

The effect of hearing impairment on speech development depends on the degree of hearing loss and time of onset (the time when the hearing impairment occurs).

2. Ear infections and speech delay

Continuous ear infections and the presence of fluids in the ear canal can interfere with receiving clear spoken messages. Unfortunately, as a result, It can adversely affect the speech and language development of the child.

3. Neurodevelopmental disorders and speech delay

Is delayed speech a sign of autism? Neurodevelopmental disorders such as ASD and attention-deficit/hyperactivity disorder (ADHD) can interfere with speech and language acquisition.

Autism and speech delay: Children with autism have difficulty in developing communication and social skills. And, tend to show signs of language delays in the early years of their life.

ADHD and speech delay: Children with ADHD face challenges in focusing and sitting still. In certain cases, this can interfere with the normal development of speech and language.

Cerebral palsy and speech delay: Cerebral palsy affects muscular control, which also includes control of the tongue and facial muscles. These challenges can also make speaking and eating difficult for the children.

4. Tongue-tie speech delay

Tongue-tie (ankyloglossia) is a condition in which the tongue is held to the floor of the mouth with a web of tissue and it interferes with tongue movement.

This condition is estimated to affect 4% to 10% of the population.

To summarize, a child with a tongue-tie is unable to stick the tongue out, move it to the sides, and produce certain sounds.

5. Bilingual environment and speech delay

Children growing up in a bilingual environment sometimes face slight delays in language acquisition. I have seen this in children who came from families where the language spoken at home was different from the one spoken in the community.

6. Lack of stimulation and speech delay

In some cases, extreme restrictions or very limited opportunities to communicate with older children and adults can lead to language delays. For example, children with normal hearing born to parents with hearing impairment might not be able to develop speech if they don’t get an opportunity to experience verbal communication.

Important milestones for speech development

To see whether your child’s speech and language are developing at an age-appropriate level, you can use the following checklist of developmental milestones from the American Speech-Language-Hearing Association.

Birth to 6 months:

• Makes cooing sounds
• Style of crying changes to indicate different needs
• Makes babbling sounds (ba, pa, etc.)
• Laughs and giggles

7 months to 1 year:

• Makes long babbling sounds (mamama, bababa, papapa)
• Points to objects
• Makes different sounds to get and hold the attention of others
• Might start saying single words (mama, baba, up, go, hi, etc.)
• Makes gestures (bye, up, go, no, etc.)

1 to 2 years:

• Points to body parts and pictures in a book when asked
• Names pictures in a book
• Learns and uses many new words
• Speaks 2-word phrases (give me, baba go, car me etc.)
• Asks and answers simple questions (who’s this? what’s this? where is it?)

2 to 3 years:

• Follows 2-step directions (e.g., bring the ball and give it to papa)
• Uses 3-word phrases
• Talks about things not present at that time
• Starts asking “why” questions
• Learns and uses new words quickly
• Understands opposites (e.g., big/small, long/short)
• Uses words to explain position (e.g., in, out, over, under)

Signs of speech delay

Please keep in mind that every child develops speech at his/her own pace. Slight individual differences are normal and expected.

If a child doesn’t reach the speech and language development milestones at the appropriate age, it can be a warning sign of speech delay.

Keep an eye on the following red flags:

• No smiling in response to people by 6 months
• No babbling by 9 months
• No pointing or using gestures to communicate by 9 months
• No words by 15 months
• Can’t understand simple questions (where is mommy? where is the ball?) by 18 months
• Not using consistent words to name specific objects (e.g., ba for ball or mama for mother) by 18 months
• Not combining words to make phrases by 24 months
• Most of what the child says can’t be understood by 24 months
• Not using 3-word sentences (e.g., mama give ball) by 36 months
• Difficulty in speaking clearly by 36 months

The child might also experience some other problems that make speaking difficult, for example:

• Not interested in communicating with others
• Excessive drooling
• Difficulty in chewing and swallowing
• Limited control of the jaws and lips
• Limited movement of the tongue
• Stuttering or difficulty in speaking words fluently

These things in mind, if you observe some of the above-mentioned delays in your child, it is better to reach out to a professional for help.

How to help a child with speech delay

When should you worry if a child is not talking? If you feel that your child’s speech and language development is significantly behind the expected level, you should seek help from a professional.

Your first point of contact can be your child’s pediatrician. If the medical professional suspects a speech delay, they will redirect your child to a speech and language pathologist (SLP). Once referred to an SLP, they can provide therapeutic help for developing your child’s speech and language.

If a child is at risk of developing a special need, they might require support from a multidisciplinary team of professionals.

For example, if your child is at risk of autism or ADHD, you might also need help from a psychologist and an occupational therapist to work on related issues. Children with cerebral palsy will also require the help of a physical therapist.

If a child has a tongue-tie and a medical professional suggests releasing the tie, the help of a pediatric surgeon might also be sought out.

How parents can help with speech and language development

As a parent, you can follow some simple strategies to facilitate language acquisition for your child.

• Talk to your child and describe every situation and object to them.
• Encourage your child to use words along gestures to make their needs known.
• Read stories to your child. Using picture stories can be very helpful in expanding vocabulary. Once your child is familiar with the story, encourage them to answer simple “what happened next” questions.
• Create opportunities for your child to communicate with peers and adults in a safe environment.
• Try to use shorter phrases and simple directions.
• Help your child learn the names and uses of different common objects.
• Do singing and rhyming activities with your child.

Remember

All children develop at their own pace. Try speaking and reading to your toddler as it helps with improving their vocabulary.

If you feel that your child’s speech is delayed, don’t hesitate to talk to a professional. Early intervention can spare your child many potential challenges in the future.