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Speech Delay

04/09/2020 Conditions

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Speech Delay

The first 3 years of life is the time when children learn to talk and learn language. These skills develop best in surroundings that are rich with sounds, sights, and constant exposure to speech and language.

Children learn to talk, like all other developmental skills, at their own pace. That pace can vary from child to child.

Generally, a child should be able to:

  • Say 1 word at about age 1
  • Say 2-word combinations at 18 months to 2 years
  • Say 3-word sentences before turning 3 years old

Just because your child has not reached a milestone by a certain age, however, does not necessarily mean something is wrong. Most children who talk late eventually catch up. If you are worried that your child is not learning to talk soon enough, talk to your child's doctor.

Patients can be seen by Texas Children's experts in Ear Nose and Throat (Otolaryngology).

Causes & Risk Factors

Causes of speech delay include:

  • Not being able to hear.
  • A disorder that affects learning to talk and learning language.
  • A delay in the neurologic processes that are needed to talk. This condition happens more often in boys.
  • Children who do not talk because they do not want to do so (elective mutism).  

Risk Factors:

Symptoms & Types

An infant who does not respond to sound or who does not vocalize (make sounds) is of particular concern.

If you are concerned that your child is not talking or learning language at the right pace, you can watch for milestones that should occur at certain ages.

Symptoms include:

  • Not using gestures, such as pointing or waving bye-bye, by 12 months
  • Preferring gesturing to talking at 18 months
  • Having trouble imitating sounds by 18 months
  • Having trouble understanding simple verbal requests

By 2 to 3 years of age, a child should be able to:

  • Use 2- or 3-word phrases to talk about and ask for things
  • Use k, g, f, t, d, and n sounds
  • Speak in a way that is understood by family members and friends

Diagnosis & Tests

Your child's doctor will do a complete physical examination.

The physical examination will include:

  • Asking about your family history 
  • Asking about the child's milestones in learning to talk
  • Evaluating how your child's developmental milestones compare to other children the same age

Your child's doctor may refer you to a speech pathologist, a healthcare professional who evaluates and treats children who have problems talking or learning language. The speech pathologist will use special spoken tests to evaluate your child. 

If your child's doctor suspects a hearing problem:

  • You will most likely be referred to an otolaryngologist, a doctor who specializes in the treatment of the ear, nose and throat. You might also be referred to an audiologist, a healthcare professional who specializes in hearing problems.

If your child's doctor suspects a psychological problem:

  • You will most likely be referred to a developmental psychologist (a health care professional with special expertise in the psychological development of infants and children).

Treatment & Care

Treatment depends on the reason your child is experiencing delays in talking.

Treatment may include:

  • Activities you can do at home to help your child learn to talk and learn language
  • Group or individual therapy with a speech pathologist
  • Treatment for a hearing problem, such as a hearing aid or surgery
  • Therapy with a developmental psychologist

Living & Managing

If no disease or health condition is found, the speech pathologist will suggest how you can talk to your child to help with talking and learning language.  

These may include:

  • Making sure your child is exposed to a variety of sounds and language
  • Talking to your child often
  • Reading to your child