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Worried About Your Child's Speech?

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Are you concerned that your child's speech is delayed? The sooner you can identify whether or not there's a problem, the better. Here's how to know if your child has too few words:

toddler holding a telephone

Within the first year of a child's life, children start to understand much of what they hear. "One-year-olds start to use single words, follow simple directions, point to body parts and listen to simple stories," says Diane R. Paul, a speech pathologist. "By 3, a child should be using sentences of three words at the very minimum." 

Momlogic pediatrician Dr.Cara Natterson gave us some guidelines -- and advice to follow if you think your child might be speech delayed:

Birth - 12 months: Babies don't speak in words, but they have a lot to say. In fact, new parents often remark about how surprisingly noisy their babies can be. Babies should coo from early on; cries take on different intensities and pitches depending upon what a baby needs. It is worrisome when a child is silent: This can be a sign of hearing loss. It takes several months (up to four or even five) for a baby to be able to tell where a sound is coming from.

If a 5- to 6-month-old cannot localize a sound, this too may be a sign of hearing loss. There are many parents who claim their children have large vocabularies -- even speak in sentences -- before their first birthdays. But this is very subjective. Most babies have nonspecific words (like "mama" and "dada," which don't necessarily refer to their mom or dad) by one year; some certainly have a few clear and consistent words that a stranger can discern. But if your child doesn't, there is no need to panic.

12 - 24 months: This is the time for real vocabulary explosion. At one year, most children can understand what their parents are trying to say but cannot speak in response; by two years, they have up to 50 or 60 words (or more) in their vocabulary, and can usually put two words together. Children who don't have a large volume of words by 2 years of age can become increasingly frustrated: They know what they want, but cannot say it. Some children are diagnosed with a speech delay at this point. But as it turns out, many don't have a true speech delay; rather, they lack the necessity to speak. 

I have taken care of many children whose parents, caretakers and siblings wait on them hand and foot, anticipating every grunt and gesture. These kids don't need to acquire words, because they can get everything they need without them. I have also taken care of many highly independent children who get what they need themselves -- for instance, they will walk to the fridge, open it and help themselves to food at age 18 months. Some of these children also have smaller vocabularies. Regardless, if you are concerned that your child has delayed speech, this is an appropriate age-window in which to bring it up with your pediatrician.

2 - 3 years: The vocabulary multiplies rapidly over this time period, and children become highly verbal. The typical 3-year-old questions everything ("But why? Why, Mommy?"). Speech delays in this age range tend to be more obvious to parents -- and when they are not, schoolteachers or daycare providers will often point them out.

4 - 5 years: The focus in this age group moves away from speech delay (because it has almost always been identified well before age 4) and toward articulation instead. Parents worry about lisps and mispronunciations. We all know that young children vocalize differently than we do, but you should ask your doctor and your child's teacher about specific articulation issues if you are concerned.

Top 8 Causes of Speech Delays, from the American Academy of Family Physicians


Most common causes:

  1. Hearing loss
  2. Slow development
  3. Mental retardation

Other causes:

  1. Psychosocial deprivation (the child doesn't spend enough time speaking with adults)
  2. Being a twin
  3. Autism
  4. Elective mutism (the child just does not want to speak)
  5. Cerebral palsy

Contact your doctor if you believe that your child is not talking at the level of his age group, or if you have concerns about his development, advises the Mayo Clinic. The doctor may refer your child to a hearing specialist or a speech-and-language specialist.



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