Dr. Ritika Khare

Associate Consultant Neonatology

KIMS Cuddles, Kondapur

Your baby is able to communicate with you long before he or she speaks a single word! A baby’s cry, smile, and responses to you help you to understand his or her needs.

Children vary in their development at different rates, but they usually are able to do certain things at certain ages. Even when there are delays, early intervention can make a significant difference.

When to worry!!

  • At 2 years: not able to say at least 25 words
  • At 2 ½ years: doesn’t use unique two-word phrases or noun-verb combinations
  •  At 3years : unable to use at least 200 words, doesn’t ask for things by name, hard to understand even if you live with them
  • Any age: doesn’t say previously learned words

Causes of speech delay

1. Problems with the mouth

There can be an issue with the mouth, tongue, or palate. Children may have a condition called ankyloglossia (tongue-tie), where the tongue is attached to the floor of the mouth which can cause difficulty to utter certain sounds, particularly D,L,R,S,T,Z.

2. Speech and language disorders

When a toddler cannot say many words or is unable to put them into understandable phrases, it can be a sign of language delay. Some speech and language disorders may be indicative of a learning disability. Premature birth is one of the important causes of speech delay. Childhood apraxia is the inability to make correct sound and sequence, another cause of speech disorders.

3. Autism spectrum disorder

Speech and language problems are often seen with autism spectrum disorder. This may include repeating phrases, repetitive behaviors, impaired communication and social interaction.

4. Neurological problems

Neurological disorders like cerebral palsy, muscular dystrophy, traumatic brain injury can affect muscles necessary for speech. 

5. Intellectual disabilities

Speech can be delayed due to an intellectual disability. If your child isn’t speaking, it may be a cognitive issue rather than an inability to form words.

6. Hearing loss

Signs of hearing loss may be very subtle. Sometimes a speech or language delay may be the only noticeable sign.

7. Lack of stimulation

It is important to communicate with your child at an early age. Environment plays a crucial role in speech and language development. Abuse, neglect or lack of verbal stimulation can refrain a child from reaching his or her utmost developmental milestones.

Diagnosing a speech delay

Delays in language are the most common types of developmental delay.  Some children will also show behavioral problems because they can’t express what they need or want.

Your pediatrician will ask questions about your toddler’s speech and language capabilities .They will assess other developmental milestones and behaviors. Your pediatrician may refer your child to other specialists for detailed evaluation such as audiologist, speech therapist or neurologist for early intervention services.

Treating the underlying condition

Advice for parents-

  • Communicate directly to your toddler, even if just to narrate what you are doing.
  • Use gestures and point to objects as you say the corresponding words like with body parts, people, toys, colors, or things you see on a routine walk.
  • Read to your toddler.
  • Sing simple songs that are easy to repeat.
  • Give your full attention and be patient when your child tries talking to you.
  • When someone asks them a question, don’t answer for them.
  • Give them a chance to ask even if you are aware of their needs.
  • Let your child interact with children who have good language skills.
  • Ask questions and provide plenty of time for response.

What to do if you think your child may have a delay

It may very well be that there is nothing wrong and your child will get there in their own time. But sometimes a speech delay could signal other problems, such as hearing loss or other developmental delays. When that’s the case, early intervention is best. If your child isn’t meeting speech milestones, make an appointment with your pediatrician.In the meantime, keep talking, reading, and singing to encourage your toddler’s speech.

The management of a child with speech delay should be individualized. The health care team might include the physician, a speech-language pathologist, an audiologist, a psychologist, an occupational therapist and a social worker to correct or minimize the handicap.

A speech-language pathologist plays an essential role in the formulation of treatment plans such as to teach the child strategies for understanding spoken language and producing appropriate linguistic or communicative behavior.

In children with hearing loss, interventions like hearing aids, auditory training, lip-reading instruction may be indicated with occasional reconstruction of the external auditory canal and cochlear implantation. The use of a high-risk registry (for babies requiring NICU admissions ) and universal hearing screening may help to identify hearing loss at an early age.

Psychotherapy is recommended for the children with elective mutism ,undue anxiety or depression. 


A speech delay for a toddler means they have not reached the milestone for speech for a particular age. Sometimes a speech delay is due to an underlying condition that requires treatment. In these cases, speech or language therapy can be used in conjunction with other therapies. Many toddlers speak earlier or later than average, so it may not always a cause for concern. If you have questions about your child’s speech or language abilities, see their pediatrician.

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