Speech Delays in Children

If a child does not develop his speech and language skills at the expected rate, it is referred to as a speech delay. It is a fairly common condition, which needs to be recognized and evaluated at the earliest, to find the cause.

While language is a set of shared rules that allow individuals to communicate their ideas and may be delivered verbally, in writing, or by gestures; speech or talking is just one way to express language. It involves using the muscles of the vocal tract, jaw, mouth, tongue to articulate the sounds that make up language. A speech delay usually does not involve problems with understanding or in non verbal communication, while a language delay presents with delays in both verbal and non verbal communication, where the child is unable to understand others and may be associated with learning disabilities.

The first three years of child development are essential for development of speech and language as the brain matures rapidly during that period. Children are exposed to sights, sounds and speech of people around them and exposure to these stimuli are critical for their own development.

Even though children progress at different times, they usually follow a timetable for acquiring language skills, for example by six months babies babble or make gurgling sounds and by one year they are able to one or two simple words like “mama” or “dada”. Although these are broad benchmarks, a more detailed milestone list to evaluate late talkers is given below.

Causes of Speech Delay

  1. Oral impairment due to tongue or palate; like a short frenulum (the fold under the tongue) or tongue tie which can limit movement of the tongue, limiting speech
  2. Oral-motor problems, that make it difficult for the brain to coordinate movements of the lips, tongue, and jaw to produce speech sounds. It may also be accompanied by feeding difficulties.
  3. Hearing problems may lead to difficulty in articulating, understanding, imitating, and using language.
  4. Lack of stimulation due to abuse or neglect
  5. Autism Spectrum Disorder
  6. Neurological problems like muscular dystrophy, cerebral palsy or traumatic brain injury
  7. Premature birth
  8. As a part of other childhood speech disorders, like apraxia (inability to speak due to difficulty in muscle co-ordination) dysarthria or stuttering.

Evaluation of a speech delay

If a child is suspected to have a speech delay, it is best to get the opinion of a speech and language pathologist, who is specially trained to evaluate and treat individuals with speech disorders. Along with detailed history from the parents and spoken tests to evaluate the child, audiology tests are also done, to rule out hearing issues, which could be one of the causes of speech delay.

Other factors that may be assessed are the child’s:

  1. Receptive language i.e. what the child can understand
  2. Expressive language i.e. what the child can say
  3. Attempt to communicate with hand or body gestures
  4. Sound development and clarity of speech
  5. Oral-motor status (how oral muscles work together for speech, swallowing and eating)

Steps that may help with speech delays

  1. Finding out the root cause of the issue, if it is organic in nature, for example correcting hearing with hearing aids, correcting tongue ties etc
  2. Therapy with a speech and language pathologist for both children and parents
  3. Parents should engage and communicate with children from infancy, reading to them and speaking with them regularly without encouraging “baby talk”
  4. There are a wide variety of assistive technologies for speech therapy which are used as tools for children to practice exercise, like phone based applications, computer smart boards etc.

There are simple observations made during different stages of child development that may indicate if they are suffering from a delay in speech. This checklist is based upon How Does Your Child Hear and Talk? courtesy of the American Speech–Language–Hearing Association . However, a clinical neurologist, child neurologist, paediatrician or speech and language pathologist can evaluate the child with more detailed examinations and testing.

Birth to 3 Months

  • Reacts to loud sounds
  • Calms down or smiles when spoken to
  • When feeding, starts or stops sucking in response to sound
  • Coos and makes pleasure sounds
  • Has a special way of crying for different need
  • Smiles when he or she sees you

4 to 6 Months

  • Follows sounds with his or her eyes
  • Responds to changes in the tone of your voice
  • Notices toys that make sounds
  • Pays attention to music
  • Babbles in a speech-like way and uses many different sounds, including sounds that begin with p, b, and m
  • Babbles when excited or unhappy
  • Makes gurgling sounds when alone or playing

7 Months to 1 Year

  • Enjoys playing peek-a-boo and pat-a-cake
  • Turns and looks in the direction of sounds
  • Listens when spoken to
  • Understands words for common items
  • Responds to requests (“Come here”)
  • Babbles using long and short groups of sounds (“tata, upup, bibibi”)
  • Imitates different speech sounds
  • Has one or two words (“Hi,” “dog,” “Dada,” or “Mama”) by first birthday

1 to 2 Years

  • Follows simple commands (“Roll the ball”) and understands simple questions (“Where’s your shoe?”)
  • Enjoys simple stories, songs, and rhymes
  • Acquires new words on a regular basis
  • Uses some one- or two-word questions (“Where kitty?” or “Go bye-bye?”)
  • Puts two words together (“More cookie”)
  • Uses many different consonant sounds at the beginning of words

2 to 3 Years

  • Uses two- or three-word phrases to talk about and ask for things
  • Uses k, g, f, t, d, and n sounds
  • Speaks in a way that is understood by family members and friends
  • Names objects to ask for them or to direct attention to them

3 to 4 Years

  • Answers simple “Who?” “What?” “Where?” and “Why?” questions
  • Talks about activities at daycare, preschool, or friends’ homes
  • Uses sentences with four or more words
  • Speaks easily without having to repeat syllables or words

4 to 5 Years

  • Hears and understands most of what is said at home and in school
  • Uses sentences that give many details
  • Communicates easily with other children and adults
  • Says most sounds correctly except for a few (l, s, r, v, z, ch, sh, and th)
  • Uses rhyming words


  1. https://www.aafp.org/afp/1999/0601/p3121.html
  2. https://familydoctor.org/condition/speech-and-language-delay/
  3. https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Delayed-Speech-or-Language-Development
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