Language Delay

Padrick is an adorable, happy, social, red headed, thirty-month-old child with a face full of freckles. He runs into the kitchen where he finds his mom and starts pointing at the freezer. His mom asks, “What do you want?” Padrick keeps pointing and reaching but then gets frustrated. Sean, his twin brother runs and in and says “Padrick want juice pop.” Padrick smiles and is rewarded with the treat but his mother worries why he is not talking.

This is a familiar scenario occurring in kitchens all over the world. Language delay is one of the most common developmental concerns raised by parents. Approximately 2% to 19% of preschool children have speech and/or language delay. Speech refers to the mechanics of oral communication and includes conditions such a stuttering, voice quality differences, or articulation errors. Language encompasses the broad ability to understand, process, and produce communication. Children may have challenges in just one area or may have both speech and language difficulties.

How Do I Know If My Child Has Speech or Language Delay?
Language skills unfold on an accepted timeline, however, there is a range of normal for each skill. For example, one child may say five words at 11 months, while another child may not master five words until age 21 months. Both children have language development in the normal range. This makes language delay somewhat difficult for parents to identify. It can be helpful for parents to utilize a chart (like the one provided) to get a general feel for when milestones should be present. Parents should be concerned if their child is not:

  • Responding to name and engaging in reciprocal interactions 6 months
  • Babbling and pointing with one finger by 12 months
  • Understanding simple commands such as “no” and “stop” by 18 months
  • Talking in short sentences such as “I want cookie” by 36 months
  • Telling little stories by 48 months
  • Being 100% clearly understood by age 48 months.

Many parents only recognize expressive language delay (like Padrick), that is, a delay in the number of spoken words used, however, children can also have receptive language which is difficulty understanding basic vocabulary and sentences. Pragmatic language delay is the term used for children who lack understanding of the social use of language such as reading social cues, understanding idioms, or failing to interpret tone of voice or gestural communication. Some children have developmental language delay, otherwise known as “late talkers.” These children have normal intelligence, normal hearing, and strong social skills but are later than their peers in developing receptive/expressive language. Eventually these children catch up on go on to communicate well.

If parents have concerns about their child’s language development, they should bring their concerns to the attention of the health care provider. The best way to determine if your child has a speech or language delay is to have them assessed.

What Causes Speech and Language Delay?
There are a variety of factors that may place a child at risk for language delay. Genetic conditions such as fragile X syndrome and autism, prematurity, environmental issues such as poverty, abuse or neglect, and delayed cognitive development can play a role. Hearing impairment should always be considered in any child with language delay. Although most children are now screened in the newborn nursery for congenital hearing loss, hearing loss can be acquired, as thus, parents should ask their child’s care provider for a hearing test as a first step towards evaluation.

What Can Parents Do?

  • Seek professional help if you are concerned. Visit the pediatrician or nurse practitioner and ask for a speech and language evaluation. Request a hearing test. Do not take the “wait and see” approach because your child may miss months of important intervention if it is needed.
  • Children need a language rich environment. Communicate with your child, starting in infancy by talking, singing, rhyming, and playing little language games.
  • Read, Read, Read. Assisting your child to find the joy of reading provides a foundation for life long learning and exposes them to the rhythm of language, millions of vocabulary words, grammatical structure, and creative ideas.
  • Limit television viewing; you are a much more effective language teacher.
  • Encourage children to talk about their feelings and their experiences. Be a good listener.
  • If your child does have language delay, keep all therapy appointments and follow the therapists recommendations.

Resources for Parents who Suspect their Child May Have Speech or Language Delay

  • The primary health care provider
  • A Speech-Language Pathologist
  • Early Intervention Screening Programs
  • Evaluation at a Developmental Clinic
  • Assessment by the school special education team

Language Milestones
Birth to 3 months
Makes pleasure sounds (cooing, gooing)
Cries differently for different needs
Smiles when sees you
6 months
Responds to his name
Responds to human voices without visual cues by turning his head and eyes
Responds appropriately to friendly and angry tones
12 Months
Uses one or more words with meaning
Understands simple instructions, especially is cues are given
Is aware of the social value of speech
18 Months
Has vocabulary of approximately 5-20 words
Vocabulary made up chiefly of nouns
Is able to follow simple commands
24 Months
Can name a number of objects common to his surroundings
Is able to use at least two prepositions
Combines words into a short sentence-largely noun-verb combinations (mean) length of sentences is given as 1.2 words
Approximately 2/3 of what child says should be intelligible
36 Months
Uses Pronouns I, you and me correctly
Uses some plurals and past tenses
Knows at least three prepositions
Handles three word sentences easily
Has about 1000 words
Is about 75-90% intelligible
Can give sex, name, and age
Adapted from Child Development Institute at and The NIH National Institute on Deafness and Other communication Disorders at