Delayed Speech

May 3, 2020

4 min read

Delayed speech can affect up to 10% of preschool children, according to the American Academy of Family Physicians (AAFP). Children all develop and grow at their own pace, but some children may not speak as much as others in their age group. Quietness in children isn't the same as a speech delay. The AAFP advises parents that their children may have a delay in speech development if they can't say simple words by the time, they are 12 to 15 months old. Simple words include "mama" and "dada." According to Johns Hopkins' Children's Hospital, most children can say about 20 words by the time they're 18 months old.

Additional criteria for speech delay include:

Lack of ability to understand simple words ("no" and "stop") by 18th months of age.
Speak in short sentences by age 3
Tell simple stories by age 4 to 5
Not using gestures like pointing or waving goodbye by 12 months
Trouble imitating sounds and prefers gestures over speech by 18 months

Finally, by age 4, most children should be able to be understood when speaking in simple sentences.

Speech and language delays aren't quite the same. Johns Hopkins Children's Hospital explains that speech refers to the verbal expression of language, including words and the way they sound and are formed. Language is a system of communication. Language can include nonverbal communication, verbal (spoken) communication, and written communication. This is why American Sign Language (ASL) is considered a language, and people who can speak in English and who also know ASL are bilingual (knowing two languages). Children with language delays may be able to speak the words that they do know properly, but can't express ideas well or utter sentences. Children with speech delays may understand language well, but have physical problems that make it difficult for their speech to be understood.

When children develop their speech and language skills, the stages of competency and ability are the same. However, they can reach these stages at different ages. Pediatricians look for children reaching some basic milestones by certain ages. If they aren't "there yet," then they may be delayed in either language or speech.

For example, before 12 months, babies should be using their voice and "practicing" speech. Baby talk and babbling is normal beginning at 9 months. One of the primary reasons for speech delay is hearing loss or impairment. If a baby watches their surroundings very carefully but doesn't begin to respond to common words (mama, bottle) by 12 months, they may be hearing impaired.

By 12 to 15 months, children should be babbling and imitating words that they hear, and be able to sat at least a word or two beyond "mama" and "dada." They should be able to follow simple directions as well.

By the time children turn two, most have a vocabulary about 50 words, and can say simple sentences, like "baby cry" or "mama big." They can identify common objects by name and can follow two-step commands. Between ages two to three, children's vocabulary grows quickly. They can begin to speak in sentences of more than two words, learn their colors and numbers, and can describe sizes, shapes, and relationships.

There are many reasons why a child may have a delay in speech. Some causes include problems with mouth development, including tongue, lips, and palate. Hearing problems are another major cause of speech delay. Ear infections can contribute to hearing problems, especially chronic infections. Developmental delays or cognitive differences may also contribute to speech delay. Autism and cerebral palsy may also influence speech delays. Finally, children who don't get enough social stimulation and nurturing can have delayed speech, and some children can speak, but do not speak, a condition called elective mutism. Children in bilingual homes may be learning a lot of language, but they also may be slower to speak than children raised in monolingual homes.

Ultimately, the American Academy of Family Physicians advises parents that their child may be developing at their own pace and may not need any type of treatment. However, if treatment is necessary, they can advise you on the best course of treatment. Your child may need help from a speech pathologist, or may have a hearing deficit which can benefit from treatment. Audiologists, psychologists, and occupational therapists can all help children with delayed speech to improve their abilities.

As a parent, you can help your child to speak better and help them to receive speech-language therapy. Speak as often as you can to your child, and help them to form words clearly and communicate using speech.