I’m approached by many parents on a regular basis with the question:
Does my child need speech therapy?
In general, child development occurs over a determined period of time. All children develop at their own pace. When one child says their first word at 10 months and another says their first word at 14 months, they are both still developing at a pace considered typical and appropriate.
With that said, we look for milestones that all children must achieve so that we know they are growing and developing as they should.There are speech and language milestones that need to be met (as well as motor, cognitive and social skills). But I’m focusing mainly on language right now. If these milestones aren’t reached by a certain time frame, I strongly recommended that you contact your pediatrician for information on how to proceed from here.
Below are 6 characteristics to look out for in your child:
1. Lack of babbling between 4-7 months.
If your infant isn’t making any consonant-vowel combinations such as bababa, mememe, or tadada, etc, let your pediatrician know. Parents gush over a really “good” baby who is quiet and doesn’t fuss often. However, babbling is crucial to language development. Babies need to babble to experiment with speech sounds, to hear themselves “talk”, to move their mouth muscles, and to have a little back and forth “conversation” with mom and dad. Sometimes, a quiet baby may indicate a hearing loss or some other developmental delay. Don’t ignore this.
2. No use of gestures or pointing between 7-12 months.
At this age, infants will reach out to mom or dad to get their attention. They can also point in the general direction of something they want. For example, they can point to the refrigerator for milk or point to a toy out of reach. Oftentimes, their pointing or gesturing is accompanied by some kind of vocalization to highlight what they want. This time frame is also marked with an infant’s ability to to wave “Hi” and “Bye” to other people. Some parents start to teach their child baby sign language at this age to help facilitate communication at home. Gesturing skills really take off at this stage.
3. Not learning their first words between 12-18 months.
Infants will learn their first word between 12 and 18 months of age. This word could be anything. Oftentimes, we hope their first word is mama or dada. But that doesn’t always happen. Yes, kids will babble mamama or dadada during the babbling period. But it’s not a true word until your child assigns meaning to it. For example, when you walk into a room and your child reaches out, looks directly at you and says “mama”, we can clearly assume that “mama” is a true word. If your child sits on the floor and babbles “mamamamama” while chewing on a board book and yells “eeeee” when you walk into the room, then your child is not yet using “mama” as a word. During this time frame, be on the lookout for your child’s first word. It’ll debut at any time.
4. Not having at least 50 words by 24 months.
This is a big milestone. Many of my early intervention kiddos start working with me around their 2nd birthday because it’s pretty obvious by now if their communication skills are delayed. Your child should be using a nice variety of words that are familiar within your home environment. An inventory of at least 50 words is special because your child has enough vocabulary to start putting words together in words and phrases. You’ll hear little phrases such as “More apple,” “Mama milk” or “No, Daddy”.
Between 24 and 36 months, your child should pick up new words at lightning speed. By the time their 3rd birthday rolls around, you’ve got a full-fledged, conversing little human. Look out for this little person to ask “Why, Mommy/Daddy?” to question everything around them. Then there’s also some excitement and dismay when their child reveals their family’s embarrassing moments during a zoom call with Great Aunt Helen. Yikes…
But what about a child who talks a mile minute, yet can’t pronounce words clearly?
That leads me to the next red flag to look out for.
#5. If your child is difficult to understand in conversation, seek the help of your pediatrician or speech therapist.
As a general rule of thumb, this is how I like to do a quickie speech screener with kids:
-at the the age of 2 years old, your child should be understood at least 50% of time to an unfamiliar listener. An unfamiliar listener is someone who does not interact with your child on a regular basis, like the cashier at the grocery store or a family member who only visits occasionally.
-at the age of 3 years old, your child should be understood at least 75% of the time to an unfamiliar listener,
-at the age of 4 years old, your child be understood at least 90% of the time to everyone they come in contact with.
There are a few lingering sounds that take a little longer to develop which may affect your child’s intelligibility around the age of 4 years old.
That would include R, S, L, and TH words. It’s okay for a young child to still use W for R in early elementary grades. I don’t worry too much about 5, 6, or 7 year old kids saying “wainbow” for “rainbow” or “bwuthah” for “brother”.
BUT, if your child is still struggling with R, S or TH sounds around 8 years old, please work with a speech therapist to correct this. It is not ok for a child at least 8 years of age to still struggle with these sounds. This is past the cute stage. It’s definitely not cute anymore.
6. Your child stutters and is struggling to talk.
There are stuttering-like behaviors that don’t necessarily lead to a full-blown stuttering disorder. These behaviors often occur in toddlers and preschoolers and are a normal phase that some children go through.
These behaviors that children can outgrow include: repeating phrases (e.g. “he did- he did- he did- it like this”), use of fillers like um and uh, minimal frustration, no tension or struggle, and dysfluencies lasting less than 6 months.
Red flag behaviors that are a sign of a more pressing stuttering disorder include: repeating sounds or syllables while talking (e.g. That’s my b-b-b-all), prolonging sounds in words (e.g. fffff-ish), showing behaviors such tension and struggle to get their words out, feeling frustration while speaking, secondary behaviors such as eye blinking, hand tapping or throat clearing, stuttering behaviors lasting longer than 6 months, and a family history of stuttering.
The last thing I’d like to mention isn’t necessarily based on textbook characteristics or red flags listed on a developmental checklist.
It’s that gut feeling that parents have about their child that doesn’t feel quite right. Some parents contact me “just in case” and to make sure that their child is developing as they should.
However, I encounter another group of parents who know that something isn’t quite right with their child’s development and it shows in their child’s daily behaviors. Parents have that feeling they can’t quite put their finger on, but they sense that their child is needing some developmental intervention. I know that we, parents, have an instinctive guide within us when it comes to knowing what our children need. We see their frustration when they lack effective communication skills at the proper age. We see a breakdown in their behaviors when they can’t engage with others as we would like them to be. Maybe they just don’t seem to “get it” when we try to sit and play with them.
Trust your gut. If there is something that doesn’t sit well with you, please seek the guidance of developmental specialist or talk to your pediatrician. We know our kids best, and the earlier we can get help, the better for your child and you in the long term.
