Signs your child might need speech therapy

When to consider a speech therapy evaluation for your child

Every child develops at their own pace, but there are established milestones that help parents and pediatricians identify when a child may benefit from professional support. Speech and language delays are among the most common developmental concerns — affecting approximately 1 in 12 children in the U.S. (All Care Therapies). The good news is that early identification and intervention can make a dramatic difference in outcomes.

Key milestones by age

By 12 months, most children babble, respond to their name, and understand simple words like "no." By 18 months, they typically use at least 5–20 single words. By age 2, most children combine two words ("more milk"), have a vocabulary of 50+ words, and can be understood about 50% of the time by strangers. By age 3, children typically speak in short sentences and can be understood 75% of the time. By age 4, most children speak clearly enough that even unfamiliar adults can understand them most of the time (All Care Therapies).

Red flags that suggest an evaluation is needed

• Not babbling by 12 months.
• Not using any single words by 18 months.
• Not combining two words by age 2.
• Loss of previously acquired speech or language skills at any age.
• Difficulty being understood by familiar people by age 2.5.
• Frustration or behavioral issues related to communication.
• Not following simple directions by age 2.
• Limited eye contact or social engagement.
• Difficulty with feeding or swallowing in infancy.

Additional signs include: only making a few sounds, not using gestures like waving or pointing, and not expressing first words by 12–15 months (Hackensack Meridian Health).

Speech delays vs. language delays

Speech refers to the physical production of sounds — articulation, fluency, and voice. A child with a speech delay may understand language well but struggle to pronounce words clearly. Language refers to understanding and using words and sentences — vocabulary, grammar, and social communication. A child with a language delay may speak clearly but have limited vocabulary or difficulty forming sentences. Some children have both. A speech-language pathologist can evaluate which areas need support (All Care Therapies).

What happens during a speech therapy evaluation

A speech and language evaluation is typically a 1–2 hour appointment during which a speech-language pathologist (SLP) assesses your child's talking, understanding, and play skills (Toddler Talk). The evaluation can be done in-person or online via a video platform (Expressable).

The process usually includes:

1. Initial meeting: The SLP gathers information about your child's developmental history, medical history, and any concerns you may have.
2. Observation: The SLP observes your child's communication skills during play or conversation.
3. Formal assessment: Standardized tests may be used to measure specific areas of speech and language.
4. Results and recommendations: The SLP shares findings and whether speech therapy is recommended.

Why early intervention matters

The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills (NIDCD). Intervention during this window can significantly improve outcomes. Research increasingly supports moving away from the "wait and see" approach, especially for communication delays. Children with untreated language delays are at greater risk for long-term academic and social difficulties (Achieve Beyond).

Quiz: Test your knowledge

At what age should a child typically be combining two words (e.g., "more milk")?

• By age 2
• By age 3
• By age 4

How the Resident Expert Can Help

If you're concerned about your child's speech or language development, Domino Therapy offers speech therapy services for families, schools, and therapists, providing both in-person and virtual support based in Philadelphia, PA. Their focus is on enhancing communication skills and professional growth. Visit Domino Therapy to learn more or schedule an evaluation.