Speech and language delay is suspected when a child does not meet average developmental milestones in speech and language development. It is very common - as many as 19% of children may have some sort of delay. A language delay can result in children not learning new words, having trouble with tenses, learning to put words in the right order, and understanding what people say to them. Speech delays may include trouble learning the sounds of speech, not understanding the rules that govern sounds, motor speech disorders, and structural problems.
Speech and language delay in children has many root causes, and therefore many potential therapies and interventions. Pediatricians typically watch for these delays on wellness visits, but parents can closely keep track if their child is reaching milestones, and meet with a pediatrician if they suspect a delay.
Although early intervention is believed the be key to the improving outcomes, most speech and language delays are not diagnosed until a child is 6 or 7 in a school screening. Scheduling a visit with a pediatrician to screen them for a language delay can aid in early diagnosis. Although a baby’s hearing is checked at birth, chronic ear infections and other illnesses can result in hearing loss which can inhibit a child’s ability to acquire language. A speech and language delay can also be caused by a motor neural abnormality (e.g. apraxia of speech) or brain damage caused by toxins (e.g. lead poisoning). A speech delay may be caused by weakness in the muscles themselves, a physical impairment (e.g. tongue tie, cleft palate), or an inability to correctly hear the individual parts of speech (leading to dyslexia). Speech and language delay can also be an early sign of other neurological conditions including autism spectrum disorder and ADHD.
Babies begin developing their communication ability within the first few weeks of life: they listen to the sounds of everyday experience and interact with their parents and caregivers. They learn that crying will get them fed, cuddled, or a fresh diaper. They fear sudden loud noises.
By 3 months old, most babies listen to their parent’s voices, react to loud noises, make cooing noises, have different cries, and smile at their parents. These are all indications that a baby is learning to react to their environment, specifically that they hear sounds, are starting to recognize different sounds and make sense of them, and are trying to communicate back.
From 4 months to 7 months, most babies start to watch moving soundmakers, pay attention to the change in the tone of their parent’s voice, starting laughing and babbling, and begin to make easy-to-produce p, b, and m sounds.
Between 7 months to a year, most babies begin to understand common words (e.g. out, eat), have more and longer babbles and sounds that mimic speech, and have a handful of real words: mama, papa, dog, no.
Between one and two years, toddlers typically begin to understand more spoken language and can understand many simple questions. They are constantly acquiring new words and use many different consonants. Children typically use between 200 and 300 words by age two. Parents can easily measure how many words a child uses in a day by keeping a day-long record of different words in a notebook. Keeping a record of how many different words your child uses is an invaluable record that you can bring with you to a pediatrician if you suspect a delay.
Between two and three years, a child will be able to put together increasingly more complex sentences like “Mama come.” They also use more difficult-to-pronounce consonants k, g, f, d, and n. They are also understood by friends and family, not only parents.
Between three and four, a child’s speech and ability to understand speech becomes more complex. They do not have trouble hearing you, do not listen to the TV or radio from a very short distance (which may indicate hearing impairment). They can answer simple questions: who, what, where, why, how.
Starting at age four, children should be able to start telling stories, use rhyming words, and say all but the most difficult sounds (l, s, r, v, z, sh, ch, th).