Speech Delay in Toddlers: Milestones, Warning Signs, and When to See a Speech Therapist

Toddlers develop communication skills at different rates. One child may begin using words early, while another relies more heavily on gestures before spoken language develops. Some variation is expected, but persistent differences in speech or language development can be worth discussing with a healthcare professional or speech language pathologist. Speech delay in toddlers may involve difficulty producing speech sounds, learning and using words, combining words, understanding language, or using communication effectively in everyday situations.

Parents do not need to wait until a child reaches a specific birthday to raise concerns. Developmental milestones provide useful reference points, but they are not diagnostic tests. If your toddler is not developing new communication skills, has lost skills they previously used, or you are concerned about their speech or language, an assessment can help clarify what support, if any may be appropriate. ASHA specifically recommends seeking professional guidance when a child is missing several communication milestones, is not gaining new skills, or loses skills they previously had.

At Second Nature Family, families in Ottawa and Kemptville can access individualized, neuro affirming speech and language support for children with different communication needs.

What Is Speech Delay in Toddlers?

A speech delay generally means that a child's communication development is progressing differently or more slowly than expected for their age. However, speech and language are not exactly the same thing. Speech refers primarily to how sounds and words are produced. A child may know what they want to say but have difficulty producing certain sounds clearly. Language includes understanding and using words, sentences, gestures, and other forms of communication. A toddler with a language delay may have difficulty understanding what others say, expressing their own ideas, or both. Parents commonly use “speech delay” to describe either situation, but a speech language assessment can help determine which areas of communication need closer attention.

Speech language pathologists may assess areas such as:

• Expressive language: words and messages a child communicates

• Receptive language: what the child understands

• Speech sounds and clarity

• Gestures and nonverbal communication

• Social communication

• Play and interaction

• Hearing related concerns

• Functional communication during everyday routines

Understanding the type of communication difficulty is important because two toddlers who both “aren't talking much” may have very different needs.

There is no single day when a toddler should suddenly begin talking. Communication develops gradually, beginning well before a child's first spoken word through eye gaze, vocalizations, gestures, pointing, showing objects, facial expressions, and shared interactions. Current CDC developmental milestones include trying to say at least three words other than “mama” or “dada” by 18 months and combining at least two words, such as “more milk,” by age 2. ASHA uses broader communication age ranges rather than exact birthdays because children develop at different rates. Its 19 to 24 month milestones include using and understanding many different words and beginning to put two or more words together. That means parents should look at the child's overall communication development, not simply count words on one particular birthday.

The following speech milestones by age are general reference points, not a pass or fail checklist.

ASHA notes that communication skills develop over ranges rather than appearing precisely on a child's birthday. Its milestones are intended to help families monitor development and decide when professional guidance may be useful not to diagnose a disorder.

Around 12 Months

By the end of the first year, communication often includes much more than spoken words.

A child may:

• Babble with different sounds

• Respond socially to familiar people

• Use gestures

• Point or show objects

• Wave

• Communicate wants through sounds, movement or gestures

ASHA identifies pointing, waving, showing and giving objects among communication milestones around 10–12 months.

Around 18 Months

By 18 months, many toddlers are beginning to use spoken words more purposefully.

The CDC lists:

• Trying to say three or more words other than “mama” or “dada”

• Following a one step direction without needing a gesture

as language and communication milestones by 18 months.

The number of words alone does not tell the complete story. Gestures, understanding, interaction, imitation, play and continued progress are also important.

Around 2 Years

Language development often becomes more noticeable between 19 and 24 months.

The CDC identifies combining at least two words as a 2 year communication milestone.

ASHA's broader 19–24 month milestones include:

Using and understanding at least 50 different words

• Combining two or more words

• Following two step directions

• Using words to ask for help

Speech does not need to be perfectly clear at this age.

Between 2 and 3 Years

Between ages 2 and 3, toddlers generally begin using spoken language more flexibly.

ASHA notes that children in this age range may:

• Use word combinations frequently

• Say their name when asked

• Use some plural words

• Use words describing actions

• Ask “why” and “how”

• Answer different kinds of questions

• Become progressively easier to understand

Speech may still not always be clear to unfamiliar listeners.

Possible signs of speech delay in toddlers depend on the child's age and the area of communication affected. Parents may notice that a toddler:

• Uses fewer spoken words than expected for their developmental stage

• Is not beginning to combine words

• Relies heavily on gestures without spoken language growth

• Has difficulty understanding simple directions

• Has difficulty using words to request or communicate needs

• Becomes frustrated when trying to communicate

• Uses few different speech sounds

• Is difficult for familiar caregivers to understand

• Shows limited progress in vocabulary over time

• Does not consistently respond to spoken language

• Uses communication differently from other children of a similar age

A single behaviour does not automatically indicate a disorder. The child's entire communication profile including understanding, gestures, play, hearing, social interaction and rate of progress should be considered.

Parents frequently search for signs of speech delay in a 2 year old because this is an age when communication often changes quickly. It may be worth discussing development with a speech language pathologist or healthcare provider if a 2 year old:

• Is not combining words

• Uses very few spoken words

• Has difficulty understanding familiar instructions

• Rarely communicates needs through words, gestures or another communication method

• Has difficulty learning new words

• Shows limited growth in communication over time

• Appears not to hear or respond consistently

• Has lost words or communication skills they previously used

ASHA's commonly used criteria for late language emergence include fewer than 50 words and no two word combinations around 24 months, although professionals consider much more than vocabulary size when evaluating an individual child. Loss of previously acquired communication or developmental skills should be brought to a healthcare professional's attention rather than simply monitored at home.

The terms late talker and speech delay are often used casually as though they mean exactly the same thing, but there can be an important difference. A late talker generally refers to a young child whose spoken language development begins later than expected but who does not have another identified developmental disability or delay explaining the difference. ASHA refers to this as late language emergence and notes that it may involve expressive language alone or both expressive and receptive language.

A child with primarily expressive late language emergence might:

• Understand much of what is said

• Communicate through gestures

• Play and interact in expected ways

• Have a smaller spoken vocabulary

• Begin combining words later

The broader term speech or language delay may describe difficulties involving:

• Understanding language

• Expressing language

• Speech sounds

• Vocabulary

• Sentence development

• Social communication

• Multiple areas of development

Some late talkers later develop language skills that fall within expected ranges, while others continue to experience communication or literacy difficulties. It is not possible to determine future language development simply by calling a child a “late talker.” An assessment can provide more useful information than waiting to see whether a child will “grow out of it.”

There is no single cause of delayed speech or language development. Speech and language differences may occur independently or alongside other factors. Possible considerations can include:

Hearing Differences

Children learn spoken language partly through hearing speech around them. Temporary or persistent hearing differences can affect access to speech sounds and language. A hearing assessment may therefore be recommended when speech or language development is delayed. The American Academy of Pediatrics notes that evaluation of language delay may include hearing testing as well as speech and language assessment.

Expressive Language Differences

Some toddlers understand language relatively well but use fewer words or sentences themselves. This is commonly called an expressive language delay.

Receptive Language Differences

A toddler may also have difficulty understanding spoken words, questions or directions. Receptive language is important to assess because it can influence how the child learns and uses language.

Speech Sound Difficulties

Some children know what they want to communicate but have difficulty producing speech sounds clearly.

Neurodevelopmental Differences

Communication differences may occur in children with autism, ADHD, developmental language disorder or other developmental profiles. A speech delay alone does not establish any particular diagnosis.

Oral Motor or Structural Factors

Certain physical or motor factors may affect speech production and may require further assessment depending on the child's presentation. A professional evaluation looks at the child's overall development rather than assuming one specific cause.

No. Autistic children have diverse communication profiles. Some begin speaking early. Some speak later. Some communicate primarily through spoken language, while others use gestures, sign, augmentative and alternative communication (AAC), or a combination of methods.

Speech delay also occurs in many children who are not autistic. A speech language pathologist can assess communication skills, but an autism diagnosis requires an appropriate developmental assessment rather than being determined from speech delay alone.

Second Nature Family's Speech Therapy service includes neuro affirming support for autistic children and recognizes spoken language, AAC, gestures and other forms of communication as valid ways to communicate.

Learning more than one language does not by itself cause a speech or language disorder. Parents should generally communicate with children in the languages they are most comfortable using. ASHA specifically advises multilingual families to continue providing opportunities for children to hear and use their languages and states that learning multiple languages does not cause speech or language problems. When a multilingual child is assessed, the professional should consider development across the child's languages rather than judging communication based only on one language.

Parents do not have to wait for communication difficulties to become severe before consulting a professional. Consider speaking with a speech language pathologist when:

• Your toddler is missing several expected communication skills

• Spoken vocabulary is growing very slowly

• Your child is not beginning to combine words around age 2

• Your child has difficulty understanding language

• Communication difficulties regularly cause frustration

• Speech is unusually difficult to understand for their developmental stage

• Your child appears not to hear consistently

• You are concerned about social communication

• Your child stops using words or other communication skills they previously had

• You simply have ongoing concerns about communication development

ASHA recommends professional guidance when a child is missing several skills, is not gaining new communication abilities, or has lost previously acquired skills. You do not need to diagnose your child yourself before requesting an assessment.

An assessment helps determine the child's communication strengths, current needs and whether additional support may be useful. For a toddler, an assessment may include:

• Parent or caregiver interview

• Developmental and medical history

• Observation during play

• Expressive language assessment

• Receptive language assessment

• Speech sound observation

• Gesture and nonverbal communication

• Social communication

• Play skills

• Hearing screening or referral when appropriate

• Discussion of communication during everyday routines

ASHA recommends gathering information from multiple sources because toddlers communicate differently depending on the person, activity and environment. At Second Nature Family, the speech therapy process begins with an individualized speech and language assessment and can include play based assessment for younger children.

Speech therapy for toddlers usually looks very different from an adult sitting at a desk practising words. Young children learn through interaction and play. Depending on the child's needs, a speech language pathologist may use play, books, everyday routines, toys and caregiver interaction to support communication goals. Therapy may address:

Early Language

The therapist may support development of:

• Vocabulary

• Word combinations

• Functional communication

• Understanding language

• Following directions

Gestures and Other Communication

Communication does not have to begin with spoken words. Pointing, gestures, pictures, sign and AAC can all support functional communication when appropriate.

Speech Sounds

If speech sound production is an area of concern, intervention may support development of age appropriate sound patterns and clearer communication.

Social Communication

Some toddlers may benefit from support with communication during play, shared interactions and everyday routines.

Parent and Caregiver Strategies

Parents spend far more time with their child than a therapist does. For that reason, toddler speech therapy often includes practical strategies caregivers can use during ordinary activities such as:

• Meals

• Bath time

• Getting dressed

• Reading

• Play

• Walks

• Car rides

Second Nature Family describes its pediatric speech therapy as play based, family centred and individualized around each child's communication profile.

Speech language support may be appropriate for some late talkers, but not every child needs the same type or intensity of intervention. Depending on assessment findings, recommendations might include:

• Monitoring development

• Parent or caregiver coaching

• Home communication strategies

• Periodic reassessment

• Direct speech language therapy

• Hearing assessment

• Referral to other professionals when appropriate

ASHA recommends ongoing monitoring for children with late language emergence because some children catch up while others continue to experience language difficulties. The goal is not to pressure a toddler to speak on command. Support should focus on making communication accessible, meaningful and functional.

Parents do not need specialized therapy equipment to support communication. Everyday interaction provides many opportunities.

Talk About What Your Child Is Doing

Describe the child's activity using simple natural language.

If your child pushes a toy car, you might say:

“Car goes fast.”

Expand What Your Child Says

If your toddler says:

“Dog.”

You might respond:

“Big dog.”

or:

“Dog is running.”

This models additional language without requiring the child to repeat it.

Give Time to Respond

Toddlers sometimes need more processing time than adults expect.

Ask or comment, then pause before speaking again.

Read Together

You do not need to read every word on the page. Talk about:

• Pictures

• Characters

• Actions

• Sounds

• Familiar objects

Offer Choices

Instead of:

“Do you want a drink?”

try:

“Milk or water?”

This provides useful language models while allowing the child to communicate in whatever way works for them.

Follow Your Child's Interests

Communication opportunities are often strongest when the child is already interested in the activity. ASHA recommends talking about everyday activities, expanding on what children say, reading together and using the languages families are most comfortable speaking.

When parents are worried about delayed speech, communication can unintentionally start feeling like a test.

Try to avoid repeatedly asking:

“What is this?”

“Say ball.”

“What's that?”

“Can you say dog?”

Instead, provide natural language models.

For example:

“Ball! Big ball. The ball is bouncing.”

Also avoid comparing one child too closely with siblings or other toddlers. Milestones are useful, but a professional assessment looks at the individual child's full communication profile.

A child can respond to some sounds and still have hearing difficulties that affect speech and language development. Hearing can be influenced by factors such as recurring middle ear problems or other auditory difficulties. For this reason, hearing assessment is commonly considered when evaluating delayed speech or language. The American Academy of Pediatrics notes that a healthcare provider may order hearing testing when investigating language delay. If parents frequently need to repeat themselves, speak unusually loudly, or notice inconsistent responses to sound, those observations should be mentioned during an assessment.

Sometimes a toddler with delayed expressive language will catch up. However, parents generally cannot determine in advance which child will catch up without support. A “wait and see” approach may therefore be less useful when:

• Several milestones are missing

• Progress has slowed or stopped

• Understanding is also delayed

• The child rarely communicates through words or gestures

• Hearing is a concern

• Communication difficulties affect everyday life

• Skills have been lost

• Parents remain concerned

An assessment does not automatically mean a child will need ongoing therapy. It can simply provide information about current strengths, development and appropriate next steps.

Toddlers do not all begin speaking at exactly the same time, and communication is much broader than the number of words a child says. What matters is the overall pattern:

Is your child developing new ways to communicate, understand others, express needs and participate in everyday interactions?

If communication development seems to have slowed, several milestones are missing, or you simply have ongoing concerns, you do not need to determine the cause yourself. A speech language assessment can help identify your child's strengths, clarify areas that may need support and guide appropriate next steps.

Second Nature Family provides individualized Speech Therapy for children and toddlers in Ottawa and Kemptville, with virtual speech language consultations also available across Ontario.