Is Your Child's Speech Delay Something to Worry About? 10 Signs Parents Shouldn't Ignore

It is understandable to feel worried when your child is not talking as much as other children. Perhaps a nursery practitioner has mentioned their communication, or you have noticed that a friend’s child seems to be using many more words. You may be wondering whether to wait a little longer, ask for help, or worry that you are overreacting.

Children develop at different rates. Some children are late to talk and go on to catch up, particularly when they understand language well, use gestures, enjoy interaction and continue to make progress. A speech delay does not automatically mean that something serious is wrong.

However, some signs are worth checking rather than ignoring. Communication includes much more than the number of words a child uses. It also includes understanding, gestures, play, social interaction, speech clarity and the ability to communicate needs and interests.

Here are 10 signs that may make an assessment helpful.

1. Your child loses words or communication skills

A child who loses words, gestures, eye contact, social interest or another skill they previously had should be assessed promptly. Regression is different from developing more slowly. It is not something to explain away as a phase or simply monitor for several months.

Contact your GP, health visitor or local NHS service for advice. A speech and language therapist may also help to understand what has changed and whether other professionals should be involved.

2. Your child is not responding to sounds or trying to communicate

By around 12 months, babies are generally beginning to communicate intentionally. This may include babbling, making sounds to gain attention, using eye contact, reaching, waving or pointing.

A baby who does not seem to respond to sounds, voices or their name may need a hearing check. Some children with hearing difficulties respond inconsistently, so it is worth raising concerns even if they sometimes appear to hear.

At this age, not having clear words is not necessarily a red flag on its own. The wider pattern of communication matters.

3. There are no words, pointing or clear communication attempts around 18 months

By around 18 months, many children are using some words, gestures or sounds to communicate what they want. They may point to an object, take an adult towards something, copy actions or use a familiar word such as “more”, “mummy” or “up”.

Some children have a smaller vocabulary at this stage and continue to develop well. It is more important to seek advice when there are no words alongside limited gestures, little pointing, difficulty understanding simple language or very few attempts to share attention.

4. Your child finds it difficult to understand what is said

Speech delay is not only about talking. Understanding language, sometimes called receptive language, is also important.

A child may need further advice if they regularly struggle to follow simple instructions, understand familiar questions or identify everyday objects. For example, they may not respond to “bring your shoes” or “where is your cup?” even when the situation and words are familiar.

A child who is late to talk but understands well may catch up. When limited speech is combined with poor understanding, an earlier assessment is generally sensible.

5. Your child is not combining words around the age of two

Around two years, many children begin putting two words together, such as “more juice”, “mummy come” or “go park”. They are also often using at least around 50 meaningful words by this stage, although there is considerable variation in vocabulary, pronunciation and sentence length, so this is not a pass-or-fail test.

It is worth asking for advice if your child is not combining words, has very few meaningful words, rarely points to share interest or does not seem motivated to communicate. Progress also matters. A child who is adding new words each week may need monitoring, while a child whose communication has remained unchanged may benefit from an assessment sooner.

6. Your child uses very few words or phrases by around three

By three, children are generally using short phrases and simple sentences to express needs, interests and ideas. Their vocabulary is often in the hundreds by this stage, and familiar adults would usually understand much of what they say, even if speech sounds are still developing and unfamiliar listeners may miss quite a lot.

It may be worth seeking advice if a three-year-old is still using only a very small number of words, is not yet using short phrases, is difficult for familiar adults to understand most of the time, or is mainly communicating by pulling an adult towards objects rather than using words, gestures and shared attention. This does not provide a diagnosis, but it is a useful reason to discuss their development with a professional.

Children who use more than one language may divide their words between languages. Bilingualism does not cause speech or language difficulties, and your family should continue using the languages that feel natural at home.

7. Your child’s speech is very difficult to understand

It is common for young children to simplify sounds while they are learning to speak. Some sounds develop later than others. However, speech may need checking when familiar adults understand very little of what a child says, the child becomes upset when trying to communicate, or their speech remains difficult to understand in everyday situations.

By around three to four years, people outside the immediate family would generally expect to understand at least some of a child’s speech. By four to five, familiar listeners would usually understand most of it.

An assessment can look at speech sounds, clarity, oral movements and how the child communicates when they are not understood.

8. Your child rarely points, shares interest or joins interaction

Some children have speech that is developing slowly but still use eye contact, gestures, facial expressions, pretend play and shared attention to connect with others.

It is worth seeking advice if your child rarely points to show you something, does not often bring objects to share, finds back-and-forth interaction difficult, does not copy actions or seems uninterested in communicating with other people. These signs can be linked to different developmental profiles. They should be assessed, not used by parents to diagnose a condition at home.

9. Communication difficulties are affecting your child’s confidence or behaviour

Children may become frustrated when they cannot make themselves understood. You might notice frequent distress, withdrawing from conversation, avoiding situations where they need to speak, or relying heavily on adults to interpret their needs.

Behaviour is often a form of communication. This does not mean every tantrum is caused by a speech delay, but repeated frustration around communication is worth discussing. Support may focus not only on words and speech sounds, but also on helping your child communicate successfully in everyday situations.

10. There are concerns in more than one area of development

A speech or language concern is particularly worth checking when it appears alongside difficulties with hearing, play, movement, learning, attention, feeding, social interaction or general development.

A hearing assessment may be appropriate, especially if your child has had frequent ear infections or does not always respond to speech. You can speak to your GP or health visitor about local NHS pathways. Nursery staff, teachers and the school SENCO can also contribute useful observations.

When is watch and wait reasonable?

Short-term monitoring can be reasonable when your child is making steady progress, understands everyday language, uses gestures, enjoys interaction and has no concerns about hearing or wider development.

Monitoring should include specific observations rather than waiting indefinitely. Note new words, ways your child communicates, what they understand and whether they are becoming easier to understand.

It is usually better to seek advice sooner when there is regression, limited understanding, a possible hearing concern, little communication intent, difficulties across more than one area, or no clear progress. Asking for an assessment does not mean you are labelling your child or committing to long-term therapy. It gives you clearer information.

What happens during a paediatric speech therapy assessment in London?

At The Speech Service, an initial assessment usually lasts between 60 and 90 minutes.

The therapist will talk through your concerns and take a full developmental history. They may look at your child’s understanding, vocabulary, sentences, speech sounds, play, interaction and communication in everyday situations. With your agreement, they may also speak with your child’s nursery or school.

The findings and possible next steps are discussed with you in clear language. A written report is not included as standard, but can be requested as an optional extra when something formal is needed for a nursery, school, GP or another professional.

Appointments may take place at home, at your child’s nursery or school, online, or at clinics in Finchley, Mill Hill, Hendon or Friern Barnet. A small additional charge applies to clinic sessions at some locations.

What does therapy look like?

Therapy is planned around your child’s communication needs and interests. Sessions are usually 50 minutes and are generally arranged in weekly blocks of six to eight sessions. Longer, shorter or fortnightly arrangements may also be considered when appropriate.

At the end of each block, progress is reviewed and future support is discussed. Therapy may involve play, books, everyday activities, visual supports, speech sound practice or coaching for parents and education staff. The aim is to make strategies practical enough to use between sessions.

The Speech Service works with children from toddlerhood through to the teenage years, including children with late first words, unclear speech, stammering, language difficulties and social communication needs. Parents, nursery staff, teachers, GPs and other professionals can be included where this would support consistent care.

You can read more about The Speech Service’s paediatric speech and language therapy.

What can you do at home while waiting for advice?

Small changes in everyday interaction can create useful opportunities for communication:

• Follow your child’s interests and join their play rather than directing every activity.

• Comment on what your child is doing instead of asking repeated questions.

• Repeat and gently expand what they say. If they say “car”, you might say, “blue car” or “the car is going”.

• Offer simple choices, such as “apple or banana?”, and allow extra time for a response.

• Share books, songs and nursery rhymes without testing your child on every page.

• Use gestures, pictures or objects alongside spoken words when helpful.

• Keep using your home language or languages. Rich, natural communication is more helpful than switching to a language that feels less comfortable.

• Reduce background television and other noise during conversations and play.

These ideas can support communication, but they should not replace professional advice when red flags are present.

If you are already waiting for NHS support, our guide to private SLT and NHS speech therapy waiting times explains some practical differences between the two routes. Families may also choose to use private and NHS services at different times, provided the professionals know about one another and support remains coordinated.

If you are unsure what your child’s communication needs mean, The Speech Service offers a short telephone consultation to discuss whether an assessment may be suitable. You can contact the team to talk through the available options.

Written by The Speech Service