In this article
Your 20-month-old understands everything you say. He plays with his trucks and picks up his toys and fetches a diaper for his baby sister. But the only real words you ever hear come out of his mouth are “mama” and “ball.” Should you be concerned?
By far, the most common referrals that cross my desk look exactly like this – questions about speech delay in toddlers: My child is 20 months old and understands lots of words, but he can only say a few. My child can follow directions, but he never talks. My child talks all the time, but it’s all gibberish.
When a child understands language, but doesn’t talk, we call this an expressive language delay. What should you do if you suspect your child has an expressive language delay? Read on to find out.
What's typical: When do toddlers start talking?
There is a wide range of normal development in kids under the age of 3. Your niece might have begun putting sentences together at 15 months, but not every child will say so much so soon.
Here are the hard numbers: A typical developing 18-month-old will say 50 words. At a minimum, we’d like him to say 15. Likewise, a typical 24-month-old will say 200 to 300 words, and should not say less than 50. If your child is not meeting these minimums, contact your pediatrician or local early intervention agency for an evaluation.
If your child appears to have an expressive language delay, your local early intervention agency will do an evaluation. Not every child who is not meeting his milestones will qualify for special education services, though. The delay has to be significant for speech therapy or other school services to kick in.
What causes speech delay
In many cases, a speech delay isn’t cause for concern. Children are often on their own developmental schedules and your toddler will catch up with their peers. Your doctor can tell you if your child needs additional testing. Some causes of speech delay are:
Problems with the tongue or palate. One of these — ankyloglossia, where the tongue is connected to the floor of the mouth — can make it difficult to create certain sounds
Hearing problems. This may lead to your child having difficulty saying, understanding, imitating, and using language.
Oral–motor problems. Conditions such as childhood apraxia of speech (CAS) occur when the brain and the muscles responsible for speech aren’t coordinating correctly.
How to help speech delay in toddlers
If your child does not qualify for speech therapy, or if you want to try and improve his speech skills while you’re waiting for an evaluation to be finished, here are some tried-and-true tricks to encourage your child to use his words.
- Repetition. Remember that old piece of advice that a child may need to try a piece of food 20 times before he’ll like it? Same goes for talking. A child needs to hear a word at least 20 times before he learns it — that means a lot of repetition on your part. Keep your sentences short and simple, and repeat the desired word over and over again. Like, “Oh, look! Ball! You like the ball. Ball fall down.” Focus on early nouns (ball) and motion words (fall) that your child hears every day.
- Meet them where they are. If your child is talking in one word phrases, you should be speaking back to him in one or two word phrases. It’s not baby talk; it’s giving him a model that he can imitate. As his language skills develop, you can start feeding him longer and more complex sentences.
- Stop and listen. We are trained early as parents to talk, talk, talk to our kids. But when your child isn’t talking, it’s important to stop and listen. Sit with your child during meal and play time and wait for her to make a sound. When she does, repeat it back to her and wait to see what she does. Doing this reinforces to your child that language is a back-and-forth activity, and that helps to build her imitation skills. If your child is not yet making sounds, then imitate a movement (clapping, banging her hands on the table) or a facial expression instead. Make it a game to keep it fun!
- Look at books together. Don’t worry about the story and reading every word. Instead, point out pictures for your child. Label pictures, teach animal sounds, and just have fun with it. Toddlers think it’s particularly funny when you try to “eat” a monkey’s banana or when the lion “bites” you. I’m partial to the Spot books that have a flap to lift on each page. Children who can sit for longer periods of time might enjoy books with repetitive text like Five Little Monkeys Jumping on the Bed or Dear Zoo. Likewise, you can teach your child repetitive songs like “The Wheels on the Bus,” and “Teddy Bear, Teddy Bear.”
- Make language necessary. I often tell parents to “put yourself in the way” of what your child wants by creating scenarios that require your child to have to request his daily wants; set favorite toys up on a higher shelf and parcel out snacks a piece at a time. (Not to the point of frustration, of course.) In the beginning, it might just be your child glancing at Teddy up on that shelf. You can say, “Oh, want teddy? Teddy soft. Hi Teddy!” as you hand Teddy over. Later, you might accept a gesture and eventually, a word. At snack time, your child might look expectantly at you after three Cheerios and you’ll begin to teach the word (and maybe, the sign) for “more.”
