Is it a speech delay? What to do when your toddler isn't talking

Does your child have a speech delay? Expert advice from TMC for Children speech pathologist Marylou FragomeniWith two older chatty siblings who love to care for their little sister, it might seem like Emily was just letting her brother and sister talk for her. And maybe she was, but when Emily’s parents took her to the 2-year-old well-check, her speech development had slowed considerably since her 18-month check up. At 2 years and 3 months, they returned to their pediatrician and Emily was assessed again. Her speech development seemed to have plateaued. Concerned that it was a negative trend, Emily’s pediatrician suggested that she be evaluated by a speech therapist and referred her to TMC for Children’s Pediatric Therapies Department.

How do you know if your child’s speech development is on track?

The American Speech-Language-Hearing Association provides the following as a guide for parents to look for:


  • Makes pleasure sounds

0-3 Months

  • Repeats the same sounds a lot (cooing, gooing).
  • Cries differently for different needs.
  • Smiles when she sees you.

4-6 Months

  • Babbling sounds more speech-like with many different sounds, including p,b, and m.
  • Tells you (by sound or gesture) when he wants you to do something
  • Makes gurgling sounds when left alone and when playing with you.

7 Months – 1 Year

  • Babbling has both long and short groups of sounds such as “tata upup bibibibi.”
  • Uses speech or non-crying sounds to get and keep attention.
  • Imitates different speech sounds.
  • Has 1 or 2 words (“bye-bye,” “dada,” “mama,” “no”) although they may not be clear.

1-2 Years

  • Says more words every month.
  • Uses some 1-2 word questions (“Where kitty?” “Go bye-bye?”).
  • Puts 2 words together (“more cookie,” “no juice,” “mommy look”)
  • Uses many different consonant sounds at the beginning of words.

2-3 Years

  • Has a word for almost everything.
  • Uses 2-3 word sentences to talk about and ask for things.
  • Speech is understood by familiar listeners most of the time.
  • Often asks for or directs attention to objects by  naming them.

Is my child just a late bloomer or do they have a speech delay?

At 2 years old, my eldest child seemed to be less verbal than her peers. The pediatrician suggested that we pay close attention over the next few months to how she responded to language and to how she was using language. Was how she was using language changing? Growing? If not, we needed to schedule to see a speech pathologist and determine why her language wasn’t developing at the expected pace. When a few short months later when she regaled us with a word for word rendition of the Sound of Music’s ‘Doe a Deer’, we recognized perhaps she was just a late bloomer rather than having a speech delay. But what if it’s not a case of being a late bloomer? What if it is a speech delay?

What should I do if I think my child has a speech delay?

Marylou Fragomeni, Speech Language Pathologist at TMC for Children Pediatric Therapies shares the following,

We have found that parents are usually right! If they have a concern about their child’s communication development, they should ask their pediatrician for a therapy referral…For speech therapy, it is a good idea for the pediatrician to refer to more than one place since there are often waiting lists around the community for this service.

Before the evaluation, Heather, Emily’s mom was nervous. The evaluation wasn’t scary though, and Heather was greatly relieved by how pleasant the speech therapists made the experience for her child.

The evaluation process with a 2-year-old is based on a criterion referenced checklist of expected skills that the therapist tries to elicit from the child during a play-based evaluation session.  We know that 2-year-olds may not perform for us in a this unfamiliar place, so we ask parents to also describe what their child can do, and make sure what we come up with matches what the family sees at home.

Emily did qualify for speech therapy and started at TMC for Children’s Pediatric Therapies program.

What can I expect when my child goes to Speech Therapy?

Marylou explains what families might expect when they bring their child to Speech Therapy.

Speech therapy for children is play-based. Usually the therapy is in a clinic room, with a variety of toys that engage that child, but also with a structure around that play that supports a change in communication habits and increases an opening for development of new skills.  This can include puzzles, blocks, bubbles, potato head, singing songs, books, playdough… and did I say BOOKS?!

But therapy isn’t just at the clinic,

Parents are expected to carry out a home program: their therapist will model methods of changing up their interaction with their child and will also provide paper activities and instructions if that is what is needed.  Mostly, we ask parents to incorporate the child’s new skills into what they currently do so well with their child, play! Expect development across environments!

That commitment to the program in the home environment is critical to the child’s success.

Just a few months after she started therapy, Emily was progressing leaps and bounds and ‘graduated’ out of the program.

If you are concerned about your child’s language development talk with your pediatrician about getting a referral to see a speech therapist.