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Doctor in the House: Do you suspect speech delay in your child? Here are some tell-tale signs

Speech delay can be a sign of hearing loss or neurological disorders. Early intervention goes a long way in finding a solution

speech delay, speech delay in kids, factors leading to speech delay, language development, signs of speech delay in kids, parenting, indian express newsA speech delay may just mean your baby has not reached a particular milestone or it may mean a part of a wider illness. (Photo: Getty/Thinkstock)

To talk about speech delay, we need to know the sequence of word and language development.

A typical two-year-old can say about 40 to 50 words and can also make sentences comprising two to three words. After this, it really speeds up and a three-year-old may even have 1,000 words in his vocabulary and sentences containing five to six words. These are general guidelines and not strict rules to measure by, children develop at different rates. If your child does not meet these developmental goals, then they may have speech delay. Not all babies who have speech delay have a developmental problem, they may just be a late bloomer. Simultaneously however, we need to rule out organic causes of speech delay like a hearing impairment or a neurological problem.

It is important to pick up on this earlier, for timely intervention and treatment.

Though speech and language delay are often spoken together and can be seen as interchangeable, in actuality, there are differences between whether there is speech or language delay.

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What is speech?

It is a physical act of producing sounds and making words. A toddler with speech delay usually has trouble saying words but usually has no problem with comprehension and no problem with non-verbal communication.

In language delay, the baby may make sounds and even say words but does not make sentences and have difficulty in comprehension. Some children may present with both.

Babies start with cooing as early as two months, which changes to unintelligible babble and finally to an understandable word.


A typical three-year old can say their name, ask questions and even tell a story and sing a song. Nearly half the children at three years can be understood by strangers.

Sometimes speech delay may be because of problems involving the mouth, tongue or palate. (Photo: Getty/Thinkstock)

When to suspect speech delay?

— When babies don’t make any sound at two months, it could be an early sign of later speech delay.
— When a two-year-old does not have at least 25 words in his or her repertoire
— When a two-and-half-year old does not make 2-word phrases
— When a 3 year does not have at least 200 words, does not ask for things and parents find it difficult to understand their toddler


Causes of speech delay

Sometimes speech delay may be because of problems involving the mouth, tongue or palate. Tongue tie is when the tongue is held down to the floor of the mouth and hence the child finds it difficult to create certain sounds which involve getting the tongue to the roof of the mouth. These babies usually would have problems feeding in the first week of life and may even need surgery to release the tongue tie.

Hearing loss: A baby who cannot hear very well is going to have difficulty in forming words. Sometimes, it is difficult to identify hearing loss, especially if it involves one ear, and speech delay may be the only sign.

Lack of stimulation: Your environment plays a very important role in speech development. So a neglected child may show speech delay as is an abused child.

* Autism Spectrum Disorder

This is another group of disorders which present with speech and language problems. Other signs of this disorder is a repeating phrases called echolalia, repetitive behaviours, impaired verbal and nonverbal communication and even speech and language regression.


* Neurological Problems

Cerebral palsy, when it affects the muscles involved in speech, can lead to delayed speech. In cerebral palsy, hearing loss can also be a cause. Cognitive issues can also affect speech.

Autism Spectrum Disorder is another group of disorders which present with speech and language problems. (Photo: Getty/Thinkstock)


As there is such a variability in the stages of speech development in toddlers, it is a little difficult to make a firm diagnosis of speech delay. Ten to 20 per cent of two-year olds are late to develop language and it is more commonly seen in male children. Most of these children don’t have an organic problem and are caught up by age three. Your paediatrician will do a full history and examination and will arrange for a hearing test before your child is sent for speech therapy.


If your paediatrician feels that your baby needs a neurological evaluation then a neurology consultation will be required.


Most children will only need speech-language therapy and the outcome is usually excellent. Your child will most likely be speaking normally by the time they join school.

When speech disorders are associated with behavioural problems and socialisation, then early intervention may be needed. This usually is an integrated approach where all issues are addressed.

Treatment for hearing loss could involve hearing aids or even cochlear implants, occupational therapy, physiotherapy and even applied behaviour analysis therapy.

What parents can do to help

* reduce screen time to the minimum
* talk as much as possible to your baby.
* you can make gestures and point to objects as you say the corresponding words.
* read as much as possible to your baby
* sing songs together instead of getting them to watch it on screen
* give your full attention to your baby when they are talking to you .
* let your baby interact with other children who have good talking skills
* when they make a mistake, repeat the word correctly .

A speech delay may just mean that your baby has not reached a particular milestone or it may mean a part of a wider illness. It is important that it is picked up early and investigated accurately so that speech therapy or early intervention can be initiated.

Dr Saroja Balan is consultant neonatologist and paediatrician at Indraprastha Apollo Hospital. Her column appears every fortnight

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First published on: 25-11-2022 at 15:06 IST
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