Signs Your Child May Benefit from Speech Therapy
A guide to the communication concerns that bring families to pediatric speech-language therapy — by age, with specific signs to look for and what to do next.
Speech-language therapy covers far more than articulation. Speech-language pathologists (SLPs) work with children on speech sound clarity, expressive and receptive language, fluency (stuttering), social communication, oral motor coordination, and feeding. So "does my child need speech therapy?" depends on which of these areas you're concerned about.
This guide walks through the most common signs that bring families to our SLPs, organized by age. If your child shows signs in even one or two areas, an evaluation is worthwhile. Earlier intervention almost always leads to better outcomes — and a clinical evaluation gives you clarity either way.
Important note: bilingual children are not "delayed" because they're bilingual. If you're raising your child in two languages, an SLP familiar with bilingual development can help you tease apart language difference vs language disorder. We routinely evaluate bilingual children and refer to specialists when more specialized assessment is appropriate.
Signs in babies (0–12 months)
Even before first words, babies are doing important communication work — making eye contact, responding to voices, babbling, and exchanging early back-and-forth communication. Concerns at this age usually focus on these pre-language skills.
- No babbling by 9–10 months
- No response to their name by 9–10 months
- Limited eye contact or reduced engagement during face-to-face interaction
- No use of gestures (waving, pointing, reaching for things) by 12 months
- Lack of imitation of sounds or facial expressions
- Feeding difficulties — gagging, choking, refusing certain textures
Signs in toddlers (12 months – 3 years)
This is the age range when most speech and language concerns surface. Vocabulary should be growing rapidly, and by 24 months children typically have at least 100 words and are starting to combine them.
- No first words by 15–18 months
- Fewer than 100 words by 24 months
- No two-word phrases ("more milk," "go car") by 24 months
- Speech that's very hard for family members to understand by 24 months
- Loss of words or skills your child previously had (regression) — this warrants urgent evaluation
- Significant frustration tied to communication struggles
- Difficulty following simple directions ("get your shoes")
- Lack of interest in interactive play, social games, or imitating others
Signs in preschoolers (3–5 years)
By preschool age, children should be using sentences, asking and answering questions, and being understood by people outside the family. Concerns at this age often involve articulation, language complexity, fluency, or social communication.
- Speech that's difficult for unfamiliar adults to understand by age 3.5–4
- Persistent stuttering, especially with tension, struggle, or avoidance behaviors
- Vocabulary or sentence structure noticeably behind peers
- Difficulty answering "wh-" questions (who, what, where, why)
- Trouble following multi-step directions
- Difficulty in social communication — taking turns, joining peer play, having back-and-forth conversations
- Continued use of jargon or unintelligible "made up" words past age 3
- Persistent specific sound errors (lisps, missing sounds) beyond developmental norms
Signs in school-age children
School-age communication concerns often involve subtle language difficulties, social communication challenges, ongoing articulation errors, fluency, or literacy-related language issues.
- Specific articulation errors persisting past expected developmental milestones
- Stuttering that affects participation or causes the child distress
- Difficulty with reading comprehension or written expression beyond what's typical
- Trouble following classroom directions or organizing thoughts to express ideas
- Social communication challenges — making/keeping friends, reading social cues, managing conversations
- Vocabulary that seems noticeably narrow compared to peers
- Difficulty with abstract language (idioms, jokes, sarcasm) at age-appropriate levels
When to act
If you're seeing several of these signs, don't wait for "he'll grow out of it." Some children do catch up on their own, but research consistently shows that earlier intervention leads to better outcomes — and waiting often costs precious developmental time.
A speech-language evaluation typically takes 60 minutes and includes play-based observation, conversation, and (when appropriate) standardized assessments. You'll leave with clear information about your child's strengths, challenges, and recommended next steps.
Frequently Asked Questions
My child is 2 and only has a few words. Should I be worried?
Is stuttering normal in toddlers?
My child is bilingual — should I expect a language delay?
Does insurance cover speech therapy?
Communication is one of the most important skills your child will ever develop. If you're seeing signs that something isn't quite on track, an evaluation gives you clarity — and lets you act early when it matters most.