“My 2 year old is not talking? Should I be worried?”

We are often asked “My 2 year old is not talking? Should I be worried?

Parents are regularly told by well-meaning friends and family, “Don’t worry, boys like to develop their physical skills first”, or “Uncle Jack didn’t talk till he was 3”. Doctors and Maternal Health Nurses can also dismiss a parents concerns and advise them to ‘wait and see’. Naturally, parents feel confused about what to do for their little ones!

It is true that all children develop different skills at different times and rates, however there has been a lot of research into milestones that should be reached by specific ages.

How many words should my child be using by 24 months?

Similar to crawling, walking, toilet training, learning to read and other developmental milestones there is a wide range of what is considered ‘normal’.

An 18 month old should use around 20 words. These are usually things you say a lot at home, including nouns (bottle, cat), verbs (go, drink), prepositions (up), adjectives (sleepy, cold) and social words (bye bye, hi)

A child should have at least 50 or more single words at the age of 2 years and be beginning to link words together into 2-word phrases. These 2 word phrases are ones made up by the child, not memorised in ‘chunks’, for example, “Thank you”, “bye bye”, “all gone” are all considered to be one word utterances. “Bye-bye Mummy”, “Daddy go”, “drink water”, “more juice” are examples of two word combinations.

What is counted as a word?

Parents count their child’s first words differently. Some count any attempt at a word, or a copied word that is never used again and some only count words that are said correctly. When the Speech Therapist is talking to you about how many words your child is using we don’t expect them to be said correctly. If your child consistently makes the same set of sounds to mean the same thing, then this is counted as a word. It is age appropriate for children of 24 months to have sound errors – sounds missing, syllables missing, sounds said incorrectly etc.

Why is my child slow to talk?

Our first job as a Speech Pathologist is to rule out any other causative factors. In the initial speech therapy assessment, the speech pathologist will take a detailed Case History from birth looking at illnesses, ear infections, milestones and their current skills.

While we are talking to the parent or playing with the child we are observing and asking questions about lots of different areas, for example, ‘How is the child communicating? Is he/she using words as well as pointing, gestures, changing intonation? Is he/she able to follow instructions? If so, what type and level of complexity? Is he/she copying actions? Copying sounds? Copying words? Is eye contact appropriate? Can they take turns? How are their play skills? Are they using symbolic play? Playing with a wide range of toys? Will he/she let me join in his/her play?

How the child is performing in the these areas dictates how concerned the Speech Pathologist is that the toddler is not talking. It then dictates what advice we give.

Area’s that need to be ruled out as causative factors include:

Hearing loss

We would always recommend a hearing test.

Parents often say that their child’s hearing is fine as they can hear a chip packet being opened a mile away! Speech sounds have different frequencies and you need to be sure that they are able to hear in different volumes and pitches. For example, ‘m’ is a low frequency sound, ‘ah’ is at the centre of the speech range, whilst ‘f’ and ‘s’ are high frequency sounds.

Most children will have a hearing screen at birth which detects any sensorineural hearing loss. Parents sometimes assume that because their child passed the hearing screen that their hearing is fine. Children often have intermittent fluid in their ears (glue ear) which stops the tympanic membrane (ear drum) from vibrating, therefore causing a conductive hearing loss. Or there could be a buildup of wax, an ear infection, rupture in the tympanic membrane etc.

Please see a great visual here for further information.

Autism Spectrum Disorders

The communication development of a child with Autism Spectrum Disorder occurs differently and more slowly. They might seem more interested in environmental sounds, such as the fan whirring, than in their parents or others talking. For further information on diagnosis for children with Autism, please see Autism Awareness: Early signs

Developmental delay (including specific language learning difficulty)

While all children develop at different rates, a child may be experiencing developmental delay if they have substantial limitation in one or more of these key developmental areas:

  • gross motor skill development – the ability to use large muscles to sit, stand, walk, run, keep balance and change positions

  • fine motor skill development – using small muscles, specifically hands and fingers to eat, draw, play and write

  • cognitive development – thinking skills including learning, understanding, ability to learn and solve problems, reasoning and remembering

  • social and emotional development – the ability to interact with others, being able to have relationships with family, friends and teachers, cooperating with others and responding to the feelings of others

  • speech and language development – speaking, using body language and gestures, communicating and understanding what others say.

The term ‘global developmental delay’ is used when a child experiences difficulty in all five key areas of development.

The Royal Children’s hospital has a comprehensive parent information pack.

If the Speech Therapist is able to rule out all of the above factors the child may be ‘late to talk’ or a ‘late talker’.  These children are going great guns with everything else: social skills, motor skills, play skills, thinking skills (cognitive), and they understand language well. So WHY aren’t they talking???

Short answer – we don’t know! Researchers however have determined that late talkers are more likely to: be male, have a family history of early language delay, small birth weight or were born before 37 weeks’ gestation. None of these factors may apply to your toddler – some children just take a little longer.

Do late talking children catch up without speech therapy or other intervention?

Many late talkers do ‘catch up’ to their peers, but many do not. It is difficult to tell which one will need extra assistance, however there are risk factors that suggest the child is more likely to have ongoing language difficulties. These include:

  • a history of ear infections

  • little babbling when a baby

  • limited number of consonant sounds (eg. p, b, m, t, d, n, y, k, g, etc.)

  • difficulty playing with peers (social skills)
  • does not link pretend ideas and actions together while playing
  • does not imitate (copy) words
  • uses mostly nouns (names of people, places, things), and few verbs (action words)
  • a family history of communication delay, learning or academic difficulties
  • a mild comprehension (understanding) delay for his or her age

  • uses few gestures to communicate

Even though many late talkers appear to catch up to their peers by the time they enter school, studies are showing that this group of children do not perform as well as their peers in certain aspects of language use such as language complexity and grammar.

If you have concerns regarding your child’s speech and language development, it’s never too early to seek help. Contact your community health speech pathologist to be placed on their waitlist for assessment or contact a private therapist. A speech and language therapist will be able to fully assess your child and tailor the advice and strategies accordingly.

The earlier children receive help, the better their outcomes.