From the Guidelines
A toddler should be referred to speech therapy if they show significant speech or language delays by 18-24 months of age, as early intervention is crucial for improving outcomes and reducing the risk of long-term developmental delays. According to the American Academy of Pediatrics (AAP) pediatric periodicity schedule, regular surveillance of developmental milestones, auditory skills, parental concerns, and middle-ear status should be performed in the medical home, with objective standardized screening of global development at 9,18, and 24 to 30 months of age or at any time if there is concern 1. Early warning signs that warrant evaluation include: no words by 12 months, fewer than 50 words by 24 months, not combining words by age 2, difficulty following simple directions, or regression in previously acquired language skills. Parents should also consider referral if they or others have difficulty understanding their child's speech by age 2-3, or if the child shows frustration when trying to communicate.
Some key points to consider when deciding to refer a toddler to speech therapy include:
- The importance of early intervention, as children with hearing loss who are identified and treated early have significantly better outcomes in vocabulary development, receptive and expressive language, syntax, speech production, and social-emotional development 1
- The need for comprehensive evaluation, including hearing testing and language testing, to identify any underlying hearing or language delays that may be contributing to the child's speech delays 1
- The role of the pediatrician in conducting initial screenings and providing referrals to speech-language pathologists for comprehensive evaluation, as well as the importance of regular well-child visits to monitor the child's speech development.
It is essential to prioritize early intervention, as the brain has greater neuroplasticity during the first few years of life, making therapy more effective, and untreated speech and language delays can impact social development, behavior, and later academic performance 1.
From the Research
Warning Signs for Referral to Speech Therapy
The following are warning signs that may indicate a need for speech/language assessment in toddlers:
- Not babbling by 6 months 2
- Not saying a few words by 12-18 months 2
- Not putting two words together by 24 months 2
- Any loss of language or social skills at any age 2
- Not meeting expected developmental milestones for speech, language, and communication 2, 3
Age for Referral to Speech Therapy
Toddlers can be referred to speech therapy at any age if they are not meeting expected developmental milestones for speech, language, and communication.
- Children as young as 12-18 months can be referred if they are not saying a few words 2
- Children aged 2-5 years can be referred if they are not meeting expected milestones for speech and language development 4
Risk Factors for Speech and Language Delay
The following are risk factors that may contribute to speech and language delay in children:
- Male sex 5
- Prematurity 4
- Low birth weight 4
- Late birth order 4
- Larger family size 4
- Maternal intimate partner violence 4
- Family history of speech and language delay 5
- Prolonged sucking habits 5
- Oropharyngeal anomalies 5
- Hearing problems 5
- Middle ear infections 5
Benefits of Early Intervention
Early intervention is key to maximizing the effects of speech and language therapy, resulting in more positive communication outcomes in later life 2, 3.
- Speech-language therapy is helpful, particularly for children with expressive language disorder 3
- Participation in augmented language intervention can result in significantly more spoken target vocabulary words and no statistically significant differences in speech sound errors when compared to children who received spoken language intervention without augmented language intervention 6