Signs of Speech Delay in Children: When to Get Help

A blog to help parents understand when a child may need a speech assessment.
By Dinesh Kumar, Pediatric Occupational Therapist & Founder – Future Wings Clinic

“He understands everything, but he does not speak.” Parents say this to us often. It is a worrying thing to watch, and it is also a useful sign. A child who understands a lot but speaks little is telling us something about how speech and language are developing. This article explains what parents usually notice, what a speech assessment looks at, and what you can start doing at home.

What Brings Parents to Us

Most parents come when they notice something that does not feel right. The signs we hear about most often are:

• Only saying 10 to 20 words by age 2, and not joining two words together.
• Speech that is unclear. After age three, only the family can understand what the child says.
• Not responding to their name, not pointing, or not making eye contact while communicating.

One sign on its own does not always mean there is a problem. But if you recognise one or more of these, it is worth asking for an assessment. You can read more about our speech therapy service for children and our complete guide to speech therapy.

What a Speech Assessment Looks At

Speech is more than talking. When we assess a child, we look at several things together:

• Receptive language: what the child understands.
• Expressive language: what the child says.
• Speech sounds and clarity: how clearly the sounds come out.
• Oro-motor skills: how the tongue, lips and jaw move.
• Play, attention and social communication.
• Hearing and feeding history.

Looking at all of these helps us find where the difficulty is, so the plan fits the child.

What “Wait and Watch” Really Means

You may hear us talk about “wait and watch”. We do not mean waiting to see if the child will outgrow it. It is a way of playing and talking with a child.

When you pause and give the child a moment, the child learns to wait and look at you. When the child looks, he pays attention. When he pays attention, he listens. And when he listens, he can begin to understand what the other person is asking. Waiting and watching is one of the first steps towards speech.

Where to Start at Home

Speech grows in a sequence. At home, parents can work in this order:

1. Pre-linguistic skills: eye contact, attention, and “wait and watch”.
2. Oro-motor skills: play that helps the lips, tongue, cheeks and jaw move well (we show parents how, for each child).
3. Imitation: the child copies what you do.
4. Sounds, then words, and then phrases.

Each step builds on the one before. Skipping ahead to words, before attention and imitation are in place, is a common reason families feel stuck.

One Example from the Clinic

A four-year-old girl, whom we will call Aanya (name changed to protect her identity), came to us with a provisional diagnosis of delayed speech and language (DSL), along with oro-motor weakness, which means weakness in the muscles used for speech. We first worked on her oro-motor skills: the movement of her lips, tongue, cheeks and teeth. Her sounds became cleaner. Then we worked on words, and she reached the phrase level. Her parents were given a plan to follow at home, and Aanya is now blowing, her sounds are clear, and she answers properly because she understands what she is asked.

Every child is different, and this is one example, not a promise of results. The home plan mattered as much as the sessions.

Screen Time and Speech

Parents with good intentions often give children a lot of screen time so the child stays busy. In our experience, screen time makes speech even more delayed.

Instead, sit on the floor, play with your child, and talk to them. That itself is the real therapy. You do not need special toys. You need a few quiet minutes of your attention each day.

When to Ask for an Assessment

If your child shows any of the signs above, you do not need to wait for a “right time”. You can call us, speak to our advisor, and decide the next step together. Your child does not always need to come to the first visit. There is no charge for visiting the clinic. An assessment may be chargeable, and we tell you about any fees in advance. Our consultations and sessions are in English and Hindi, and online sessions are available with parent support.

We are at 131, Second Floor, Pocket A2, Indraprastha Enclave, Sector 17, Dwarka, New Delhi 110078, open Monday to Friday 11 am to 7 pm and Saturday and Sunday 10 am to 2 pm. Schedule a visit or call +91 95555 19482.

Related reading: Speech Therapy for Children With Special Needs: Key Features.