Language Delay in Toddlers: When to Be Concerned

"Should my toddler be talking more?" It's one of the most common worries parents bring to pediatricians. Language develops at different rates, but knowing what's typical—and when to be concerned—helps you decide when to seek help. Early intervention makes a significant difference, so understanding the signs matters.

Normal Language Development: What to Expect

Language development has a wide range of normal, but here are typical milestones: AAP

### 12 Months

Says 1-3 words (often "mama," "dada," "no")
Babbles with expression
Responds to name
Understands simple words ("no," "bye-bye")
Waves and uses other gestures

### 18 Months

Says 10-25 words
Points to familiar objects when named
Follows simple instructions ("get your shoes")
Points to show you things
Starts combining words (around 18-24 months)

### 24 Months

Says 50+ words
Uses 2-word phrases ("more milk," "daddy go")
Names common objects
Follows 2-step instructions
Strangers can understand about 50% of speech

### 36 Months

Speaks in sentences of 3-4 words
Asks questions
Uses pronouns (I, me, you)
Strangers can understand most speech (75%+)
Has conversations
Tells simple stories

"Late Talkers" vs. Language Delay

Not all late talkers have a problem, but the distinction matters: AAP

### Late Talkers

Develop speech later than typical
Catch up by age 3-4
Have strong understanding (receptive language)
Communicate well nonverbally
Often have family history of late talking

### Language Delay Concerns

Both expressive (speaking) AND receptive (understanding) are delayed
Limited nonverbal communication (gestures, pointing)
Regression (losing words or skills)
Not meeting milestones consistently
Other developmental concerns

The challenge:
You can't always tell who will catch up without intervention and who won't. This is why early evaluation is recommended when there are concerns—better to check and find out everything is fine than to wait and see.

Red Flags for Language Delay

Talk to your pediatrician if your child: AAP

### By 12 Months

Doesn't babble
Doesn't respond to name
Doesn't use gestures (waving, pointing)
Doesn't make eye contact
Shows no interest in communicating

### By 18 Months

Says fewer than 10 words
Doesn't point to show you things
Doesn't seem to understand simple words
Doesn't follow simple instructions
No two-syllable babble

### By 24 Months

Says fewer than 50 words
No two-word combinations
Doesn't imitate words
Doesn't follow simple commands
Strangers can't understand any speech
Doesn't engage in pretend play

### By 36 Months

Doesn't speak in sentences
Strangers can't understand most speech
Can't follow two-step instructions
Doesn't ask questions
Doesn't engage in back-and-forth conversation

### Any Age

Regression—losing words or skills they had before
No response to sounds or voices
Not interested in communicating
Avoids eye contact
Very limited play skills

Important:
Regression of language skills is always a reason to seek evaluation immediately.

Causes of Language Delay

Language delay can have many causes: AAP

### Common Causes

Family history: Late talking often runs in families
Hearing loss: Even mild hearing loss affects language
Chronic ear infections: Can temporarily affect hearing and language
Bilingual environment: May show slight early delay but typically catch up
Limited language exposure: Children need lots of verbal interaction

### Developmental Causes

Autism spectrum disorder: Language delay with social communication differences
Developmental language disorder: Primary language difficulty
Global developmental delay: Delays across multiple areas
Intellectual disability: Language delay with cognitive differences
Apraxia of speech: Difficulty with motor planning for speech

### Physical Causes

Hearing impairment: From mild to profound
Oral-motor issues: Tongue tie, structural issues
Neurological conditions: Cerebral palsy, genetic syndromes

Getting an Evaluation

If you're concerned, don't wait—evaluation is the first step: AAP

### Talk to Your Pediatrician

Describe specific concerns
Ask about developmental screening
Request referral if concerned
Trust your instincts—you know your child

### Hearing Test

Essential for any speech/language concern
Even if your child seems to hear you
Can be done at any age
Usually the first step in evaluation

### Early Intervention Evaluation

In the US: Free evaluation through your state's Early Intervention program (ages 0-3)
Contact your pediatrician or search "early intervention" + your state
Can self-refer in most states
Evaluates all developmental areas

### Speech-Language Evaluation

Conducted by a speech-language pathologist (SLP)
Assesses receptive and expressive language
Evaluates speech sounds
Looks at play skills and social communication
May be done through early intervention or privately

### Developmental Pediatrician or Child Psychologist

For comprehensive developmental evaluation
When autism or other conditions are suspected
When there are concerns across multiple areas

Early Intervention: Why It Matters

Research consistently shows early intervention improves outcomes: AAP

Why early:

Brain plasticity is highest in early years
Language builds on itself—early skills affect later learning
Preventing secondary effects (frustration, behavior, social)
Catching up is easier when started young

What intervention looks like:

Speech-language therapy
Parent coaching (strategies to use at home)
Play-based learning
Small group settings
Often integrated into everyday routines

Important:
Even if a child would eventually "catch up" on their own, intervention often speeds the process and prevents frustration.

Supporting Language Development at Home

Whether or not your child is in therapy, these strategies help: AAP

### Talk, Talk, Talk

Narrate your day: "I'm putting on your socks. Red socks!"
Describe what you see
Talk during routines
Don't wait for responses—bathe them in language

### Read Together

Every day, even briefly
Point to pictures
Ask questions
Let your child hold the book and turn pages
Repeat favorite books

### Get Face-to-Face

Get on your child's level
Make eye contact
Let them see your mouth move
Follow their attention

### Wait and Expand

Give your child time to respond
When they say something, expand: Child: "truck." You: "Yes, big red truck!"
Add one word to what they say

### Limit Screen Time

AAP recommends no screens under 18 months (except video chat)
Screens don't teach language as well as interaction
Co-viewing with conversation is better than solo viewing

### Follow Their Lead

Play what they want to play
Talk about what interests them
Join their world

When Delay Might Be More

Sometimes language delay is part of a bigger picture: AAP

### Signs that suggest autism spectrum disorder:

Limited eye contact
Not responding to name
Limited pointing or showing
Lack of interest in other children
Repetitive behaviors or interests
Unusual reactions to sounds or textures
Regression of skills

If you notice these: Request a developmental evaluation. Early diagnosis allows early intervention, which significantly improves outcomes.

### Signs of hearing loss:

Not responding to sounds
Needs TV unusually loud
Says "what?" frequently
Watches faces closely
Speech is unclear

If you notice these: Request a hearing evaluation immediately.

The Bottom Line

Language develops on a spectrum, and some children are simply late talkers who catch up. But when there are concerns, early evaluation and intervention lead to better outcomes. There's no downside to getting checked—and significant benefit to early support if it's needed.

Trust your instincts. You know your child best. If you're worried, ask for an evaluation. If professionals reassure you everything is fine, great. If they find something that needs support, you've given your child the advantage of early help.

Clara is here to help you think through language concerns or figure out next steps.