Speech Delay Warning Signs — When to See an SLP

Get a hearing test first

A formal hearing test by a paediatric audiologist is the recommended first step for any child with a speech or language concern — regardless of whether you think your child has a hearing problem.

This is different from:

• The newborn hearing screen (tests hearing at birth, does not detect later hearing loss)
• A parent observation at home (“they seem to hear fine”)
• An informal check at the GP’s office

Children with mild-to-moderate conductive hearing loss — often caused by fluid in the middle ear from repeated ear infections — may appear to hear normally in quiet environments but miss important speech sounds, especially in background noise. This is one of the most common and most treatable causes of speech and language delay, and it is routinely missed without a formal test.

Ask about developmental screening

At 18 and 24 months, your child’s paediatrician should offer a developmental screening using a validated tool — most commonly the M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-Up) or the ASQ-3 (Ages and Stages Questionnaire). These are brief structured questionnaires, not long assessments.

A child who “seems fine” on casual observation can flag on a formal screening tool. If you haven’t been offered a developmental screening and have concerns, you can ask directly: “Can we do a developmental screening today?”

You don’t need to wait for certainty

One of the most common things parents say after an evaluation is: “I wish I’d come sooner.” The uncertainty that keeps many parents waiting — “maybe they’ll just catch up,” “their father talked late too,” “our paediatrician said to wait and see” — is understandable. But the cost of waiting when a child would benefit from support is real.

Earlier referral means earlier evaluation. Earlier evaluation means earlier support, if support is what’s needed. And if an evaluation shows your child is developing typically, you haven’t lost anything by asking.

Signs worth mentioning at any age

Some concerns are worth raising regardless of how a child’s overall development looks:

• Regression — a child stops using words, sounds, or gestures they were using before. This warrants prompt follow-up, not waiting.
• Loss of language alongside staring spells or unusual eye movements — this combination warrants urgent follow-up with a paediatrician, not just an SLP referral.
• Only using one hand consistently before 18 months — using one hand significantly more than the other very early can be a neurological sign worth raising.
• Not responding to their name by around 12 months.
• Language delay alongside significant low muscle tone or feeding difficulty — these together suggest a broader evaluation may be needed beyond speech-language alone.
• A gut feeling that something is different — especially from a parent who knows this child well.

Signs by age range

These are general benchmarks. They are not a diagnostic test — they are a guide to when a conversation with a professional is warranted.

By 12 months:

• Not babbling with varied sounds
• Not using gestures (reaching, waving, pointing)
• Not responding to their name

By 18 months:

• Fewer than ten words used consistently
• Not pointing to share interest (not just to request)

By 24 months:

• Fewer than fifty words
• Not combining two words (“more juice,” “daddy come”)
• Familiar adults find it very hard to understand the child

By 36 months:

• Not using three-word sentences regularly
• Strangers find it hard to understand most of what the child says
• Not following simple two-step instructions

By age 4–5:

• Mostly not understood by strangers
• Not using sentences to tell a simple story or sequence of events
• Significant frustration when trying to communicate

If your child seems behind in more than one area

A speech or language delay that occurs alongside delays in other areas — motor development, social development, learning, or feeding — may point toward a broader evaluation than speech-language therapy alone. This is sometimes called a global developmental delay.

If you’re noticing that your child seems behind in multiple areas, mention all of those concerns together at your paediatrician appointment — not just the speech piece. The paediatrician may refer you to a developmental paediatrician, a paediatric neurologist, or a genetic counsellor in addition to an SLP.

The “wait and see” conversation

Many parents have been told to “wait and see.” This advice sometimes reflects genuine clinical reasoning — some children with mild delays do catch up without intervention, and a clinician may choose to monitor rather than refer immediately.

But “wait and see” can also reflect under-referral, long waiting lists, or a desire to avoid alarming a parent. You are allowed to ask for a referral to a speech-language pathologist even if your paediatrician suggests waiting. A speech-language evaluation is an information-gathering step, not a commitment to intervention.

When communication and behaviour are linked

Children who can’t communicate their needs effectively often express frustration through behaviour — tantrums, hitting, biting, or meltdowns. This is not a behaviour problem. It’s a communication problem.

Strategies that increase a child’s ability to communicate — accepting pointing and gestures as valid communication, offering simple choices, responding to any attempt to communicate rather than waiting for words — often reduce frustration-driven behaviour directly. This is one reason that addressing communication early can have a wide positive effect beyond language itself.

If your child has both a speech or language delay and significant behaviour challenges, mention both to your paediatrician. They may be more connected than they appear.

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Next: What to expect at a first evaluation →