A typical 2-year-old can say about 50 words and speak in two- and three-word sentences. By the age of 3, their vocabulary increases to about 1,000 words, and they’re speaking in three- and four-word sentences. If your toddler hasn’t met those milestones, they may have a speech delay. Developmental milestones help gauge your child’s progress, but they’re just general guidelines.

Children develop at their own rate: If your child has a speech delay, it doesn’t always mean something is wrong. You may simply have a late bloomer who’ll be talking your ear off in no time.

A speech delay can also be due to hearing loss or underlying neurological or developmental delay.

How speech and language delays are different: Although the two are often difficult to tell apart — and frequently referred to together — there are some differences between a speech and language delay.

Speech is the physical act of producing sounds and saying words. A toddler with a speech delay may try but have trouble forming the correct sounds to make words. A speech delay doesn’t involve comprehension or nonverbal communication.

Language delay involves understanding and communicating, both verbally and nonverbally. A toddler with a language delay may make the correct sounds and pronounce some words, but they can’t form phrases or sentences that make sense. They may have difficulty understanding others.


A typical 3-year-old can:

  • use about 1,000 words
  • call themselves by name, call others by name
  • use nouns, adjectives, and verbs in three- and four-word sentences
  • form plurals
  • ask questions
  • tell a story, repeat a nursery rhyme, sing a song

SIGNS OF A SPEECH DELAY If a baby isn’t cooing or making other sounds at 2 months, it could be the earliest sign of a speech delay. By 18 months, most babies can use simple words like “mama” or “dada.” Signs of a speech delay in older toddlers are:

Age 2: doesn’t use at least 25 words

Age 2 1/2: doesn’t use unique two-word phrases or noun-verb combinations

Age 3: doesn’t use at least 200 words, doesn’t ask for things by name, hard to understand even if you live with them

Any age: unable to say previously learned words


A speech delay may mean that their timetable is a little different and they’ll catch up. But speech or language delays can also tell something about overall physical and intellectual development. Here are some examples.


A speech delay can indicate an issue with the mouth, tongue, or palate. In a condition called Tongue tie there could be difficulty with pronounce:

  • D
  • L
  • R
  • S
  • T
  • Z
  • th

Tongue-tie can also make it hard for infants to breastfeed.


A toddler who can’t hear well, or hears distorted speech, is likely to have difficulty forming words. Child doesn’t acknowledge a person or object when you name them but does if you use gestures.

However, signs of hearing loss may be very subtle. Sometimes a speech or language delay may be the only noticeable sign.


We learn to speak to get in on the conversation. It’s hard to pick up on speech if no one engages with you. Environment plays a crucial role in speech and language development. Abuse, neglect, or lack of verbal stimulation can keep a child from reaching developmental milestones.

  • Autism spectrum disorder
  • Echolalia, Repeating Phrases
  • repetitive behaviors
  • impaired verbal and nonverbal communication
  • impaired social interaction
  • speech and language regression

Neurological problems: Certain neurological disorders can affect muscles necessary for speech. These include:

  • Cerebral Palsy
  • Traumatic brain injury
  • Muscular Dystrophy

Cont. in next edition

Dr. Pargat Singh Bhurji
MD,FRCP ( C ) Consultant Pediatrician Surrery BC