Speech Delay in Toddlers: Milestones and When to Get Help
Speech delay in toddlers is common, and many late talkers catch up, but “wait and see” should never mean doing nothing. If a child is not using single words by about 15 to 18 months, has fewer than about 25 words at 2, or no two-word phrases by 30 months, it is time to act: get the hearing checked first, then ask for a developmental and speech assessment. Growing up with Urdu, English and Punjabi at home is not the cause.
In brief
- First step, always: a proper hearing test.
- 15 months: using at least a few words.
- 24 months: at least about 25 words, pointing to body parts when named.
- 30 months: putting two words together.
- 36 months: simple sentences, follows two-step instructions.
- Any age: losing words or skills a child already had needs a doctor soon.
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When should a baby start talking?
Talking starts long before words. A baby coos in the first months, babbles strings like “ba-ba” and “da-da” around 6 to 9 months, and around the first birthday often says a first real word, used on purpose for one thing. Understanding runs ahead of speaking: a 1 year old usually turns to their name and knows “no”, and an 18 month old can follow “bring the shoe”.
The warning signs below, used by MedlinePlus, include understanding as well as speaking. A child who understands well and points to show you things is in a different position from one who neither speaks nor understands.
| Age | Ask a doctor if the child is not… |
|---|---|
| 15 months | using three words; looking at or pointing to people or things when named |
| 18 months | saying “Mama”, “Baba” or other names; following simple directions |
| 24 months | using at least 25 words; pointing to a picture or body part when named |
| 30 months | using two-word phrases; answering with words, a nod or a shake |
| 36 months | using simple sentences, asking for things by name, following two-step directions |
2 year old not talking: late talker or speech delay?
A “late talker” is a toddler who is behind on spoken words but whose understanding, play, gestures and social connection are on track. Many of them catch up by school age. A speech or language delay or disorder is a broader picture where understanding, sound-making or putting words together is also affected, and it is less likely to sort itself out.
From the outside you cannot reliably tell which is which at 2, which is why the honest advice is to get a check rather than wait for a birthday. An assessment that finds nothing wrong costs you an afternoon. A missed delay costs months of support at the age when it helps most.
See a doctor soon, not at the next routine visit, if your child loses words or skills they used to have, does not respond to their name by 12 months, does not point or wave by around 12 to 15 months, rarely looks at your face or shares interest in things with you, or has had repeated ear infections with a runny ear. These can be signs of hearing loss or of autism, and both do better with early support. A speech delay alone never proves either, and only a proper assessment can say.
Speech delay causes, and why hearing comes first
Hearing loss is one of the most common reasons for a language problem, and it can be partial, one-sided or come and go with glue ear after colds. A child with partial hearing may react to loud sounds and seem fine to the family. That is why audiometry (a formal hearing test) is recommended for any child with suspected language delay. In Pakistan, ask your paediatrician for referral to an ENT or audiology service at a teaching hospital. The whisper test is a rough home screen, not a substitute.
Other possible reasons include a developmental language disorder (no single cause found, often runs in families), autism, general developmental delay, problems with the mouth muscles, and, less often, tongue tie, which usually affects some sounds rather than the start of talking. Often no single cause turns up, and the child still benefits from therapy.
Bilingual child speech delay: myth or real?
Myth: speaking two or three languages at home causes speech delay. Children around the world grow up with several languages and reach the main milestones in the usual range. A bilingual toddler may mix words from different languages, or know some words only in Urdu and others only in English. Count all of them together; that combined total is the child’s real vocabulary.
The NHS advice is to talk to your child in whichever language you feel most comfortable with. Dropping the home language so the child “only learns English” usually means less talk overall from the people who love them most, which is the opposite of what helps. If a bilingual child is delayed in every language, that is a delay to check, not a bilingualism side effect.
Screen time and speech delay
Screens do not talk with a child. They talk at them. Toddlers learn words in back-and-forth exchanges: a face, a turn, a reply. Hours of cartoons, especially fast ones with background TV always on, take time away from those exchanges. Screens are unlikely to be the only cause of a real delay, but cutting background TV and keeping screen time short is worth doing whatever the cause. The screen time by age guide has workable limits for a busy house.
What helps at home, starting today
- Narrate the ordinary. “I’m cutting the tomato. Red tomato. Chop, chop.” Cooking, bathing and dressing are better word lessons than flashcards.
- Get down to their eye level and wait. Give them a pause of 5 to 10 seconds to try.
- Add one word. If the child says “ball”, you say “big ball”. Do not demand they repeat it.
- Offer choices instead of yes or no: “milk or water?” holding both up.
- Turn off background TV during play and meals.
- Read the same picture book daily and let them fill in the last word.
- Dummy only at sleep time, if at all; it is hard to babble around one.
The five-minute word log
Before the doctor’s appointment, keep a list for one week of every word your child uses, in any language, plus gestures like pointing or waving. Parents almost always remember fewer words than the child really has, and a written list makes the assessment faster and fairer.
Speech therapist in Pakistan: how to find help
Start with your child’s paediatrician, who can screen development and refer you. Speech and language therapists (sometimes called speech-language pathologists) work in many teaching hospitals and children’s hospitals in the larger cities, as well as in private practice and some special education centres. Ask whether the therapist holds a recognised degree in speech and language pathology. Therapy for toddlers is mostly coaching parents in play routines like those above, so expect to be given homework. Stammering, where a child knows the words but gets stuck, is a different issue covered in hakla pan in children, and motor milestones are in baby not walking yet. More child development guides are in Bachon Ki Sehat.
Count every word, in every language. That total is your child’s vocabulary.
Speech delay: parents ask
Is it normal for a 2 year old not to talk?
No, a 2 year old with no words should be checked. By 24 months most children use around 25 words or more, and hearing should be tested first.
When should a baby say their first word?
Most say a first word around 12 months, with a wide normal range. By 15 months, a child should be using at least a few words.
Does speaking two languages cause speech delay?
No. Bilingual children reach milestones in the normal range. Count words in all languages together, and keep speaking the language you are most comfortable in.
Can mobile phones cause speech delay?
Heavy screen use cuts down the face-to-face talk toddlers learn from, and background TV gets in the way. Screens are rarely the only cause, so a delayed child still needs a check.
Should I get my child’s hearing tested?
Yes, a formal hearing test is the first step for any child with delayed speech, even if they seem to hear normally at home.
Is speech delay a sign of autism?
Not by itself. Speech delay has many causes. Signs that raise the question of autism include little eye contact, not pointing or sharing interest, and not responding to their name, and only an assessment can decide.
Do late talkers catch up?
Many do, especially when understanding, play and gestures are on track. Because you cannot tell in advance, an early assessment is still worth it.
Does tongue tie cause speech delay?
Rarely. Tongue tie may affect a few sounds in older children, but it does not usually stop a child starting to talk.
At what age should I see a speech therapist?
There is no minimum age. If your child misses the milestones above, a referral at 18 months to 2 years is reasonable, and earlier if skills are lost.
How can I help my toddler talk at home?
Narrate daily chores, wait for your child to respond, add one word to what they say, and turn off background TV during play.