No Medical Condition – Yet a Speech and Language Delay!!!

Acquiring typical speech and language abilities is an important developmental milestone that most parents look forward to with excitement. Understandably, parents experience concerns and anxiety when there are differences from their expectations or perceived standards. Many parents feel worried if their child is not verbalizing as much as peers at a similar age. This often leads to the frequent question from parents: Why is my child experiencing a speech delay despite having no other medical issues? Therefore, it is essential to comprehend the typical patterns of speech and language development and to identify delays in young children.

What is Speech and Language Delay? How is it different?

The ability for a child to communicate verbally begins with soft sounds. As they grow older, infants start to experiment with babbling, leading to one of the most delightful experiences for parents. On average, a 2-year-old can form two-word combinations and use approximately 50 – 200 words. By the age of three, their vocabulary expands to around 1,000 words.

When a child fails to meet these anticipated speech milestones, it is referred to as a speech delay. Around 10% of preschool-aged children face this common developmental challenge.

Another question that comes up for many parents is, “What distinguishes speech delay from language delay?” They are different, as speech refers to the physical action of producing words and sounds. Conversely, language encompasses the ability to convey and interpret information. Language includes verbal, nonverbal, and written communication to understand and facilitate understanding.

Prevalence of Speech and Language delay

The estimated prevalence of isolated speech and language delays and disorders among children aged 2 to 5 years in the United States ranges from 5% to 12%, with a median of 6% (Wallace et al., 2015). It’s quite likely that the numbers could be similar in Asian countries as well.

Signs of speech and language development

1. Inconsistent or lack of response to auditory stimuli at any age

2. No babbling by age nine months

3. No pointing or gesturing by age 12 months

4. No intelligible single words by age 16 months

5. No joint attention (i.e. following the eye gaze of others) by age 15 months

6. No two-word spontaneous phrases by age 24 months

7. Inability to respond to simple directions or commands (e.g. ‘sit down’, ‘come here’) by age 24 months

8. Speech predominantly unintelligible at age 36 months

9. Hypernasality at any age

10. Inappropriate vocal quality, pitch or intensity at any age

11. Regression in language or social skills at any age

Let's understand the causes of speech and language without any medical conditions

1. Excessive screen time

2. Lack of speech and language stimulation

3. Environmental deprivation

4. Lack of communications opportunities

5. Psychosocial aspects

6. Family breakdown

7. Emotional/ social factors

Recommendations for Parents and Caregivers

1. Limit Screen Time: As per the American Academy of Pediatrics: (1) Children under 24 months of age must not be exposed to screens (except video calls with family for 15 minutes or less). (2) A maximum of one hour/ day of high-quality programming for 2–5 year-olds, with a caregiver co-viewing.

   Replace screens with interactive play, reading, or outdoor activities.

2. Create a Language-Rich Environment: Talk to your child during daily routines (mealtime, bath time, travel). Use simple words and phrases, label objects, describe what you’re doing, and expand on your child’s attempts at speech.

3. Prioritise Face-to-Face Communication: Encourage eye contact, gestures, pointing, and turn-taking.

4. Read Aloud Daily: Start with picture books, rhymes, and songs. Use “dialogic reading” – ask simple questions like, “Where’s the dog?”, “What is he doing?” Encourage your child to point, turn pages, and name pictures.

5. Encourage Social Interaction: Provide opportunities to play with peers, siblings, or cousins. Additionally, ensure to involve the child in family conversations, even if they are not fully verbal.

6. Build Play Into Learning: Use pretend play (kitchen, shop, doctor) to stimulate imagination and language. You could also offer toys that require interaction such as blocks, dolls, and cars instead of passive electronic toys.

7. Support Emotional and Social Well-being: Be patient and avoid pressuring the child to speak. Always celebrate small successes in communication attempts.

8. Seek Early Professional Support: If concerns persist beyond age milestones, consult a certified Speech-Language Pathologist (SLP) without delaying. Early intervention significantly improves long-term outcomes.

Take-home message: Speech and language delays can occur even when no medical condition is present. What matters most is creating a rich, interactive, and supportive environment where your child feels encouraged to communicate. Keep screens to a minimum, talk to your child throughout daily routines, read and play together, and celebrate every small step in communication. If you remain concerned, don’t wait - early guidance from a speech-language pathologist can help you make the right decisions and can improve long-term outcomes.

By Lisha Kariappa (MSLP)

Sr Speech Language Pathologist 

&

Chitra Thadathil (MSc. Sp & Hg; PGCert SI)

Lead Speech Language Pathologist 

REFERENCES

American Academy of Pediatrics. (2016). Media and young minds. Pediatrics, 138(5), e20162591. https://doi.org/10.1542/peds.2016-2591

Asha Speech & Hearing Clinic. (n.d.). Understanding speech delay. Asha Speech & Hearing Clinic. https://www.ashaspeechhearingclinic.com/understanding-speech-delay/?srsltid=AfmBOopKRkn1KGTnM2KLtds3OdXFcr6VcF0bT-ADObVmGLEJeVZnxNVT

Kaur, S., Tan, Y. Q., & Tan, H. K. K. (2022). Speech and language delay in children: A practical framework for primary care physicians. Singapore Medical Journal, 63(2), 61–66. https://doi.org/10.4103/singaporemedj.SMJ-2022-051