Dr. Alan Greene on Speech Delay

Does my child have a problem or is she just a late bloomer?


My daughter is 2 years and 8 months young, and she doesn't speak very well. She only knows how to say easy words such as "up," "come," "go," "mama," and maybe a couple more. I'm concerned because she doesn't make an effort to say more. I make her repeat words after me and we learn the alphabet together. She'll repeat some easy words, but won't use them until I make her. She understands almost everything I tell her, but she communicates back in sign language. Should I be concerned? Is it time for her to start talking? Is she a late bloomer?


The pace of language development varies wildly from child to child, but the pattern is often the same.

There are two sides of the language coin: understanding and usage. Receptive language begins to develop even before birth, as babies begin to respond to, and remember, words, voices, and music -- well as the steady sound of their mothers' hearts.

Since spoken language is easier to observe than this silent, steady growth in understanding, I'll focus here on expressive language, or speech.

Babies begin by making cooing sounds. As the weeks go by, they begin to experiment with varying the volume of their cooing. Within several months they practice varying the pitch.

Sometime in the second half of the first year, babbling -- mixing consonants and vowels -- begins. The amount and quality of babbling vary, depending on how well babies hear and how much people speak to them.

Babbling gives way to jargon, when kids begin to imitate the sounds and tones of adult speech. Around this time, kids begin to point at objects around them.

Kids' jargon begins to coalesce into a few words, with the same sound being used for the same object, over and over again. This might be "ba" for ball, or "da" for dog. The first words are usually nouns -- names of people, animals, or objects that are important to them.

Symbolic gestures begin during this period. A child will pick up an object, say a remote controller, and will point it at the television to indicate that she knows its use. Hats on the head and telephones to the ear are all symbolic gestures.

The time period for gaining the first 50 or so words is often a long one. These early words are usually very simple and useful for getting the children's needs met. Most kids at this stage either overgeneralize (all men are "Daddy," all animals are "doggy") or overrestrict (only her cat is "kitty"). Words appear and disappear in kids' vocabularies. This slow ebb and flow causes many parents to worry -- especially if they know other kids of the same age who are talking up a storm. During this slow gain in single words, a rich, complex comprehension is developing almost unseen.

An explosion of language follows, when children rapidly learn to use hundreds of words and begin combining them in unique ways ("spoon comb" for fork, or "me puter TV now" for wanting her turn at the computer monitor -- you've been surfing long enough!). Verbs, adjectives, and pronouns are incorporated into their repertoires: "Her goed to the store."

After another plateau, most kids go through another language explosion, this time of sentence complexity. At first, all past tenses end with "ed" (boy falled down) and all plurals end in "s" (I like mouses and gooses). Rules of grammar begin to find their places, and at the same time intelligibility improves greatly. Others outside the family can understand whatever the child is saying.

Now, before you know it, language becomes sophisticated enough to give rise to word play. Puns, jokes, and poetry mark the flowering of this remarkable growth.

Several warning signs along the way suggest that this powerful process may need some extra help. There may be no problem at all, but a child should definitely get a hearing and speech evaluation if any of the following apply (Nelson Textbook of Pediatrics, Saunders 1996):

  • 12 months: no babbling or jargon
  • 18 months: no single words
  • 24 months: vocabulary of 10 words or fewer
  • 30 months: vocabulary of fewer than 100 words or no two-word phrases
  • 36 months: vocabulary of fewer than 200 words, no sentences, clarity less than 50 percent
  • 48 months: vocabulary of fewer than 600 words, no complete sentences, clarity less than 80 percent

Children who point at objects in the first year and who use symbolic gestures at 13 months are likely to have completely normal language, even if they are late bloomers.

I don't know if your daughter is a late bloomer who's on the perfect course for her, or if there is some obstacle (such as fluid in the ears) hindering her development. Either way, a hearing test is the next step. Even if your daughter should turn out to need some extra help, most speech problems can be successfully dealt with when discovered at this age. Because of your concern for her now, you will treasure all the more the pearls that she will eventually say to you.

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.

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