Signs your child may need speech and language therapy

How speech and language typically develop

Language grows in broadly predictable stages: babbling in the first year, first words around one, two-word phrases around two, and speech that strangers mostly understand by four. The range of "normal" is wide. The ages below are guides, not deadlines. The charity Speech and Language UK publishes detailed ages-and-stages information, and the NHS has practical advice on supporting talking at home.

Signs worth acting on, by age

• Around 18 to 24 months: very few words, no two-word phrases emerging, or your child doesn't seem to understand simple instructions
• Around age 3: people outside the family understand little of what your child says, or your child says very little compared with peers
• Around age 4 to 5: speech is still hard to understand, sentences are much shorter or more muddled than classmates', or school raises concerns
• At any age: your child stops using words they previously had, becomes very frustrated trying to communicate, or you notice persistent stammering
• Feeding: coughing or choking during meals, or ongoing difficulty chewing and swallowing. Raise this promptly with a professional

Trust your instinct: parents are usually right when they feel something isn't following the expected pattern.

It's not only about speech sounds

Speech and language therapists don't just work on pronunciation. They also assess understanding of language, vocabulary and sentence-building, social communication (how a child uses language to interact), fluency (stammering) and feeding or swallowing. A child can have clear speech and still benefit from support with understanding or using language. This is common in developmental language disorder, which affects roughly two children in every classroom.

What to do next in the UK

Start with the adults who see your child most: nursery or school staff, your health visitor (for under-fives) or your GP. NHS speech and language therapy is reached by referral, and in many areas parents can also self-refer to the local NHS service; check your area's community health pages. You can also book a private speech and language therapist directly, without a referral. Some families do this for a faster initial assessment, then share the report with school or the NHS service. Whichever route you take, make sure the therapist is registered with the HCPC. It's a legal requirement for practising SLTs in the UK, and the Royal College of Speech and Language Therapists sets professional standards.

What a first assessment looks like

For young children the assessment is play-based and low-pressure: the therapist observes how your child communicates, tries a few structured activities, and asks you about development and daily life. You'll get a clear picture of whether your child's communication is in the expected range. If it isn't, you'll get a plan, usually a mix of therapy sessions and daily practice activities at home, where much of the progress actually happens.

Common questions