Speech and Language Delay in Children: When to Get Help in the UK

Children develop skills at different rates. Speech and Language UK, a children's communication charity, says that by about 2 years children usually understand at least 200 words, say 50 or more single words (many not yet clear) and start to put 2 to 3 words together, such as "more juice". By about 4 years they usually use sentences of 4 to 6 words, answer simple "why" questions, and strangers can mostly understand them. Sources: Speech and Language UK: 18 to 24 months and Speech and Language UK: 3 to 4 years.

These are signs that Speech and Language UK and the NHS Healthier Together website say are worth talking to a professional about. A single sign is not a diagnosis.

• By about 9 months, your baby does not respond to noises. By 1 year, they do not point to things they are interested in or try to get your attention with sounds, eye contact, expressions or reaching (Speech and Language UK).
• At 18 to 24 months, your child cannot follow simple instructions or is not saying 25 recognisable words (Speech and Language UK).
• By 3 years, your child cannot understand simple instructions or questions, is not saying about 50 words, or is not putting two words together (NHS Healthier Together).
• At 3 to 4 years, your child is not joining words into sentences, their sentences are jumbled, they find following instructions hard, or adults who do not know them cannot understand them (Speech and Language UK).
• At any age, your child stops doing something they could do before (NHS Healthier Together).

Late talking can have many causes, including hearing difficulties, and some children have a developmental language disorder, which is lasting difficulty understanding or using language. A speech and language therapist can assess what is going on for your child.

The NHS suggests simple everyday things:

• Chat about what you are doing as you feed, dress, cook and play, and name and point to things you can both see.
• If your child gets a word wrong, say it back properly ("Yes, it's a cat") without telling them off.
• Give choices, such as "Do you want an apple or a banana?", and use short, simple instructions.
• Look at books, sing and play turn-taking games such as peek-a-boo together.
• Switch off the television and radio when you want your child to listen, and limit daily TV time.
• Only offer a dummy at sleep time, and aim to stop dummies by 12 months.

If your family speaks more than one language, the NHS says to talk to your child in whichever language feels comfortable to you; children adapt to this very well. Source: NHS: help your baby learn to talk.

One NHS speech and language therapy service points out that fluctuating hearing can contribute to speech sound difficulties, and that your GP or health visitor can advise on getting a hearing test if you are concerned. Source: Cambridgeshire and Peterborough NHS Foundation Trust: late talkers.

The NHS says to talk to your GP or health visitor, who will refer your child to the local speech and language therapy department if needed, and that you can refer your child yourself if you prefer. Speech and Language UK explains that many local services accept referrals for children under five straight from families, while for older children the school may need to refer. Some services ask you to try their advice and activities for a set time first, such as 10 or 12 weeks, so check your local service's website or phone line. Speech and Language UK also runs a free advice line, a confidential 30-minute phone call with a speech and language therapist. Sources: NHS, Speech and Language UK: how do I find a speech and language therapist? and Speech and Language UK: advice line.

If your child is in nursery or school, tell the staff or the school's special educational needs coordinator (SENCo) about your worry; they can often help with a referral. For wider support, see getting help for your child's mental health.

If you would like to be seen sooner, or choose who you see, you can pay for an independent speech and language therapist. Speech and language therapist is a protected title on the HCPC register, so check the therapist's registration on the HCPC register. Our guide to finding a registered speech and language therapist explains the NHS and independent routes, including the ASLTIP search for independent therapists, and what speech and language therapists do. Some children also benefit from other professions, for example occupational therapists for play, sensory and daily-living skills; see which professional for my child.

Whoever you choose, check their register and ask about fees, session length and how you will review progress together. See questions to ask before you book and how much therapy costs. On Therapist Circle, each practitioner's registration is checked when they join, and their profile shows the register and number so you can check it yourself.