Speech Problems

What are speech and language difficulties?

Speech and language difficulties are made up of two sets of delays or difficulties. Speech difficulties include challenges in pronunciation or articulation like stuttering or lisping. Language difficulties include challenges in speaking using words and/or gestures (expressive language). It can also include challenges in understanding language commands and questions (receptive language).

Signs and symptoms of speech and language difficulties

There is a wide range of speech and language milestones which can vary from child to child, but there is an expected age range of onset. In general, speech and language milestones include:

8 to 13 months

  • starts using gestures like pointing, shaking head to indicate "no", waving good-bye
  • uses sounds as if they were words (babbling and repetitive babble like "mamama")
  • immitates adults' sounds

12 to 18 months

  • uses approximately 10 to 20 words or word approximations
  • expands use of gestures (nodding, eye contact, hand gestures)
  • begins to develop a receptive vocabulary of understood words (points to objects when named by an adult)
  • responds to name
  • understands a number of single words and short phrases

18 to 24 months

  • using too many single words to count (200+)
  • begins to combine two words ("mommy up", "daddy go")
  • understands simple questions
  • follows one-step commands
  • begins to use negatives: "no juice"
  • speech is 50% intelligible to strangers at 2 years

2 to 3 years

  • uses three-word sentences ("I want juice")
  • grammar will become more precise (adds 'ing', 's' for plurals, using 'a' and 'the' to fill and lengthen sentences, uses prepositions such as "in" and "on")
  • learns to use pronouns, negatives, and conjunctions in the middle of sentences: "he," "can't," "and"
  • understands many concepts: in/out; big/little; go/stop; top/bottom; animals; toys
  • follows two-step directions: "get your coat and close the door"
  • follows simple stories in books
  • begins to ask "why?"
  • can produce the following sounds: h, p, m, d, and k
  • speech is 75% intelligible to strangers at 3 years

3 to 5 years

  • vocabulary increases to 1,000 words at 3 years and 5,000 words by 5 years
  • uses full sentences
  • retells stories
  • turn taking and conversational skills develop
  • speech is 100% intelligible at 4 years
  • complexity develops (links ideas in sentences using "and," "because," "what," "when," "but," "that," "if," "so")
  • adjusts order of words in sentences (What is he doing?" as opposed to "What he is doing?")
  • uses pronouns correctly (I, she, he, her, him, me, mine, they)
  • uses more advanced forms of negatives ("didn't")
  • uses plurals, but may make some errors ("two gooses") and overgeneralizes some rules ("I runned")

Between 3 to 5 years, pronunciation improves and blended letter use grows. Children are able to produce the following specific sounds:

  • at 4 years: w, b, t, f, g, ng, n
  • at 5 years: l, sh, ch, s, j
  • at 6 years: z, r
  • some pronunciation of specific sounds and articulation difficulties (like stuttering) may be normal until about 5 years old



A family history of speech and language difficulties is common. A family will often report that someone was a 'late talker'. Learning difficulties or developmental delays may also be more prevalent and increase the risk of a child having speech and language difficulties.

Hearing loss

The presence of any amount of hearing loss can affect your child's communication. If your chilf has had some ear infections, this may put your child at risk for hearing loss. Meningitis, severe jaundice as a newborn or prematurity can also cause hearing loss. If you think your child is not hearing well for any reason, ask your doctor about performing a hearing test.

Another condition

Speech and language difficulties can be a sign of another condition like autism spectrum disorder. Physical disorders like cerebral palsy can also affect your child's ability to speak. Many other medical conditions such as snoring or allergies, and more complex conditions which cause developmental delays may also cause speech and/or language problems.

When to see a doctor

Monitor your child's speech and language development. If you have questions, speak to your child's doctor on the next visit. If you are concerned, see your doctor as soon as possible.

What your child's doctor can do

Your doctor will take a medical and developmental history and do a physical examination to assess the cause of the speech and language difficulties. Treatment and intervention will depend on the cause of the speech and language difficulties, and on how severe the problem is. Your doctor will order a hearing test to rule out hearing loss and may recommend that your child see a speech-language pathologist (SLP) or another type of specialist (developmental paediatrician; ear, nose and throat specialist).


If possible, the underlying cause should be treated (hearing loss) with a referral to an ear, nose and throat specialist. If the speech and language difficulty is part of another condition (autism spectrum disorder), then this should be evaluated and a referral to a developmental paediatrician may be needed. All children with significant speech and language problems should be seen by an SLP.

Parents can self-refer their child to their provinces Preschool Speech and Language Services program. This is a free service funded by the government and offered to children from birth until school age.

An SLP will help your child develop their speech and language skills. An SLP may work one-on-one with your child or work in a small group setting with other children needing support. The SLP will teach parents techniques to use at home to encourage your child to speak.

Key points

  • Development of speech and language milestones varies tremendously from child to child.
  • Children who are not meeting milestones or are at risk for speech and language delay should have a hearing test, be seen by their doctor and then assessed by a speech language pathologist.
  • Children with speech and language difficulties should be evaluated as early as possible. Watching and waiting is not recommended.
  • Articulation difficulties and stuttering may be normal until about 5 years of age.
  • Speech and language therapy is very helpful for children and the earlier the intervention is started the better the outcome.
Janine Flanagan, HBArtsSc., MD, FRCPC