When to See a Speech Therapist: Signs at Every Age

Most parents who ask this question are not really asking about speech. They are asking whether they are overreacting. A relative has said he will talk when he is ready, a friend's child said nothing until three and is fine, and the internet has handed you a list of red flags that reads like a diagnosis. The answer I give in my clinic in Beirut is shorter than the lists: if you are worried enough to search for this, ask a professional. An assessment that finds nothing wrong is the clearest answer you can get, and it costs you a morning.

But 'ask a professional' is not much of a guide on its own. So here is how I actually decide, what changes with age, the reasons that have nothing to do with late talking, and the situations where the honest answer is to keep watching.

Three questions that matter more than any age chart

When a parent describes their child to me, three things settle most of the decision before I look at a single milestone.

Is your child moving forward?

Direction matters more than position. A child with ten words in June and twenty-five in September is on the move, even if twenty-five is behind for the age. A child with ten words in June and ten in September has stopped. Three months without new words, new sounds or new gestures in a child under three is reason enough to book an assessment, whatever the total.

Is it only the talking?

Speech is the last thing to arrive and the loudest, so it is what parents count. But language is built on understanding, gesture and play, and those tell me far more. A child who follows 'put the cup on the table' without you pointing, who points to show you a plane, who waves, who feeds a doll, has the foundations in place. A child who is quiet and also does not point, does not seem to understand, and does not draw you into what they are doing needs an assessment now, however many words they have.

Has anything been lost?

Signs by age

With those three questions in mind, these are the points at which I would move from watching to assessing. The ages are ranges describing most children, not deadlines. Being a few weeks past one of them is not the concern. The pattern is.

If your child is two and the right-hand column describes them, late talker or language disorder walks through exactly what I weigh at that age. For the full picture from birth, see speech milestones by age.

Reasons to see a speech therapist that are not about late talking

Late talking is what brings most families to me, but it is not the only reason, and the others are missed more often precisely because the child is talking.

• Speech that is hard to understand. A child who talks constantly but whom only you can decode has a speech-sound problem, not a language one. By three, family should understand about three quarters of what a child says; by four, a stranger should understand nearly all of it. A four-year-old saying 'wabbit' is within the range. A four-year-old the nursery staff cannot understand is not.
• Stuttering that has settled in. Most stuttering begins between two and five, often suddenly, and most of it passes. Book an assessment if it has lasted more than six months, if you see tension, blocks or blinking while the child tries to speak, if they are frustrated by it or avoiding talking, or if it runs in the family. When stuttering starts and when it needs help covers the rest.
• Understanding that lags behind talking. A child who follows instructions only as part of a routine, or only when you gesture, may be reading the situation rather than the words. Comprehension is the best single predictor of how language develops, and a gap there matters more than a small vocabulary.
• Talking that does not become conversation. A child with plenty of words who repeats phrases from cartoons, does not answer questions, does not respond to their name, or rarely uses language to share something with you needs an assessment of how they communicate, not just how much. Sometimes a wider team is needed, and a speech and language therapist is usually one of the first people involved.
• A voice that has been hoarse for weeks. Persistent hoarseness in a child who does not have a cold should be seen by an ear, nose and throat doctor first. Voice therapy follows if the vocal folds are being strained.

Who to see first

You do not need a referral to ask a speech therapist a question. The first step can simply be a message describing your child's age and what you have noticed. But two other appointments belong in the plan.

• A hearing test, for every child with a language concern, including the ones who startle at a slammed door. Fluid behind the eardrum after repeated ear infections can blunt the quieter sounds that tell words apart while leaving a child responsive to loud ones, and it is a cause of late talking a speech therapist cannot treat.
• The paediatrician, when there is more than language on your mind: motor skills, growth, sleep, or how your child interacts with people. A speech therapist assesses communication. A paediatrician sees the whole child and knows who else should be involved.

The order does not matter much. What matters is that the hearing test happens, and that nobody tells you to wait six months before doing anything at all.

When the honest answer is 'not yet'

Some of the parents who write to me are told, plainly, that their child does not need therapy. I want to say that as clearly as the warnings, because articles like this frighten the parents of perfectly normal children.

• A 20-month-old with a dozen words who points, understands, plays pretend and is adding words every few weeks.
• A three-year-old who says 'wed' for 'red' or 'tar' for 'car', and is otherwise easy to understand at home.
• A two-and-a-half-year-old who has been repeating whole words ('I want, I want the ball') without any effort for a few weeks, after a burst of new sentences.
• A child raised in Arabic and French whose French lags behind classmates but whose total vocabulary, counted across both languages, is where it should be. Bilingualism does not cause delay; counting one language at a time creates one on paper.

In each of those cases what I offer is not 'wait and see' but a plan: a baseline, a hearing test, specific things to do at home, and a review in three months with clear thresholds for what would change the advice. If you are not sure which side of the line your child is on, that is exactly the question to send.

What happens when you get in touch

The first exchange, on WhatsApp, is free and carries no obligation. Tell me your child's age, what they do when they want something, roughly how many words they use across all their languages, and anything that worries you. Sometimes the answer is that no assessment is needed yet, and you will be told that just as plainly. If one is warranted, it has three parts: a detailed history with you, testing suited to your child's age and languages, and observation during play, which for a toddler is most of it. Children can be assessed from around twelve months, and it is usually completed in one to two appointments, with a written report in plain language. For families outside Lebanon the same assessment runs online with a parent in the room; for children under three I will tell you honestly whether video is enough. Fees follow the profession's published scale, and what the assessment involves is set out in one place.

I will not promise you an outcome. What I can say is that early intervention is consistently more effective than waiting, that the difference between starting at two and starting at four is real, and that the cost of looking too early is a morning. The cost of looking too late is not.