When to be concerned about your child's speech and language development

Refer by one year if the child

• is having difficulties with eating and/or drinking.
• is not responding to environmental noises and familiar voices (refer to audiology as well).
• is not enjoying interacting with a parent/carer.
• is not ‘babbling’ (playing with sounds).

Refer by 2 years if the child

• is not showing understanding of familiar routines e.g. bath time, bedtime etc.
• needs a lot of extra cues (e.g. gesture, facial expression, pointing etc.) to help him understand simple naming words e.g. cup, car.
• is not interacting with familiar adults.
• is not attempting to use any words.

Refer by 3 years if the child

• has difficulty understanding action words such as ‘jump’ or ‘wash’.
• is using only single words and two words phrases (often consisting of naming words i.e. nouns rather than action words i.e. verbs).
• uses learned phrases or sentences in many situations even when not appropriate.
• speech is unclear, even to familiar adults.

Refer by 4 years if the child

• has difficulty understanding instructions that include words such as big/little and in/on/under.
• only understands and uses a small vocabulary.
• is not able to understand and take part in conversations about past and future events.
• is not asking and answering questions.
• has difficulties in mixing with other children (poor social skills).
• has difficulties with pronunciation (except “th” or “r”).
• sentences are not well formed e.g. word order is confused, e.g. “me ball throw”, word‐endings are missed off e.g. “two brick”.  
• refer at any stage if the child is dysfluent (‘stammering’ or ‘stuttering’).

What to do if you are concerned

• come along to one of our drop‐in sessions or chattertime and look at our health promotion leaflets for ideas of activities to support communication development.
• see our website, your health visitor or child’s nursery for information on these sessions and resources.