When to be concerned about your child's speech and language development Information for children under 5 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.