Does Your Child Need a Speech Therapy Evaluation?


As a pediatric speech therapist, I am frequently asked by friends and family members about whether or not a child may need to be evaluated for a speech and/or language delay.

My short answer is usually, “Trust your gut. If you feel there is an issue, you are probably correct.” If a parent has a concern, it’s better to err on the side of safety and get an evaluation. Typically speaking, the earlier a speech and/or language problem can be identified, the easier it will be to remediate. 

What is the cause?

Speech and language issues are not uncommon.  Around one in ten children in the U.S. has a communication disability.  This can stem from a number of issues, including but not limited to prematurity, cleft lip and/or palate, auditory processing deficits, or developmental delays and disorders such as autism. The disability may present itself as an issue with articulation, fluency, voice, reading, hearing, language, eating, etc. Pediatric speech therapists can and do treat patients from birth (NICU speech therapists often target feeding and swallowing reflexes in newborns). In older toddlers and children, we work on everything from literacy to social skills, stuttering, safety awareness, etc. Although you often see speech therapists in the schools, many of us work in private practices, day cares, or even in-home.

Here are some basic guidelines for determining whether a child could benefit from a speech therapy evaluation. 

A pediatrician will usually recommend an evaluation if…

  1. Other people outside of the home are having difficulty understanding your child’s speech production.
  2. Your child is frustrated by his or her lack of ability to communicate.
  3. Your child stutters and it has been noticeable for a period of three or more months.
  4. Your child struggles with reading or writing.                                                
  5. Your child struggles with social skills (i.e. playing or interacting with other children).
  6. Your child is not eating or gaining weight and/or has been diagnosed as failure to thrive.
  7. Your child is not speaking in at least three word sentences by age 3.

It is important to remember that children develop at different rates. A good rule of thumb is, by the age of 3, 90% of what the child says should be intelligible to others.  He or she should use basic grammar, participate in conversations using three word utterances (or longer), follow a two step basic directive, and ask “Why?”

Speech therapy can last a few months or even a few years. If your child does warrant speech therapy, the therapist will likely use a variety of techniques to help your child improve. Oral motor exercises may be used to strengthen muscles in the cheeks, lips, tongue, etc. Play-based therapy may be used to elicit a specific sound or word. The therapist will likely give you worksheets or activities to practice at home between sessions. 

Encouraging Speech Development in the Home

If your child does have speech and/or language difficulties or delay, here are a few tips for encouraging development within the home setting:

  1. Encourage play with other children. Model appropriate turn-taking interactions and social skills such as initiating, maintaining, and closing a conversation.
  2. Talk to your child. Read books together, tell stories, play joint attention games (peek-a-boo, patty-cake, etc).
  3. Ask lots of questions, but don’t force a child to speak. Listen when the child does speak, and give appropriate responses.
  4. Engage in activities that are of high interest to the child, and model good speech and behavior for him/her to follow.
  5. Practice expansion. For example, if your child requests, “Cookie,” say, “You want the big cookie or the small one?”

If you feel your child does need a speech therapy evaluation, talk to your pediatrician about making an appropriate referral. You can also visit the American Speech and Hearing Association webpage for a list of certified professionals in your area.


Please enter your comment!
Please enter your name here