GPAtlas🧭 When to suspect
Consider a speech, language or communication problem whenever a parent, carer, health visitor, or nursery raises concern about how a child communicates. Such concerns are common, and early identification improves educational, social and emotional outcomes, so they should always be taken seriously rather than dismissed.
It helps to think in three domains: speech (the physical production of sounds), language (understanding, or receptive language, and use, or expressive language) and fluency (the flow of speech, e.g. stammering). The umbrella term is speech, language and communication needs (SLCN). Where a child has a persistent language disorder that is not explained by another condition, the current term is developmental language disorder (DLD) – the label agreed by the CATALISE consensus that replaced “specific language impairment”.
The two key primary-care skills are simple: always exclude a hearing problem, and recognise the red flags – especially regression and poor comprehension – that need specialist referral rather than watchful waiting. Critically, multilingualism does not cause delay and is beneficial; but equally, a genuine delay must never be written off as “just because the child is bilingual”.
| Age | Typically by this age (a guide – ranges are wide) | Be concerned / assess if |
|---|---|---|
| ~12 months | Babbles tunefully; understands a few familiar words; uses gestures and points; responds to own name; first word(s) emerging | No babbling; no gestures or pointing; not responding to name |
| 18 months | Says several single words (≈6–20); points to show you things; follows a simple instruction; understands more than they say | No clear words; not pointing to share interest; not following simple instructions |
| 2 years | Uses ≈50+ words; joins two words together (“more juice”); understood by familiar adults | < 50 words or no two-word combinations; ELIM word-list ≤ 17/50 at the 2–2½ year review |
| 2½–3 years | Short phrases and sentences; understands simple “what/where” questions; about half their speech understood by strangers | Mostly unintelligible to unfamiliar listeners; poor comprehension |
| 4 years | Connected sentences; tells simple stories; readily understood by strangers | Strangers still struggle to understand; persistent word-finding or grammar difficulty (consider DLD) |
| Any age | Steadily gaining words and skills | Regression – loss of words or skills – is urgent (autism team if under 3) |
|
⚠️ Common pitfall Attributing a genuine delay to bilingualism and deferring referral. A child raised with more than one language should reach milestones on the same overall timeline when words are counted across all their languages. NICE is explicit that language delay must not be assumed to be accounted for by English being a second language – reassure the family that bilingualism is beneficial, while still arranging a hearing test and assessment if there are red flags. |
Source: ELIM (Public Health England) · NICE CG128 · RCSLT
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