Your two-year-old says ten words. Your friend’s child the same age speaks in sentences. The health visitor mentioned it casually, your mother-in-law mentioned it less casually, and now you’re lying awake wondering: how can you tell if your child needs speech therapy? It’s one of the most common worries parents bring to GPs — and one of the most answerable, because speech and language development has well-studied milestones.

First, the reassurance: variation is enormous. Some perfectly typical children are “late talkers” who explode into language at 2½. Around 10% of children have some speech, language or communication difficulty, and early support makes a genuine difference — which is why knowing the signs matters more than worrying in silence.

Speech and language milestones: what’s typical

  • By 12 months: babbling with varied sounds, responding to their name, using gestures (waving, pointing), first words emerging.
  • By 18 months: 10–50 words, following simple instructions (“give me the ball”), pointing to show you things.
  • By 2 years: 50+ words and starting to join two words (“more juice”, “daddy go”). Strangers understand about half of what they say.
  • By 3 years: sentences of 3–4 words, asking questions, understood by strangers most of the time, following two-part instructions.
  • By 4–5 years: telling simple stories, grammar mostly correct, clear speech, back-and-forth conversation.

Remember these are ranges, not deadlines — but persistent, significant gaps warrant a conversation with a professional, not just “wait and see”.

Signs your child needs speech therapy: when to get assessed

  • No babbling or gesturing by 12 months — limited sounds, not responding to name, no pointing or waving.
  • Fewer than 50 words and no two-word phrases by 2 — the classic “late talker” threshold worth assessing.
  • Strangers can’t understand them at 3 — family understanding a child is normal; nobody else understanding them at 3 isn’t.
  • Regression — losing words or skills they previously had. Always worth prompt assessment.
  • Stammering that persists — most early stammering resolves, but if it continues beyond 6 months, involves tension or struggle, or the child is distressed by it, get support early. Early intervention for stammering is highly effective.
  • Difficulty understanding — not following instructions appropriate for their age, seeming not to listen (get hearing checked first — glue ear is a common hidden cause).
  • Frustration and behaviour changes — hitting, biting or meltdowns in a child who can’t express themselves are communication, not naughtiness.
  • Social communication differences — limited eye contact, not engaging in back-and-forth play, very literal understanding — discuss with your GP or health visitor, who can consider broader assessment.

Rule out hearing first

This is important: many “speech delays” are actually hearing issues. Glue ear (fluid behind the eardrum) is extremely common in under-5s and fluctuates — a child might hear fine one week and muffled the next. If your child doesn’t respond consistently, turns the TV up loud, or had many ear infections, ask your GP for a hearing test before anything else.

How to get help in the UK

  1. Talk to your health visitor or GP. They can refer to NHS speech and language therapy — free, but waiting lists vary wildly by area (weeks in some places, many months in others). Ask for the referral in writing and chase it.
  2. Nursery/school SENCO. If your child attends childcare, the Special Educational Needs Coordinator can observe, implement strategies and refer.
  3. Private assessment. £80–£150 for an initial assessment, £50–£90 per session. Worth considering if NHS waits are long — the Royal College of Speech and Language Therapists’ website has a find-a-therapist directory.
  4. While you wait: support at home. You don’t need to wait for therapy to help. Narrate your day, read together daily, get down to their level, follow their lead in play, reduce questions and increase comments (“you’re building a tall tower!” beats “what colour is that?”), and give them time to respond — count to ten silently.

Choosing the right educational environment matters too — our guide on choosing the right school covers what to ask about SEN support. And mealtimes are language opportunities as well: calm, chatty family meals build both nutrition and conversation skills.

Supporting speech at home: what actually helps

Whether you’re waiting for an assessment or supporting therapy, there’s a lot parents can do at home. The evidence favours surprisingly simple approaches.

Talk with them, not at them. Narrate what you’re doing (“I’m cutting the apple — crunch!”), follow their lead in play, and respond to their attempts — even babble — as if it’s conversation. The research is clear: responsive, back-and-forth interaction builds language far more than drilling words or flashcards.

Get down to their level. Face-to-face, eye-to-eye. Children read faces for language cues, and towering over them while multitasking isn’t the rich interaction their brain needs. Ten minutes of genuine floor-level play beats an hour of background telly.

Expand, don’t correct. If they say “doggy run”, respond “Yes! The doggy is running fast!” — modelling the fuller version without the discouragement of correction. Repeat their attempts back with one extra word or a grammatical step up. This “expansion” technique is the core of most speech therapy for young children.

Read interactively. Don’t just read the words — ask “what’s happening?”, “what do you think comes next?”, let them turn pages, go off-script. Dialogic reading (the fancy term for chatty reading) has some of the strongest evidence in all of child development. Library story times are free and excellent.

Cut the background noise. Constant TV or radio as background genuinely impairs language learning — children can’t distinguish the speech they need from the noise. Quiet house, talking humans: that’s the environment language grows in.

What doesn’t help: baby-talk beyond infancy (simplified is fine, but keep real words), pressure to “say it properly”, comparing with siblings, or screens marketed as educational — no app substitutes for human interaction. And if grandparents or others criticise your child’s speech, a calm “we’re working on it with support” shuts it down.

None of this replaces professional assessment when it’s needed — but it’s never wasted, whatever the outcome. Every child benefits from more responsive interaction.

Your takeaway: trust your instincts, act early

You can’t tell definitively at home whether your child needs speech therapy — but you can spot the signposts: limited words by 2, unclear speech by 3, regression, persistent stammering, or frustration from not being understood. Get hearing checked, talk to your health visitor or GP, and start supportive strategies at home while you wait. Early help works; parental worry is data, not overreaction.