Alexis Irazoque, M.S., CCC-SLP
Treatment for speech delay may include speech therapy, which can help children build communication skills when they're having trouble meeting expected milestones. For example, if your child isn’t using words by 15 months, combining two words by 24 months, or being understood by age 3, a speech evaluation is a good next step. No age is too young for an evaluation, so if you have concerns about your child's communication, a speech-language pathologist, also known as a speech therapist, can help you decide what to do next.
Key takeaways
Speech therapy is a common treatment for speech delay. Therapy can help children build communication skills when they're having trouble meeting expected speech and language milestones.
Every child develops at their own pace, but missed milestones, limited progress, or loss of skills can be reasons to seek an evaluation.
There’s no minimum age for a speech evaluation. A speech therapist can look at your child's communication skills and help you understand whether they need support.
Speech therapy is personalized, play-based, and designed around your child's unique needs and interests.
Parents and caregivers play an important role in speech therapy. When you practice therapy strategies at home, during everyday routines, it gives your child more chances to communicate.
Concerned about your child's speech?
We're here for you. Get matched with a speech therapist who's experienced in your child's area of need and available when you are.
Find a speech therapistWhen to get speech therapy for a speech delay
If your child isn't meeting several communication milestones for their age, isn't making steady progress, or has lost skills they once had, it's a good idea to talk with your pediatrician or a speech therapist. You don't need to wait to see if they "catch up," or wait until a certain age. An evaluation can help identify what's going well, what's challenging, and whether speech therapy or another type of support may be helpful.
From birth, babies start to communicate through crying, cooing, facial expressions, gestures, and sounds. As they grow, they begin to babble, use gestures, understand words, and combine words into phrases. If you're concerned about any part of your child's communication development, trust your instincts.
Not sure whether your child is on track? Take our free online screener with questions tailored to your child’s age. You’ll learn whether a speech evaluation is recommended for your child.
It's important to know how to spot the signs and symptoms of a speech delay and seek help early. The sooner speech therapy can start, the better.
What are the signs of a speech delay?
Every child develops at their own pace. However, there are general timeframes when kids typically gain certain skills. Developmental milestones can give you an idea of what to expect and help you know when your child may need more support.
This isn’t a full list, but below are some signs of speech delay to watch for. “It’s important to remember that one missed milestone doesn't mean your child has a speech delay,” adds Abby Barnes, M.S., CCC-SLP, an Expressable speech therapist and toddler mom. However, if your child is missing several skills, isn't gaining new skills, or loses a skill they previously had, talk with your pediatrician or a speech therapist.
3-6 months
At this age, babies are beginning to interact more with the people and sounds around them. Look for signs of delay such as:
Rarely making sounds such as cooing or squealing
Rarely smiling, laughing, or making sounds during interactions
Not responding to your voice or other sounds
Showing little interest in interacting with caregivers
When to seek help: If your baby rarely vocalizes or doesn't respond to sounds by 4-6 months, talk with your pediatrician. A hearing evaluation may also be recommended.
6-9 months
Babies become more vocal during this stage. They begin experimenting with repeated sounds. Look for red flags such as:
Little or no babbling, such as “ba-ba-ba” or “ma-ma-ma”
Rarely making sounds back and forth with caregivers
Not responding to their name or familiar sounds
Rarely imitating sounds or participating in social games like peek-a-boo
When to seek help: If your baby isn't babbling or participating in back-and-forth vocal interactions by around 9 months, talk with your pediatrician or a speech therapist about an evaluation.
9-12 months
During the second half of the first year, babies begin using gestures and sounds in order to communicate. Look for speech delay signs such as:
Not pointing, waving, or using other gestures
Rarely imitating sounds or gestures
Not responding to familiar words or simple requests
Rarely trying to get your attention or communicate wants and needs
Not using a variety of sounds, including repeated sounds like “ba-ba” or “da-da”
When to seek help: If your child isn't using gestures or showing clear attempts to communicate by around 12 months, schedule a speech evaluation or talk with your pediatrician. You don't need to wait for your child to start talking before asking for help.
18 months
By 18 months, children are typically communicating in several ways, including gestures, sounds, and words. Look for red flags for speech delay such as:
Using very few meaningful words, or not talking at all
Not pointing to ask for something or show you something interesting
Having difficulty understanding familiar words or simple directions
Rarely imitating words, sounds, or actions
Not adding new communication skills over time
Often getting frustrated when trying to communicate
When to seek help: If your child has very few or no meaningful words by 18 months, or you're noticing several communication concerns, schedule an evaluation with a speech therapist.
24 months and beyond
By around 24 months, many children are using a growing vocabulary and combining words into short phrases. At this age and beyond, look for:
Using fewer than about 50 words around age 2
Not combining two or more words, such as “more milk” or “go outside”
Having a hard time following simple directions
Rarely using words or gestures to ask for help, make requests, or share interests
Speech that’s hard for familiar caregivers to understand
Often frustrated because it's difficult to communicate
Not adding new words or communication skills over time
Losing words or other communication skills they had before
When to seek help: If your child isn't combining words around age 2, has a very limited vocabulary, isn't making steady progress, or loses communication skills they once had, schedule an evaluation with a speech therapist. An evaluation can help determine whether speech delay therapy or another type of support may be helpful.
What happens in speech therapy for speech delay?
Speech therapy is personalized to your child's needs, strengths, and interests. For young children, sessions are play-based. This way therapy feels less like a lesson and more like a chance to practice communication during fun activities.
Let’s look at a few examples of what speech delay treatment looks like. Let's say your child loves dinosaurs. A speech therapist might use dinosaur toys to practice saying new words, following directions, taking turns, or putting words together.
A child who loves books might practice naming pictures, answering questions, or describing what happens in a story.
Say a child is working on using more words while playing with a toy car. The speech therapist can prompt them to say car-related words and phrases as they play together. These can be anything from making car noises, like “beep beep,” to saying phrases like “The car is fast” or “Ready, set, go!”
Take a peek at a therapy session for speech delay! This short video features one of our speech therapists working with a 2-year-old. He’s learning to use more words through song (and he’s having a blast).
Find the right speech therapist for your needs
Get startedYour child's speech therapy goals will depend on their individual needs. Goals might focus on:
Learning and using new words
Combining words into phrases and sentences
Following directions and understanding language
Using gestures or other ways to communicate
Improving speech sounds and being easier to understand
Using communication to interact and connect with others
“Therapy changes as your child develops,” says Barnes. “As they master one skill, their speech therapist can introduce new goals that build on what they've learned.”
Sessions often happen once or twice a week, although the recommended frequency depends on your child's needs and goals. Your speech therapist will work with you to determine an approach that makes sense for your family.
You can help your child practice their speech skills no matter where they are. Their therapist sees them once or twice a week, but you’re with them every day!
Parent and caregiver involvement is an important part of therapy. During sessions, your speech therapist can show you strategies to use during everyday activities like meals, playtime, getting dressed, or running errands. This gives your child more chances to practice speech skills outside of therapy. For example, it’s amazing when your child starts saying new words with their speech therapist. But we want them to use those words at home, at school, or at the store. As a parent, you can help your child practice their speech skills no matter where they are. Their therapist sees them once or twice a week, but you’re with them every day!
To make practice even easier, at Expressable, your speech therapist will assign personalized home activities in an online portal just for your child. The portal is packed with videos, tips, and at-home techniques to help your child make faster progress.
Discover how Expressable’s portal makes it easy to practice speech and occupational therapy at home, with expert tools, tips, videos, and lessons.
How long does speech therapy for speech delay last?
The amount of time in speech therapy differs for everyone. However, children with a speech delay usually spend at least a few months in speech therapy. Change doesn’t happen overnight, but your child will make steady progress if they have the right supports in place.
There are ways you can help your child make progress faster–and maybe even graduate from speech therapy sooner. Check out this list of things to do:
Attend therapy sessions with your child so you can learn alongside them.
Tell your speech therapist what’s going well and what feels challenging. They can adjust any goals or approaches as needed.
Practice your speech therapist’s recommendations at home so your child gains skills faster.
How much does speech therapy cost? Insurance coverage explained
The cost of speech therapy can vary depending on where you live, where your child receives therapy, and whether you use insurance. Without insurance, speech therapy may cost around $100 to $250 per session. Your actual cost may be lower if your insurance plan covers speech therapy.
Many health insurance plans cover speech therapy when it’s considered medically necessary, but coverage varies by plan. Your plan may have rules about which speech therapists you can see, how many sessions are covered, what your copay or deductible is, or whether you need prior authorization.
Before starting therapy, contact your insurance provider. Ask questions such as:
Whether speech therapy is covered
Whether your child needs a specific diagnosis
Whether you need a referral
What you'll pay out of pocket
There are also public programs that may help make speech therapy more affordable. For children under age 3, early intervention may provide speech therapy at no cost, or at a reduced cost for children who qualify. Children ages 3 and older may be able to receive speech therapy through their public school at no cost if they qualify for an Individualized Education Program (IEP).
Learn how to find out if your insurance covers speech therapy and alternative payment options to help you get started with speech therapy.
What happens in the first speech therapy session?
The first appointment is usually about getting to know your child and understanding how they communicate. You don't need to prepare your child to perform or practice specific words beforehand. The speech therapist will guide the appointment to learn more about your child's skills.
You can expect the speech therapist to:
Ask about your child's speech and language development
Ask what you're noticing at home and what you'd like help with
Observe how your child communicates through play and interaction
Listen to your child's speech and sounds
Look at how your child understands and uses language
Consider how your child uses gestures, facial expressions, and other ways to communicate
Use formal or informal assessment activities when appropriate
Your child may play with toys, look at books, sing songs, or participate in other activities during the evaluation. The goal isn't to see whether your child can “pass a test.” Instead, these activities give the speech therapist a chance to see how your child communicates in a natural, age-appropriate setting.
You also have an important role in the appointment. You can tell the speech therapist how your child communicates outside of therapy, including what they do at home, with siblings, or in other familiar settings.
At the end of the evaluation, the speech therapist will talk with you about what they noticed and whether speech therapy is recommended. If it is, you'll discuss goals and next steps. If therapy isn't needed right away, the therapist may give you strategies to try at home or recommend monitoring your child's development.
Early support can help children build communication skills
If you're concerned about your child's speech or language development, you don't have to wait and see what happens. An evaluation can give you a clearer picture of your child's communication skills and help you understand whether support may be useful. Trust your instincts! “Having an evaluation doesn't commit you to speech therapy,” Barnes notes. “It simply gives you more information about your child's communication. That way you can make an informed decision about what support, if any, would be helpful.”
Check out our treatment guide to learn more about how Expressable works with children who have a speech delay. If you’re concerned about your child’s speech, we're here to help. Get matched with a speech therapist who's right for your family.
Frequently asked questions (FAQs)
There’s no minimum age for a speech evaluation. If your child isn't meeting several communication milestones, isn't making progress, or has lost skills they once had, talk with your pediatrician or a speech therapist. An evaluation can help you understand your child's communication skills and whether speech therapy may be helpful.
Every child is different, so there isn't one set timeline for speech therapy. The length of therapy depends on your child's communication needs, goals, and progress. Some children may need support for a few months, while others benefit from therapy for longer. Your speech therapist can monitor progress and adjust goals as your child's needs change.
Speech therapy can help children build communication skills, but every child's progress looks different. Progress can depend on a child's communication needs, what's causing the delay, and how often they get to practice speech skills outside of therapy. Your speech therapist will work with you to set meaningful goals and adjust therapy as your child develops.
How Expressable Can Help
Concerned your child isn't reaching age-expected milestones? Looking for communication support from a professional? Expressable is a national online speech and occupational therapy practice serving children and adults. We treat all major areas of communication, feeding, and developmental skills, offer flexible hours including evenings and weekends, and accept most major health insurance plans. We’re proud to have earned more than 4,500 5-star reviews from our clients (4.83/5 average).
Our therapy model is centered on parent and caregiver involvement. Research proves that empowering caregivers to participate in their loved one’s therapy leads to better outcomes. That’s why we combine live, 1-on-1 speech and occupational therapy with personalized education and home practice activities for faster progress.
