Guest post by Natalie Waldman – speech & language pathologist and owner of Well Spoken Therapy

communication development

Concerned about your child’s communication development?
Insider tips from a pediatric Speech-Language Pathologist

It happens frequently. A parent confides in me that they feel guilty for not getting help for their child sooner. The story often goes like this: The parent suspects a problem and raises the concern to a friend, family member, or parenting group on social media, who offers well-intentioned advice like, “don’t worry, my son/cousin/next door neighbor didn’t speak until he was four years old and just graduated from Harvard Law.” Now I, as much as the next person, love a story where the underdog goes on to show the world who is boss however, as a pediatric Speech-Language Pathologist (SLP), I cringe.

I’m going to let you in on a little secret. No one has a crystal ball to know whether your child’s communication difficulty will resolve itself or be a longer-term issue. The truth is, while occasionally children do “grow out of” a speech or language problem on their own, other times they do not. While we can’t predict the future, an assessment of the potential problem will reveal whether help is warranted. The good news is, early intervention reduces the likelihood of a long-lasting impact. 

So…what’s a parent to do?

1. Trust your gut.

When it comes to your child, you are the expert. If you suspect there is a problem with your child’s communication skills, you’re usually right. Pursuing a professional evaluation is never a waste of time or money. If you learn that your child’s development is on track, you’ll rest easier having that information. If an assessment indicates your child does need support, then you’ll be empowered to get them they help they need. The sooner you obtain skilled intervention, the less “catching up” your child will have to do. 

2. Seek professional expertise

When your child has a toothache, you take her to the dentist. When it comes to concerns about your child’s communication, I encourage you to place your trust in a licensed Speech-Language Pathologist. We spend years earning a graduate degree in communication disorders, complete over 1600 hours of supervised clinical experience, and once licensed continue to build our expertise through hands on therapy and hours of continuing education each year.  It would be unrealistic to expect another professional, even a well-informed pediatrician, to possess that level of specialized knowledge.  SLPs are language development experts and therefore uniquely qualified to address concerns about your child’s communication development. Our scope of practice spans the evaluation and treatment of individuals experiencing difficulty with speech sounds (pronunciation), receptive language (understanding what is said), expressive language (formulating sentences), pragmatics (social skills), fluency (stuttering), and swallowing, to name a few.

3. Avoid being misled by confusing terminology

Milo is a 2-year-old who says about 45 words consistently. When his parents don’t know what he wants, he grunts, cries, or tantrums. Milo’s mom notices her son’s peers seem to be using many more words and even putting 2-words together.  She wonders if Milo’s communication development is on track.

A quick internet search for communication development leads her to a website such as the Mayo Clinic, which lists vocabulary milestones. She reads that by 2 years of age, the milestone is 50 spoken words. Since Milo nearly meets the milestone, his mom feels relieved and decides to wait and see how he develops rather than consult a professional.  Seems logical, right?

What Milo’s mom doesn’t realize is that while the terms milestone and average are often used interchangeably by resources and professionals alike, they actually mean two very different things.  A milestone represents what 90% of children are able to do by a certain age and is the minimal expectation of a child’s progress. On the other hand, average is what 50% of children are able to do by a certain age, therefore making it a better measure of typical development. Confusion over these terms leads many parents to believe their child’s language development is on track when in reality it might not be.

Returning to Milo’s story, the vocabulary milestone for a 2-year-old is 50 words, whereas the average child at this age uses 200-300 words. Thus, he is not only slightly behind, but rather he is performing below the bottom 10% of his same-age peers. When a child’s communication skills fall below the milestone, it's a good idea to seek a professional evaluation.

4. Gather more information

An evaluation is an assessment of your child’s communication strengths and areas of need. Vocabulary concerns are one reason you might seek an evaluation. Other reasons might include your child struggles to understand what is said (e.g. follow directions, answer questions), express messages (e.g. formulate sentences, use correct grammar), demonstrates frustration when trying to communicate, or is difficult to understand.  The results of the evaluation guide next steps. If your child’s skills appear age appropriate, nothing else may be necessary. If not, intervention will be recommended.

5. Know where to get help

Once you decide it is necessary to get your child professionaly evaluated, you may wonder where to turn. Here are some options to consider:

Regional Center (children 0-3 years):
Pro: Free or low-cost services
Con: Therapist is assigned 

Public School (3-21 years):
Pro: Free
Cons: Can take several months, child must show problems accessing education/be significantly behind same-age peers to qualify for therapy               

Health Insurance:
Pro: More economical
Cons: Can be confusing to understand coverage, may require a referral from a doctor, frequent coverage limitations, in-network providers may have long wait times, therapy often provided by Speech-Language Pathologist Assistants

Private Therapy 
Pros: More choice in therapists, convenience (typically greater flexibility in service location – teletherapy, your child’s home/daycare/private school – and scheduling), generally shorter or no wait time for evaluations, easier to get help before your child is extremely behind, no doctor’s referral or insurance approval necessary, may be covered by out-of-network benefits
Cons: Potentially more costly

When it comes to your child, you are the expert. When it comes to communication development, trust a licensed SLP to guide you. If you have questions about your child’s communication development, I’d love to help! Email This email address is being protected from spambots. You need JavaScript enabled to view it. to schedule a free phone consultation.  

For more information on vocabulary milestones versus averages by age, visit:

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