questionMy son is 2 years and 4 months old. I am a little worried about his speech. How much and what should he be saying at this age? I hear little words, but no combination of words. Does he need a specialist to work with him? Thanks and I look forward to hearing from you.

answerThank you for your question. I often hear parents express similar concerns, and this isn’t an easy question to answer since we know that a child’s rate of speech development is as unique as he or she is and that young children’s speech development can vary a great deal and still be considered “normal”. One of the best things to do is to discuss all aspects of your child’s development with your child’s pediatrician at every routine well-child checkup. This conversation is especially important if you have concerns. Knowing some general speech and language developmental guidelines may help you determine if you should seek additional professional services. I am listing just a few speech and language guidelines below, but you can find additional information about infant and toddler communication development in the South Carolina Infant Toddler Guidelines on our website: or by visiting

By age 12 months, a child should be progressing from babbling to making intentional sounds and a few word approximations (although words may not be clear), should be reaching for objects and using gestures to communicate, should enjoy games like “peek-a-boo” and “patty-cake, and should begin to respond to simple requests/questions like “come here” and “want more?”.

Between one to two years, children should begin to point to body parts when asked, listen to simple stories, rhymes and songs, point to pictures or objects when named, and follow simple commands. Though there is a lot of variability, most toddlers are saying about 20 words by 18 months and 50 or more words by the time they turn 2. Around this age they start to learn new words on a regular basis, start to put 2 words together (like “more cookie” “no juice”), use different consonant sounds at the beginning of words, and ask 1-2 word questions (like “where kitty?” or “go bye-bye?”). Also keep in mind that communication involves more than just saying words. Eye contact, comprehension, how the child plays, socializes, imitates and gestures are all important considerations as well.

Without knowing more information about your child, I cannot tell whether he should see a specialist. I know that it can be difficult for parents to determine when to seek professional help, but I highly recommend that you start by talking with your child’s pediatrician. During this process, please consider not only speech and language developmental guidelines, but also whether your child has any of the following additional risk factors for potential communication problems: premature birth, frequent ear infections, other health issues, limited or lack of eye contact, and/or developmental delays in other domains. The following general guideline may also be helpful: parents and familiar caregivers should understand about half of a child’s speech at age 2 and about three-quarters at age 3 years. By 4 years-old, a child should be mostly understood, even by people who don’t know the child. If your child has multiple risk factors and/or you continue to be concerned about your child’s communication, ask your child’s health care provider for a referral for a speech and language evaluation. Parents may also seek an evaluation on their own from their state’s early intervention program or a speech-language pathologist in their area.

Good luck and please let us know if you need any additional information.