Child is not saying three words by 12 months, 20 words by 20 months, two-word combinations and a minimum of 25 words by 26 months.

Child has had three episodes of otitis media (inflammation of the middle ear) within a 12-month period up to 18 months of age.

Parents of child are concerned about communication skills at any age.

Speech is difficult to understand after age 2½.

Three-word sentences are not being used by age 3.

Child uses mostly vowel sounds in his speech.

Sentence structure is noticeably faulty at age 5.

Child is embarrassed and disturbed by his speech at any age.

Child is distorting, omitting or substituting any sound after age 6.

Voice is monotone, extremely loud, largely inaudible or of poor quality.

Pitch is not appropriate to the child's age and sex.

Child often sounds as if he is talking through his nose or sounds as if he always has a cold.

Childs voice is chronically hoarse or sounds rough.

Childs speech is abnormal, non-fluent or is characterized by excessive hesitations and/or repetition of words.

Child uses head jerks, eye blinks, body or facial movements to help get the word out.

Child has difficulty following directions.

Child does not respond to loud and soft sounds appropriately.

Child has difficulty describing his ideas or finding the right words.

Advice for parents of children
with delayed speech

When you don't understand your child, ask for one repetition. If you still don't understand him, ask him to show you what he means.

Help your child to believe he is a terrific speaker.

Take responsibility for communication breakdown rather than letting your child feel badly for delivering an unclear message. Let him off the hook by saying that you were not a ready listener.

Set up contexts for successful communication by introducing topics the child can contributes to. This is especially useful in conversations that include a third person who might not be familiar with your child's speech.

Rather than correct your child's mispronunciations, model the correct pronunciation in your immediate response.