Does my child need speech therapy?

First of all, take a deep breath. If you are reading this, you are  in the right place . Maybe your child isn't talking much, or at all. Maybe your child doesn't have many words. Maybe your child is highly unintelligible. For whatever reason, you are here looking for some answers and guidance. You are doing the right thing for your child. The American Speech and Hearing Association has developed a useful list of guidelines for when a speech referral should be sought.  Unfortunately, this list starts at age 3. Babble Books has compiled information for parents of younger children who are looking for insight into whether a speech therapy consult is warranted.  

The chart below has been compiled by the American Speech and Hearing Association. Remember, every child is different. A medical professional should be consulted to fully assess your child if there is a concern. 

Speech Referral Guidelines for Pediatrics

Potential Consequences or Impact of Speech Impairment Can Include:

  • Difficulty expressing need or routine information intelligibly

  • Difficulty communicating intelligibly in order to function at level of independence expected for age

  • Difficulty expressing feelings intelligibly; may be at risk for frustration or depression

  • Difficulty engaging successfully in social and/or classroom situations that require intelligible speech

  • Difficulty achieving adequate intelligible speech to reach educational potential

  • At risk for personal injury due to difficulty communicating intelligibly about a dangerous situation or calling for help

Behaviors That Should Trigger an SLP Referral:

By age 3 years cannot: 

  • be understood by family and/or caregivers 

  • correctly produce vowels and such sounds as p, b, m, w in words 

  • repeat when not understood without becoming frustrated 

By age 4 years cannot: 

  • be understood by individuals with whom they do not associate regularly 

  • be understood by family and/or caregivers 

  • correctly produce t, d, k, g, f 

  • be asked to repeat without becoming sensitive 

By age 5 years cannot:

  • be understood in all situations by most listeners 

  • correctly produce most speech sounds 

  • be asked to repeat without exhibiting frustration 

Disturbance in neuromuscular control causes difficulty learning to produce sounds appropriately

  • speech is usually slurred; difficulty controlling respiration for speech; abnormal loudness, rhythm, or vocal quality 

  • exhibits difficulty learning sounds to form words; may sound nasal, strangled and/or breathy 

  • exhibits frustration and/or avoidance of speech due to extreme difficulty forming sounds or difficulty being understood 

Disturbance in programming, positioning, and sequencing of muscular movements

  • sound errors are prevalent but variable (i.e., "dog" could be produced "dog," "tog," "gog," "god" by same child) 

  • varies from rarely being able to produce sounds to ongoing speech that is rarely understood, or speech that is usually understood with frequent sound errors 

  • unaware of sound variations or exhibits varying degrees of frustration and/or anxiety regarding inability to "control speech" 

Disturbance in performing voluntary movements with mouth and vocal mechanism

  • cannot produce movements for sound production or sounds are produced without voice (whispered speech) 

  • varies from inability to produce any words to extreme difficulty being understood 

  • exhibits frustration and/or avoidance of speech due to difficulties 

Deafness/severe hearing loss causes severe prosodic disturbances in intonation, duration, and rhythm in addition to sound errors

  • produces no meaningful words or sounds understood only by family 

  • speaks loudly in high pitched voice with frequent distortion, omission, and substitution of sounds 


Autism, emotional disturbance, and/or intellectual disabilities may cause very unusual prosodic variations

  • intonation and/or rhythm of connected speech may sound abnormal 

  • volume may be consistently or intermittently too loud or too soft 


Deviation in structure of speech mechanism

  • difficulty producing specific sounds and intelligible speech 

  • exhibits frustration and/or avoidance of speech 

  • speech has excessive nasality 


Difficulty in hearing and/or inability to differentiate between sounds inhibit child's ability to detect and correct error sounds; usually unaware of errors.

Intelligibility and sound production are compromised when nasal passages, nasopharynx, and larynx are bypassed due to tracheostomy/ventilator dependence


Exhibits sudden decrease in speech intelligibility

  • ranges from slurred, generally intelligible speech to total absence of speech, or totally unintelligible speech 

  • awareness ranges from extremely aware to totally unaware of sound errors 


Exhibits decline in ability to be understood by family, friends, and/or caregivers in the expression of basic needs, preferences, and feelings

Information obtained from: American Speech and Hearing Association. Speech Referral Guidelines for Pediatricians [Web log post]. Retrieved May 22, 2017, from