The early childhood years are filled with important milestones. One of the biggest is when your baby or toddler starts to talk for the first time. A toddler who is delayed with their speech can understandably be a cause for concern for a lot of parents.
The development of speech can be divided into two separate but related categories. The first is the processing of language and includes the understanding of or receptive language and the production of or expressive language. The second category is the ability to speak clearly, and is also known as articulation. Problems can occur in either category separately, or in both together.

Several things can disrupt or delay a toddler’s speech development. Some are truly a cause for concern, whereas others are easy to remedy. Causes may include physical impairments that make it hard for your toddler to correctly form words, or developmental issues, which impede the part of your child’s brain that helps them interpret and process words. In some cases, minor hearing problems or chronic ear infections can factor into why your toddler is a “late talker.”

Physical Impairments That Affect A Toddler’s Speech Development

Some physical impairments can interfere with a toddler’s ability to speak clearly (articulation).

Cleft Palate

This is an abnormality in the formation of the roof of the mouth and may affect the upper lip and gum line as well. Most cleft palate cases are caught very early by a physician, and can often be addressed or minimized surgically. The timing of the surgery can vary. Your toddler’s physician might recommend waiting until your child is a little older to surgically correct the cleft palate.

An Unusually Short Frenulum

This is the fleshy fold that holds the tongue to the lower mouth. This is a problem that your pediatrician will usually catch before your toddler begins to start talking, though some cases might not be detected until your child’s first dental visit. It is possible to have a short frenulum and have no speech impairment. It is also possible to have a normal frenulum and have speech delay. Your pediatrician can help you sort out if the frenulum is influencing your child’s development and if the problem should be addressed.

Deviations In The Sinus Cavity

Some children have minor deviations in the sinus cavity or struggle with chronic severe sinus infections. These issues can make it hard for them to speak and enunciate clearly, which can slow their speech development.

Oral-Motor Problems That Delay Toddler Speech Development

Some children with speech delays have a problem in the area of the brain responsible for communication and speech production. The most common underlying reason is a condition known as “Childhood Apraxia Of Speech” or CAS.
In these cases, the toddler may have problems controlling the muscles used for speech. This might include problems with the lips, tongue, or jaw. In some of these cases, Childhood Apraxia Of Speech will also show up in other oral issues such as difficulty eating. It might also occur in conjunction with other physical oral problems such as a cleft palate.

Developmental Delay of Expressive or Receptive Language

Trouble with language processing is usually caused by one of four problems: delayed expressive or receptive language, autism spectrum disorder, hearing loss, and global developmental delay. Some of the risk factors for delayed expressive language are shown below:

  • Poverty
  • Low parental educational attainment (ie, parent did not graduate from high school)
  • Low birth weight or prematurity, including late-preterm (ie, 34 to 36 weeks) and early term gestations (ie, 37 to 38 weeks)
  • Family history of language delays, language disorders, or language-based learning disabilities (eg, dyslexia)
  • Maternal depression
  • Male sex

Most pediatricians screen regularly at the 18 and 24 month office visits for the presence of autism spectrum disorder. This diagnosis can have profound effects on a child’s life, many of them stemming from a disability of or a lack of communication.
The concept of “General Developmental Delay” can occur in just about any child and can sometimes be challenging to diagnose as children tend to hit developmental milestones at their own pace.

Speech problems of the expressive or receptive delay type tend to manifest as minimal talking or not talking at all. When affected children do talk, their words might be monotone or lacking intonation. You might be especially concerned if your child seems to struggle to understand what is being said by others, or they are expressing very little emotion.

If your child is 18 to 24 months old and you haven’t noticed any improvements in their speech development, your pediatrician might refer you to a speech pathology specialist.

Hearing Problems Can Delay Speech Development In Toddlers

Hearing problems are hard to catch early in an infant’s life. For this reason, all newborns born in New Jersey are screened for hearing loss before being discharged from the hospital. A child who cannot hear clearly will have problems processing words in a way that they can understand, which later prevents them from learning to make those sounds and speak clearly as a toddler.

A toddler who has significant hearing loss may have trouble understanding speech and creating their own vocalizations. This makes it challenging for toddlers to form specific words by imitating words they already hear. It can also delay fluency development.
If your toddler is showing little to no progress with speech development, your pediatrician might recommend a comprehensive hearing test, or perhaps refer you to an audiologist specialist. Some hearing loss disorders in small children can be addressed with special hearing aids or therapies administered by a pediatric speech pathologist.

Ear Infections Can Affect Language Processing In Small Children

Some small children are unfortunately prone to problems with otitis media, or the classic childhood ear infection. Multiple ear infections before a child’s third birthday can affect their hearing and speech development.
In these cases, the obscured ability to hear clearly causes the child to have problems clearly processing and imitating sounds. This can then make it harder for them to produce clear words. If your child has been struggling with chronic ear infections and they are delayed in their speech development or they are consistently mispronouncing certain words without improvement in correction, there might be a correlation between the two.

Chronic ear infections are typically characterized by inflammation in the child’s middle ear and may require treatment with prescription antibiotics. In a case like this, your pediatrician might refer you to an ear nose and throat specialist or ENT.
The ENT specialist can assess whether or not your child would benefit from having tubes installed in their ears. This is a simple, outpatient procedure requiring minor sedation. The tubes will help keep your child’s middle ear clear, making it easier for them to hear sounds and process words that they can then imitate. Most tubes are a temporary measure and will come out as your child grows. Most children outgrow chronic ear infections between 5 to 7 years of age.


A delay in your child’s ability to speak clearly is a cause for concern for a lot of parents. It’s important to remember that every child develops at their own pace and in their own way. If your child has shown little to no speech development by 18 to 24 months old, your pediatrician can help you understand your options, and if necessary, refer you to a specialist who can help your toddler reach their important milestones.