A couple of years ago I poured my heart into an article I wrote called “Help! My Baby Has a Tongue Tie.” It was really important to me to encourage others to advocate for their baby’s well-being, chosen feeding journey, and mental health.
Well, friends, I’m back! I’m advocating further because 1) writing the post proved a really cathartic experience for me, even though my main hope was that it might give a mom who needed encouragement support when she needed it; and 2) I believe the more we talk about our experiences, the more we learn that we are NOT the only mom struggling. While our parenting experiences are unique, shaped by different events and informed by our own childhoods, many of us are facing the same dilemmas as we raise our little ones. I feel like this is especially true for those like me who had their child or children just before or during the intense period of the pandemic, because I’ve noticed that certain experiences (both those we actually had and those that were lacking) have continued to shape my experience of motherhood.
As the title suggests, my two-year-old has a speech delay—and he isn’t alone. A long-range pediatric health survey carried out between 2009–2017 estimated that one in six children in America experiences some kind of developmental delay. However, a more recent Columbia University study in 2022 found that children born during the pandemic have almost twice the risk of children born before it (so one in three). These delays are especially prevalent in the areas of social development: not responding to their own name, not playing with children or adults they know, and not looking to see what adults are paying attention to within their environment; and communication: learning to talk later, talking less, or using gestures instead of words. This is pretty unsurprising when we consider that kids born in 2020 have had less interaction with other children, fewer opportunities for social interaction (such as mom and baby classes, library story time, etc.), and encountered adults and older children wearing masks during formative social visits.
“Late talkers” are relatively common (I myself was one!), and a speech delay is one of the most typical delays faced by children. Often, these delays are “expressive” rather than “receptive”—meaning that your child has a good comprehension of what you’re saying, can follow basic instructions (when they want to), and uses gestures to get their needs met. While research tends to be the bearer of good news here, with 70–80% of late talkers catching up on their own, it’s impossible to know if your child will be among the minority that continues to struggle without intervention.
All children are unique and develop along their own timelines and on their own trajectories. Kids may perfect certain skills sooner, and others later, without much cause for concern. The recently updated CDC guidelines for children also represent a wide range of what is typical at any given point. It’s really easy to get bogged down in comparing your child to their friend, your niece or nephew, or even your other children—so it’s worth remembering that developmental milestones represent a skill that 90% of children can achieve within a specific age range (say, 12–18 months, 18–24 months, etc.); and that developmental averages are met by 50% of children.
My son was born in late October 2020, so he turned two a few months ago. At his 18-month well visit with his pediatrician, my husband and I both remarked that we felt that he was making plenty of sounds, but had very few actual words. The doctor said that she wasn’t especially concerned but we could revisit our concerns as he approached his second birthday and see if intervention was necessary. Speech—a little like crawling or walking—is a skill that requires a great deal of practice, but one that can emerge suddenly and develop very quickly. Language explosions are common and a normal way for speech and communication skills to develop.
I diligently read books (and more books) throughout the day, did flashcards, took walks, and described what we were seeing around our neighborhood and in our home. I read loads of articles and Instagram posts from speech pathologists and did everything I could think of to encourage and support his progress. Even so, as his birthday approached it became clear that his language wasn’t developing—even if he did make his needs known and became proactive and independent at getting what he wanted—and we would need to think about getting some help.
We set up an Early Childhood Intervention screening at home the day before his birthday, because it can take time both to get a screening visit (in our case, about a month) and then find an available speech therapist. I guess I could’ve waited until after his well visit, but my mind was made up: I wanted our pediatrician to know that we were being proactive, and I also didn’t want her to dismiss my concerns.
As the title suggests, the assessment did reveal an expressive speech delay, and my son now sees a speech-language pathologist (SLP) a couple of times a week. It hasn’t always been a smooth journey and we are still learning—week in, week out. Based on our experience, I wanted to write about why, when, and how to seek help and to let you know that, if this is your reality right now, you aren’t alone.
1. Should I Worry?
I mentioned developmental milestones and averages earlier, and that’s probably the best place to start. There is a HUGE range of “typical” when it comes to baby and toddler development, and within that speech and language vary drastically from one two-year-old to another. It’s really easy to see other kids at the playground, your friends’ kids, or even children on social media, and compare your little one to them. Comparison isn’t called the thief of joy for no reason, my friend—it can make you feel like your little one is behind, even if they are actually pretty average.
The CDC guidelines for development suggest that, at two years old, a child should have a vocabulary of anywhere between 50 and 400 words. Words can be partial (“ba” for ball, “duh” for dog, etc.) if said consistently and with understanding. Similarly, sounds (animal sounds, beep, wee-yoo) also count as words in your toddler’s vocabulary, because they are associated with a concept.
We knew that our son had nowhere near 50 words at two—and that’s the lower end of “typical”—which was a red flag for a follow-up. Other red flags include:
- a family history of speech and language delays or disorders
- difficulty understanding simple directions
- recurrent or chronic ear infections
- not using gestures, especially pointing, to communicate
- vocabulary regression—not using sounds or words they used to have
- not making consonant sounds
- poor play skills, or not playing in ways you’d expect them to
These signs don’t necessarily always mean that something is wrong, but they do indicate that your child would benefit from an evaluation by an SLP.
2. Screening and Evaluation
In Texas, the Health and Human Services Commission operates the Early Childhood Intervention (ECI) program for families with children from birth up to age three. They offer help and support with developmental delays, disabilities, and other medical diagnoses that can have an impact on development during the all-important early years of childhood.
An ECI screening for any child under three is free and covers all areas of development—social emotional, adaptive/self-help, communication, motor, and cognition. Based on the results of the screening, children will qualify for assistance if they have a developmental delay of 25% in one or more areas—or 33% if the only delay is expressive language development. Assistance usually takes the form of a therapist who comes to the home and teaches caregivers activities and daily routines that promote development in the area in which the child is experiencing the delay.
The therapist is often also the family’s case manager, helping them access services, resources, and support they need. Since ECI is only for children up to three years old, they can also help with the transition to a suitable preschool, childcare center, or community program.
Even if you suspect that the only delay your child is facing is expressive language, I highly recommend having an ECI evaluation. You are entitled to do so, and it can help soothe any fears you may have about typical development. (I’d say this is especially important if you don’t have a great family network around you and this is your first child.) As your child has to have an expressive speech delay of 33% or greater to qualify for services through ECI, you have the freedom to choose whether their plan is the right fit for you. You can still opt to seek other help if they don’t quite meet that threshold, or go for a different type of therapy than the one suggested.
Armed with the knowledge that our son had a speech delay, we also had a second assessment done outside of our home. In most cases, your health insurance policy will cover this (and part/all of the actual therapy sessions) or you can choose to pay out of pocket. During this time, I added a post to the Alamo City Moms Community + Conversation group on Facebook, and a mom whose children had grown and left replied to me. Her words have really stuck with me: “Be your child’s best advocate: ask, research, interview. The right person to help your son is out there, and when you find them it should be like magic.”
3. Finding the Right Fit
After our ECI evaluation, we had a single at-home session with the therapist assigned to our case. It was an important lesson for me in “going with my gut” for two reasons: 1) my son immediately didn’t like the therapist and felt uncomfortable, even though we were at home; and 2) I realized that going to a clinic or office would be a much better fit for our family. While in-home services can be wonderful, you are at the mercy of having to be more flexible with your therapist’s routine. As my husband works from home, I wanted a consistent schedule of appointments that I knew I would always be able to make.
They do tell you to give it a few sessions with a given therapist in order to decide if they are a good fit, but my mind was made up. I read extensive reviews and asked for recommendations online, then called several local offices and scheduled initial assessments/consultations at the ones that I felt would fit us best. For me, it was important that the SLP who carried out the assessment would also be working with us on a regular basis because it’s an important part of the process, and some things (child temperament included) cannot be expressed on paper.
The in-office assessment at Greater Learning took around one hour and 15 minutes and was an overwhelmingly positive experience. We booked our first real therapy session for the following week, and after that followed our therapist’s recommendation of two sessions per week. Primarily play-based, our speech therapy sessions are fun and engaging, I can be involved if he wants me to be, and my son loves going.
Finding the right fit is absolutely vital. Two sessions a week is no small commitment of time and effort for me as a mom, but the most important aspect is that your toddler relates to, has fun with, and enjoys the company of their therapist. My son has a sensitive temperament and is extremely wary of people he doesn’t know, so having a therapist he loves to play with and feels safe with has been such a relief for me. Speech therapy may be necessary, but it is also a service, and you can’t ever feel bad advocating for more and better for your child. Any therapist or clinic should respect that.
4. The Above and Beyond
As a stay-at-home mom, I’ve been privileged (and also maybe slightly burdened) to be so directly involved in my son’s speech therapy sessions and his progress outside of that. If your child is currently in daycare, some (or all) of their sessions may take place there—but there are still lots of ways to be actively involved with the time spent with their therapist. Ask another member of the daycare staff about how your child interacts with their therapist, what their mood is like, and whether they seem to enjoy their play and activities together. Ask for regular progress updates from the therapist and make time to speak on the phone so you can implement some of the same techniques and strategies at home.
Following up with “homework” and making sure that you and your SLP are consistent in labeling/referring to things is important. I always ask (if not at the end of every session, at least once a week) if there’s anything more I can do at home to help him progress. I also try to offer a roundup of new words and sounds he’s made so we can both share in his victories—because they are as much hers as mine.
Working with an SLP is one piece of a larger puzzle of helping your child overcome a speech delay. Children learn best when they can spend time with their peers, emulate one another, and play together. At the moment, my son balances two speech therapy sessions with two days at a Mother’s Day Out program—with other opportunities for socializing in between. I often worry I’m not doing enough or giving him enough time with other kids, even though I’m doing as much as I feel able to do. I’ve noticed in toddler parenting, even more than the baby stage, that if the tiredness doesn’t get you, the mom guilt surely will.
I’m not always the most objective person and I will freely admit that in the midst of a particularly bad tantrum, I’ve felt so frustrated and upset that my son can’t tell me what he wants or needs. I’ve worried that I somehow caused his speech to be delayed by doing or not doing something—but then I remember, I’m not alone in this, and I’m doing everything I can to advocate for him now. The chances are good (70–80%) that he might have outgrown his language delay, even if we’d done nothing, but now his chances are exceptional. When he’s talking my ear off (which he’s already started to do!), it’ll only be me, his mama, who remembers carrying the worry of those quieter days.