My Child Is Not Talking Yet: Milestones, Myths and When to Act

Almost every week a parent sits in our clinic and says a version of the same thing. My child is not talking yet, and everybody told me to wait. My mother said boys talk late. The clinic said give it time. He is nearly three now.

Sometimes waiting is genuinely the right call, and the child catches up on their own. Often it is not, and the months spent waiting are months of language development that are far harder to make up later. The difficulty is that from the outside those two situations look identical.

This article sets out what typical speech and language development looks like, which signs are worth acting on, and what actually happens at an assessment. It is written for parents in Uganda, where wait-and-see is still the default advice and where good speech and language services are thin on the ground.

What typical speech development looks like

Children vary enormously, and these are guides rather than deadlines. A child a month or two behind on one of these is usually fine. A child behind on several, or a long way behind on one, is worth having looked at.

Around 12 months

Babbling with a mix of sounds that starts to resemble speech rhythm. Responding to their own name. Understanding simple words like no and bye. Often one or two recognisable words, though not always.

Around 18 months

Somewhere in the region of ten to twenty words, used deliberately rather than copied. Pointing at things they want. Following a simple instruction like give me the cup. Enjoying being read to, even briefly.

Around 2 years

Putting two words together, such as more milk or daddy go. A vocabulary growing noticeably month to month. Understanding far more than they can say, which is normal. Familiar adults understanding roughly half of what they say.

Around 3 years

Short sentences of three or four words. Asking questions. People outside the immediate family able to understand most of what the child says. Following instructions with two parts.

Around 4 years

Telling you about something that happened earlier. Speech that is clear to strangers, even if a few sounds are still developing. Joining in conversation rather than simply naming things.

When waiting is not the right answer

Book an assessment if a child:

• Is not babbling by around 12 months
• Has no single words by 18 months
• Is not putting two words together by two years
• Is difficult for people outside the family to understand by three
• Has stopped using words they previously used
• Does not respond consistently to their name or to sounds behind them
• Is stammering in a way that is getting worse or upsetting them
• Struggles to follow simple spoken instructions
• Avoids talking to other children, or gives up trying to be understood

Losing skills a child already had is different from being slow to gain them. That one is always worth checking, at any age.

The thing that gets missed most often

A child who cannot hear speech clearly cannot learn to produce it clearly. It sounds obvious written down, and it is still the single most commonly missed explanation for a child who is not talking.

The reason it gets missed is that childhood hearing loss is rarely total. A child with mild or moderate loss still responds to a shout, still turns when a door bangs, still seems to hear. What they are missing are consonants, which is where most of the meaning in a word sits. They hear that you are speaking. They cannot make out precisely what you said.

Fluid behind the eardrum, which often follows repeated ear infections, is a common and very treatable cause. So is wax. Neither is permanent, and both are found in minutes with the right equipment.

This is why our first step with a child who is not talking is usually to check hearing. We do hearing testing in the same building as speech therapy, so it can be ruled in or out on the same visit rather than becoming another referral and another six-week wait.

Myths worth putting down

Boys always talk late

Boys are, on average, very slightly later than girls. The difference is far too small to explain a child who is significantly behind, and it has been used to justify a great deal of unhelpful waiting.

He will grow out of it

Some children do. Many do not, and there is no reliable way to tell which group a particular child is in without assessing them. That is the entire argument for assessing rather than guessing.

Speaking two languages at home confuses them

It does not. Children across Uganda grow up with Luganda, English and often a third language, and multilingualism does not cause speech delay. A bilingual child may know fewer words in each language while knowing the same number overall. If a child is delayed, they are delayed in every language they speak, and that is what an assessment looks at.

He understands everything, so his speech is fine

Understanding more than you can say is normal at every age. But a large gap between the two, sustained over time, is one of the patterns we look for.

What happens at a speech assessment

Nothing about it is frightening for the child. Most of it looks like playing, because for a young child play is how learning happens and how a therapist sees what they can actually do.

We start with a lot of questions for you about pregnancy and birth, ear infections, how the child communicates at home, what they understand, and what worries you specifically. Then we observe, using structured play and, where appropriate, formal assessment tools. Where hearing has not recently been checked, we check it.

At the end we tell you what we found, whether therapy is needed, roughly how many sessions we would expect, and what you can start doing at home immediately. If everything is developing normally, we say so, and that is a perfectly good outcome.

What helps at home, starting today

An hour a week with a therapist will not change a child’s language on its own. What changes it is what happens during the other hundred and sixty seven hours. These cost nothing:

• Get down to their level. Face to face, so they can see your mouth as well as hear you.
• Narrate what you are doing. I am washing the cup. The cup is wet. Ordinary running commentary builds vocabulary faster than quizzing does.
• Wait longer than feels comfortable. Ask, then count to ten in your head. Children who are slow to find words often get answered for.
• Add one word. If they say juice, you say more juice. Always one step above where they are.
• Cut the background noise. Turn the television off while you talk. A child straining to hear is a child not learning.
• Ask fewer questions. Comment more than you test. A running commentary invites language; a quiz invites silence.

Common questions about speech delay in children

At what age can a child be assessed?

Any age. Hearing can be tested from birth, and communication development can be assessed in infants long before first words appear.

Do I need a referral from a doctor?

No. You can book directly with us. If you have a referral letter or hospital notes, bring them, because the history helps.

How many therapy sessions will we need?

It depends entirely on what we find. We will give you a realistic estimate after the assessment rather than a number invented beforehand.

Can therapy happen online?

Yes for many children, and it removes the biggest barrier for families outside Kampala. Consistency matters more than intensity in speech work, so a weekly session that actually happens beats an ambitious plan that collapses after a month.

My child has autism. Can you help?

Yes. Communication difficulties associated with autism are part of what our speech and language therapy team works with, alongside families and schools.

Is it too late if my child is already six or seven?

No. Earlier is better, but therapy helps at every age, and children who start later still make real progress. The World Health Organization is clear that identifying hearing and communication difficulties early changes outcomes for children.