Is your toddler still refusing to speak or perhaps she’s just shy? The words that he/she says is unclear and difficult to understand. Should you wait or get help immediately? Children vary in their speech and language development and there are milestones for what is considered normal.

Ms Desiree Lau, Principal Speech Therapist from the Speech Language Therapy Service at KK Women's and Children's Hospital, gives detailed answers to your questions.

Question by huangyuisan

my son is turning 20 months this 27th june and till this date he only speaks single syllables, he doesnt talk but can gesture or hold your hand if he wants something, is this still normal or if not, what things should i look out for.. ?

Answered by Ms Desiree Lau, Senior Speech-Language Therapist, Rehabilitation Department, KK Women’s and Children’s Hospital

Firstly, we need to clarify your definition of "single syllable". Is your son's "single syllable" meaningful (e.g., "mum" for eat, "ma" for mother, “pa” for father), or are the syllables babbling (i.e. without meaningful context, e.g. "mamama" is said without consistent relation to requesting for mummy.)? As a general rule of thumb, a child is expected to have said their first words between 12 to 18 months of age. First words are syllables/sounds that the child uses that are meaningful.

The use of gestures is part of the developmental process before a child speaks their first words. Before expressive vocabulary (what he says) is developed, a child has to build up his receptive vocabulary (his understanding of words – e.g., knowing that a cup is called “cup”, but not saying the word yet). Research suggests that children have about 50 to 100 words in their receptive vocabulary before they say their first words.

At 20 months old, we hope that he has started to say his first few meaningful words. As a general rule of thumb, if a child has not started saying their first words by 18 months old, we would recommend a referral to a speech and language therapist, to assess how his receptive language and to suggest an appropriate treatment plan. For now, do name the objects or actions that your child points to or gestures to enrich his vocabulary.

Question by csfkat

My grand daughter is 2.5 years old. She is still unable to string a sentence well n her pronunciation of words are not clear. I can barely make out what she wanted to say. I have 4 girls. All of them spoke very well by the time they were 2. Should I be worried? What can I do? Thank you.

Answered by Ms Desiree Lau, Senior Speech-Language Therapist, Rehabilitation Department, KK Women’s and Children’s Hospital

I understand your anxiety. Different children develop language at different pace. There is an acceptable age range of when certain language skills should have developed. At two years of age, we expect that typically developing child can combine at least two words together. For example, they can say "mummy drink" or "give bear'. At three years of age, we hope that their sentences have increased to at least between three to four words. For example, they can say "I want drink water". Is your granddaughter able to do the above mentioned? If she is reaching these milestones, I would suggest that it is acceptable to wait. If not, then perhaps it may be useful for her to seek an assessment with a speech and language therapist.

Your second query is about your granddaughter's articulation. Two-year-olds are usually about 50% intelligible to an unfamiliar speaker, whilst a three-year- old would be about 75% intelligible to an unfamiliar listener. As I am unsure how unintelligible your granddaughter is, I am not able to advise further. If you are concerned, you may seek further assessment with a speech and language therapist.

Question by​ valinorian

Hello, my 2 yr old boy can only babble incoherently. He has no problems listening to commands. He understands what's right and what's wrong. He can tell us what he wants by showing us and pointing. But we talk to him a lot, yet he cannot say single words or short phrases. He can't even call me "mummy". He just babbles and its frustrating when we don't understand each other. May I know if this is a cause for concern? Should I bring him for any tests? Thank you..

Answered by Ms Desiree Lau, Senior Speech-Language Therapist, Rehabilitation Department, KK Women’s and Children’s Hospital

It is good that your son yearns to communicate via gestures. The use of gestures is part of the developmental process before a child speaks their first words. Before expressive vocabulary (what he says) is developed, a child has to build up his receptive vocabulary (his understanding of words – e.g., knowing that a cup is called “cup”, but not saying the word yet). Research suggests that children have about 50 to 100 words in their receptive vocabulary before they speak their first words.

It sounds like your son's receptive language is more advanced than his expressive language. However, it seems like he has some difficulties with verbal language (saying words). Children are expected to say their first meaningful word between 12 to 18 months of age. It will be worthwhile to bring your son to see a speech and language therapist for an assessment of both his understanding and expressing of language. The speech and language therapist may also assess how you provide language stimulation, to further enhance the language stimulation exposure your son receives.

It can be very frustrating for both parents and child when they are unable to use words to express themselves. Hence, do continue to encourage the use of gestures, pointing and other forms of non-verbal communication to help reduce the frustration. Gestures are still part of the developmental process before their first words. It helps if you can teach him more gestures as this also increases his vocabulary. Do remember to always name the gesture when you use it or when he uses it, so that he continues to get the stimulation.

Ref: Q15