Paeds · growth-development-and-behaviour
Speech and language delay
Also known as Late talker · Late language emergence · Developmental language disorder · Speech delay · Language delay · Expressive language delay
Fellowship guide to speech and language delay: speech versus language versus social communication, late talkers versus DLD (CATALISE), mandatory hearing pathway, red flags, differentials, concurrent SLP and early intervention, equity and exam defence across ANZ, UK, US and Canada.
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Target exams
Red flags
- Loss of previously acquired words, phrases or social communication skills
- No babbling by 12 months with other developmental concerns, or no response to sound
- No meaningful words by 16–18 months or no two-word combinations by 24 months with concern
- Speech-language delay with social-communication red flags suggesting autism pathway
- Suspected hearing loss, chronic middle-ear disease or failed newborn/hearing screens without follow-up
- Global delay, regression, seizures or encephalopathy mistaken for 'late talking'
- Caregiver concern dismissed with wait-and-see despite clear functional impact
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Growth and development
- Developmental and behavioural paediatrics
- Learning goal 10 developmental and behavioural paediatrics
- Learning goal 15 essential general paediatrics
- Communication and advocacy
- Clinical Applications
- Long Cases
- Short Cases
- Communication
- Neurodevelopment and Neurodisability
- Patient management
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Development
- Clinical
- General Pediatrics Content Outline — Domain 2: Growth and Development
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics EPA: Assess and manage patients with common behavioural/developmental concerns
- Patient Care 1: History
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice 3: Coordination of Care
- Medical Expert
- Communicator
- Collaborator
- Health Advocate
- Pediatrics EPA — Assessing development and behaviour
Overview & Definition
A parent says, “He is almost two and only says mama and ball.” Your job is not to guess whether he will “grow out of it” from the doorway. Your job is to define the problem, protect hearing and safety, and start a pathway that can still use early plasticity. [1] [2]
Speech is the motor and sound system: articulation, phonology, voice and fluency. Language is the code: understanding words and grammar (receptive) and producing words and sentences (expressive). Communication is broader and includes gesture, pointing and social use. A child can have clear speech with empty language, or rich language that is hard to understand because speech sounds are disordered. [1] [3]
Primary-care reviews treat speech-language delay as a common reason for concern in early childhood and emphasise structured evaluation rather than reassurance alone. [1] [2]
References18ShowHide
- [1]Rupert J Speech and Language Delay in Children. Am Fam Physician, 2023.PMID 37590860
- [2]McLaughlin MR Speech and language delay in children. Am Fam Physician, 2011.PMID 21568252
- [3]Feldman HM Evaluation and management of language and speech disorders in preschool children. Pediatr Rev, 2005.PMID 15805236
- [4]Bishop DVM Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology. J Child Psychol Psychiatry, 2017.PMID 28369935
- [5]Bishop DV CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS One, 2016.PMID 27392128
- [6]Bishop DVM Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD). Int J Lang Commun Disord, 2017.PMID 28714100
- [7]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
- [8]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
- [9]Barry MJ, Nicholson WK, Silverstein M, et al. Screening for Speech and Language Delay and Disorders in Children: US Preventive Services Task Force Recommendation Statement. JAMA, 2024.PMID 38261037
- [10]Siu AL Screening for Speech and Language Delay and Disorders in Children Aged 5 Years or Younger: US Preventive Services Task Force Recommendation Statement. Pediatrics, 2015.PMID 26152670
- [11]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
- [12]Wieckowski AT Sensitivity and Specificity of the Modified Checklist for Autism in Toddlers (Original and Revised): A Systematic Review and Meta-analysis. JAMA Pediatr, 2023.PMID 36804771
- [13]Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems. Pediatrics, 2014.PMID 24777209
- [14]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI Evid Synth, 2020.PMID 32813387
- [15]Garner AS Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 2012.PMID 22201148
- [16]Garner A Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. Pediatrics, 2021.PMID 34312296
- [17]Yogman M The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics, 2018.PMID 30126932
- [18]Levickis P Associations between maternal responsive linguistic input and child language performance at age 4 in a community-based sample of slow-to-talk toddlers. Child Care Health Dev, 2018.PMID 30043426