What They Say
& How They Say It

How many words should a three-year-old have -- and when can you tell if he or she actually has delayed speech? A pediatrician offers some ideas here, and explains about a few things you can do to help your toddler or preschooler.

speech delay

The question:

My grandson, who turned 3 last March, is a happy, healthy, active child who appears on target for a three-year-old except he is behind in verbal skills. He "jabbers" a lot but other than a very few words his speech is not understandable. When I say a word and ask him to repeat it, he does, but it does not sound like what I have spoken. He seems to try very hard to speak clearly. Does he have a problem? - Concerned Grandmother

The physician answers:

Yes, there is a problem. The critical question to ask is: Will this problem go away by itself as he develops, or does he need intervention? Here are some things to consider:

What is normal speech for a 3 year old?

By three years of age, a child should have a vocabulary of 600 words with 80 percent intelligibility to a listener who does not know the child. This means that a person who has not previously listened to this child talk can understand 8 out of 10 words. (Parents can often understand what a child is communicating better than anyone else, in spite of any speech delay.)

  quotation mark open By three years of age, a child should have a vocabulary of 600 words with 80 percent intelligibility to a listener who does not know the child. quotation mark close

When should a three-year-old be referred for speech evaluation? Evaluation is indicated if he or she has a vocabulary of 200 words or less, is not using short sentences, and has less than 50 percent intelligibility. This three-year-old has both limitation in vocabulary and few intelligible words, which means he should be evaluated.

Trust your instincts, Mama!

You are right in being concerned. In my practice I found that, for the most part, parents and other family members familiar with the child are pretty good developmental diagnosticians. When the family is worried about an aspect of development in a child, the pediatrician should pay attention to their concerns.

But sometimes the family is not aware of a speech delay or its potential significance. Pediatricians sometimes don't ask the right questions. For example, instead of "How many words does he have?" it's better to ask "How does he let you know what he wants?" (A 3-year-old should be using sentences) and "Can strangers understand most of what he says?" (By age 3, this answer should be yes.)

Does your child have a delay?

Developmental Language Disorder (DLD) is the term we use for selective impairment of speech and language development in children without other manifestations of developmental delay. These children generally have normal intelligence, and their hearing and social-emotional development are also normal. (Children with a speech delay due to something like an Autistic Spectrum Disorder would not be classified as DLD.)

Estimates of Developmental Language Disorders' incidence range from about 5 to 10% of preschool children, and boys are much more likely to be affected than girls are. Although DLD is associated with a variety of possible underlying factors, in most cases the etiology is unknown -- although there is a often a family history for speech delay so that genetic factors may be playing a role.

What happens next?

Children with a suspected Developmental Language Disorder should be thoroughly evaluated immediately. Such a child needs a complete physical and neurological examination as well as a psychological evaluation to determine the child's intelligence level. Hearing should also be carefully tested as the child could have a selective hearing loss which might not be noticed by the family.

If and when the diagnosis of DLD is made, the child should be referred for immediate speech and language therapy. He will do best in a preschool that is experienced in teaching children with speech problems.

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Comments on "Delayed speech in three year old is a problem"

noopur April 05, 2014 | 12:25 AM

my son is 3year4months old he can pronounce so many words but they are not clear he can make small sentences like i want water,papa is going to office ,i ate tiffin in school but they are not very clear he can sing a poem like johny johny ,twinkle twinkle,but again words are not clear he can't pronounce r and l so is this case to worry about please give your suggestions

alberto March 28, 2014 | 6:34 AM

i have a three years nephew and he developed a slow speeh abilty...he is already three year now but could not speak nice ly...pls suggest....

trisha March 05, 2014 | 6:24 AM

im a caregiver for 3years7 months , he cannot construct sentences and cannot make any simple requests like "im hungry or thirsty" though he memorize the lines of his favorite cartoon characters and knows alphabets and numbers very well.im really trying to help him the best that i could but i always end up disappointed coz he does not respond most of d time with simple tasks. When asked a question like "what are u doing?"he answers back "what are u doing" too. He has lots of helpful dvd's (words around d house,social skills meeting and greeting,sentence builder and etc.). I think he has no hearing problem coz he memorize the lines of his favorite cartoon character. He just dont speak with us. Help!

Loreen Chitongo January 28, 2014 | 2:20 AM

I am also concerned ,My son just turned 3 in January and is not yet able to construct any sentences ,If he wants something ,he will take you to it ,at the moment he is able to tell you if he wants to go to the toile by saying one word,My peadeatrian told me to see a specialist to check his hearing ,He reponse if you call him ,but sometimes he dosent .I did not think his hearing could be a cause for concern but the peadeatrician says he looks like his hearing is partial,i though he would just be ignoring me because he is a bit stubbon,, Please help

katherine January 27, 2014 | 4:30 PM

My 3 yrs old can only say one word at a time. She has been seen and is in speech thearpy. she did not walk until she was 3 yrs old.she was a preme the doctors have run all the test and everything came back normal. Her mother does have a mutantation in some of her genes,but my grandaught has seen a gene specialist,he found nothing wrong with her. Her third child was born with william sydrome,the first child died. The doctor told her never to have kids,but she did.the doctors said she does not have william sydrome. please help we need a doctor who is willing to do the foot work and give us something to work with.

Anissa January 22, 2014 | 9:02 PM

Hi, It depends on your state as to where you go to have a child evaluated for speech services. In CA at 3 years of age you go to your elementary school to see the speech therapist there. Just call the school, the therapist will point you in the correct direction. In CA if they are under three the child is served by ALTA. Not sure how to contact them other than to look on the internet.

nadia muntaha December 22, 2013 | 12:00 AM

My son is 3years5months,he has a problem of speech delivery,last 5/6months he is delivering words,repeating words whats we r says but still not capable of making any sentence,only thank you,bye etc.follows instruction properly,but not answer the question of unknown and totally reacts on his mood,now i want to send him preschool,is it will be wise?please give me suggessions

Rabaa Aldaboos October 07, 2013 | 10:32 PM

My child is 3 years old, he had hearing problem and was late to talk. Hearing problem was solved, once he started talking and with help of speech therapist, she said that he has problem in understanding. He was saying open for close and close for open, but he got a bit better. Building up the vocabulary list is difficult as he doesn't pick up fast. With repeating more than 20 to 30 times he will know the word but still will not be sure. He is first year in the Kinder garden and now he is beating the kids. School is observing his attitude. Still on toilet training, with the rewarding system but still not working. I need your help please..

Mia June 16, 2013 | 12:12 PM

I recommend contacting your local early intervention agency. Most pediatricians don't use screening tools and often take the "let's wait and see" approach. In the meantime, there are plenty of books out there that are parent-friendly, including The Cow Says Moo Ten Tips to Teach Toddlers to Talk (McErlean), Let's Talk Together (Poland), and My Toddler Talks (Scanloon) are a few. Try Amazon; they have everything.

Tina December 09, 2012 | 10:19 AM

Also, it is important to remember that all things are relative to the child. My son has a vast vocabulary. When using an iPad app for articulation, he can correctly identify hundreds of pictures on "flashcards," and his articulation has improved greatly in just the past six months to the point where there are only a few sounds that give him any trouble at all. However, his expressive speech is at the "low end of normal" compared with his knowledge of vocabulary words, which is at the higher end of normal. Consequently, the gap we see between what we know he knows and what he can express is great, as are his temper tantrums when he can't get out his thoughts or feelings. He says plenty of sentences ranging from, "I want to go on the fire truck" to "Mom, can I have a powdered donut?" However, he cannot converse on the level of responding to open-ended questions like, "What did you do at school?" or "What should we name this new teddy bear?" He usually will just stare blankly and not answer the question, or he may say semi-related things like "I go to school" or "It's my teddy bear." Nor does he ever ask you a question like, "Where are we going?" or "What did you do today, Daddy?" Again, compared to some 36-month-olds, he is probably totally normal, but compared to his vocabulary, which is certainly in the hundreds of words, if not over 1000 words, his expression is behind. Therefore, we have him starting speech therapy to work on his expression and to bring it up to the level of his understanding and vocabulary. The therapist verified that I'm not crazy and that he is below the mean on expressing thoughts, and I'm glad that we're intervening early.

diane August 07, 2012 | 6:29 AM

my son who is now 31/2 and when he was born we new he could not hear properly after many trips to doctors and hospital he had gromits after alot of ear infections we was told the gromits would help his speech improve they have a little a few months ago he had a hearing test which came bk as mild hearing loss and hes had another one and they passed him as he was doing all things before bhe said noise weve been told to learn makaton to help him but we feel like we banging our head against a brickwall he gets very frustrated getting himself over he got another hearing test nxt week but were do we go from here please help

Younes July 11, 2012 | 9:45 AM

is always a good idea and you could catleinry tell him a little story in return for the sweet one he just told you.One thing to remember is that there really is something to motherese. Motherese is that syrupy sweet way all of us (not just moms) talk to little ones we love. The sing songy and high pitched intonation of it and the way it's delivered, with smiles and affection, are all important to establishing strong connections in those language centers of the brain. So don't be afraid to baby talk. You can skip the sheepy for sleepy or the wawa for water but the aren't you just daddy's cutest little, sweetest little, boy in the whole world s are keepers.Kim recently posted..

levassar April 14, 2012 | 7:08 PM

my grandson seems to have his own vocabulary.he struggles to communicate with us.

bola ogunkeye December 03, 2011 | 3:39 AM

My son is going to be 3 years in march. I expect that by now he should b constructing and speaking clearly relatively long sentences but he speaks just phrases. Do you think he has any impairment? Is there any thing he can take to correct this? Pls I will appreciate suggestions.

kariuki james August 28, 2011 | 10:04 AM

My daughter was born at eight months and since then her development has been slow but sure.She recently walked at three years and is now as fast as one can imagine. But speech is a little down.At 3years nine months, she gestures very well and utters noises to express herself. She likes going outside to play and really becomes agitated.We have seen a speech therapy and are currently taking therapy lessons. But what about speech-nutrients?

Joeann Mccoy August 28, 2011 | 4:09 AM

I am concern about my Grandson who was three in June. He started talking earlier about sixteen months and was make small statements like. "I know", "Oh No", and "You stop!" with the emotion tones. However, now he does not talk as much and I know he can because he made a statement about a month ago saying "I told you I be back in a minute,". He repeated this comment more than once. This let me to believe that he is capable of full sentences, however, he has just stop talking clearly most of the time he just won't say anything. We are training him to say when he has to go to the bathroom but he will not talk, he will sometime just take off his lower garments and you have to take him by the hand to the bathroom. Should his parents have him evaluated for DLD or is there something else causing his delay in speech?

sandra August 27, 2011 | 4:27 AM

My 3 year old grandson can communicate ok, but he seems to have lazy speech and doesn't pronounce his words correctly. He will make up words such as his favorite movie is Toy Story and he will call Woody Hidie.Is this normal?Will his speech improve?Is there a possibility he has a hearing problem?

CARLA HARRIS May 15, 2011 | 6:29 AM

I think my granddaughter my have this problem. I don't no were to take her. I live in Staten Island New York

jooles November 17, 2010 | 6:00 PM

What a load of rubbish! I hate these people who say your child should be doing this by then and this by that age. My son is coming up 3 he knows a lot of words and is picking up words everyday. He dosent use sentences yet but he will. Ive been told he slightly behind where he should be yet he was walking at 6 months he can count to 15! and can put a 10 piece puzzle together. He struggles with his knife and fork and cant quite grasp potty training. My point is every kid is different and should be treated as such dont follow these stupid guidlines that the so called experts tell us to because your child will be ahead on some and get no credit and behind on some when there then told there is something wrong. Trust your instinct if you child is piking something up thats all that matters it will take aslong as it takes just make sure you give them as much help as possible.

peaches August 26, 2009 | 3:32 AM

You have the right to be concerned for your child. Your Dr. should have referred you to an speech therapist or to your local elementary school for evaluation. They will test him and if he qualifies, they will refer him to a school in your district for help with his speech developement

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