Speech and Language Delay in Babies: Red Flags by Age and What to Do

Speech and language development is one of the most closely watched areas of infant development, and also one of the most variably paced. Some babies begin talking relatively early; others are entirely silent until well past their first birthday and then begin producing sentences almost fully formed. The challenge for parents is knowing when variation is within the normal range and when it warrants professional attention.

This guide sets out what to expect by age, which signs should prompt a referral, and what families can do to support language development at home.

Understanding What Language Development Involves

Language development is not just about producing words. It encompasses:

Receptive language: Understanding what is said to you — following instructions, responding to their name, pointing to named objects
Expressive language: Producing communication — babbling, gesturing, first words, combining words
Social communication: Using language and gesture to share attention, express interest, and connect with others

Problems in receptive language are generally more clinically significant than expressive delays alone, because receptive language is the foundation on which expressive language builds. A child who understands a great deal but produces few words is often simply taking longer to produce speech. A child who neither understands nor produces much language needs earlier and more thorough assessment.

Red Flags by Age

These are not diagnostic criteria, but signs that warrant discussion with a health visitor or GP, who can then initiate a speech and language therapy (SALT) referral if needed.

By 6 months:

Not turning to look at the source of a sound
Not responding to familiar voices
Not babbling (making strings of consonant-vowel sounds like "ba ba" or "da da")
Not making eye contact during interaction

By 12 months:

Not responding to their own name
No babbling or jargon (babbling that has the rhythm of sentences)
No pointing, waving, or other communicative gestures
No first words (though many children do not have words by 12 months — the absence of the above social communication behaviours is more significant than the absence of words alone)
Not turning to look when someone new enters the room

By 18 months:

Fewer than 6 to 10 recognisable words used consistently
Not understanding simple instructions without gesture ("give me the cup," "wave bye-bye")
Not pointing to show or share interest in something (as opposed to pointing to request)
Loss of previously acquired skills — if a baby who was babbling has stopped, this is a red flag at any age

By 24 months:

Fewer than 50 words
Not combining two words spontaneously ("more milk," "daddy go")
Not following simple two-step instructions ("get your shoes and bring them here")
Difficulty being understood by familiar adults

The Difference Between Delayed and Disordered Language

Language delay means that language is developing in the typical pattern but more slowly than average. A child with language delay is doing all the same things as younger children — they are just doing them later. Many children with language delay catch up with appropriate support.

Language disorder (or developmental language disorder, DLD) means that language is not simply delayed but is developing in an atypical pattern. There may be specific difficulties with certain aspects of language while others are intact, or the pattern of errors may be unusual. Language disorder tends to be more persistent and may require more intensive and specialised support.

Autism spectrum condition (ASC) and hearing loss are two of the most important conditions associated with language differences that require specific identification and support. Both can be missed if the concern is framed only as "late talking." A hearing test should be part of any investigation into language delay.

The SALT Referral Pathway in the UK

Speech and language therapy is available on the NHS, though waiting times vary considerably by area. The typical pathway is:

Raise concern with your health visitor or GP
Referral to a paediatric speech and language therapist
Initial assessment, which may include standardised language assessments and, if needed, referral to a paediatrician or hearing specialist
Ongoing therapy or monitoring depending on the findings

In many areas, self-referral to the local SALT service is possible — you do not always need a GP referral. Contact your local NHS trust or search for your area's children's SALT service directly. Many trusts also offer early access programmes for children under 2, recognising that early support produces better outcomes.

While waiting for an assessment, some areas offer SALT support groups or parent programmes — Look Who's Talking, Talking Point, and the Elklan Early Talk programmes are examples — which give parents practical strategies to use at home.

What Parents Can Do

A language-rich environment is the single most important factor in language development. This is not about expensive educational toys — it is about how you interact with your child day to day.

Talk about what you are doing. Running commentary during nappy changes, mealtimes, and outings — "I'm fastening your nappy now, there we go, all done" — exposes babies to vast amounts of vocabulary and sentence structure in meaningful context.

Follow the child's lead. When your baby or toddler shows interest in something, name it, talk about it, and expand on what they say or do. If they point at a dog and say "da," respond with "yes, dog! A big dog. The dog is running."

Limit background noise. Babies learn language most effectively in one-to-one interaction with a responsive adult. Background television, in particular, has been shown to reduce the quality and quantity of adult-child interaction.

Read aloud from birth. Sharing books — not for comprehension but for the shared experience of hearing language, seeing pictures, and being in a reading relationship — is strongly associated with better language outcomes.

Reduce use of screens. There is no robust evidence that any screen-based programme improves language in children under 2. The best language learning happens in real, responsive interaction.

Early identification and support for language difficulties genuinely changes outcomes. Trust your instincts: if you have a concern about your child's communication, raising it sooner rather than later is always the right thing to do.