Alexis Irazoque, M.S., CCC-SLP
When it comes to your 2-year-old’s speech and language development, a common question is, “What’s normal?” Is your toddler simply a “late talker,” or should you be thinking about speech therapy? It can be hard to tell whether toddlers are reaching age-appropriate milestones, if professional help from a speech therapist is needed, and when to get started. Although there is no simple formula for determining exactly when a child should start speech therapy, 2-year-olds can benefit greatly from working with a speech therapist! In this article, we’ll explain how speech therapy can help young toddlers, how to know if your child needs therapy, how to find a speech therapist, and what sessions with a toddler might look like.
What do 2-year-olds receive speech therapy for?
Speech and language skills begin developing in infancy. And building strong language skills in toddlers can set the foundation for communication and literacy skills once they enter school.
There are many ways speech therapy can benefit toddlers. Here is a breakdown of each.
Nonverbal communication Speech therapy can help toddlers with the most basic forms of communication. This can include the use of gestures or facial expressions, as well as simple sounds to express their needs and wants even before they’re able to talk.
Other nonverbal communication skills include joint attention, turn taking, showing social interest in others, imitating gestures and actions, and following directions. By strengthening skills like these, speech therapy can help young children grow into effective communicators.
Cognitive development and play A 2-year-old child’s brain is rapidly developing. Cognitive abilities impact so many aspects of a child’s daily life, including working memory, reasoning and problem-solving skills, self-awareness, executive functioning, comprehension, and motivation.
Strong language and communication skills are needed to improve cognitive function and raise healthy, independent children. Speech therapists can use play and daily routines to help your child improve their cognitive skills!
Language and early communication skills Language skills are divided into two categories: receptive and expressive. Receptive language refers to how we attend to, process, and understand language. Expressive language refers to how we use sounds and words to communicate our wants and needs.
There are so many reasons humans need to communicate. It can be extremely frustrating for a young child who can’t express themselves clearly. Speech therapists can help your child communicate for a variety of reasons, including:
Getting basic needs met, such as eating and drinking
Social routines: Waving “hi/bye” and giving high fives
Requesting: Asking for “more” of something
Showing and sharing: Holding a toy up to show you
Protesting: Saying “no,” “stop,” and “all done”
Asking for “help”
Commenting: “Big truck” or “Hi, dog!”
Answering yes/no with a head nod or shake
Speech Speech involves how children verbalize and articulate their communication–how they say and pronounce words. A young toddler’s speech should be understood by people they often interact with, like family members or close friends. A 2-year-old in speech therapy may work on developing early sounds such as /p/, /b/, /m/, /w/, /h/, /d/, and /n/.
Feeding skills Many people don't realize that speech therapists also see children for feeding therapy. If a child is having trouble safely eating or drinking, or is nervous about trying new foods, feeding therapy can help. Feeding skills involve a child’s ability to feed themselves, use utensils, drink from cups and straws, and even try new foods and textures.
How do you know if your 2-year-old needs speech therapy?
Now that we’ve discussed the reasons a toddler may need speech therapy, let’s focus on signs that your 2-year-old could benefit. To do this, we need to know what is typical development.
It’s important to remember that all children are different and follow their own developmental timeline. Just because your child isn’t displaying certain behaviors doesn't mean they won’t eventually catch up. However, if you do notice your child isn’t hitting milestones appropriate for their age, you should consider talking with your doctor or seeking an evaluation from a certified speech therapist.
2- to 3-year-old developmental milestones
Receptive language milestones:
Points to body parts when named such as “nose,” “head,” “feet”
Points to pictures in a book when you name them
Chooses an item when given a choice of two, such as “book or ball?”
Follows simple two-step directions like “Go to the closet and get your shoes”
Answers simple questions such as “Who’s that?” and “Where’s __?”
Points to objects when described (example: Child points to shoes when asked “What do we wear on our feet?”)
Understands directional concepts, such as under, in, on, in front of, behind
Begins to understand differences in sizes, such as big, large, small, little
Understands “yours” and “mine” as well as turn taking: “my turn” and “your turn”
Understands verbs and points to them in pictures, such as jump, run, throw
Listens to books for longer periods of time, and points to objects of interest while listening to the reader
Expressive language milestones:
Says at least 50 words when speaking spontaneously and independently
Uses words more than gestures to communicate (rather than just reaching to be picked up, says something like “Mommy, up”)
Names family members and peers
Begins to play and experiment with their voice, such as whispering
Initiates singing their favorite songs
Uses two- to three-word phrases around 24 months, which increases to three- to four-word phrases by 36 months (examples: “my juice” and “me throw ball”)
Engages in short conversations
Speech sound milestones:
Between ages 2 and 3, we expect a child to have mastered /p/, /m/, /h/, /n/, /w/, and /b/ sounds. They should be close to mastering the /k/, /g/, /d/, /t/, and /ng/ sounds. We also want to see them start to attempt the /f/ and /y/ sounds.
Play milestones:
Children’s play becomes more complex as they begin to participate in pretend play and use toys for their intended purpose. You may see your toddler playing “house,” talking on a pretend phone, or holding a conversation with their dolls. They should also be able to complete more complicated activities such as puzzles and engage in sensory play such as PlayDoh or kinetic sand. As toddlers are learning how to use language, simple pretend play allows them to expand these foundational communication skills.
Exploring most foods and textures:
Children around age 2 should be feeding themselves with a fork or spoon as well as using their pincer grasp (holding something between the thumb and first finger). They should be able to drink from an open cup or a straw and no longer be using bottles or pacifiers.
Even if your child greatly prefers chicken nuggets, they should also be trying new foods, and, after a few attempts, may accept those new foods into their diet.
Signs that your 2-year-old isn’t meeting milestones
Here are some signals that your 2-year-old child may not be meeting age-appropriate milestones:
Using fewer than 50 words
Using fewer than 5 consonant sounds
Not following simple directions such as “Get your shoes”
Uses more gestures than words
Still babbling
Not combining words into phrases
If your toddler is 2 or 3 years old and isn’t yet talking, it’s vital to talk with their pediatrician or with a speech-language pathologist, also known as a speech therapist. They will likely recommend a speech evaluation for your child.
How to find a speech therapist for your toddler
If you notice your 2-year-old is struggling to communicate, especially if it’s affecting their daily life and interactions, it’s generally recommended that you seek an evaluation from a speech therapist. As communication experts, speech therapists can make a clinical recommendation about “if and when” your child should begin therapy.
But how do you find a speech therapist? It’s always smart to speak with your pediatrician about your concerns. They likely have a list of local speech therapy providers that they recommend. And you may need a pediatrician referral in order to be reimbursed for speech therapy by your health insurance.
Here are some other ways to find a speech therapist:
Ask friends or acquaintances whose children have had speech therapy if they’d recommend their experience.
If you have health insurance, contact your plan to better understand their coverage for speech therapy. Your health plan may have a list of in-network speech therapy providers that you can research.
There are several online directories where you can search speech therapists by location and qualifications. One of these directories is compiled by the American Speech-Language-Hearing Association (ASHA), which is the professional credentialing organization for speech-language pathologists.
An extra note: No matter which route you take to finding a speech therapist for an evaluation, make sure to read any online reviews you find! And remember, you are in the driver's seat when it comes to the final choice. It should be someone who is licensed and experienced, and who connects well with your child.
What speech therapy looks like for a 2-year-old
Typically, speech therapy for 2-year-olds is play-based. Play-based therapy is when a speech therapist uses motivating toys and activities to practice speech and language skills. Play is meaningful to children, so when we play to teach skills, those new skills become relevant to the child’s life. In other words, play helps children learn!
Play is actually linked to language development. Here’s a great example: When a child starts using one item to represent another (say, a banana for a phone), they often start to use single words. By playing, we are encouraging language development!
Play can happen anywhere, which means a caregiver can help a child develop speech and language skills anytime.
Another benefit is that play can happen anywhere, which means a caregiver can help a child develop speech and language skills anytime. Speech therapists will use everyday items in therapy, teaching caregivers how they can help their child at home with things they already have. Some examples include stuffed animals, puzzles, books, and blocks.
How speech therapists keep toddlers engaged in therapy
Speech therapists are masters at keeping young children interested in speech therapy. They do this by using toys and materials that are relevant and fun for a child. These could include things like bubbles, toy cars, animals, and songs. When we use things of interest to the child, we increase their participation, which leads to better speech therapy results.
But, what about keeping a young child engaged in online speech therapy? Speech therapists have lots of fun and interactive toys and games they'll present to a child on screen. But we’d never expect a toddler to sit in front of a computer uninterrupted for 30 minutes. So while toddlers are encouraged to sit alongside their parents during online sessions, it’s not necessary for this age group.
That’s why parents and caregivers play an absolutely vital role at this age. The speech therapist will provide parent coaching to help you use the techniques taught during therapy during day-to-day interactions with your child. This is because speech and language-building skills happen throughout a child’s daily life, from playtime to dinnertime to bedtime rituals. Your speech therapist will arm you with education, tools, cues, and strategies so you can practice with your child at home. Home practice is one of the most important factors in a child’s progress. And it’s easy to make it a part of your daily routine!
How long will my child be in speech therapy?
Generally, the earlier you start therapy, the more progress your child will make. The length of speech therapy depends on a variety of factors, including:
The type of speech disorder or communication challenge
The frequency of speech therapy sessions each week/month
How often you practice at home
Your child’s age
Any underlying medical conditions
While many speech and language issues begin in childhood and may improve over time, others can persist into adulthood and require long-term therapy. So the duration and frequency of speech therapy will be different for every person.
Benefits of speech therapy for toddlers
A huge perk of speech services is that your child will have a speech therapist who sees them regularly and truly knows your child’s personality, learning style, and communication strengths and weaknesses. This is helpful when it comes to setting and achieving the right goals for your child.
In addition, your speech therapist will provide weekly home practice exercises and ideas that target exactly what your child needs. At the end of each session, a speech therapist should give you an overview of how your child is progressing. The speech therapist should then give you some ideas for how to incorporate their goals at home. Again, practice at home is extremely important, since it helps your child to maintain progress made between sessions. This way, your child isn’t just practicing their speech and language skills for 30-60 minutes a week, but around the clock.
Don’t wait if you have concerns
Sometimes children need extra help to develop their speech and language. Language skills build on top of each other over time, much like a ladder. And when children don’t reach important communication milestones early on, they’re often at risk of falling behind. The earlier you can intervene, the more likely they are to reach their communication goals.
If you’re just now recognizing that your child may benefit from therapy, try not to worry about the time they’ve gone without treatment. We can only make decisions that affect the here and now. Be proud that you’re taking the time to learn how to help your child! Being your child’s advocate is an important role, and who better to fill that role than you? Taking this first step will be life-changing for your child, thanks to you!
