My child is hard to understand — should I get help?

It is completely normal for toddlers to be unclear, but by about three a stranger should catch roughly half of what your child says, and most of it by four. If teachers, relatives or shopkeepers regularly turn to you for a translation, a speech check is a sensible next step rather than something to feel embarrassed about.

Can speech therapy help a child who gets frustrated when talking?

Yes. Many children cry, hit or melt down when they cannot make themselves understood, and it looks like a behaviour problem when it is really a communication one. Therapy gives them clearer ways to get a message across. Families usually notice calmer evenings before they notice new words, and behaviour tends to settle as communication improves.

Do I need a doctor’s referral or a diagnosis before speech therapy?

No. You can contact us directly and bring your child in without a referral or a diagnosis. If you already have reports from a paediatrician, an audiologist or a school, bring them, because they save time. If we think a medical opinion or a hearing test is needed first, we will tell you plainly and help you arrange it.

Should my child have a hearing test first?

If there is any doubt about hearing, yes — it is the first thing worth ruling out. Repeated ear infections can leave fluid behind the eardrum that muffles sound for weeks with no pain and no obvious sign, and a child who cannot hear speech clearly cannot easily learn to produce it. The test is quick and painless.

We speak Urdu and English at home — should we drop one language?

No. Growing up with two or more languages does not cause a speech delay, and removing a language usually removes warmth and conversation rather than confusion. Count your child’s words across every language they use — paani and water are two words. Speak whichever language you are most natural and most talkative in.

10 Signs Your Child May Need Speech Therapy

Q: Is it better to wait and see, or start therapy early?

Early support usually wins, because young children pick up language so quickly. Waiting rarely does harm, but nobody can tell in advance which quiet two-year-old is the one who will catch up on their own. A short check tells you which situation you are in, and often ends in reassurance rather than therapy.

Your child may need speech therapy if they use far fewer words than other children their age, are hard for people outside the family to understand after about three, get stuck or repeat sounds, do not follow simple instructions, or have lost words they once used. One sign on its own rarely means much. A pattern across several is worth a check.

Most parents sense it long before they say it out loud, then talk themselves out of it — “maybe I’m overreacting”. You are not. Noticing early is one of the most useful things a parent ever does, because children’s speech therapy works best while language is still being built. Below are the ten signs we look for, the age each one starts to matter, and what to do if any of them feel familiar.

How do I know if my child needs speech therapy?

Compare your child to what is typical for their age, not to a cousin or a neighbour’s child. If your child has noticeably fewer words, is hard for strangers to understand, struggles to follow everyday instructions, or has stopped using words they had, a speech and language check is sensible. It costs you an hour and often ends in reassurance.

A therapist weighs four things together: how much your child understands, how much they say, how clear it is, and how well they use it to connect. A child can be behind in one and fine in the others — which is why a checklist online is a starting point, never a verdict.

The 10 signs a speech therapist looks for

1. Very few words for their age

Roughly, we expect a first word around the first birthday, ten to twenty words by eighteen months, and two words joined — “more juice”, “daddy gone” — around two. A two-year-old with a handful of words and no combinations is the most common reason families come to us, and it is often a straightforward speech delay.

2. Speech that people outside the family cannot understand

All toddlers are unclear at first, and parents become expert translators without noticing. The useful test is a stranger: by about three, someone outside the family should catch roughly half of what your child says, and most of it by four. If teachers and shopkeepers keep looking to you for a translation, the sound system may need articulation support.

3. Repeating sounds, stretching them, or getting stuck

Many children repeat whole words in a burst of excitement between two and four, and it passes. What we watch for is different: repeating single sounds (“b-b-ball”), stretching them out, silent blocks where nothing comes, or visible effort in the face. If that has lasted more than six months, is getting worse, or your child avoids talking, ask about stammering rather than waiting.

4. Not following simple instructions

Understanding — what therapists call receptive language — matters as much as talking, and is easier to miss, because a quiet child looks compliant. By two, most children can fetch a named object from another room; by three, follow a two-part instruction like “get your shoes and give them to Baba”. If not, the first thing to rule out is hearing, including glue ear after repeated ear infections. The signs of a hearing problem are worth reading first.

5. Frustration, tantrums, or pulling you instead of asking

Crying, hitting, dragging your hand to the fridge or melting down over something they cannot explain is often not a behaviour problem at all — it is a communication problem wearing a behaviour costume. Give a child a reliable way to be understood and families usually report calmer evenings before new words.

6. Little babbling as a baby

Babble is the practice ground for speech. By around nine to twelve months we want to hear real consonants in it — “bababa”, “dadada”, “gaga” — not only vowel sounds, and aimed at you rather than muttered at a wall. A very quiet baby is worth mentioning at the next check-up.

7. Losing words or skills they used to have

This is the one sign we never ask a family to watch and wait on. If your child used ten words and now uses three, has stopped waving or pointing, or no longer responds to their name as they did, arrange an assessment promptly. Regression is always better looked at early.

8. Little interest in back-and-forth with people

Language is built on connection. Fleeting eye contact, not turning to their name, little pointing to show you something, playing beside other children rather than with them, or repeating film lines instead of talking to you can sit alongside a language delay — and are part of what we look at when families ask about autism. This deserves a proper look, not a label from the internet.

9. Trouble eating, chewing, or constant drooling

The lips, tongue and jaw used for eating are the ones used for talking. A child past toddlerhood who gags on lumps, keeps food in their cheeks, refuses whole textures, or drools heavily long after teething may be telling us about oral-motor control. Occasionally a restrictive tongue-tie is part of the picture, though far less often than parents fear.

10. Your own instinct

You have watched your child every day of their life. In our experience parents are almost always right that something is different, even when they cannot name it. Worry alone is reason enough to ask — and “this is normal, keep doing what you are doing” is a good outcome, not a wasted visit.

At what age does each sign actually matter?

The same behaviour can be normal at two and a clear signal at four. Below is the rough ladder we use: what most children are doing at each age, and what would make us suggest a check rather than more waiting. A child born prematurely is measured from their due date, not their birthday.

If your child is around a year and a half, our guide to the 18-month-old who isn’t talking yet goes through this age in far more detail, including what reassures us at that stage.

Which signs mean “ask now” rather than “wait a little”?

Arrange a check soon — not next year — if you see any of these. None means something is definitely wrong; they mean the picture is worth reading properly by someone who does it every day.

Any loss of words, gestures or skills your child previously had.
No babble with consonants by around a year, or no pointing and waving.
Very few words plus limited understanding of everyday instructions.
Any doubt about hearing, or a run of ear infections.
Stammering that has lasted more than six months, is worsening, or is upsetting your child.
Coughing, gagging or choking during meals and drinks.
Speech strangers cannot follow at four, or an older child avoiding speaking at school.

If your child is under three and none of these apply, you are almost certainly in “watch, help at home, review in a few weeks” territory rather than anything urgent. Our piece on when a speech delay becomes a concern draws that line more precisely.

Is it fair to just wait and see?

Sometimes, yes — plenty of late talkers do catch up, and no one should be frightened into therapy. But “he’s a boy, they talk late”, “his uncle spoke at four” and “two languages confuse them” are the three lines that most often cost a family a year. None of them holds up; we go through them in the myths about late talking.

The honest position: waiting rarely harms a child, but nobody can tell in advance which quiet two-year-old is the one who catches up. A check is how you find out.

What can I do at home tomorrow morning?

These are the strategies we teach parents in the first session. They cost nothing, they work in Urdu as well as English, and they help whether or not therapy turns out to be needed.

Get face to face and follow their lead. Sit on the floor, play with whatever they picked, and put words on it: “car! go, car, go!”
Name things instead of quizzing. “What’s this? Say car!” adds pressure. Commenting adds language.
Add one word to whatever they manage. They say “ball”, you say “big ball” or “throw ball”.
Pause and wait. Start a familiar game, then stop, look at them expectantly, and count silently to ten. Adults fill silences far too fast.
Build in reasons to ask. Hold up two snacks and let them choose. Put a favourite toy in sight but out of reach. Stop mid-song and wait to be prompted.
Cut background screens and read every day. A face beats a screen for teaching talking, every time.

“Mera bacha bolta nahi” — what if we speak Urdu and English at home?

Growing up with Urdu, Saraiki, Punjabi and English together does not cause a speech delay, and dropping a language rarely helps. Count your child’s words across all the languages they hear — paani and “water” are two words, not half a word each — and mixing languages in one sentence is normal bilingual development, not confusion.

What matters is that your child hears warm, unhurried talk in whichever language you are most natural in. If you are worried that zaban saaf nahi — speech is not clear — or about der se bolna, being late to talk, we work in Urdu and English and coach parents in the language the family uses at home.

What happens if you bring your child in?

The first consultation is free, and it is a conversation rather than a test. We sit on the floor at our Model Town centre in Multan, play, and watch the four things above — understanding, talking, clarity and connection — while we listen to what you have noticed at home. Nothing is decided for you on the spot.

If a fuller picture is needed we explain what a developmental assessment adds before you agree to anything. If your child needs nothing but more chances to talk, we say so plainly and set a review point a few weeks out. We refer on rather than press ahead when hearing has not been tested, when there are swallowing or feeding concerns, or when the picture looks medical rather than developmental.

When therapy is right, sessions are mostly play with a goal underneath, and much of the work happens between sessions at your dining table. What usually shifts first is not words — it is attempts: more pointing, more sounds aimed at a person, more turn-taking. Words follow that, and clear speech follows the words.

If two or three of these ten signs sounded like your child, that is worth an hour of somebody’s time. You can book the free first consultation whenever you are ready. If none of them did, keep playing, keep chatting, and keep leaving those expectant little pauses — you are already doing the thing that helps most.