When Should You See a Speech Therapist? Signs by Age

See a speech therapist when your child is behind for their age, when they lose words or skills they clearly had, or when the same worry keeps coming back to you. You do not need a referral and you do not need to be certain. An assessment either reassures you or starts help early — both are useful answers.

Almost every parent who contacts us opens the same way: mera bacha bolta nahi — my child doesn’t talk — and everyone keeps saying he’ll speak when he’s ready. Sometimes that turns out to be true. Sometimes it is a year of waiting nobody gets back. This guide gives you the signs by age, the ones that mean act now, what actually happens if you come in, and what to try at home meanwhile. For everything else we have written for families, start at our parent resources hub.

Which signs matter at which age?

Broadly: no babbling or pointing by 12 months, very few words by 18 months, fewer than about 50 words and no two-word joins by 2 years, no short sentences by 3 years, and speech that people outside the family cannot follow by 4 years. Any one of these is worth an assessment.

• By 12 months — not babbling with consonants (“bababa”, “dadada”), not waving, pointing or holding things up to show you, not turning when you call their name. Gestures and shared attention matter far more than words at this age.
• By 18 months — very few words, not copying the words and sounds you make, not following a familiar instruction like “get your shoes”. Understanding that lags behind matters more than a small vocabulary on its own.
• By 2 years — fewer than about 50 words, no two-word joins (“more milk”, “daddy go”), and close family understanding only a little of what is said.
• By 3 years — not using short sentences, hard for family to follow, not answering simple who, what and where questions, or leaning on the same few phrases for everything.
• By 4 years — people outside the family struggle to understand, frequent stumbling or getting stuck on words, or sentences that stay short and jumbled while children the same age tell stories.
• School age — speech is clear but your child cannot follow classroom instructions, cannot retell what happened at school, or is unexpectedly stuck on reading and spelling.

If your worry is mainly about how much your child says, our guide to speech delay in children walks through what is typical at each stage. If it is that last, school-age pattern — a bright child who finds reading and spelling unusually hard — read dyslexia explained for parents instead.

If more than one language is spoken at home, count words from all of them. A child with fifteen Urdu words, ten English words and a few Saraiki ones has around thirty words, not fifteen. Mixing languages inside one sentence is normal. Being bilingual does not cause delay — but counting one language only can hide a real one.

Which signs mean don’t wait, at any age?

Arrange an assessment straight away, whatever your child’s age, if they lose words or skills they clearly had before, if you have any doubt at all about their hearing, if nobody outside the family can understand them, or if speaking has started to look effortful and upsetting for them.

• Losing words or skills. A child who said words and stopped, or who used to wave and point and no longer does. This is the one sign we never advise waiting on.
• Any doubt about hearing. Repeated ear infections, turning the television up, responding to their name only sometimes. Get hearing checked first — it changes everything else we would recommend.
• Effort and tension around speaking. Repetitions with visible struggle, getting blocked, swapping words to dodge a hard one, or a child who has started to go quiet. Our page on stammering in children explains what helps and what makes it worse.
• Frustration and giving up. Hitting, biting or melting down where words should be — or a child who has stopped trying to be understood.
• Coughing, choking or a very restricted diet. Feeding and swallowing sit with speech therapists too.
• Your own instinct. Parents notice first. The parent who says “I just know something is different” is very often reading something real.

Late talker or speech delay — how do I tell?

You cannot tell for certain from the outside, and that is the honest answer. A late talker understands well, points, plays and copies you, and is simply slow to produce words; many catch up. A speech delay usually shows up in understanding, gestures or play as well. An assessment separates the two.

What tips the balance for us is rarely the word count. It is whether your child brings you in — looking from the toy to your face and back, holding something up for you to see, pulling your hand towards what they want. A child doing all of that with very few words is a far more reassuring picture than one with the same word count who plays alone.

Do I need a doctor’s referral first?

No. You can approach a speech and language therapist directly — no referral letter, no diagnosis, no paperwork needed before an assessment. Some families come because a paediatrician suggested it, and just as many come on their own worry alone. Both are equally welcome and neither gets a better appointment.

The one thing worth arranging alongside is a hearing check, especially after repeated ear infections — even mild, temporary hearing loss makes learning sounds harder.

Why is it better to come earlier?

The early years are when the brain is most ready to build language, so support that starts early tends to go further with less effort from everyone. Coming early also commits you to nothing: very often a single assessment is enough to reassure a family, or to catch something small before it becomes the reason a child is unhappy at school.

If “wait and see” is what is holding you back — or nazar, or log kya kahenge — our piece on the myths Pakistani parents hear most answers them one by one. To see what starting early looks like week to week, read what early intervention means and when it should start.

What happens at a first speech therapy visit?

A first visit is a play-based assessment. The therapist plays with your child, listens to how they communicate, and asks you about their history, hearing, routines and the languages spoken at home. There is nothing to pass or fail and nothing your child needs to get right. You leave with a plain-language picture and a recommendation.

That first visit is our standard developmental assessment, and you may book it as a one-off with no obligation to come back. It looks like play from the sofa, so here is what is actually being noted: how often your child starts a communication rather than only replying; whether they use gestures, eye contact and shared looks to bring you in; which sounds they can make and which are missing; how much they understand once your gestures stop helping; and how they cope when something is hard. We always ask which languages are spoken at home and by whom, because that shapes the plan.

You will get one of three honest answers. Your child is within the usual range, and here is what to do at home. Your child is a little behind, and a short block of speech and language therapy is worth doing. Or there is something we would like a colleague to see as well. We give the first answer often, and we mean it when we do.

What can I do at home while I decide?

Get face to face at your child’s level, turn the background television off, and say less. Comment on what your child is doing instead of asking questions, use short phrases they could realistically copy, then pause and count silently to five so they have room to answer. Reward every attempt, however unclear.

• Say it, don’t test it. Swap “what’s this?” for “a big red bus”. Questions put a child on the spot; comments hand them the word for free.
• Wait five seconds. Say your bit, then count silently to five. Children who are slow to find words very often find them if the room stays quiet long enough.
• Offer a real choice. Hold up two things — doodh ya paani?, milk or water — so that one word, or even a point, gets your child something they actually want.
• Add one word. When your child says “car”, you say “red car” or “car going”. One step above what they said, never five.
• Use the language you are warmest in. A parent speaking rich, natural Urdu or Saraiki gives a child far more language than a parent working hard in careful English.

Keep a note on your phone for two weeks: the words your child says without copying anyone, the things they clearly understand, and how they ask when words fail them. Bring that list with you — it turns a first appointment from guesswork into a real starting point.

What would make us refer you on?

A speech therapist is often the first professional a family sees, so part of the job is recognising when your child needs somebody else as well — and saying so plainly.

• Audiology, for a proper hearing test before we plan anything else.
• Paediatrician or developmental review, where movement, growth or general development lag alongside speech.
• Autism assessment, where the pattern is social — limited shared attention, limited pretend play, few gestures — and not only limited words.
• Psychology or special education, where a child is learning slowly across every area rather than only speaking late. That difference matters, and our guide to what “slow learner” really means explains it.
• ENT or a surgical opinion, for cleft palate, structural differences or persistent glue ear.

Seeing a speech therapist in Multan

If you are looking for a speech therapist (اسپیچ تھیراپسٹ), or for what many families call گویائی کا علاج, our centre is on MPS Road, Block A Model Town, Multan, near Bloomfield Hall School, Street No. 2, open Monday to Saturday, 10am to 7pm. Families reach us from across Multan and from Bahawalpur, Muzaffargarh, Khanewal and Dera Ghazi Khan. Sessions run in the language your child actually hears at home, which for most of our families is Urdu.

Fees are a fair question, and we would much rather you asked than stayed away — our note on what shapes the cost of speech therapy in Multan explains what you are paying for. The first conversation costs you nothing.

If you have read this far, you already have a worry that keeps coming back. That, on its own, is reason enough to ask someone. Message our Multan team on WhatsApp or call +92 314 6040262 — tell us your child’s age and what you are noticing, and we will tell you honestly whether it is worth coming in.