One of the first things you likely learned as a parent? No two kids are alike. All children have their own temperaments, sleeping habits and food preferences. And they'll hit those developmental milestones like walking, talking or self-feeding on their own timelines too.
That's why it's rarely cause for concern if a toddler strings together her first sentence or scribbles a few months later than most of her peers. But in some cases, taking significantly longer to reach key markers in areas like behavior, movement or speech (or not reaching them at all) could be a sign of a developmental delay.
Pediatricians check to make sure that toddlers are ticking off their developmental boxes during well-child visits. But if your sweetie has signs of a potential delay, there's a good chance that they'll show up on your radar first.
And it's important to bring it up with the doctor sooner rather than later if you sense that something might be off. Diagnosing delays early may help toddlers get the care and support they need to reach their developmental milestones and avoid falling further off track.
Signs of a developmental delay
A developmental delay is when a child isn't hitting milestones or learning skills at the same pace as most other kids her age. Developmental delay symptoms aren't one-size-fits-all. A toddler who's struggling with certain speech milestones, for instance, won't necessarily have all the same symptoms as one with a fine motor skill or gross motor skill delay.
In other cases, a toddler might have delays in multiple areas and show a wide range of symptoms.
That said, there are some broader signs that parents should watch for that could indicate a developmental issue.[1] These can include:
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Hitting major milestones (like crawling, walking, scribbling or self-feeding) much later than usual
Muscles that seem stiff or floppy
Lack of interest in interacting with others or the surrounding world
Slow growth or weight gain
Talking late
Speaking in a way that's much harder to understand compared to other kids of the same age
Speech and language delays in toddlers
A speech delay is when a child is not using the right sounds expected for her age. She may be hard to understand, and her words may be unclear. The child may leave off parts of a word or substitute one sound for another. Parents may find themselves playing interpreter, and a little one may get frustrated because she's trying to get her message across but can't.
A language delay is when a child is not using or understanding words at the typical pace for her age. If your child isn't combining words yet and should be, she may have an expressive language delay. If your child isn't following directions (and you know she can hear you), that may be a sign of a receptive language delay. There are also children who have both a speech and a language delay.
One of the most common speech delays in toddlers is articulation disorder, which happens when a child frequently lisps, leaves out consonants, or substitutes one sound for another.[2]
The causes of speech and language delays aren't fully understood. Possible contributing factors may include genetics, cleft palate, prematurity, hearing problems, brain injuries, failure to thrive, autism and other neurological differences.
While no child goes straight from uttering her first word to being ready for a speaking role on Broadway, there is a natural progression toward learning language and acquiring sounds.
Signs of speech delays in toddlers
A child with a speech delay may:
- Be hard to understand
- Take extra time to form words while speaking
- Use mostly vowel sounds after 18 months (“aah-aah” instead of “mama”)
- Leave out some consonants in words (“at” instead of “cat”)
- Add extra sounds to words (“animinal” instead of “animal”) — though this is quite common in young children with normal developmental function too
- Substitute certain sounds when speaking (“tat” instead of “cat”)
- Have trouble stringing together syllables in the right order (“minacin” instead of “cinnamon”)
Signs of language delays in toddlers
A child with a language delay may:
- Not point to items or people when you name them
- Struggle with following directions
- Not be saying new words each month
- Have difficulty putting words together to make short sentences or appear to be "stuck" at single words
- Not use hand gestures like waving bye-bye or giving high-fives
- Not be babbling or using baby talk to communicate with caregivers
Diagnosing toddler speech and language delays
The earlier you get a diagnosis, the more effective treatment may be, so don’t hesitate to bring up any concerns you may have with your child’s doctor.
The pediatrician will also be on the lookout for lags in your toddler's language development during screenings, and may even recommend a hearing test to rule out some simple explanation, like fluid in the ears.
You know your child best, so if you have concerns, get your little one evaluated by a speech-language pathologist (SLP). The SLP will look at your child's use and understanding of words, gestures and sounds and let you know if she's on track for her age or could use some extra support.
Treating toddler speech and language delays
Sometimes childhood speech delays will clear up on their own. If your child's pediatrician doesn't think an evaluation or treatment is necessary, you may be able to help your little one hone her speech skills simply by taking lots of time each day to interact and communicate with her. Just reading, playing and chatting together can sometimes make a big difference. Toddler playdates and playgroups are also a great way to stay connected to other parents and learn about local resources that could be helpful.
If your child does get an evaluation and speech therapy is recommended, your SLP may lead your child in some fun, favorite toddler activities — like blowing bubbles, looking at books together, imitating sounds and words while playing, and learning new vocabulary to help your little one interact more with the world around her.
If your child is not making progress or is showing signs of having more difficulty learning than would be expected of a toddler with a speech delay, talk to your child's doctor about having further testing done. Your little one's skills may be more indicative of a disorder like autism or apraxia of speech, and getting the right kind of evaluation will lead to the appropriate therapy and support for your child.
Outcome of toddler speech and language delays
Many tots can completely overcome their speech and language delays through speech therapy and early intervention. Regardless of how they do it, most kids will find a way to let you know what’s going on in their little heads, so don’t worry: You won’t miss a single smart, sweet, funny thing.
While they're working hard on putting more words together and saying them clearly, young children can learn to express themselves in other ways, such as sign language or by pointing to pictures to get a message across. Caregivers can learn what sounds and words their child is trying to say to help reduce frustration, and by working closely with an SLP, can make progress to get back on track.
Fine motor delays and gross motor delays in toddlers
Children with fine motor delays have difficulty using their small muscles, so tasks like grasping crayons with their fingers are tricky. When it comes to gross motor delays, the trouble instead is with large muscles and mastering skills like walking, kicking, hopping and climbing stairs.
Underlying neurological conditions, such as cerebral palsy or muscular dystrophy and dyspraxia, a motor skill disorder that makes it difficult to plan and complete tasks, affect how well the brain sends signals to muscles and are usually to blame for motor skill issues.
Structural issues (like having one leg that's shorter than the other) or vision problems may also be the cause of some fine motor delays.
Signs of fine and gross motor skill delays in toddlers
Some important warning signs to watch for include:
Being late to reach physical milestones, like rolling over and sitting up
No signs of walking by 18 months
Stiff limbs or low muscle tone (she can’t hold much weight)
Frequently walking on tip toes
Having trouble holding and using objects — managing a cup, for example, or scribbling with a crayon
Being clumsy and falling frequently
Drooling beyond 18 months of age
Having trouble chewing and swallowing
Losing toddler motor skills, such as waving bye-bye or jumping, that she’s already mastered (unless she’s sick, stressed or learning a new skill — backsliding is normal in those cases)
Diagnosing fine and gross motor skill delays in toddlers
Although your pediatrician will be monitoring your munchkin’s milestones at well-child doctor appointments, diagnosing a physical delay will really start with you.
Keep an eye out for the signs listed above, and if you notice any deficiencies or other indicators of toddler developmental delays bring them to the pediatrician’s attention as soon as you become aware of them.
Your doctor may suggest further screenings, probably by a developmental specialist and/or neurologist, or perhaps through a state early-intervention program. These screenings will focus on your child’s muscle tone, muscle strength, reflexes and coordination.
After that, a developmental specialist will look at the results of the screenings and come up with an official diagnosis, which could be anything from hypotonia (i.e. low muscle tone), dyspraxia or simply a motor delay.
Treating fine and gross motor skill delays in toddlers
Here’s some good news: The typical Rx for children with motor delays includes occupational, physical and speech-language therapies, which typically feel more like play than work to a tot.
For instance, to strengthen a child’s hand muscles, an occupational therapist may give her manipulative toys to handle. Improving balance and coordination may involve spending time on playground equipment.
Outcome of fine and gross motor skill delays in toddlers
Children with severe motor delays due to conditions such as cerebral palsy may need life-long care. But kids with mild motor delays can learn to move normally, catch up with their peers and look forward to leading independent lives as grown-ups.
Causes of developmental delays in toddlers
Developmental delays can stem from a number of factors, but in some cases, doctors aren't able to pinpoint a specific culprit. Possible causes of developmental delays include:
Being born prematurely
Neurological or genetic conditions such as cerebral palsy or muscular dystrophy
Genetic conditions like Down syndrome or chromosomal disorders
Serious brain injuries or infections like encephalitis
Vision or hearing problems
Alcohol or drug use during pregnancy
Trauma, abuse or neglect
Exposure to environmental toxins, like lead
Problems during labor or delivery
Treatments for developmental delays in toddlers
Therapy can often bring toddlers with developmental delays up to speed with their peers, especially when started early. Even if a delay can't be cured, the right care plan can help kids achieve more important milestones — and do more of the things they love.
The type of therapy a toddler might receive will depend on the specific delay. Your child's pediatrician might recommend:
Physical therapy. Physical therapy helps kids with physical delays get stronger so they can move more easily. Your toddler might practice crawling or walking on a playground or at an indoor gym, practice kicking or splashing in the water, or play games that hone her balance and coordination skills.
Occupational therapy. Occupational therapy guides kids through exercises that make it easier for them to perform everyday activities. For toddlers, that might mean working on fine motor skills so your child can learn to do things like scribble or draw, feed herself, and get dressed.
Speech and language therapy. An evaulation by a Speech-Language Pathologist can help determine whether your child is a late talker, has a language delay, or is on the right track with her speech skills. For a young child who struggles with articulation, speech and language therapy can help improve pronunciation of sounds and syllables, often through play-based activities. For a child with a receptive or expressive language delay, speech therapy can help improve understanding and increase the use of words.
When to call the doctor
It's never too soon to bring up concerns about delays with your child's pediatrician. The best advice? Trust your gut. If your tot's developmental timeline seems very different than that of her peers, or if she has habits or behaviors that seem off, let the doctor know. Together you can talk about your toddler's symptoms and decide if she should be evaluated for a delay.
Developmental delays can be challenging to deal with, and it's easy to worry whether your toddler will be able to catch up to other kids her age. But with early intervention and a dedicated care team, you can get your cutie on the road towards reaching her goals — and thriving.
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