Many parents are told, or assume, that they should "wait and see" when they have concerns about their child's speech and language development. While individual variation in the timing of communication milestones is genuine and significant, waiting when specific warning signs are present delays access to intervention that is known to be more effective the earlier it is delivered.
Understanding which signs warrant referral, how to access speech and language therapy, and what to expect from the assessment process helps parents act confidently on concerns about their child's communication development rather than waiting past the optimal window for early support.
Healthbooq supports parents in tracking their child's communication development with age-appropriate milestone guidance and clear information about when professional assessment is appropriate.
The Case for Early Referral
Speech and language difficulties are among the most common developmental concerns in early childhood, affecting approximately ten per cent of children to a degree that warrants some professional support. The evidence for early intervention is consistent: children who receive speech and language therapy earlier in development make better progress than those who start later, because the developing brain is more plastic and language-learning systems are more responsive in the early years.
The "wait and see" advice, when applied to children with genuine communication difficulties, wastes developmental time. There is no downside to an early referral that results in assessment confirming normal development — the family has been reassured and any concerns have been professionally evaluated. There is significant potential downside to delayed referral if there is a genuine difficulty.
Key Signs That Warrant Referral
The following signs, individually or in combination, warrant discussion with a health visitor or GP and consideration of SLT referral. By twelve months: no babbling; no use of gestures (pointing, waving, showing); not responding to their name; not making eye contact or engaging in back-and-forth social interaction. By sixteen months: no single words. By eighteen months: fewer than ten words; no pointing to show things to others (protodeclarative pointing); not following simple instructions. By twenty-four months: no two-word combinations (e.g. "more milk," "daddy go"); fewer than fifty words; not using words to communicate.
Any regression — loss of words or communication skills that the child previously had — is a significant concern that warrants prompt assessment regardless of age, as it may indicate an underlying neurological or developmental condition.
Absence of joint attention (the shared focus on an object or event between the child and a caregiver, where the child looks between the object and the caregiver's face) is an important early indicator that is screened for in the twelve and eighteen-month developmental reviews, partly because it is an early marker assessed in autism screening.
How to Access Speech and Language Therapy
In England, parents and carers can self-refer to NHS speech and language therapy services in most areas without needing a GP letter — they can contact the local SLT service directly. The health visitor can also refer following the twelve or eighteen-month review if concerns are identified. GP referral is available but not usually required.
Waiting times for NHS SLT vary significantly by area; some families choose to access private SLT assessment while waiting. Early Years services and Sure Start Children's Centres (where available) also offer communication support and can signpost to further services.
What to Expect
A speech and language therapy assessment for a young child involves observation of the child's communication in natural interaction and structured activities, parent report about current communication skills and developmental history, and sometimes standardised assessments. The SLT will identify whether the child's communication is within the normal range, whether it represents a delay (development following the normal pattern but at a slower rate), or whether there are features suggesting a disorder or underlying condition requiring further investigation.
Following assessment, the SLT will recommend a management plan: this may range from advice and guidance for parents on supporting communication at home (which is appropriate for mild or borderline concerns) to direct therapy, specialist assessment for underlying conditions, or referral to other services.
Key Takeaways
Speech and language therapy (SLT) referral for concerns about communication development in children under three is appropriate, evidence-based, and never too early. Early intervention for speech and language difficulties produces better outcomes than waiting. The signs warranting referral include: no babbling by twelve months; no single words by sixteen months; no two-word combinations by twenty-four months; any regression in communication skills; and absence of pointing or joint attention by twelve months. Parents and carers can refer directly to NHS speech and language therapy services in most areas without needing a GP referral.
