Credit: Speech team at Joya

Birth to three years is a critical time in a child’s development. Children learn and grow rapidly during this period and need to master important skills quickly. Because of this short time frame, infants and toddlers can fall behind easily without parents realizing it.

You should tell parents to get services for their child as soon as concerns arise. This is important because of how the brain develops at this stage of life. Please refer to the child’s pediatrician if you have concerns, or if you are working with a family and see a child with concerns.

Below are warning signs that may indicate a need for speech and feeding therapy referrals for children from birth to three years.

Feeding Concerns – Infants

• NICU history (such as prematurity, birth trauma, drug exposure during pregnancy, heart problems)
• Feeding problems, including:
  • Mother reports pain when nursing
  • Poor weight gain
  • Reflux
  • Problems with latch, volume or efficiency
  • Watery eyes during feeding
  • Clicking sounds on breast or bottle
  • Blisters on the lip
  • Heart-shaped tongue
  • Feeds that last over 30 minutes
• Foster care placement
• Problems transitioning to solid foods

Feeding Concerns – Toddlers

• Limited diet (such as child only eats dry, crunchy textures)
• Sensory problems, including:
  • Gagging
  • Does not like food on hands or wet textures
  • Has trouble sitting during meals
• Medical history, including:
  • Poor weight gain
  • Reflux as a baby or tongue tie
  • Stomach or intestinal problems
  • Drug exposure
  • Suspected food allergies
  • Currently seeing a dietitian or occupational therapist
• Delays in drinking from a cup

Language Concerns – Infants Under 12 Months

• Poor eye contact
• History of foster care
• Medical history, including:
  • Problems with hearing test at birth
  • Prematurity or medical trauma at birth
  • Motor delays
• Not smiling by 4 months or laughing by 5 months; limited facial expressions overall
• Very quiet; limited vowel sounds by 5 months and limited babbling (such as “baba”)
• Child is not interested in grabbing toys by 6-7 months

Language and Speech Concerns – Toddlers Ages 1-3 Years

• Lack of eye contact; appears not to hear you when you call their name
• Frequent ear infections
• Limited gestures such as waving or clapping
• Very quiet; uses fewer than 5 words by 18 months
• Sibling has a history of speech therapy or family history of autism spectrum disorder
• Daycare or preschool reports poor attention, behavior problems, or hyperactivity
• History of foster care
• Hard to understand; multiple mispronounced consonants (parent can understand, but friends and family cannot)