"Wait and see" is one of the most common pieces of advice parents get when they raise a worry about their toddler's speech, and it is also one of the most often regretted. Children do vary in when language arrives, but variation is not the same as silence. When specific signs are present, waiting six months is a year of brain development you cannot get back.
This piece walks through the signs that warrant a referral, how to actually get one in the UK, and what an assessment looks like — so you can act on a worry without feeling like you are overreacting. Healthbooq keeps milestone records you can take to a health visitor or therapist appointment, which makes the conversation faster.
Why Early Beats Late
Speech and language difficulties affect roughly one in ten children to a degree that benefits from professional input. The evidence on when to start is consistent: kids who get speech and language therapy earlier make more progress than kids who start later. The brain in the toddler years is doing exactly the kind of pattern-learning the therapy is designed to support, and that window is wider at two than at four.
The asymmetry matters. If you refer early and assessment finds typical development, you have a clear baseline and a reassured family — the only cost is a couple of hours. If you wait and there is a real difficulty, you have spent six to twelve months of the most plastic period your child will ever have.
The Signs Worth a Referral
Use these as anchors. Any one of them — not a combination — is enough to start the conversation with your health visitor.
By 12 months:- No babbling at all
- No gestures (pointing, waving, holding things up to show you)
- Not turning when you say their name
- Limited eye contact or no real back-and-forth play
- No single words
- Fewer than 10 words
- Not pointing at things to share interest with you (different from pointing to ask for something)
- Not following simple instructions
- No two-word combinations like "more milk" or "Daddy go"
- Fewer than 50 words
- Not using words to communicate, even with familiar adults
- Loss of skills your child previously had. A toddler who was using ten words and is now using three needs prompt assessment, regardless of cause.
The "shared looking" point — your child glancing between an interesting object and your face to share a moment — is what speech therapists call joint attention. Its absence is screened for at the twelve and eighteen-month checks because it is one of the earliest markers in autism screening, and because language tends to lag without it.
How to Actually Get a Referral
In England, most NHS speech and language therapy services accept self-referral — you can phone or email the local team directly without a GP letter. Search "speech and language therapy [your area] NHS" or ask your health visitor for the local pathway. Health visitors can also refer following the twelve or eighteen-month review, and a GP referral is always an option if you prefer.
Waiting times for NHS SLT vary a lot by area; some lists run several months. Two practical things that help: ask for a watching brief in the meantime (some areas run parent groups or telephone advice during the wait), and consider a one-off private assessment if the wait is long and you want quicker direction. A private SLT assessment with a written report can also be shared with the NHS team when your appointment comes up.
What the Assessment Looks Like
Bring the buggy and snacks — a toddler SLT assessment is mostly play. The therapist will watch your child interact with toys, with you, and sometimes with them, and ask you a lot about what your child does at home (parents are generally a more reliable source than a forty-minute observation in a strange room). Standardised tests get used at the older end of this age range, but they are not always necessary for a useful conclusion.
The output is usually one of three things: typical development with reassurance and parent-led strategies for home; delayed development where direct therapy or a parent training programme like the Hanen "It Takes Two to Talk" course is recommended; or features that warrant onward referral — most commonly hearing testing, sometimes paediatric or autism assessment. Most under-threes referred for speech concerns end up either in monitoring or in a parent-coaching pathway, not in one-to-one weekly therapy.
A Word on Bilingualism
Growing up with two languages does not cause speech delay — this has been studied extensively, and the conclusion is consistent. A bilingual toddler may have fewer words in each language than a monolingual child, but the total across both languages is usually comparable. If you are counting words at 24 months, count them across both languages. The red flags above are still red flags in bilingual children, and being bilingual is not a reason to delay a referral.
Key Takeaways
If something about your child's communication is bothering you, a speech and language therapy referral is the right call — early is always better than waiting. The clearest red flags are: no babbling by 12 months, no single words by 16 months, no two-word combinations by 24 months, and any loss of skills a child already had. In England you can usually self-refer to NHS speech and language therapy without going through your GP.
