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Am Fam Physician. 2023;108(2):181-188

Patient information: See related handout on speech and language delay in children.

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Childhood speech and language concerns are commonly encountered in the primary care setting. Family physicians are integral in the identification and initial evaluation of children with speech and language delays. Parental concerns and observations and milestone assessment aid in the identification of speech and language abnormalities. Concerning presentations at 24 months or older include speaking fewer than 50 words, incomprehensible speech, and notable speech and language deficits on age-specific testing. Validated screening tools that rely on parental reporting can serve as practical adjuncts during clinic evaluation. Early referral for additional evaluation can mitigate the development of long-term communication disorders and adverse effects on social and academic development. All children who have concerns for speech and language delays should be referred to speech language pathology and audiology for diagnostic and management purposes. Parents and caretakers may also self-refer to early intervention programs for evaluation and management of speech and language concerns in children younger than three years.

Speech is the verbal production of language. Language is the processing of a communication system. Receptive language includes an individual's comprehension abilities. Expressive language includes conveying ideas in spoken, written, or visual forms.1

Clinical recommendation Evidence rating Comments
Developmental surveillance should be completed at every well-child visit until at least five years of age.3 C American Academy of Pediatrics consensus report that summarized findings from 24 studies to determine accuracy of screening tools; no studies met inclusion criteria for investigating improved outcomes with screening
For abnormal speech and language developmental screening findings, immediate referral is recommended rather than following conservatively.3,26 C Studies demonstrating that late talkers either have a language impairment or further delayed-language accession
Early identification and treatment of speech and language delays are recommended to avoid long-term negative impacts on social development and school performance.3,22 C American Academy of Pediatrics consensus report that summarized findings from 13 randomized control trials and one systematic review of speech and language outcomes from treatment.
American Speech-Language-Hearing Association medical review guidelines
Universal hearing screening should be completed after birth; at four, five, six, eight, and 10 years of age; and once between 11 and 14, 15 and 17, and 18 and 21 years of age.27 C American Academy of Pediatrics Bright Futures recommendation
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