Speech Therapy Archives

Identifying Speech and Language Delays: A Guide for Referring Providers

Educational, Featured, General, Speech Therapy | Aug 13, 2025 4 min read

As a pediatrician or primary care provider, you are often the first professional a family consults when they have concerns about their child’s development. One of the most common questions parents ask is:

“Is my child’s speech development on track, or should I be concerned?”

Speech and language delays are among the most prevalent developmental concerns in early childhood, yet many children with delays are not identified or referred for support until after critical early windows have passed. Early intervention and timely referrals can significantly improve long-term outcomes in communication, academic readiness, and social-emotional health.

This guide outlines key speech and language early indicators, supported by current research, to help guide your decisions around when to refer for a speech-language evaluation.

The Prevalence of Speech and Language Delays

According to the National Institute on Deafness and Other Communication Disorders, approximately 8-9% of young children have a speech sound disorder, and 7-8% of preschool children have language delays that may affect learning, behavior, and social interaction.

While every child develops at their own pace, persistent delays or lack of progress in key communication areas can indicate the need for further evaluation. Below are typical early indicators that suggest a child may benefit from a referral to a speech-language pathologist.

Early Indicators of Speech and Language Delays

By 12 Months

Does not babble with a variety of sounds (e.g., “ba,” “da,” “ga”)
Does not respond to name or familiar voices
Limited use of gestures (e.g., pointing, waving)

By 18 Months

Says fewer than 10 meaningful words
Does not attempt to imitate words or sounds
Cannot follow simple one-step commands without gestures

By 24 Months

Says fewer than 50 words
Not combining two words (e.g., “more juice,” “mama help”)
Speech is largely unintelligible to caregivers

By 36 Months

Struggles to form simple sentences
Speech is unclear to unfamiliar listeners more than 50% of the time
Limited vocabulary for age
Difficulty answering basic “wh” questions (e.g., what, where)

At Any Age

Regression in language skills
Persistent drooling or oral motor difficulties
Frustration or behavior issues related to difficulty communicating

Why An Early Referral Matters

Research supports early intervention as a key predictor of long-term success in children with language delays.

Children who receive therapy before age 3 make significantly greater gains in expressive language skills than those who begin later.
Without support, early speech and language delays can evolve into academic struggles, including reading and writing difficulties.

The earlier children receive therapy, the more effective and efficient their progress tends to be, both developmentally and from a resource perspective.

Our Approach at SmallTalk Pediatric Therapy

At SmallTalk, we specialize in evaluating and treating children with speech and language delays from infancy through school age. We understand that your time with families is limited, and our role is to support both you and your patients by providing:

Prompt evaluations and clear feedback
Family education and involvement in treatment planning
Collaborative care with pediatricians, early childhood educators, and specialists
Evidence-based, play-centered therapy that fosters engagement and growth

Whether a child is showing subtle signs of delay or more significant concerns, our team is here to help determine whether intervention is needed, and to guide families with care, compassion, and clinical expertise.

How to Refer

Referrals can be sent directly via fax or by calling our administrative team. We welcome direct conversations with providers who may want to discuss a particular case or family dynamic prior to referral.

If you’re unsure whether a child qualifies, we’re happy to offer an evaluation and determine if therapy is appropriate.

You as the primary care provider are the starting point for families. By identifying and referring children early, you play a critical role in shaping their communication journey—and in many cases, changing their trajectory for life.

Should My Child Start Speech Therapy? What Parents Should Know

Featured, General, Speech Therapy | Jul 16, 2025 3 min read

When you’re worried about your child’s speech development, it can feel overwhelming to know what to do next. Maybe you’ve heard well-meaning advice like, “They’ll grow out of it,” or “Just wait and see.” But how do you know if waiting is the right choice? What if early speech therapy could help your child thrive?

At SmallTalk Pediatric Therapy, we often meet parents who aren’t sure whether to seek support or give their child more time. Here’s what you should know to make an informed decision.

Understanding Speech and Language Milestones

All children develop at their own pace, but there are general milestones most kids reach around certain ages. For example:

By 12 months: Babbling, using gestures, responding to their name.
By 18 months: Saying about 10–20 words.
By 2 years: Using two-word phrases (“more juice,” “mama help”).
By 3 years: Speech is clear enough for familiar adults to understand most of what they say.

You can read more about specific milestones with our Developmental Checklist. If your child is significantly behind in these milestones, it may be time to consider an evaluation.

The “Wait and See” Approach

Many parents are told to wait and see if their child will “catch up.” While this can be appropriate in some cases, especially when there is steady progress, delaying help can also mean missing the window when therapy is most effective.

Should My Child Start Speech Therapy? What Parents Should Know

Research shows that early intervention leads to better outcomes in speech and language development. If a delay is identified early, therapy can help build skills before gaps widen.

A 2011 meta-analysis published in the American Journal of Speech-Language Pathology found that parent-led early speech interventions significantly improved expressive language in young children—especially those under age 3 (Roberts & Kaiser, 2011). These findings support the importance of not delaying care when communication concerns arise.

Benefits of Starting Speech Therapy Early

Here are a few reasons why acting early can be so powerful:

Brain Plasticity: Young children’s brains are more adaptable, making it easier to learn new communication skills.
Confidence: Kids often feel frustrated when they can’t express themselves. Therapy helps reduce this frustration and build self-esteem.
Social Connection: Communication delays can impact play and peer relationships. Early support helps kids engage more successfully with others.
Family Support: Therapy gives you tools and strategies to help your child at home.

When to Seek an Evaluation

You don’t need a referral to have your child evaluated by one of our speech-language pathologists. If you notice any of the following, it’s a good idea to schedule an eval:

Your child is not meeting speech milestones for their age.
They appear frustrated by not being understood.
They rarely imitate sounds or words.
You have a gut feeling that something isn’t quite right. Trust your instincts—you know your child best.

How SmallTalk Pediatric Therapy Can Help

At SmallTalk, we believe in early, compassionate, play-based therapy that meets kids where they are. Our licensed speech-language pathologists will:

Assess your child’s speech and language skills.
Create an individualized treatment plan.
Guide you on how to support your child at home.
Celebrate every success, big and small!

You Don’t Have to Wait and Wonder

If you have concerns about your child’s speech, you don’t have to navigate them alone. Early intervention doesn’t mean something is “wrong”, it means you’re giving your child every opportunity to communicate confidently.

How Virtual Speech and Language Therapy Can Support Your Family

Educational, Featured, General, Speech Therapy, Therapy | Apr 22, 2025 2 min read

As the world continues to expand its abilities to connect with other people, so has our ability as therapists to connect with you in ways that are flexible, effective, and fun! Virtual visits are a great method of speech-language services that ensure your child’s ability to make progress on their communication goals, while simultaneously supporting your family navigating busy schedules and lives.

What can be accomplished virtually?

There are a variety of benefits that a virtual visit can provide, much like in-person visits:

Assessments: Standardized assessments to determine the diagnosis of potential speech-language delays, as well as implementation of a comprehensive treatment plan are entirely achievable by meeting virtually. Virtual assessment sessions usually include a combination of standardized testing, particularly if your child is of age to participate. Another effective measure is parent interview, hearing from you exactly what your concerns and observations are of your child in their home environment.
Treatment: Virtual speech therapy sessions can be designed to meet the communication-specific needs of your child. Whether it is articulation, expressive/receptive language, social/pragmatic skills, or related areas, tasks developed through various online games, interactive stories, and songs/videos help support the progress of your child. Not to mention, they are designed to be fun and engaging so that your child will want to continue to attend these virtual visits!
Parent Education and Collaboration: Parents are just as important to the process of speech-language development as the therapists that work with your child. Virtual visits allow for private, constructive conversations to give parents suggestions, resources, and in-the-moment opportunities to demonstrate language facilitation strategies with their children right in the comfort of their own home!

So what now?

If your child might need a little guidance in speech and language, receiving services virtually is an effective way to support the communication journey of your child. SmallTalk offers virtual sessions all-week long, including several therapists, like me, who have dedicated an entire day to virtual sessions to connect with more families around the San Diego community. Please consider giving it a try – I hope to see you online!

By Alex Maloney, SLP

Tips For How to Use Books to Target Speech and Language Goals

Educational, Speech Therapy | Feb 27, 2025 3 min read

Life with children can be so busy, sometimes it feels like there’s not enough time in the day to work on speech and language goals. I have a great solution – BOOKS! Books are everywhere! I bet you’ve seen books in the dentist’s office lobby, your child’s pediatrician’s office, schools, and maybe even all over your child’s room! As a speech pathologist, I’m constantly grabbing and using books in my speech therapy sessions. Whether it’s associated with the time of year, a holiday, or just to use a book that is loaded with actions, books are an incredible resource to support your child’s speech and language development. Now, taking a book and putting it into practice whether that’s working on speech sounds, questions, perspective taking, etc. can feel daunting. Let’s make it simple, practical, and of course, FUN! Here is a list of my top 3, go to books, how to work on a variety of goals, and keep your child engaged throughout the process.

Go Away Big, Green Monster

1. Language:

Words have POWER in this book! What your child says goes, if they say “go away!” POOF, it’s gone! How cool is that cause/effect relationship!
Early language, Core word: “go,” this can be a sign, vocalization, word, etc
Identify: work on identifying body parts on the monster
Descriptions: big, green, purple, squiggly, etc.

2. Speech sounds: /g/, “go,” “big,” and “green”

3. AAC Device:

TouchChat WordPower 60 page set has this book programmed into the device!
Go to Read>Early books>Go Away Big, Green Monster

Where is Spot?

1. Language:

Yes/No questions, “is this Spot?”
Actions: knock knock, “open” sign
Answering “where” questions
Labeling animals, furniture, etc
Using prepositions
Animal noises associated with each animal
Gestalts:

– Let’s open it

– It’s not Spot

– What’s inside?

– It’s a X (label animals)

– What’s next?

2. Speech sounds:

/s/ blends (spot)
Multisyllabic words: honey, monkey, alligator, hippo, puppy, mommy, etc

3. AAC Device:

Model language on the animals page after opening each door

Little Blue Truck

1. Language:

Imitation and use of animal and environmental noises! “Beep!” “Croak,” “Neigh,” “Cluck,” etc
Identifying and/or labeling of animals
Variety of questions such as “Where are they going?” “Where are the animals?”
“What happened to the truck?”

2. Speech sounds:

Final consonants: beep, dump, honk, toad
/l/ (little, blue)
/k/ (truck, stuck, duck, honk, cluck, cow)

3. Rhyming

Great book for phonological awareness!

Next time your child brings you a book (or five), to read before bedtime, try to use a tip that best
resonates with you and your child’s needs! Happy reading!

By Brie Russell, M.S., CCC-SLP

Big Voices in Little People: Understanding Vocal Nodules in Children

Educational, Speech Therapy, Therapy | Dec 23, 2024 2 min read

What Are Vocal Nodules?

Vocal nodules, often called singer’s nodules, are callus-like bumps on the vocal folds.
Caused by repeated misuse or overuse of the voice, they prevent the vocal folds from closing completely when producing sound.
Unlike vocal polyps (blister-like growths that can form from a single event, e.g., yelling), nodules develop gradually over time.
Their size can range from a pinhead to a split pea and, if untreated, can lead to further vocal strain and damage.

Common Causes of Vocal Nodules

Vocal Abuse Behaviors in Children:
- Excessive talking for extended periods.
- Loud vocalizations like shouting, screaming, whining, cheering, or crying
- Frequent coughing or throat clearing
- Strained vocal sounds (e.g., imitating vehicles, animals, or superheroes)
Vocal Misuse and Other Contributing Factors:
- Poor breath support during speaking or singing.
- Straining the voice or using incorrect pitch or volume outside of one’s natural range
Environmental and health factors:
- Chronic upper respiratory infections or allergies
- Acid reflux
- Exposure to second-hand smoke or air pollution, which exacerbates swelling and inflammation

Healthy Vocal Practices and Alternatives

To reduce strain and help nodules heal, children should follow these guidelines:

Avoid loud talking
- Family members should take turns speaking so that the child does not need to talk over other members in the family to be heard. Also, the child should walk closer to the listener instead of yelling from a distance.
No screaming when angry
- Offer alternatives like punching a pillow or tearing paper.
Stop imitating loud sounds (e.g., animals, motors, superheroes)
- Use a gentle humming sound instead.
Refrain from talking over background noise
- Turn off TVs or radios during conversations to avoid shouting.
Replace throat clearing with a hard swallow
- This clears secretions without damaging the vocal folds.
Pause singing for now
- Encourage playing a musical instrument or using a whistle instead.
Stay hydrated
- Drink plenty of water and avoid caffeinated drinks. Caffeine causes dehydration, making vocal folds more prone to injury.

Encouraging Compliance

Positive reinforcement works best. Use tools like sticker charts to track progress.
Offer gentle reminders rather than nagging if rules are broken.

By adopting these practices with consistent effort and patience, vocal nodules will typically heal over time. Your speech-language pathologist can assist your child in regaining healthy vocal habits and preventing future issues.

By Kathleen Winger, M.S., CCC-SLP

Great Games for Gifts from a Speech Therapist

Educational, Speech Therapy | Nov 21, 2024 2 min read

…and fun ways to target speech and language

As a speech therapist, we always love to incorporate fun in games into sessions. It’s the best way to engage kids in therapy while also targeting their goals to improve speech and language. Here are some favorites and goals you can target with the game!

Pop the Pig (ages 4+, 2-6 players)

Turn taking
Two step directions (e.g., roll the dice, then feed the pig; feed the pig, then press his head)
Speech sounds (e.g., say a word before every turn)
Simple “what” questions (e.g., what color did you get?; what number is it?)

Feed the Woozle (ages 3-6, 2-5 players)

Following directions
R words in phrases (e.g., chocolate covered flies, moldy macaroni, spider egg pudding)
L words in phrases (e.g., liverwurst popsicle, lemon flavored underwear, iced garlic
S words in phrases (e.g., sugar coated sardines, baseball sandwich, soggy sausage)

Zingo (ages 4+, 2-6 players)

Naming objects in pictures
Turn taking
Answering yes/no questions for facts (e.g., do you have a tree?)

Tell Tale (ages 5+, 1-8 players)

Using story telling elements
Maintaining conversation topic
Answering wh- questions
Retelling stories

I Spy Eagle Eye (ages 5+)

SP blends in phrases (e.g., I spy…)
Naming objects in pictures
Where questions (e.g., where is it?)

By Jess Wi MS, CCC-SLP

The Frightful Facility

Speech Therapy | Sep 26, 2024 2 min read

A parody of Disney’s Haunted Mansion ride attraction

When asking for candy is an appropriate behavior
And fun and colorful doors decorate the halls
When you get a pumpkin sticker
Because your speech therapist said you did well
That is the time when kids are learning
Practicing their speech sounds in “ghoul”, “witch”, and “fright”.

Welcome, SmallTalk families, to our Halloween celebration. I am your speech therapist. Well,
your child’s speech therapist. Kindly reschedule any missed appointments, and call ahead for
planned absences. Please switch to a virtual session if you’re sick.

Our lesson begins here on this blogpost, where you see lists of words for some of our
frequently-targeted speech goals.

Your puzzled facial expression betrays your sense of skepticism, almost as though you think
this might be a waste of your time. Is practicing just five target words daily actually useful? Or is
it just more busywork? And consider this interesting observation: your child is motivated to say
these ghostly words this time of year…which offers you this additional challenge: to think of
more spine-chilling Halloween words! Of course, there’s always Halloween word lists published
online.

Did you know that when practicing speech sounds, repeating target words is often more
effective than practicing a long list of new words? Here are lists of some of our commonly-
targeted speech sounds to incorporate into your regular speech practice routine at home. If you
don’t see a list appropriate to your child’s speech sound goals, try making your own!

Final /l/
candle
chill
ghoul
howl
caramel apple

Initial /k/
costume
cauldron
candy corn
coffin
cobweb

Medial K
Pumpkin
decay
licorice
Chocolate
rock candy

Final K
Shriek
Spook
Panic
Cloak
Magic

SK blends
skeleton
skull
scarecrow
scream
Skittles

SP blends
spooky
spider
spell
spirit
Spice Drops

SN blends
snack
Snickers
snake
Sneak
sneer

SM blends
smash
Smarties
smoke
smelly
smile

SW blends
swarm
swoop
swamp
Swedish Fish
SweeTARTS

SL blends
slime
slug
slash
slay
slab

ST blends
street
glowstick
sticky
stem
Starburst

Medial ST blends
Costume
Frankenstein
Gravestone
Haystack
monster

Initial R
rat
raven
robe
robot
Reece’s

R Blends
Creepy
Broom
Frankenstein
Dracula
Graveyard

“AR”
dark
carve
larva
Mars bar
hard candy

“ER”
October thirty-first
spider
wizard
Butterfinger
Hershey

“AIR”
werewolf
fairy
eclair
gummy bears
Ghirardelli

“IRE”
vampire
dire
conspire
bonfire
entire

“EAR”
fear
appear
hero
3 Musketeers
Zero

“OR”
trick-or-treat
decorate
candy corn
Lindor
Oreo

Happy Halloween from all of your friends at SmallTalk!

By Kathleen Winger, M.S., CCC-SLP

OMG, it’s an OMD!

Educational, General, Speech Therapy | Jul 26, 2024 2 min read

What is an oral motor disorder?

Difficulty with the function of the muscles and structures involved in speech and feeding

May be the result of:

A physical, structural issue such as cleft palate or tongue-tie
Prolonged pacifier or sippy cup use, which interferes with natural oral development
Injury
Fetal Alcohol Syndrome
A neurological condition such as cerebral palsy and Down syndrome which includes issues with muscle tone, resulting in dysarthria

Signs of an oral motor disorder include:

Droopy or “long” face with mouth that frequently hangs open
Drooling past the age of 18 months
Speech which is difficult to understand
Lisped speech
Difficulty sticking out tongue or moving it from side to side
Difficulty producing certain consonants or deleting them past age 3
Refusal to eat certain foods, especially meat or other tough foods to chew
Frequent gagging when eating
Open-mouth breathing (may be only when sleeping) and/or snoring

Key components affected by oral motor disorders include:

Articulation: Difficulty in coordinating and controlling the movements of the lips, tongue, and jaw which can lead to reduced intelligibility
Chewing: Challenges chewing and manipulating food in the mouth
Swallowing: Difficulty with coordinated and sequential movements required for safe and effective swallowing
Facial Expression: Limited control over facial muscles, impacting facial expressions and non-verbal communication

If you suspect that your child may have an oral motor disorder which is impacting articulation and/or feeding, it is important to seek treatment with a speech-language pathologist and/or occupational therapist. We are here to help!

By Kathleen Winger, M.S., CCC-SLP

Summer Themed Activities for Speech and OT

Activities, General, Occupational Therapy, Speech Therapy | Jun 28, 2024 3 min read

Summer is finally here! We are excited to share some summer-themed activities you can enjoy with your child. These activities offer therapeutic benefits, helping your child work toward their goals while still enjoying the summer season.

Ice Cube Animal Rescue

To do this activity, put little plastic animals in an ice cube tray, fill it with water, and freeze it. Gather some tools found in your home to break the ice and rescue the animals. For example, use a small hammer to break open the ice, tongs/tweezers to pull the animals out, or an eye dropper with warm water to melt the ice. Use the tools to break and melt the ice more quickly. Once all of the ice melts, you have rescued the animals!

To target language goals, talk about the animals using descriptive language. Describe the animal’s appearance, where they live, and the sounds they make. Use language like, “Oh no, we need to rescue the animals,” “The animals are stuck,” “It feels very cold,” “This animal is really fast,” “That animal has cool stripes,” etc.

To target occupational therapy goals, use a variety of tools, as mentioned above, to work on hand strengthening, force modulation, and grasping patterns, which will contribute to your child’s overall fine motor development.

Use your imagination with this activity! If you do not have little animals, you can freeze other mini objects or toys, little craft pom-poms, etc.

Fun with Chalk

Use sidewalk chalk to draw pictures to target both speech and language goals! Draw pictures and practice speech sounds your child works on in speech therapy. For example, if your child is working on “s,” draw a sun, a bus, an octopus, ice cream, etc. Play pictionary! Take turns drawing pictures and guessing the drawing. Use language to describe colors, patterns, etc. Drawing with chalk is great for developing fine motor and visual motor skills as well!

Make a sensory path! Use sidewalk chalk to create a series of guided movements to challenge your child’s gross motor skills while providing regulating sensory input. These movements could include anything that involves running, jumping, skipping, spinning, or balancing.

For example, start with a two-foot bunny hop, then walk along a curved line, trying to maintain balance. From there, do an animal walk, such as a bear walk or frog jumps, followed by a hopscotch sequence. Then, balance on one foot for 10 seconds and end with a race to the finish line! Get more inspiration on Pinterest or Instagram!

For an added challenge, have your child create their own sensory path to work on executive functioning skills such as planning and organization. See how creative they can get!

Scavenger hunt

Get outside and look for items in nature that are a specific color, texture and/or size! For example, look for something pink, yellow, bumpy, smooth, crunchy, etc. This simple activity can target skills such as describing, following directions, and increasing vocabulary. It is also great for tactile sensory processing, for example, exploring and discriminating between textures. Scavenger hunts can also help your child develop visual perceptual skills, such as finding differences between items and scanning through a busy background to locate an item.

By Nathalie-Rose Malecot, MS CCC-SLP and Jamie Carlson, OTR/L

How SLPs Make a Difference

Speech Therapy | Apr 30, 2024 2 min read

Raising awareness, changing lives

May is national speech, language and hearing month – a time to celebrate and acknowledge the profound influence and dedication of speech-language pathologists (SLPs). We are so grateful to all of our SLPs for their unyielding commitment, and the remarkable impact they make on the lives of so many families. Here are some of the areas that SLPs in pediatrics focus on:

Speech sounds—A child may substitute one sound for another, leave sounds out, add sounds, or change a sound. It may be hard for others to understand them.
Spoken and written language—A child may have trouble understanding what others are communicating to them and may have problems explaining what they are thinking or feeling. They may also have difficulty with reading and writing.
Stuttering (fluency)—A child may get stuck on certain sounds or words. They also may have tension or negative feelings about talking. This tension can get in the way of how they talk to others.
Cognition—A child may have problems with long- or short-term memory, attention, problem solving, or organization.
Social communication—A child may have difficulty understanding how others feel or following the rules of conversation, such as knowing how to take turns.
Voice—A child may lose their voice frequently or use a hoarse or breathy voice. They may also speak with strain or effort.
Augmentative and alternative communication—A child may need to find other ways to communicate besides talking, such as using a picture board or a speech-generating device.
Feeding and swallowing—Problems with feeding and swallowing can make it hard for a child to participate in their school day. Speech-language pathologists help students eat and drink safely during the school day so that they have the energy to learn.

At SmallTalk, we asked some of our SLPs why they love their field. They responded:

“I love being a speech-language pathologist because….”

“I get to help kids become more confident with communicating.” – Miss Sara
“I get to play all of my favorite games. My childhood spirit will never die!” – Miss Amanda
“I get to work hands-on with families and see the difference we make first-hand” – Miss Hannah

By Julia Navarra M.A. CCC-SLP