Late Talker or Speech Delay? When to Get Your Toddler a Speech Evaluation in Minnesota

What is a late talker, and is that different from a speech delay?

“Late talker” is an informal term, not a diagnosis. Speech-language pathologists (SLPs) use it for toddlers, usually 18 to 30 months old, who usually understand what's said to them and are developing as expected in play, movement and social skills, but say fewer words than other children their age. Clinicians call this late language emergence. A common marker is a 2-year-old who says fewer than 50 words and isn't yet putting two words together.

“Speech delay” is a looser phrase for almost any toddler who is behind with talking. Professionals look at two areas, because a toddler who understands a lot but says little is in a different spot than one who also struggles to understand:

• Speech: making sounds and words clearly
• Language: understanding words (receptive) and using words, gestures and phrases to communicate (expressive)

What speech milestones should my toddler reach by 12, 18, 24 and 30 months?

In 2022, the CDC and the American Academy of Pediatrics (AAP) updated the CDC's milestones so each one sits at an age when most children — about 75% or more — can do it. Missing one doesn't mean “a little behind average.” It's a reason to talk with your child's doctor. Words don't need to be perfect to count; “ba” for ball is a word.

Language and communication milestones most children reach by each age:

• By 12 months: waves bye-bye, calls a parent “mama,” “dada” or another special name, and understands “no”
• By 18 months: tries to say three or more words besides “mama” or “dada,” and follows one-step directions without gestures, like handing you a toy when you ask
• By 24 months: says at least two words together, like “more milk,” points to pictures in a book and to at least two body parts when asked, and uses gestures like blowing a kiss or nodding yes
• By 30 months: says about 50 words, combines two or more words including an action word, like “doggie run,” names things in a book, and uses words like “I,” “me” or “we”

When should I worry about my toddler's speech?

Trust your instincts — you don't have to wait for the next checkup. Understanding and gestures matter as much as the number of words. The American Speech-Language-Hearing Association (ASHA) notes that toddlers who also have trouble understanding language, or who use few gestures, are at greater risk of ongoing difficulties.

Call your child's doctor or make a Help Me Grow referral if your toddler:

• Loses words, babbling or social skills they used to have — at any age, call the doctor right away
• Doesn't respond to their name most of the time, or doesn't seem to hear you
• Uses few gestures, like pointing, waving or showing you things
• Doesn't seem to understand simple words or easy directions
• Isn't saying a few words by 18 months, or combining two words by age 2
• Is very hard for family to understand, or gets very frustrated when they can't get their message across

Is it okay to wait and see if a late talker catches up?

It's the advice parents hear most, and there's some truth to it. ASHA reports that roughly 50% to 70% of late talkers reach typical language by the late preschool or early school years.

The catch is that no one can reliably tell in advance which toddlers will catch up — ASHA notes the difference can only be seen after the fact. That's why the CDC moved its milestones to ages most children have reached: to cut down on waiting when a child is behind.

An evaluation doesn't lock you into therapy. For a typical late talker, the SLP may suggest monitoring plus home strategies. If something else is going on, like a hearing problem, you'll know months sooner. Common reasons to wait don't hold up well:

• “Boys talk later.” Boys are more likely to be late talkers, but that's a reason to watch closely, not to skip an evaluation.
• “Two languages confuse kids.” Learning two languages doesn't cause speech or language delays. A good SLP looks at both languages together.
• “She'll talk when she's ready.” Maybe, but waiting can mean losing months when support could already be helping.

How do I get my toddler a speech evaluation in Minnesota?

Minnesota families have two main routes, and you can use both at once.

Help Me Grow (free, birth to age 5). Anyone can refer a child at helpmegrowmn.org, with no diagnosis, doctor's referral or income requirement. Your local school district's early childhood team contacts you and, with your consent, may start with a screening before a full evaluation. For children under 3, federal rules generally require the evaluation and first planning meeting within 45 days of referral. Under Minnesota rules, toddlers can qualify based on a significant delay in an area like communication, the team's informed clinical opinion, or certain diagnosed conditions. Not every late talker qualifies, but you'll still get useful information. Our Help Me Grow guide explains the process.

Private pediatric speech therapy. A licensed pediatric SLP at a clinic, hospital or home-based practice can evaluate and treat your child. Medical Assistance generally covers medically necessary speech therapy for children, and many private plans do too. You'll often need a doctor's order or referral, and some plans require prior authorization. Plans vary on visit limits and developmental delays, so check yours; our insurance overview covers the basics.

1. Write down what you're seeing: the words your child says, what they understand, and any skills they've lost.
2. Talk with your child's doctor. Ask about a developmental screening, a hearing check and a referral to a pediatric SLP.
3. Refer your child to Help Me Grow, even while you wait for a private appointment.
4. Compare pediatric speech therapy providers in Minnesota and ask about waitlists. Getting on more than one list can help.

What happens at a toddler speech evaluation, and what should I ask?

Whether through Help Me Grow or a clinic, a toddler evaluation looks a lot like play. The SLP asks about your child's health and development, then watches how your child plays, communicates and responds to you. They look at what your child understands and how they get their message across — words, sounds, gestures, or leading you by the hand. Many combine standardized tests with parent questionnaires, because you know what your child does on a typical day.

Ruling out hearing loss is a standard early step, usually with a hearing screening or a referral to an audiologist. Passing the newborn hearing screen doesn't rule out hearing issues that show up later, so if a full test with an audiologist is recommended, it's worth doing.

You should leave with results and a recommendation: monitoring with a recheck, home strategies or regular therapy. Good questions to ask:

• Is the delay mostly in talking, or also in understanding, gestures or play?
• What do you recommend, and when should we recheck?
• How much of therapy will be coaching me, and can sessions happen at home or child care?
• How will we measure progress over the next few months?
• Should we also look at hearing, autism or other areas of development?
• Do you take our insurance or Medical Assistance, and is there a waitlist?

What does speech therapy look like for a toddler?

Toddler speech therapy rarely looks like drills at a table. It's usually play-based and built around routines like snack time, bath and books, and much of it is coaching parents and caregivers, since your child spends far more time with you than with a therapist. ASHA describes monitoring plus caregiver-led language activities as the typical starting point for late talkers, with direct therapy when delays persist or other concerns show up.

How often sessions happen varies, and they may be at home, in a clinic or during early intervention visits. An SLP may also suggest signs or pictures alongside speech; these don't keep children from talking (our guide to speech therapy for autistic children explains more). Expect strategies like these:

• Follow your child's lead and talk about whatever has their attention
• Pause with an expectant look to give your child a turn to communicate
• Model words just beyond what your child says — if they say “ball,” try “big ball” or “roll ball”
• Narrate routines in short, simple phrases
• Offer choices, like “apple or cracker?”, so your child has a reason to communicate

Could a speech delay be a sign of autism?

Sometimes, but most late talkers aren't autistic. A speech delay is often one of the first things parents of autistic children notice, but autism is mainly about differences in social communication and behavior, not just the number of words. ASHA notes that late language emergence can turn out to be part of another condition, including autism.

The AAP recommends autism screening for all children at their 18- and 24-month checkups, often with a parent questionnaire such as the M-CHAT. You don't have to choose one path: start Help Me Grow or speech therapy now and get on a waitlist for an autism evaluation at the same time, since waits can be long. You can compare autism evaluation providers in our directory. Ask your child's doctor about an autism evaluation if, along with fewer words, your toddler:

• Rarely responds to their name
• Doesn't point to show you something interesting
• Seldom shares interests with you, like bringing things to show you
• Uses few gestures or facial expressions
• Has strong routines or repetitive movements, or reacts strongly to sounds, textures or other sensations

Keep in mind

This article is general information, not medical advice, and it can't tell you whether your child has a delay — only an evaluation can. Milestone checklists aren't screening tools; they're a way to start a conversation. Talk with your child's doctor about any concerns, and confirm current details on eligibility, coverage and timelines with Help Me Grow, your school district, your health plan or the Minnesota Department of Education.

If your gut says something is off, it's okay to ask for an evaluation, even if someone tells you to wait.