When Should a Child be Referred for Speech Therapy?

When should a child’s doctor send a referral?

When should a child be referred for Speech Therapy?

There are many reasons why a child or teen might benefit from a referral for speech and language therapy. A family might be surprised to find out that their child needs speech therapy, as they often chalk up their child’s speech-language-related problems to a behavioral issue, simply not listening, or just a small “quirk.” Understandably, with families who have children with other needs, some parents can focus more on a child’s other medical conditions or therapy needs that they overlook those that require speech therapy.

Due to these common circumstances, it often falls on the pediatrician or primary care provider to catch areas of need for speech and language when concerns are brought up by a parent or caregiver. These are issues that may be noticed a home or at school or even in the office during an annual well child check.

What issues/symptoms might look like.

A referral for a speech or language evaluation and possible treatment is appropriate if the child or teen has the following symptoms:

  • Struggles to imitate the sounds made by others
  • The variety of sounds decreases instead of increases
  • Makes only a few or poor quality sounds
  • Has difficulties following commands
  • Slow to show an understanding of new words
  • Cognitive changes such as decreased memory or problem-solving skills
  • Difficulties communicating basic needs
  • Not combining words by 18 months of age
  • Stops saying sounds or words he or she had previously mastered
  • Has difficulty or is not responding to directions, questions or conversations with others
  • Struggles to or is not able to start conversations with others
  • Unintelligible speech after 24 months of age
  • Cannot be understood by “strangers” (those who do not know the child well)
  • Not speaking in sentences by 36 months of age
  • A child is not fluently speaking by 3 ½ years
  • Struggles with breathing/regulating speech or vocal tone
  • Diagnosed with Vocal Fold Dysfunction or Paradoxical Vocal Fold Movement
  • Poor oral muscle tone
  • Frequently has difficulties understanding new concepts or following multi-step directions
  • Significantly behind their peers in social settings and communication
  • Is an extremely picky eater or has an extreme aversion to specific textures and flavors
  • Any changes in communication or cognition following an injury or surgery (examples could include concussion or head trauma, any oral surgery such as tongue-tie, and more)

Where to go from here.

Parent and caregivers who suspect that a child may need speech or language therapy should speak with the child’s physician (PCP) about getting a referral to their local therapy clinic for a formal evaluation or call us to schedule a meet and greet with an informal and free language screener.


Health care providers.

Call our office today to speak with a speech therapist. If you would like to send a referral to Spark Therapies please fax the most recent year’s notes, any applicable specialist office notes (allergist, ENT, oral surgeon, etc) and your referral to 603-843-8607. Learn more by visiting our provider page.

Sources and Additional Resources.

Article: American Family Physician: Speech and Language Delay in Children

Post: Cleveland Clinic: How to Know if Your Child Needs a Speech Evaluation

ASHA: Preschool Language Disorders

ASHA: Speech and Language Services in Schools

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