Intended for healthcare professionals

Clinical Review

How to investigate and manage the child who is slow to speak

BMJ 2004; 328 doi: (Published 29 January 2004) Cite this as: BMJ 2004;328:272
  1. Jamiu O Busari, paediatrician (,
  2. Nielske M Weggelaar, specialist registrar in paediatrics1
  1. lEmma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
  1. Correspondence to: J O Busari, Department of Paediatrics, Boven IJ Hospital, Statenjachtstraat 1, 1030 BD, Amsterdam
  • Accepted 8 December 2003

Children who are slow to speak often present clinicians with a dilemma—should they conduct further investigations or just wait and see if the problem resolves (as it does in most children aged under 3 years)? Two paediatricians propose a guideline that can be used to investigate and manage children with speech or language delays


Delay in speech and language development is the most common developmental disorder in children aged 3 to 16 years. The prevalence of this disorder ranges from 1% to 32% in the normal population and is influenced by factors such as the age of the child at presentation and the test method used in diagnosis.1 2 A high rate of comorbidity (up to 50%) is known to exist between psychiatric disorders such as autism and disorders of speech and language development.3 Despite the prevalence and reported risks of comorbidity, however, about 60% of cases of speech and language delay tend to resolve spontaneously in children aged under 3 years.1 Children who are slow to speak form a particular category of patients with speech and language developmental disorders and often present clinicians with a dilemma—whether to conduct further investigations or just wait and see. This is because a delay in speaking could be either a normal (and temporary) stage in the child's development or the initial symptom of a psychiatric, neurological, or behavioural problem. As a result, the timely diagnosis, choice of therapy, and an individualised approach to the child with a speech and language delay become imperative as these interventions may prevent subsequent psychological or psychiatric problems later in life.

We provide here an update of the current literature on speech and language development in children. Using a real patient encounter, we illustrate how a child with a delay in language development is presented …

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