Intended for healthcare professionals

Clinical Review

Identifying and managing common childhood language and speech impairments

BMJ 2015; 350 doi: (Published 14 May 2015) Cite this as: BMJ 2015;350:h2318

This article has a correction. Please see:

  1. Sheena Reilly, speech and language therapist1,
  2. Cristina McKean, speech and language therapist12,
  3. Angela Morgan, speech and language therapist1,
  4. Melissa Wake, paediatrician13
  1. 1Murdoch Childrens Research Institute and The University of Melbourne Department of Paediatrics, Parkville, VIC 3052, Australia
  2. 2Newcastle University, Speech and Language Sciences, Newcastle upon Tyne, UK
  3. 3Centre for Community Child Health, Royal Children’s Hospital, Parkville, Victoria, Australia
  1. Correspondence to: S Reilly sheena.reilly{at}

The bottom line

  • Language, speech, and stuttering impairments are common in childhood and often have debilitating long term social, educational, and health consequences

  • These impairments may occur in isolation; however, they are often the first presenting symptom of developmental conditions and as such practitioners should actively seek causes (for example, hearing impairment) and associated problems (for example, learning disability, autism)

  • In the first 3-4 years of life, speech and language development varies greatly between normal children

  • There is evidence that treatment is effective for speech disorders after 3 years of age

  • Treatment is effective for major distressing stuttering that has lasted for more than 12 months

  • Treatment can improve difficulties with expressive language that are present beyond 3 years of age, but has little impact on receptive difficulties

Learning to speak is one of life’s most important accomplishments. Language, usually acquired so effortlessly, underpins every child’s learning and ability to interact with others and to establish relationships. Poor communication has profound implications for employment, health, literacy, parenting the next generation, and social inequalities. It is therefore of great societal concern that language, speech, and fluency disorders are among the most common developmental disorders.

The aim of this clinical review is to summarise the current information on language and speech impairments to help general practitioners, universal well child services, and paediatricians to identify the most common problems, understand their clinical course, decide when to refer and for what services, and understand what improvements can be expected.

Sources and selection criteria

We carried out a search of Medline using the terms “children”, “language”, “speech”, “stuttering” or “stammering” AND “delay”, “disorder”, “impairment”, “treatment”, and “intervention.” We also searched the Cochrane database of systematic reviews using the terms “children”, “language”, “speech”, and “stuttering/stammering”. Incidence and prevalence data were derived from prospective longitudinal cohorts and cross-sectional population studies with direct assessment of …

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