Speech issues in 18 month old - Kaiser?

Hello BPN parents,

My adorable daughter who is just a few weeks shy of turning 18 months old has only 2 words in her vocabulary. At this point she is only able to say mama and papa and I am starting to feel concerned that she may have a possible speech delay. At this age I know that most kids should be speaking closer to 4-10 words which she is not even close. She also does not tend to repeat for as much as we encourage her too. At her 15 month check up her doctor seemed a bit concerned but said we would reconnect at her 18 month check up. I feel like no progress has been made and was wondering if anyone else had the same experience with their little one. I am not sure if I should wait or seek an evaluation. I am guessing that the earlier the intervention the better. She seems to understand directions well and is otherwise developing great. We are Kaiser members and I have been told that they do not offer services until children are over 3. Is that true? If anyone has had similar experience I would leave to hear about it. Thank you!

Parent Replies

New responses are no longer being accepted.

Hi! I would press the doctor for a speech and language evaluation. Kaiser offers services starting at birth! If your doctor will not recommend your daughter for an evaluation, I would get a new doctor. I am a speech therapist and have found that many doctors are not knowledgeable enough about speech and language development and the "wait and see" method is NOT effective. If anything, children must get early intervention services to make solid progress. The other option you have is trying to talk to your school district- some districts offer birth-5 services for their students. Hope this helps!

At 18 months, there is still a lot of variability in speech.  My son was in a similar situation, and my pediatrician responded the same way your did - keep an eye on it, and reevaluate in a few months.  We reevaluated at 21 months, and he was still a little bit behind (10-15 words as opposed to 20-50), but we decided to wait a bit longer (especially because he's being exposed to multiple languages, which often results in a bit of delay in starting speech), and now at 24 months he is gaining multiple words a day.  If you are worried and want to be proactive about it, contact the East Bay Regional Center (http://www.rceb.org/ - assuming you live in the East Bay).  The Regional Center will send someone out to your house, or you visit them, and you do an initial evaluation, and if your child meets the requirements of needing speech therapy, they'll cover a large portion or all of the costs for speech therapy, even if your insurance doesn't, until the child is 3.  After the child turns 3, my understanding is that responsibility for speech therapy goes over to your school district.  I would recommend waiting a bit longer to jump into therapy, especially if your daughter is being exposed to multiple languages, but there's also no harm in contacting the Regional Center and finding out more details.

HI there,

I just read your post and had to reply! I'm a speech-language pathologist (and soon to be mama) and wanted to answer some of your questions/concerns. So, by 18-24 months of age, children typically have a large spurt of expressive language acquisition. At 18 months, she should have an expressive vocabulary between 20-25 words and by 2 years around 50 words in their lexicon.They should understand much more than they speak it sounds like she does as she's able to follow simple directions etc. - so that's good! Here's a link to what the American Speech Language Association has on early language development http://www.asha.org/public/speech/development/12/

With regards to seeking out an evaluation, I would if I were in your position. I'm not sure about Kaiser only taking children after age 3, but the Golden Gate Regional Center (GGRC) through their Early Start services for children birth-3. I have a close friend who was in the very same position with her daughter being 18 months and she wasn't even saying mama/papa and was evaluated through GGRC and they began in-home services. And you are right, early intervention is the highly effective and best practice!

Please let me know if you have any more questions! I'm happy to help.

kind regards,


My daughter had a similar language delay at 18 months.  Her pediatrician recommended an extensive language assessment at kaiser (I think it was $400 out of pocket).  They determined that my daughter's receptive language/comprehension was very high but her expressive language was behind  for her age. Kaiser wasn't too concerned because my daughter's language comprehension was not an issue. Fast forward 3.5 years and my daughter is a chatterbox with an extensive vocabulary (she caught up to other kids at about 2.5 years old).  My second child also behind her peers in terms of expressive language.  This time I am not worried and I am not pursuing the language assessment. Children develop language at different rates but just to be on the safe side, to allow for intervention, you can have her assessed at Kaiser.  

In Alameda County Help Me Grow is a great resource, http://www.first5alameda.org/help-me-grow-parent-resources or  call them at  888-510-1211

Please contact The Regional Center East Bay to schedule a speech and language test.  These assessmenta fall under Early Intervention and should be no cost to you.  14 years ago I was in your same situation---wondering ahould I be concerned/ should I get testing. I decided to get my child tested to let the experts determine if early intervention was needed.  I found out we did need speech and language services.  I am assuming this Federally Funded program is still available.  From 20 months - 3 years we had free services.  At 3 years speech services go through the public school system where the child is retested and receives services at 3 yrs old until no longer needed.  I encourage you to have your child tested.  Either they will require services or won't. If they require services, you are giving them the best opportunity to catch up to their peers.  If they don't require services then your mind can be put to rest. 

Absolutely get an evaluation. You have at least 2, maybe 3, reasonable cost/free options: insurance (yes Kaiser can do speech therapy under age 3, but I'm not sure it's any good. I know some parents have described the services they received as more parent education than direct therapy, but not sure if they have other options at that age), Regional Center of the East Bay (assuming you live in Alameda or Contra Costa County, it would be a different regional center elsewhere), and possibly your school district. The earlier the better for sure, so go ahead and ask those places for evaluations. The only harm is if she comes up borderline in an evaluation, some places won't qualify her and won't give her another evaluation for 6 months.

I've been there. Kaiser member, and my son seemed "late" in his verbal development but only to me. Everyone else gave a million reasons why he's just fine, and the Kaiser doctor seemed unconcerned. I realize in order to get free treatment your child needs to be VERY delayed (services goes to those who really need it, I get it), and if you are borderline or within range nobody will offer you anything for free. The answer, if you can afford it, is to pay for private evaluation. I recommend Work Works in Oakland (near Kaiser Oakland), call and speak to one of the directors, and see if they feel you should come in for an evaluation. If you don't want to go private, at your 18 month appointment, keep hounding the doctor. What they will do is send you a paper worksheet which you will fill out, and if you raise the right red flags, you will be referred to speech therapy and or a developmental specialist, or, you might not. You really do need to keep asking and pushing, and it will take time. For my son, I listened to the naysayers till he was 5, did nothing, and eventually went the private route. He got private speech therapy for some language processing issues, and now at 6 he is doing great and no longer needs speech therapy. Wish I had taken him in earlier.

Do not want wait! I can't stress the importance of early intervention. My daughter, who is now 3 1/2, also had only a two words at 18 months. We pushed our pediatrician for a referrals to a speech therapist, ENT (to rule out any ear issues) and to the regional center. Turns out, my daughter needed ear tubes because she suffered from ear infections as an infant and couldn't hear properly. Insurance initially didn't want to cover speech therapy but the regional center stepped in and covered the costs until my insurance kicked in. It has been tough but speech therapy has worked wonders! My daughter is still delayed compared to kids her own age but speaking enough to communicate effectively. Definitely ask your pediatrician for referrals to the regional center or a speech therapist who takes your insurance. 

You are correct to think that early intervention is best for a potential speech delay. Two words at 18 months is a bit low. The first thing her doctor will do is a thorough hearing screening. Fluid in the middle ear is the most common type of problem leading to speech delay and is easy to clear up. Even a slight reduction in hearing acuity can have an impact on language learning. Most importantly, don't take a wait and see approach as these months are important for language acquisition. Good luck and don't worry, you're right on top of things.
A Speech-Pathologist

As the mother of a 2 year-old who just went through the "when is he going to start speaking??" ordeal, my advice to you is: stop worrying. You say that she understands directions, so there are no hearing or comprehension problems. My son didn't say more than 2 words at 18 months either, but it was clear that he understood what we said. Between then and 24 months, he added a handful more words, but overall wasn't very verbal at all. I know, it's hard when you're around same-age children who are more verbal; you can't help wondering if there's a problem. I always tried to remember that there's a range to these milestones. Some children start on the early side and some on the later side. We're also with Kaiser, and at his 2 year checkup, I discussed it with his doctor. Honestly, I wasn't terribly concerned, because I could tell that he understood so much, and was taking everything in. But we were visiting the in-laws the week after, and I wanted a "the doctor said" response ready for them. His doctor did a couple of checks, and said that when children aren't particularly verbal at 2, the two main areas of concern are hearing problems and autism. As my son could clearly hear, and didn't show early signs of autism, he was probably just a late talker, but it was up to me whether I wanted an evaluation. She gave me the evaluation questionnaire (you fill it out, send it back to Kaiser, and they contact you about next steps). I took the questionnaire home, read through it, and decided against an eval. Why? Mainly because reading the questions gave me perspective: instead of hyper focusing on the one thing he wasn't doing, I saw all the developmental things he was was doing so well. Lo and behold, a week or two after he turned 2, it started: each day, more words. He started repeating after us, and putting words together. He's behind some of the children who started speaking early, but I have no doubt that he'll catch up. I don't think any amount of us prodding him to repeat after us at 18 months would have changed the outcome - he just wasn't ready. My advice is that if you can rule out hearing issues and early signs of autism, just give her time, and don't act like there's anything wrong with her, as she'll pick up on that. 

Hi, my son had language development, and was also a late walker.  It as a long journey, and with a lot of work on my part (research and insisting on tests and access to specialists) before we found out that he had a hearing issue, as well as low muscle tone.  Was your daughter's hearing tested?  In my son's case, he had a cold at one point, and then fluid remained in his ears long after the cold was gone, to the point that his hearing was affected.  The doc suggested tubes, but at that point his ears finally cleared (long story).

And, it's not true that "services" start at age 3 at HMO.  Sure, the school district assesses kids when they turn 3, if you request it.  But, your HMO should be able to refer you to their specialist, at least definitely a developmental one (I asked for two different ones, because the first one only read my son's letter written by his preschool and his assessment was pretty much that same letter he paraphrased!).  So, request a developmental specialist (I liked Dr. Reiff in SF Kaiser - and he might be the only dev specialist available now anyway), ask for hearing test if there wasn't one, and see if there are any other physical or behavioral concerns that would require a specialist.  In our case, my son had to be seen by neurologist, and is still under her observation (Dr. Jean Hayward at Kaiser Oakland is fantastic).  

Regards, and good luck!