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Speech Therapy
Explore explanations, everyday questions and next steps connected with speech therapy.
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Signs & concerns
Observing receptive and expressive communication on a home visit
On a home visit, a frontline worker should observe both sides of communication: receptive understanding (responding to name, following simple instructions, looking when pointed) and expressive sending (gestures, babbling, words, joining ideas), watching how the child uses these naturally with caregivers. Always check hearing first. These are signs to note and route to a developmental check, never to diagnose at home.
Read the answer AnswerWhat to observe about a child's social language on a home visit
On a home visit, a frontline worker should observe how a child connects socially through language: eye contact, shared smiles, responding to their name, pointing and gesturing, joint attention, taking turns in babble or words, and following simple instructions. These are behaviours to note and reassure about, not to diagnose at home. When several seem missing for the child's age, the kind next step is a developmental screen, not a label.
Read the answer AnswerObserving descriptive language on a home visit
On a home visit, a frontline worker should observe whether a child names familiar objects, people and actions, adds describing words (size, colour, feelings), joins words into short phrases, and answers simple 'what' and 'where' questions — all in the family's home language. This is observation and monitoring, not diagnosis. Confirm the home language and hearing first. Refer to a PHC check if concerns persist across months or affect more than one area.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning expressive language?
On a home visit, observe how a child uses sounds, words and gestures to express needs — babbling and pointing in infancy, first words by around 12–15 months, two-word phrases by age 2, and using words to ask, name and refuse. Watch for no babbling by 12 months, no words by 16–18 months, no phrases by 2 years, or any loss of skills, and always note hearing. These are observations to monitor, never to diagnose at home; persisting or widening gaps should be routed for a developmental and hearing check.
Read the answer AnswerGrammar use on a home visit: what to observe
On a home visit, a frontline worker should observe how a child combines words — moving from single words to two- and three-word phrases, then adding small grammar words (in, on, my) and endings (-ing, plurals, past tense). What matters is steady growth over months and whether family understand the child by about age 3, not perfect grammar. Check hearing first. These are signs to observe and note, not diagnose at home; refer for a screen if combinations are clearly behind or not progressing.
Read the answer AnswerWhat to observe about a child's language structure on a home visit
On a home visit, a frontline worker should observe how a child combines words into phrases and sentences — moving from single words to two- and three-word combinations, using simple grammar and word order, and understanding short instructions for their age. These are things to observe and note, not diagnose at home. Consider the family's mother tongue, since bilingual children may mix languages normally. If language structure seems markedly behind, route the family for a hearing screen and a developmental check.
Read the answer AnswerNon-Verbal Communication on a Home Visit
On a home visit, a frontline worker should watch how a child connects without words — eye contact, shared looking between object and caregiver, pointing, waving, reaching, showing objects, facial expressions, response to name, and turn-taking in play. These build the foundation for speech. They are signs to observe and share with the family, not to diagnose at home; if gestures, pointing or eye contact are clearly limited for age or fade over months, encourage a developmental screen (with a hearing check first).
Read the answer AnswerObject identification during a home visit
During a home visit, a frontline worker should observe whether a child looks at, points to, reaches for or hands over familiar named objects, responds to simple requests like 'Where is the ball?', uses objects correctly in play, and stays connected with eye contact. This is an observe-and-note screen, not a home diagnosis. No response to familiar object names by around 18 months, little pointing, or concerns across several areas warrant a hearing and vision check and routing to a developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning pronunciation skills?
On a home visit, a frontline worker should observe how clearly a child's speech sounds emerge, how much family and outsiders understand them, which sounds are present or missing, and whether speech grows month by month. Rules of thumb help: understood by family by age 3, by others by age 4. These are signs to monitor and refer — never to diagnose at home. A hearing check is a sensible first step, and steady progress matters more than isolated errors.
Read the answer AnswerWhat to observe about a child's question-asking on a home visit
During a home visit, a frontline worker should observe how a child uses questions to explore and connect — pointing and looking to ask, raising the voice questioningly, and using words like what, where, who and why. Note whether the child waits for and uses the answer, and across which people. Children may ask freely in their mother tongue, and talkative homes invite more questions. This is gentle observation to share with the team and route to a developmental check — not a diagnosis.
Read the answer AnswerWhat to Observe About Question Comprehension on a Home Visit
On a home visit, a frontline worker should observe how the child responds to simple spoken questions in their home language — looking, pointing, fetching or answering "where", "what", "who" and "which one" within familiar routines. Question comprehension (ICF d3) develops step by step, so the worker watches the pattern across play, meals and chatter, noting what the child can do rather than testing or diagnosing. Supporting clues include attention to the speaker, response to name and use of gestures or words. Gently flag a hearing check and developmental screen if responses to spoken words seem consistently limited or the family is concerned.
Read the answer AnswerWhat to observe about receptive language on a home visit
On a home visit, a frontline worker should observe how a child responds to language without gestures — turning to their name, quieting to a familiar voice, following simple spoken instructions, and looking at named people or objects. These are everyday signs of receptive language (understanding) growing, and understanding usually develops ahead of speech. The worker observes and notes patterns, not diagnoses; consistently not responding across visits, possible hearing concerns, or lost skills should prompt a gentle referral and a hearing check first.
Read the answer AnswerWhat to observe about a child learning sentence repetition
On a home visit, observe how a child copies back short spoken sentences — sentence length, correct word order, whether small joining words are kept, clarity, and whether sentences grow over months. Sentence repetition reflects language and listening memory. Frontline workers observe and note patterns, not diagnose; check hearing first and route any clear or lasting gap to a developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about social communication?
On a home visit, a frontline worker should observe how a child connects and shares with people — eye contact, social smiling, responding to their name, pointing and showing, turn-taking in babble or play, gestures and growing words. These are everyday signs of social communication (ICF d3). The worker observes and notes patterns — never labels — and refers early for a developmental check, with a hearing check first, if signs like no response to name, faces or pointing persist across months.
Read the answer AnswerObserving a child's sound production on a home visit
On a home visit, a frontline worker should observe how a child makes and uses speech sounds for their age — cooing and babbling in babies, first clear words in toddlers, and understandable sentences in preschoolers. The task is to observe and note, not diagnose. Watch for very limited or unclear sounds, loss of sounds once used, or speech far behind same-age peers, and note any hearing concern. When a pattern persists, gently route the family to a developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about spatial concepts?
On a home visit, a frontline worker should observe how a child understands and uses spatial words and ideas — putting toys in, on, under or behind things, following simple position directions, and grasping big/small, near/far and up/down through play. These are behaviours to observe and note, not diagnose at home. A pattern that persists across visits, or a child clearly behind same-age peers, should be gently routed for a developmental check and a hearing screen.
Read the answer AnswerObserving speech intelligibility on a home visit
On a home visit, a frontline worker should observe how clearly a child's speech is understood by family and by strangers, and whether the child uses words to communicate. As a guide, a stranger should understand about half of a 2-year-old, three-quarters of a 3-year-old, and almost all of a 4-year-old. Note unclear speech, missing sounds, or any hearing concern — and refer persistent worries, especially after age 3. This is observation, not diagnosis.
Read the answer AnswerObserving Speech, Language and Communication on a Home Visit
On a home visit, a frontline worker should observe how a child connects, understands and expresses — eye contact, response to name, gestures like pointing and waving, sounds and words for the age, and turn-taking with caregivers. Also note how much the family talks, sings and responds to the child, and any worry about hearing. These are observations to note and route gently, never a home diagnosis. A hearing screen comes first, and any persistent gap across areas should be referred to the nearest PHC or developmental check.
Read the answer AnswerObserving Temporal Concepts During a Home Visit
During a home visit, a frontline worker should observe how a child understands everyday time words and sequences — "now", "later", "before", "after", parts of the day — and whether daily routines carry meaning. Temporal concepts grow with language and play, so the aim is to observe and note patterns, not test or diagnose. A persistent, wide gap, especially alongside communication delays, signals the need for a general developmental check.
Read the answer AnswerDuring a home visit, what should a frontline worker observe about a child learning verbal understanding?
On a home visit, a frontline worker should observe how a child understands language — turning to their name, following simple words and gestures in the home language, pointing to named people or objects, and responding to everyday instructions. These are observations to note and track, not to diagnose. Always confirm a hearing screen first, and route any child whose understanding seems clearly behind age to a routine developmental check.
Read the answer AnswerObserving vocabulary on a home visit
On a home visit, a frontline worker should observe how a child understands and uses words for their age — responding to their name, following simple instructions, pointing and gesturing, saying clear words, and imitating sounds in play. These are things to note across visits, not to diagnose at home. Check that hearing has been screened, and gently route any concern to a PHC or developmental check.
Read the answer AnswerSigns of hearing loss in a 9–12-month-old
By 9–12 months babies turn to their name, babble, and respond to sound. Hearing loss is easy to miss but highly treatable when caught early. If your baby doesn't react to sound, has reduced babble, or ignores her name, arrange a hearing test now.
Read the answer AnswerHow do I know if my child has strong speech readiness?
Strong speech readiness shows in the foundations beneath talking: responding to sound and to their name, babbling, sharing attention, pointing and gesturing, understanding simple words, and wanting to connect. These matter more than word count in the early years. Seek a gentle developmental check — and a hearing check — if babbling, gestures, name response or understanding seem quiet for your child's age, or if a skill is lost. This guides support early; it is not a diagnosis.
Read the answer AnswerWhen to escalate cognitive-communication and pre-literacy delays
A frontline health worker should escalate when a child shows a clear, persistent gap in cognitive-communication and pre-literacy milestones — for example, not understanding simple instructions or pointing by 18–24 months, not following directions or enjoying books by 3–4 years — or when several flags appear together or a skill is lost. A single missed step is not a diagnosis, but a clear gap, multiple flags, or skill loss means refer to the PHC medical officer and arrange a developmental check now, because early support works best.
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