When Parents Ask About Speech

A Quick-Reference Guide for Well-Child Visits

This guide is intended to support clinical conversations during well-child and sick visits. It is not a diagnostic instrument and does not replace a professional speech-language evaluation. When in doubt, a referral for evaluation is always a reasonable and low-risk recommendation.

What Parents Say vs. What to Consider

Parents rarely use clinical terminology when describing speech and language concerns. The table below maps common parent phrases to the clinical considerations they may reflect.

What the Parent Says	What It May Indicate	Follow-Up Consideration
“Nobody can understand him except me.”	Possible persistent phonological processes, articulation delay, or childhood apraxia of speech. May also be age-appropriate depending on the child’s age.	Ask about the child’s age, how well unfamiliar listeners understand the child, and whether intelligibility has been improving over time. If the child is school-age and unfamiliar listeners still struggle, a speech-language evaluation is warranted.
“She talks fine at home but won’t talk at school.”	Possible selective mutism, social communication difficulty, or speech/language awareness leading to avoidance.	Ask whether the child speaks freely with familiar people. Selective mutism is an anxiety-based condition that benefits from coordinated treatment. A speech-language evaluation can rule out or identify underlying speech/language factors.
“He’s so smart, but his teacher says he’s behind in reading.”	Possible phonological awareness deficit affecting the speech-to-literacy connection.	Ask whether the child has any history of speech sound errors, even if they seem resolved. A speech-language pathologist can evaluate phonological processing skills that underlie both speech clarity and reading development.
“She still can’t say her R’s.”	Likely persistent /r/ distortion. Research suggests most children produce /r/ accurately by around age 6 (Crowe & McLeod, 2020).	Ask how old the child is and whether the /r/ difficulty affects their confidence or willingness to speak. For children age 6 and older, a speech-language evaluation is a reasonable next step.
“He gets so frustrated when he tries to tell me something.”	Possible expressive language difficulty, word-finding challenges, or fluency disorder. Frustration during communication is a meaningful signal.	Ask the parent to describe what happens: Does the child struggle to find words? Start and stop? Give up and use gestures? Any pattern of communication breakdown causing emotional distress warrants evaluation.
“She talks a lot, but she doesn’t really answer questions.”	Possible receptive language or pragmatic language difficulty.	Ask whether the child follows multi-step directions, responds appropriately to questions, and stays on topic during conversation. A gap between expressive volume and conversational quality may indicate a language processing concern.

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Speech Sound Expectations for School-Age Children

The following chart reflects current research on when most children in the United States produce specific speech sounds accurately in conversation (Crowe & McLeod, 2020). These represent the ages at which 90% or more of typically developing children have acquired each sound.

Age	Sounds Typically Mastered by This Age
By age 3	/p/, /b/, /m/, /d/, /n/, /h/, /w/
By age 4	/g/, /k/, /f/, /t/, /ng/, /y/
By age 5	/v/, /j/ (as in “jump”), /s/, /ch/, /l/, /sh/, /z/
By age 6	/r/ (including vocalic r as in “bird,” “car,” “later”), /zh/ (as in “measure”), voiced “th” (as in “the”)
By age 7	Voiceless “th” (as in “think”)

Clinical note: The /r/ sound shows the greatest variability of any English consonant. Some children produce /r/ accurately by age 4, while others may not fully master it until age 6 or beyond. If a school-age child is consistently distorting /r/ across speaking contexts, an evaluation can help determine whether intervention would be beneficial.

Clinical note: If a child is still producing errors on sounds expected at earlier ages (for example, a 7-year-old who substitutes /w/ for /l/), this suggests a pattern worth evaluating regardless of whether it is causing academic or social difficulty yet.

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Five Screening Questions for Well-Child Visits

These are not a standardized screening instrument. They are conversation prompts designed to help you identify whether a speech-language referral may be useful. Each question takes about 15–20 seconds to ask.

“Can unfamiliar adults — like a new teacher or a cashier at a store — generally understand what your child says?”

What you are listening for: If the parent says no, or qualifies heavily, intelligibility may be a concern. School-age children should be understood by unfamiliar listeners the majority of the time.

“Does your child ever get frustrated, shut down, or act out when trying to communicate?”

What you are listening for: Behavioral indicators of communication difficulty. Children who cannot express themselves effectively sometimes show it through frustration, withdrawal, or avoidance.

“How is your child doing with reading and spelling compared to classmates?”

What you are listening for: Literacy struggles that may have a speech-language foundation. Phonological awareness underlies both speech clarity and reading development.

“Does your child follow multi-step directions without needing them repeated?”

What you are listening for: Receptive language processing. A child who consistently needs directions repeated may have difficulty processing spoken language — even if their expressive speech seems fine.

“Is your child comfortable speaking up in class, with peers, and in new situations?”

What you are listening for: Avoidance patterns. Children who are aware of their own speech or language differences sometimes avoid speaking in situations where they feel exposed.

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Refer or Reassure: A Decision Framework

This is a triage guide to help you feel confident in your recommendation. It is not a diagnostic algorithm.

Monitor & Reassure

When Reassurance and Monitoring Are Reasonable

Speech sound errors are consistent with the child’s developmental age
The child is generally understood by unfamiliar listeners
No frustration, avoidance, or behavioral changes related to communication
Reading and spelling are progressing on track
Concern is primarily about a single sound within the expected developmental window

Suggested language: “The sounds your child is still working on are typical for their age. I would not be concerned right now, but let’s keep an eye on it. If it does not improve over the next six months, or if you notice any frustration, we can revisit.”

Refer for Evaluation

When a Referral for Evaluation Is Warranted

School-age child is not intelligible to unfamiliar listeners
Speech sound errors persist beyond expected age of mastery
Child is avoiding speaking, reading aloud, or participating verbally
Frustration or behavioral changes related to communication
Reading, spelling, or writing difficulties may have a phonological component
Fluency concerns (repetitions, prolongations, blocks) with awareness or distress
Difficulty understanding or following age-appropriate spoken language
History of speech/language delay, hearing concerns, or neurological factors

Suggested language: “Based on what you are describing, I think it would be helpful to have a speech-language pathologist take a closer look. An evaluation does not mean there is definitely a problem — it gives us a clear picture of where your child is and whether support would help. I can connect you with a resource for that.”

Immediate Referral

When Immediate Referral Is Recommended

Sudden loss of previously acquired speech or language skills
Significant regression in communication ability
Suspected childhood apraxia of speech (inconsistent errors, groping movements, limited sound repertoire in an older child)
Fluency that involves visible physical struggle, facial tension, or avoidance that interferes with daily communication
Voice quality concerns (persistent hoarseness, breathiness, or pitch abnormalities lasting more than two weeks without an upper respiratory cause)

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What Happens After a Referral

When parents know what to expect, they are more likely to follow through. Here is a brief overview you can share:

A speech-language evaluation typically involves:

A review of the child’s developmental history and current concerns
Standardized and informal assessment of speech sounds, language comprehension, language expression, and other areas as indicated
Observation of the child in conversation and structured tasks
A written report with findings and recommendations

Timeline: Most evaluations take 60–90 minutes for the assessment itself, with results and recommendations discussed with the family shortly after.

About telehealth: Speech-language evaluations and therapy can be conducted via telehealth for many school-age children. Research suggests that telehealth speech therapy can be as effective as in-person sessions for many clients, and it eliminates transportation barriers and scheduling conflicts for busy families.

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About Strategic Speech Solutions

Strategic Speech Solutions is a telehealth speech-language pathology practice serving children and adults across New York and New Jersey.

Free speech screenings — a brief, no-cost consultation to determine whether a full evaluation is recommended
No waitlist — families can typically begin within days of contact
Flexible scheduling including evening appointments
Parent participation in every children’s session
One consistent clinician throughout the course of treatment

This guide was developed by a certified speech-language pathologist (M.S., CCC-SLP). Speech sound acquisition data referenced from Crowe & McLeod (2020), “Children’s English Consonant Acquisition in the United States: A Review,” American Journal of Speech-Language Pathology. This resource is provided at no cost and without obligation.