Speech & Communication

Toddler Has Both Understanding and Speaking Delays

Medically reviewed by Dr. Emily Torres, PhD, CCC-SLP · Pediatric Speech-Language Pathologist

Content reviewed against published ASHA, AAP, NIH guidelines

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Speech and communication milestones vary widely, and worries about toddler has both understanding and speaking delays, here is what you need to know.

The short answer

A mixed receptive-expressive language delay means your child has difficulty both understanding and producing language. This is more significant than an expressive-only delay and typically requires speech therapy. A comprehensive evaluation including hearing testing is essential to determine the cause and guide treatment. Early intervention leads to the best outcomes.

Key takeaways

  • A mixed receptive-expressive language delay means your child has difficulty both understanding and producing language. This is more significant than an expressive-only delay and typically requires speech therapy. A comprehensive evaluation including hearing testing is essential to determine the cause and guide treatment. Early intervention leads to the best outcomes.
  • Usually normal when: Your toddler is a bit behind in both understanding and speaking but is making steady progress
  • Call your doctor if: Your toddler shows no understanding of any language and produces no words or meaningful sounds
  • Varies by age — see the age-by-age breakdown below

Parents everywhere have the same worry. You are doing the right thing by looking into it.

What Parents Should Know

According to ASHA, AAP, NIH guidelines, a mixed receptive-expressive language delay means your child has difficulty both understanding and producing language. This is more significant than an expressive-only delay and typically requires speech therapy. A comprehensive evaluation including hearing testing is essential to determine the cause and guide treatment. Early intervention leads to the best outcomes. At 12-18 months, signs include not responding to name, not following simple directions, limited babbling, and no words. While some variation is normal, a combination of receptive and expressive delays at this age warrants evaluation. It is generally considered normal when your toddler is a bit behind in both understanding and speaking but is making steady progress. However, you should contact your pediatrician promptly if your toddler shows no understanding of any language and produces no words or meaningful sounds.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Your toddler is a bit behind in both understanding and speaking but is making steady progress
Your toddler shows no understanding of any language and produces no words or meaningful sounds
Your toddler has mild delays but is bilingual and developing both languages simultaneously
Your toddler has lost both comprehension and expressive language skills
Your toddler recently started early intervention and progress is beginning
Your toddler has few words and also does not seem to understand common words or directions

By Age

What to expect by age

12-18 months

Signs include not responding to name, not following simple directions, limited babbling, and no words. While some variation is normal, a combination of receptive and expressive delays at this age warrants evaluation.

18-24 months

A child with mixed delay may have few or no words and also struggle to understand common words and simple directions. Hearing testing is essential to rule out hearing loss as a cause. Early intervention services can be accessed through your state's early intervention program.

24-36 months

Both comprehension and production should be rapidly improving at this age. If your child has significant difficulties in both areas, a speech-language evaluation is strongly recommended. Treatment will address both understanding and producing language.

3-4 years

Ongoing speech therapy targeting both receptive and expressive skills is important. Children with mixed delays may need more intensive therapy. Progress should be monitored regularly and goals adjusted as your child develops.

4-5 years

Some children with mixed receptive-expressive delays are eventually diagnosed with a developmental language disorder. Ongoing support through speech therapy and educational accommodations can help your child succeed in school.

What to Tell Your Pediatrician

  • Describe when you first noticed toddler has both understanding and speaking delays and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your toddler has few words and also does not seem to understand common words or directions.
  • Mention if your 18-month-old does not respond to their name and has no words.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Your toddler is a bit behind in both understanding and speaking but is making steady progress
  • Your toddler has mild delays but is bilingual and developing both languages simultaneously
  • Your toddler recently started early intervention and progress is beginning
Mention at your next visit when...
  • Your toddler has few words and also does not seem to understand common words or directions
  • Your 18-month-old does not respond to their name and has no words
  • Your toddler is not progressing in either comprehension or production over several months
Act now when...
  • Your toddler shows no understanding of any language and produces no words or meaningful sounds
  • Your toddler has lost both comprehension and expressive language skills

What You Can Do at Home

  • Keep track of when you notice toddler has both understanding and speaking delays — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that your toddler is a bit behind in both understanding and speaking but is making steady progress — this is generally within the range of normal.
  • At 12-18 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Talk, read, and sing to your baby frequently. Narrate daily activities to build language exposure.
  • While monitoring at home, seek immediate care if your toddler shows no understanding of any language and produces no words or meaningful sounds.

Delayed Receptive Language

Receptive language is your child's ability to understand what they hear. Most children understand far more words than they can say. If your child seems to have trouble understanding language - not just speaking it - that's an important concern to address early. Receptive language delays can be harder to spot than expressive delays, but they respond well to speech therapy, especially when caught early.

Speech Delay in My Child

Speech delay means a child is developing speech and language skills in the expected order but at a slower pace than typical. It's one of the most common developmental concerns - affecting about 10-15% of toddlers - and early intervention through speech therapy is remarkably effective, with many children catching up fully by school age.

Language Delay vs. Language Disorder: What's the Difference?

A language delay means a child is following the typical path of development but at a slower rate and is expected to catch up. A language disorder (now often called Developmental Language Disorder or DLD) means the pattern of development is different, not just slower, and typically requires ongoing support. A speech-language pathologist can evaluate your child and help distinguish between the two.

Milestone

Milestone Checklists by Age

Track your baby's developmental milestones from birth to 5 years with age-specific checklists.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is toddler has both understanding and speaking delays normal?
A mixed receptive-expressive language delay means your child has difficulty both understanding and producing language. This is more significant than an expressive-only delay and typically requires speech therapy. A comprehensive evaluation including hearing testing is essential to determine the cause and guide treatment. Early intervention leads to the best outcomes.
When should I call the doctor about toddler has both understanding and speaking delays?
Your toddler shows no understanding of any language and produces no words or meaningful sounds Your toddler has lost both comprehension and expressive language skills
When is toddler has both understanding and speaking delays normal?
Your toddler is a bit behind in both understanding and speaking but is making steady progress Your toddler has mild delays but is bilingual and developing both languages simultaneously Your toddler recently started early intervention and progress is beginning
What causes toddler has both understanding and speaking delays?
A mixed receptive-expressive language delay means your child has difficulty both understanding and producing language. This is more significant than an expressive-only delay and typically requires speech therapy. A comprehensive evaluation including hearing testing is essential to determine the cause and guide treatment. Early intervention leads to the best outcomes. Common explanations include: Your toddler is a bit behind in both understanding and speaking but is making steady progress. Your toddler has mild delays but is bilingual and developing both languages simultaneously.
What should I mention to my pediatrician about toddler has both understanding and speaking delays?
You should mention toddler has both understanding and speaking delays at your next visit if: Your toddler has few words and also does not seem to understand common words or directions. Your 18-month-old does not respond to their name and has no words. Your toddler is not progressing in either comprehension or production over several months.
Is toddler has both understanding and speaking delays normal at 12-18 months?
Signs include not responding to name, not following simple directions, limited babbling, and no words. While some variation is normal, a combination of receptive and expressive delays at this age warrants evaluation.
Is toddler has both understanding and speaking delays normal at 18-24 months?
A child with mixed delay may have few or no words and also struggle to understand common words and simple directions. Hearing testing is essential to rule out hearing loss as a cause. Early intervention services can be accessed through your state's early intervention program.
Should I go to the ER for toddler has both understanding and speaking delays?
Seek emergency care if your toddler shows no understanding of any language and produces no words or meaningful sounds, or if your toddler has lost both comprehension and expressive language skills. When in doubt, call your pediatrician's after-hours line for guidance.
Does toddler has both understanding and speaking delays go away on its own?
In many cases, toddler has both understanding and speaking delays resolves on its own, especially when your toddler is a bit behind in both understanding and speaking but is making steady progress. By 4-5 years, some children with mixed receptive-expressive delays are eventually diagnosed with a developmental language disorder. Ongoing support through speech therapy and educational accommodations can help your child succeed in school.
ASHAAAPNIH

References

  1. [1]American Speech-Language-Hearing Association. Spoken Language Disorders. ASHA
  2. [2]American Academy of Pediatrics. Language Delays in Toddlers. HealthyChildren.org. AAP
  3. [3]National Institute on Deafness and Other Communication Disorders. Specific Language Impairment. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Toddler Has Both Understanding and Speaking Delays.

Things to mention

  • Describe when you first noticed toddler has both understanding and speaking delays and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your toddler has few words and also does not seem to understand common words or directions.
  • Mention if your 18-month-old does not respond to their name and has no words.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your toddler has few words and also does not seem to understand common words or directions
  • Your 18-month-old does not respond to their name and has no words
  • Your toddler is not progressing in either comprehension or production over several months

Urgent signs to report immediately

  • Your toddler shows no understanding of any language and produces no words or meaningful sounds
  • Your toddler has lost both comprehension and expressive language skills

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

Milestone ChecklistsEarly Intervention DirectoryDevelopmental ActivitiesBaby Sign Language GuideBaby Tracker

Bottom line

Most cases of toddler has both understanding and speaking delays are normal. Talk to your pediatrician if your toddler shows no understanding of any language and produces no words or meaningful sounds.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Related Speech Concerns

Delayed Receptive Language

Receptive language is your child's ability to understand what they hear. Most children understand far more words than they can say. If your child seems to have trouble understanding language - not just speaking it - that's an important concern to address early. Receptive language delays can be harder to spot than expressive delays, but they respond well to speech therapy, especially when caught early.

Speech Delay in My Child

Speech delay means a child is developing speech and language skills in the expected order but at a slower pace than typical. It's one of the most common developmental concerns - affecting about 10-15% of toddlers - and early intervention through speech therapy is remarkably effective, with many children catching up fully by school age.

Language Delay vs. Language Disorder: What's the Difference?

A language delay means a child is following the typical path of development but at a slower rate and is expected to catch up. A language disorder (now often called Developmental Language Disorder or DLD) means the pattern of development is different, not just slower, and typically requires ongoing support. A speech-language pathologist can evaluate your child and help distinguish between the two.

Accent vs Speech Disorder in Bilingual Toddlers

When toddlers grow up hearing more than one language, they naturally blend sounds, patterns, and accents from both languages. This is normal and healthy, not a speech disorder. A bilingual child may pronounce some sounds differently than monolingual peers because they are learning the sound systems of two languages simultaneously. True speech disorders affect both languages equally, while accent influence appears only in specific sounds borrowed from one language to another.

Ear Fluid Affecting Baby's Speech Development

Chronic or recurrent middle ear fluid (otitis media with effusion) can temporarily reduce hearing by 15 to 40 decibels, which is like hearing through water. During critical periods of language learning, this muffled hearing can impact speech and language development. If your baby has frequent ear infections or persistent fluid, discuss the potential speech impact with your pediatrician.

Will Ear Tubes Help My Child's Speech?

Ear tubes (tympanostomy tubes) can restore normal hearing by draining persistent fluid from the middle ear. Many children show speech and language improvement within weeks to months after tube placement, particularly if hearing loss from fluid was contributing to their speech delay. However, ear tubes alone may not resolve all speech delays, and some children benefit from speech therapy alongside tube placement.