Speech Therapy for Kids: What an SLP Does and When to Get an Evaluation
What pediatric speech-language pathologists treat, what CCC-SLP and state licensure mean, early signs to watch for, and what happens at an evaluation.
What a speech-language pathologist does
A speech-language pathologist, usually called an SLP or speech therapist, is a clinician trained to evaluate and treat problems with communication and swallowing. With children, that covers much more than "saying sounds right." Parents are often surprised by how broad the field is, so it helps to know the main areas an SLP may work on:
- Speech sounds (articulation and phonology). Difficulty producing sounds clearly or using sound patterns that are expected for a child's age, which can make a child hard to understand.
- Language. Understanding what others say (receptive language) and putting thoughts into words and sentences (expressive language). This includes vocabulary, grammar, following directions and telling a story.
- Social communication. Using language with other people: taking turns in conversation, staying on topic, reading and using gestures and facial expressions.
- Fluency (stuttering). Repetitions, prolongations or blocks that interrupt the flow of speech. ASHA has a plain-language overview of stuttering and cluttering.
- Voice. Hoarseness, pitch or loudness concerns that persist.
- Feeding and swallowing. Trouble sucking, chewing, moving food in the mouth or swallowing safely. See ASHA's page on feeding and swallowing disorders in children.
- Augmentative and alternative communication (AAC). Tools such as picture boards, sign or speech-generating devices for children who cannot rely on speech alone. ASHA explains AAC and why it does not stop a child from learning to talk.
SLPs also work closely with audiologists, because hearing affects speech and language. If there is any question about a child's hearing, a hearing test is usually part of the picture.
Credentials to look for
Two credentials matter most when you are choosing a pediatric SLP.
ASHA certification (CCC-SLP). The American Speech-Language-Hearing Association awards the Certificate of Clinical Competence in Speech-Language Pathology. To earn it, a clinician completes graduate coursework and supervised clinical practicum, passes the national Praxis exam in speech-language pathology, and completes a mentored clinical fellowship. You can read about the requirements and verify an individual's status on ASHA's certification page. ASHA also runs a search tool for certified SLPs.
State licensure. States regulate who may practice speech-language pathology, and requirements vary from state to state. Most state licensing boards offer an online license lookup. SLPs who work in public schools may hold a state education credential in addition to, or in some states instead of, a health-department license. It is reasonable to ask a clinic which credentials each therapist holds.
You may also meet speech-language pathology assistants (SLPAs) in some clinics and schools. Where states allow them, assistants work under the supervision of a licensed SLP, who remains responsible for evaluation and the treatment plan.
How to tell if your child may need an evaluation
Children develop at different rates, and a wide range is normal. Milestone lists are not a test, but they are a useful way to organize what you are noticing. Two reliable, free starting points are:
- ASHA's developmental milestones chart, birth to 5 years, which focuses on hearing, speech and language.
- The CDC's developmental milestones from its Learn the Signs. Act Early. program, which covers checkpoints from 2 months to 5 years and includes free checklists and a milestone tracker app.
Signs that are commonly worth raising with your pediatrician or an SLP include a baby who does not respond to sounds or babble, a toddler who is not adding new words or combining words as expected, speech that even familiar listeners struggle to understand as a child gets older, stuttering that is frequent, causes visible tension or frustration, or lasts for months, frequent coughing or choking during meals, and any loss of words or skills a child used to have. ASHA's page on early identification explains why earlier support tends to be easier for families.
If something concerns you, you do not have to wait for a milestone to be missed. You can talk with your child's doctor and ask about developmental screening. In many cases you can also contact an SLP directly, although your insurance may require a physician referral. For children under 3, you can refer your child to your state's early intervention program yourself, at no cost for the evaluation.
What an evaluation involves
A speech and language evaluation usually takes about an hour or two, sometimes spread over more than one visit. The exact content depends on the concern, but it commonly includes:
- A case history. Questions about pregnancy and birth, medical history, hearing, milestones, languages spoken at home and what you have noticed.
- Standardized testing. Structured tasks such as naming pictures or following directions, scored against children of the same age.
- Informal observation. Watching your child play and talk, often with you in the room, because this shows how they communicate in everyday life.
- An oral-motor check. A look at how the lips, tongue and jaw move, and, for feeding concerns, observing your child eat.
- A hearing screening or a referral to an audiologist if hearing has not been checked recently.
Afterward, the SLP should explain the results in plain language and give you a written report. If therapy is recommended, the report typically lists specific goals, how often sessions are suggested and how progress will be measured. If therapy is not recommended, ask what to watch for and when to check back.
What therapy looks like, and your role
Pediatric speech therapy for young children usually looks like play: games, books, toys and snacks are chosen to create many chances to practice a target skill. Older children may work on more structured tasks. Sessions often run 30 to 60 minutes, once or twice a week, though plans vary widely.
Parents matter a great deal. The time between sessions is far longer than the sessions themselves, so good SLPs coach caregivers on simple ways to practice during daily routines such as meals, bath time and reading. Ask to watch or join sessions, and ask what to do at home this week.
Finding a provider
Speech therapy is offered by private practices, hospital outpatient departments, rehabilitation clinics, early intervention programs and public schools. Our directory lists clinics from the NPPES registry, the federal database of health care providers, which you can use alongside ASHA's search tool and your insurer's network list. When you call, ask whether the clinic sees children of your child's age, which areas it specializes in, and how long the wait is for an evaluation.