Word Loss in Toddlers

When a toddler stops saying words he once said, the change is worth raising with a professional right away, and both the Centers for Disease Control and Prevention and the American Academy of Pediatrics list a lost skill as a reason to talk to the child’s doctor. Word loss has more than one explanation, and an evaluation looks into each.

What you’ll learn

• Why losing words is treated differently from talking late
• Possible explanations for word loss, including hearing that changes after birth
• What to write down before the appointment
• Who to call first, and what happens after the call

Should I Wait If My Child Has Lost Words?

Words a toddler used to say and has stopped saying are worth raising with a professional now, because losing a skill is handled differently from being slow to gain one. The Centers for Disease Control and Prevention (CDC) lists a child losing skills he or she once had as a reason for parents to talk with the child’s doctor and share their concerns, separate from any missed milestone.

The American Academy of Pediatrics (AAP) says the same in its own words, asking parents to tell the child’s doctor if a child stops talking or stops doing things he or she used to do, with no age attached. The American Speech-Language-Hearing Association (ASHA) goes further in its guidance for speech-language pathologists, where a loss of language or social skills at any age counts as grounds for a professional to look further.

Losing skills is the change clinicians want to hear about soonest, so the order of steps differs as well. Home strategies for encouraging talk suit a child who understands and simply isn’t saying much yet, while for a child who is losing words, the first step is a call to a professional, with any new routine at home coming after it.

Lost Words and a Slow Start Are Different Questions

Late talking and word loss can sound alike, but they describe different patterns. A late talker is a toddler whose words are slow to arrive, and ASHA’s clinical name for that pattern, late language emergence, means a delay in the start of language in a child with no other diagnosed disability or delay. The definition covers words that have not come yet, so it says nothing about words a child had and then lost.

Different again is a toddler who has said words but seldom uses them to ask for things or to share them, a pattern explained in toddlers who have words but rarely use them.

The difference matters when it comes to catch-up figures. About half of children who talk late catch up without help by age three, and clinicians cannot tell ahead of time which children those are. Because the figures come from children who started slowly, they cannot describe what follows a loss of words, and they offer no grounds for waiting once words have gone.

The CDC’s milestone checklists run from 2 months to 5 years, and the pages for different ages, 18 months and 3 years among them, each ask whether a child has lost any skills he or she once had, so the question is not tied to one age. The usual way words build up over time is covered under speech and language development, and the slower pattern of a delay is explained in speech delay in children.

Possible Explanations for a Toddler Losing Words

Several different things can explain word loss, and nobody can work out from home which one applies, which is the job of an evaluation. The AAP’s policy sends a child found at risk for a developmental disorder down two paths at once, early intervention and thorough medical and developmental evaluations, so the search for a cause and the start of support happen together.

Autism is one possibility an evaluation considers. Among children later diagnosed with autism, the AAP says about 25 percent may develop some language that they then stop using, suddenly or gradually, and the AAP calls that change a regression in skills. The figure looks back at children who already have the diagnosis, so it works in one direction only and does not mean a child who loses words is autistic.

Some explanations are medical, and a few are rare. The National Institutes of Health (NIH) describes Landau-Kleffner syndrome as a rare nervous system disorder beginning in childhood, with seizures and a sudden or gradual loss of the ability to understand or express language, which a doctor diagnoses from the overall picture and an EEG, a recording of the brain’s electrical activity.

For a child growing up with two languages, tell the evaluator every language your child hears and who speaks it.

Hearing Can Change After the Newborn Test

A newborn hearing test describes hearing at birth, and a child can pass it and still develop hearing loss later. ASHA notes that some children have a hearing loss from birth while others lose their hearing as they get older. The National Institute on Deafness and Other Communication Disorders (NIDCD) says hearing loss can begin at any time of life, with some inherited forms not appearing until a child is older.

Because a child needs hearing to understand spoken language, the AAP tells parents to make sure a formal hearing evaluation happens promptly whenever they or the pediatrician suspect a hearing problem, at any point in a child’s life. NIDCD also says a parent concerned about hearing at any age should talk to the pediatrician right away. A hearing check is one part of looking into word loss, and on its own it may not account for the change.

NIDCD adds that a speech-language pathologist may suggest further evaluation by an audiologist, a professional trained to identify and measure hearing loss, or by a developmental psychologist, so more than one specialist can end up involved.

A Written Record of the Words That Went

Before the appointment, write down what your toddler used to do: each word or skill your child no longer uses, and roughly when you last saw or heard it. A description that concrete is something a pediatrician or speech-language pathologist can work from, far more than a general sense that the talking has slipped.

From clinical practice

Memory blurs quickly, and the order in which words dropped away is easy to lose. A plain written record holds it: the words that went, roughly when each one was last heard, and anything else that shifted at about the same time.

Kept on paper or a phone, that list helps an evaluation for lost words more than almost anything else a family can bring. It shows the pattern on its own, including whether the losses came together or one by one.

The CDC tells parents to be ready to share their specific concerns when they call, and to hold on to any notes they have written about them. The AAP’s developmental and behavioral pediatricians suggest taking videos of anything you want to talk about and sharing them during the visit, along with reports from any earlier evaluations.

Keep a log of the calls as well. Whenever you phone a doctor’s office, early intervention or the school system, the CDC suggests noting the name of the person you spoke with, the day, and what they told you, since you might need those details later.

The First Call: Pediatrician or Early Intervention

Either call is a reasonable place to begin, and a family can make both. The AAP describes several things a pediatrician may do next: talk with you and spend time with your child, use a questionnaire, arrange a hearing test along with a referral to a speech-language pathologist, or send your child to early intervention for an evaluation.

Parents of children under three don’t need anyone’s referral to reach their state’s early intervention program, and its evaluation costs nothing in any state, since federal law requires the evaluation to be paid from public funds. Federal rules allow the program 45 days, counted from when it receives the referral, to finish the evaluation and, if your child is eligible, hold a first planning meeting. Each step is laid out in getting a speech evaluation.

Once a child has turned three, the request goes to the school system, and the CDC suggests phoning any public elementary school nearby, including one your child doesn’t go to, and requesting an evaluation for preschool special education. Early intervention stops at the third birthday in most states, although some continue it beyond three.

If the advice you get is to give the words a few more weeks and you are still uneasy, you are entitled to ask for a referral anyway, or to contact early intervention on your own. The AAP considers a second opinion fine whenever a doctor is not worried and a parent still is.

In a joint article, the AAP and ASHA tell parents who remain concerned to go with their instincts, whether by seeking another opinion or by having a speech-language pathologist evaluate the child. For speech worries other than lost words, when to seek help for a speech delay walks through the options.

Common Questions From Parents

My Toddler Stopped Saying Words He Used to Say. Should I Wait?

No. Call the pediatrician now, because the CDC counts losing a skill as reason enough to talk to the doctor, with no other sign needed. For a child under three, you can also contact early intervention yourself, without a referral.

Is Losing Words a Sign of Autism?

Not by itself. Some children later diagnosed with autism did stop using words they once had, but that finding starts from the diagnosis, so it cannot be read in reverse. An evaluation also looks at hearing, rarer medical causes and other explanations.

Can a Hearing Problem Cause a Child to Lose Words?

Hearing is checked because a child relies on it to understand speech, and hearing loss can begin after a passed newborn test. A hearing evaluation answers one part of the question, and other explanations are looked into alongside it.

What Counts as Losing Words?

A word or sign your child used on their own, with a clear meaning, and has stopped using. The AAP’s guidance reaches past words to anything a child used to do and has stopped. If you are unsure about a change, write it down and ask.

What Should I Write Down Before the Appointment?

Each word that has gone and about when you last heard it, plus any other change from that period. The AAP’s developmental pediatricians also suggest bringing videos of what you want to discuss, and the CDC suggests a note of every call you make.

Who Do I Call First?

Either your child’s pediatrician, where the CDC and the AAP both point parents, or, for a child under three, your state’s early intervention program, which takes calls from parents directly. From the third birthday, the CDC says any local public elementary school can start the request.

Reviewed by Monica d’Errico-Franklin, M.S., CCC-SLP

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