Abby Barnes, M.S., CCC-SLP
A premature baby has a higher risk of speech delay, although research shows different rates of delay depending on the child’s age and the language skills being measured. The good news is that many preemies do develop communication skills on track with their peers. When looking at milestones, use your baby’s adjusted age (in other words, their age minus the weeks they were born early) to get a more accurate picture of their development. In this article, we explain what to expect from your preemie’s speech development, how to spot a possible delay, and when to consider a speech evaluation.
Key takeaways
Premature babies have a higher risk of speech or language delays, especially those born very early or with health complications.
Adjusted age gives you a more accurate way to track your preemie’s development. Subtract the weeks your baby was born early from their actual age. Use this adjusted age for milestones until about age 2.
Your baby develops many communication skills before saying their first words, including babbling, responding to sounds, using gestures, and understanding simple words and directions.
If your child is not meeting communication milestones for their adjusted age, talk with their pediatrician or a speech therapist. A speech evaluation can help you understand what support they may need.
Early speech therapy can help your child build communication skills and give you practical strategies to use during everyday routines and play.
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Find a speech therapistParents and caregivers often have lots of questions about their preemie’s development in the first year and beyond. Here’s how a speech therapist would answer these common questions about speech delay in premature babies.
Q: How likely is it that my preemie will have a communication delay?
A: About 40% of premature babies experience some type of speech or language delay. The risk is higher for babies born very early, especially before 28 weeks. Babies born late preterm (34 to 36 weeks) also have a higher risk than full-term babies, but many develop communication skills without ongoing delays.
While we can never predict which kids will have difficulty with language, there are some risk factors that make a premature baby more likely to have a communication delay:
Needing respiratory support, especially for an extended amount of time
Having a hearing loss
Having a tracheostomy
Has many other health problems related to prematurity
Having had bronchopulmonary dysplasia (BPD)
Researchers are looking at ways to prevent these delays. One study from 2025 revealed that greater exposure to their mother’s voice promotes a premature baby's early language-related brain development. This means that hearing mom's voice more often might reduce language delays among preemies.
Learn the speech and language milestones to look for in your baby or toddler, from birth to 18 months.
Q. How can I tell if my premature baby has a speech delay?
A: “There is so much language development that happens in a baby's first year,” says Expressable speech therapist Alexis Irazoque, M.S., L/SLP. “While most infants don't begin to say true words until around age 1, there are many other communication skills that need to develop before this point!”
These skills can offer a clue as to whether your child is on track. But if you don't know the signs to look for, it may be a little tricky to spot a possible speech or language delay.
It helps to know the speech and language milestones for ages 0-12 months, 12-23 months, and 24-36 months. Research has shown that much of the connection between prematurity and speech and language delays decreases by around 36 months of age.
Q: What are the signs of a possible speech or language delay in a premature baby?
A: As mentioned above, it helps to understand the skills that babies and toddlers are expected to gain in their first few years. But when you compare your child's current skills to expectations for their age group, make sure you're going by their adjusted age, also called corrected age.
How to find your premature baby's adjusted age: Take your child's age, and subtract from it the number of weeks that they were premature.
Example: Say your baby is 12 weeks old, but they were born 4 weeks before their due date. 12 weeks - 4 weeks = 8 weeks. That makes your baby's adjusted age 8 weeks old. So, when looking at milestones, you should look at the list for 2-month-olds as opposed to 3-month-olds.
Adjusted age helps you compare your premature baby's development to the right milestones. Subtract the number of weeks your baby was born early from their actual age.
Here's another example. You may wonder when your preemie should start talking. Children usually say their first word around 12 months of adjusted age. If your baby was born 4 weeks early, 12 months adjusted age would be about 16 months of chronological age.
Most doctors recommend adjusting your child's age until they're about 2 years old. That’s because by age 2, differences related to being born early are usually much less important when looking at a child’s development. But be sure to talk with your child's pediatrician to get their recommendation.
Now that you know how to find your child's adjusted age, let's review some major communication milestones during the first and second years:
Milestones for 0-3 months:
Responding to sound by startling or reacting to loud sounds (could be a sign of hearing loss if baby does not respond to sound)
Cooing
Smiling
Learn what to expect in your child's early language development. Plus, how early intervention speech therapy can support your toddler's communication.
Milestones for 3-6 months:
Shifting eyes and turning head toward sound
Experimenting with their voice
Simple babbling like “ma!”
Laughing
Milestones for 6-9 months:
Reacting to simple games like “peek-a-boo”
Waving
Longer strings of babbling: “babababa”
This month-by-month guide helps you support your baby’s speech and language growth and development, from birth to age 1 year.
Milestones for 9-12 months:
Displaying joint attention
Responding to very simple directions like, “Come here” or “Stop”
Imitating sounds after you
Saying first words around 12 months
Milestones for 12-18 months:
Responding to their name
Following simple directions such as, “Give me the ball”
Lengthening attention during play routines
Speaking more spontaneously
Milestones for 18-24 months:
Should be able to understand around 50 words
Saying early consonants like /p/, /b/, /m/, /n/, /d/
Playing with toys appropriately (such as using a toy bottle to feed a baby doll)
Making eye contact consistently
Saying at least 5 to 10 words frequently
Beginning to use 2-word phrases, like “Want milk”
Q: When will my premature baby start talking?
A: Most children say their first words around 12 months of age. For a premature baby, use adjusted age. For example:
A baby born 4 weeks early may say their first word around 13 months chronological age (12 months adjusted).
A baby born 8 weeks early may reach this milestone around 14 months chronological age.
By 18 months adjusted age, most children use several single words. By 24 months adjusted age, most begin combining two words, such as “more milk.” If your preemie is not using words by 18 months adjusted age or combining words by 24 months adjusted age, talk with your child’s doctor or schedule a speech evaluation.
“It’s easy to compare your preemie to a full-term baby of the same age, but adjusted age gives you a better picture of your child’s development,” Irazoque says. “It can help you understand what’s expected for your preemie and recognize when extra support may be helpful.”
Q: How do I know if my premature baby needs speech therapy?
A: All children develop at different rates, whether they were born premature or full-term. If you notice that your child isn’t demonstrating some of the skills expected at their corrected age, talk to their pediatrician. Your premature baby or toddler may need a speech evaluation.
You can take our simple online screener to find out if your child would benefit from an evaluation. The questions are tailored by age, and you'll receive personalized results in minutes. Your doctor may recommend waiting a bit longer to watch your child’s development. But please note that it’s important to trust your gut. These first years of development are crucial, and it’s better not to waste time when your child could be receiving help. If your pediatrician recommends a “wait and see” approach, don’t wait more than a month before contacting a speech therapist.
If you have concerns, you could go ahead and make an appointment with a speech therapist now. “Many speech therapy providers have long waitlists, so it makes sense to get on the list,” Irazoque adds. “If your child makes progress, you can always take your name off!”
On a waitlist for speech therapy? Try these tips to shorten the wait, find other options, and work on speech at home in the meantime.
Q: How do I find a speech therapist for my premature child?
A: First, you will likely need a referral from your pediatrician. Ask if there are speech therapists they recommend. You can also talk with family and friends whose children have had speech therapy. Researching online is another option. Be sure to pay attention to online reviews.
If you have health insurance and want to use it for speech therapy, you’ll need to see a speech therapist that’s in-network with your insurance company. Learn more in our guide to insurance coverage for speech therapy.
Once you find a speech therapist, you’ll make an appointment for a speech-language evaluation. In this evaluation, the speech therapist will assess your child’s current communication skills and determine if therapy is needed. If it is, the speech therapist will create a treatment plan of goals that target areas where your child needs to improve.
Throughout speech therapy, you'll work closely with your child's speech therapist. They will keep you updated on your child's progress and teach you what to practice at home.
Ready to get started? Get matched with a speech therapist at Expressable. Our therapists have experience working with children with a variety of communication needs. We accept many large health insurance plans, and there are no waitlists.
Early intervention makes a difference
If your baby or toddler is behind in their communication development, try not to worry. Every child is different, and getting support early can help you understand your child's needs and start building their communication skills.
Some children may catch up within months, while others may need more support over time. Children may also use different ways to communicate, such as sign language or AAC. No matter what their journey looks like, your involvement makes a world of difference. No one is better at knowing what your child needs than you are! Be proud of all that you're doing for your little one, and get ready to watch their communication skills soar.
Frequently asked questions (FAQs)
Premature babies may be more likely to have developmental delays, but being born early does not mean your child will have a delay. Development can vary based on how early your baby was born and their overall health. When tracking milestones, use your child’s adjusted age until about age 2. If your child is not meeting milestones for their adjusted age, talk with their pediatrician or a speech therapist.
By 24 months adjusted age, most children are beginning to combine two words into short phrases, such as “more milk.” If your preemie is not talking or combining words at this age, has very few words, or has lost words they used before, talk with your pediatrician or a speech therapist. Around age 2, adjusted age is generally no longer needed when tracking milestones, but your pediatrician can help you decide what’s right for your child.
Preemies may reach some language milestones later than full-term babies, especially when they are born very early. Adjusted age helps account for the weeks your baby was born early. For example, a baby born 8 weeks early who says a first word at 14 months chronological age would be 12 months adjusted. Many differences related to prematurity become less important by age 2, which is why adjusted age is generally no longer used after this point. If you have concerns about your child’s communication, a speech-language evaluation can help you understand their development and next steps.
How Expressable Can Help
Concerned your child isn't reaching age-expected milestones? Looking for communication support from a professional? Expressable is a national online speech and occupational therapy practice serving children and adults. We treat all major areas of communication, feeding, and developmental skills, offer flexible hours including evenings and weekends, and accept most major health insurance plans. We’re proud to have earned more than 4,500 5-star reviews from our clients (4.83/5 average).
Our therapy model is centered on parent and caregiver involvement. Research proves that empowering caregivers to participate in their loved one’s therapy leads to better outcomes. That’s why we combine live, 1-on-1 speech and occupational therapy with personalized education and home practice activities for faster progress.
