What observation in a child should indicate the need for a referral to a specialist regarding a communication impairment?

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If a 2-year-old child fails to respond consistently to sounds,it is an indication for referral to a specialist regarding communication impairment.At age 3 years,the child failing to use sentences of three words would be an indication for referral; impaired sentence structure would be seen in a 5-year-old child and poor voice quality in an older child who has a communication impairment.

What Observation in a Child Should Indicate the Need for a Referral