Background: Speech and language delay is among the most common developmental concerns in early childhood, with reported prevalence ranging widely across populations. Early identification using simple, culturally appropriate tools may improve outcomes. The Language Evaluation Scale Trivandrum (LEST) is an Indiandeveloped, validated screening instrument suitable for primary and tertiary care settings. Objectives: To determine the prevalence of speech and language delay in children aged 3 to 6 years attending a tertiary care paediatric outpatient department, and to examine its association with sociodemographic, perinatal, family, growth and screen-time variables. Methods: A cross-sectional observational study was conducted at the paediatric outpatient department of Narendra Modi Medical College and L.G. Hospital, Ahmedabad, India, between November 2023 and February 2024. Two hundred and fifty consecutive children aged 36-72 months whose primary caregivers consented were screened using LEST (3-6 years). Sociodemographic data, perinatal history, family environment, screen time and anthropometry were recorded. A child was classified as delayed if at least one age-appropriate item was failed. Associations were tested using the chi-square test or Fisher's exact test, with p < 0.05 considered statistically significant. Results: Of 250 children, 34 (13.6%) were screened positive for speech and language delay. Delay was significantly associated with increasing age (5.9% at 36-48 months vs 28.6% at 61-72 months; p = 0.0003), preterm birth (p = 0.009), low birth weight (p = 0.03), neonatal intensive care unit admission (p = 0.002), past history of convulsion (p = 0.003), family history of developmental delay (p = 0.014), lower socioeconomic status (p = 0.05), lower maternal education (p = 0.03), multilingual home environment (p = 0.01) and parental concern about language development (p = 0.02). Sex, family type, birth order, paternal education, excess screen time and current nutritional status were not significantly associated with delay in this cohort. Conclusions: More than one in eight children aged 3-6 years attending a tertiary care paediatric clinic screened positive for speech and language delay using LEST. Routine screening, particularly in children with perinatal risk factors, low maternal education or multilingual exposure, can identify affected children early and enable timely referral for intervention.

Speech delay, language delay, LEST, developmental screening, preschool children, India, risk factors.