I have an almost 27 month old daughter. She was 7 weeks premature, but in all other aspects is completely normal for her actual age.
She only has about 30 words. Comprehension isn't an issue. She understands everything including following through on 2 part requests and can differentiate between a huge number of objects, knows her body parts, etc. Basically understands everything very well, but often communicates what she wants with gestures and actions rather than words.
Her hearing has been tested and is fine and the words she does have are very clear and understandable. She puts the few words she has together e.g. "Mama more nana" - meaning she wants me to get her more banana, etc. She also understands you, me, I, etc.
I personally wasn't super concerned about this. She has a cautious personality and seems to hold back until she feels confident she can do something well (didn't walk unassisted until 20 months and one day got up and walked a significant distance and was running within a couple days with very few stumbles).
My daughter's family doctor doesn't think there is a reason for major concern at this point due to her comprehension and thinks she will talk soon. We saw a speech therapist who said this is a very significant issue and if we don't act right now, we can't predict how she will do in school, may always be behind because of her poor verbal skills and this may be a sign of greater delays. The speech therapist said her diagnosis is "fine motor delay in language". All her other fine motor skills are normal.
My personal feeling is that she is fine. The speech therapist told me that she is probably very frustrated because she can't verbalize what she wants and because of this she uses gestures and actions to get her point across. To me, I don't see any frustration. She's a happy child who doesn't seem to have any delays with understanding language and isn't slow or lagging behind in other areas. She follows all instructions and it is clear she has a good understanding of language.
When she was a late walker, there was some concern about that too, but I had a feeling that it was just confidence (she'd walk far distances holding onto a finger, but didn't want to let go of that security) and sure enough she walked perfectly fine when she felt confident.
I'm just curious how often you see late talkers that go on to be okay without it resulting in significant issues in school, etc. The speech therapist is quite concerned and I'm wondering if my thoughts may be wrong since I'm not the expert! We will take her to see a speech therapist as it can't hurt.
I'd appreciate any comments or thoughts you may have observed in your experience.
From what you say, I would share the level of concern your doctor has. Her receptive vocabulary is fine, she understands and hears well. I'm really not sure what the role is for a speech therapist here. I don't think a speech delay at this age is a very good predictor of broad scale delay, especially when everything else is fine. I have seen many smart kids, who say nothing at two years, and then speak fine later on.
I would watch and follow.
Good luck, Dr. Olson