Some children may have excellent pronunciation and may even be early readers, but they may need speech therapy to improve “pragmatic” language, or the process of using verbal and body language appropriately in social situations for everyday purposes such as making requests, having conversations, and making friends. Other reasons children may need speech therapy include medical conditions such as a brain injury or infection that has affected their ability to communicate and an identifiable disability such as Down syndrome. Services often begin at a young age and continue as children enter school and start to communicate with written language.