“Why Don’t You Recommend Folate or Thiamine?”

Recently, I saw a social media video questioning—and criticizing—why speech-language pathologists do not recommend supplements like folate or L-thiamine for children with speech and language delays. While social media can be a powerful space for discussion, it can also blur the line between opinion and evidence. I want to take a moment to explain why evidence, ethics, and scope of practice guide my decisions as a clinician.



This response isn’t about dismissing parent concerns. It’s about clarifying what we know, what we don’t, and what is truly supported by science when it comes to helping children communicate.

Scope of Practice Matters

As a speech-language pathologist, my role is to assess and treat communication and feeding disorders using evidence-based therapy—not to prescribe supplements or medical treatments.

Professional guidance from organizations such as American Speech-Language-Hearing Association is clear:

• SLPs do not diagnose nutritional deficiencies
• SLPs do not recommend vitamins or supplements
• Medical and nutritional concerns are addressed in collaboration with physicians

Saying “I’m not a doctor and can’t make those recommendations” is not avoidance—it is ethical, responsible care.

But If We’re Asking the Question — What Does the Evidence Say?

If supplements like folate or thiamine truly improved speech or language development, I would absolutely want to know—and use that information. Evidence-based practice requires us to look beyond trends and ask whether high-quality research supports a recommendation.

Folate (Vitamin B9)

Folate is essential for:

• Neural tube development during pregnancy
• DNA synthesis and cell growth
• Red blood cell production

There is strong, well-established evidence supporting folate:

• During pregnancy
• For individuals with a documented folate deficiency

There is not strong evidence showing that folate supplementation:

• Improves speech sound development
• Improves expressive or receptive language
• Treats speech or language delays in otherwise healthy children

Without a medically diagnosed deficiency, recommending folate as a treatment for speech or language delays is not supported by current research.

L-Thiamine (Vitamin B1)

Thiamine plays a role in:

• Energy metabolism
• Nerve function
• Severe deficiency states (which are rare in developed countries)

Online discussions often reference:

• Small studies
• Case reports
• Populations with severe malnutrition or rare metabolic conditions

These findings are frequently taken out of context and generalized to children who do not meet those criteria.

At this time, there is no strong clinical evidence that thiamine supplementation:

• Improves speech development
• Treats language delays
• Improves articulation, phonology, or language processing
  in the general pediatric population

In most cases, recommending thiamine without a medical indication is a shot in the dark, not an evidence-based intervention.

Why “It Can’t Hurt” Isn’t a Clinical Standard

In healthcare, biological plausibility (“the brain needs nutrients”) is not the same as evidence.

Recommending supplements without evidence:

• Creates false hope
• Distracts from therapies proven to work
• Risks unnecessary or excessive supplementation
• Blurs professional and ethical boundaries

Good intentions alone are not enough. Children deserve interventions backed by data—not trends.

What Is Supported by Evidence?

Decades of research consistently support:

• Early identification
• Individualized speech-language therapy
• Parent coaching and language-rich environments
• AAC when appropriate
• Collaboration with medical providers when nutritional or medical concerns are suspected

These approaches directly target communication skills—and we know they work.

About the Narrative That This Is “Wrong”

Choosing not to recommend unsupported supplements is not neglect.
Staying within scope of practice is not lack of care.
Saying “we don’t have evidence for that” is not closed-minded—it is responsible.

Evidence-based care sometimes means saying no—even when something is popular online.

My Commitment to Families

My responsibility is to:

• Be honest about what science supports
• Use interventions with demonstrated benefit
• Collaborate with medical providers when appropriate
• Protect children from unnecessary or unsupported treatments

If there is concern for a nutritional deficiency, I will always encourage families to discuss that with their pediatrician—because that is where those decisions belong.

The Bottom Line

I do not recommend folate or L-thiamine for speech and language delays—not because I don’t care, but because the evidence does not support it, and because children deserve care grounded in science, ethics, and respect.

And I will always choose that—even when social media says otherwise.