Hi there. This is a great question. So, she is still really young. Almost too young for speech evaluation to be telling. We waited until our son was 3.5. He also garbled his words and left out the middle part of it. We saw a phd speech pathologist at our city's Children's Hospital and he fell within normal. Which basically means there is a really wide range of normal for kids under 4. With that said, my son has something called sensory processing disorder. Tripping frequently is a sign as is garbled speech. When you do a speech eval, they check the three areas of speech which are articulation (the ability to understand the words she is saying), expressive language (ability to formulate what to say to others) and receptive language (ability to understand and process what is said to her). You can have an issue in any one of the three areas or all three but they are separate parts of speech. The garbled speech can be very normal for a toddler of her age. But kids ARE supposed to make some progress. If she is using the wrong word, that can be a sign to eventually have her evaluated. They actually have a name for mixing up words which is phonological processing disorder. Not saying she has this because PLENTY of kids exhibit these exact same things and nothing is wrong and they outgrow it. She's still very young, remember that. By the way, my son with sensory processing disorder is now a teenager. He's a straight A student, athlete, plays an instrument in first chair of the school Jr. band, and has a small group of friends. It's not always been easy but we did occupational therapy and addressed his processing disorder and things greatly improved. So IF there does end up being this or that going on, please don't despair. They can do amazing things for children these days! Does she exhibit any other issues? How is her motor development? Does she undersand basic instructions you give her? Is she clumsy at all?