Abstract Background Speech communication is a complex process based on the function of the central nervous system, and also on speech mechanisms conditioned and controlled by auditory perception, verbal memory, intellectual activity and peripheral speech apparatus. The aim of this study was to determine the prevalence of the most common phonological articulation disorders in preschool children, from 4-6 years old. Methods A cross-sectional study was conducted during 2018 year on a representative sample of 550 preschool children aged 4 - 6 years, who attend preschool institutions-kindergartens in the city of Skopje. The study used standardized articulation tests: the Global Articulation Test (GAT) and the Triple Test (vocals, plasia, africative, fricative, nasal, and lateral), and a questionnaire filled out by a social worker at the kindergarten for socioeconomic status and the child's health condition. Results Using GAT, we found that 260 (47.3%) children didn't have a phonological articulation disorders, and 290 (52.7%) had disorders. The analysis of gender-based data showed a higher percentage of speech disorders in 57% of boys and 46.9% of girls. The highest percentage of speech disorder is sigmatism with 24.5% in boys and 20.4% in girls, rhotachism was found in 17.8% in boys and 16.5% in girls. Lambdacism with 8.3% was found in boys and 4.2% in girls. A mixed form (sigmatism, rotacism, and lambdacism) was also found in 2.4% of boys and 3.5% of girls. Conclusions The prevalence of phonological articulation disorders in preschool children is 52.7%, 57.9% in boys and 46.9% in girls, or every second child in kindergarden at age 4-6 years has speech disorder. These findings indicate that the treatment of speech disorders should be started in appropriate services as soon as possible, because early detection and treatment of speech disorders enable to child normal intellectual development. Key messages Speech disorders are important public health issue because these children will require in some cases emotional and behavioral support, not only speech-related intervention. The treatment of speech disorders should be started in appropriate services because early detection and treatment of speech disorders gives the child more confidence to build his intellect.