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Language Development Milestones

This article outlines key language development milestones as well as hearing issues and ways to detect them early. It also includes a test to assess your own child's language development.

How do speech and language normally develop?

The most intensive period of speech and language development for humans is during the first three years of life, a period when the brain is developing and maturing. These skills appear to develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

There is increasing evidence suggesting that there are "critical periods" for speech and language development in infants and young children. This means that the developing brain is best able to absorb a language, any language, during this period. Research has shown that by six months of age, most children recognize the basic sounds of their native language.

As the speech mechanism (jaw, lips, and tongue) and voice mature, an infant is able to make controlled sound. This begins in the first few months of life with "cooing," a quiet, pleasant, repetitive vocalization. By six months of age, an infant usually babbles or produces repetitive syllables such as "ba, ba, ba" or "da, da, da." Babbling soon turns into a type of nonsense speech (jargon) that often has the tone and cadence of human speech but does not contain real words. By the end of their first year, most children have mastered the ability to say a few simple words. Children are most likely unaware of the meaning of their first words, but soon learn the power of those words as others respond to them.

By eighteen months of age, most children can say eight to ten words. By age two, most are putting words together in crude sentences such as "more milk." During this period, children rapidly learn that words symbolize or represent objects, actions, and thoughts. At this age they also engage in representational or pretend play. At ages three, four, and five, a child's vocabulary rapidly increases, and he or she begins to master the rules of language.

How do I know if my child is reaching the milestones?

Take the test.

What should I do if my child's speech or language appears to be delayed?

You should talk to your family doctor if you have any concerns about your child's speech or language development. Your doctor may decide to refer you to a speech-language pathologist.

HEARING MILESTONES

In the first few years of life, hearing is a critical part of a child’s social, emotional, and cognitive development. Even a mild or partial hearing loss can affect a child's ability to speak and understand language.

Hearing loss is a very common birth defect. Approximately 1 to 3 out of every 1,000 babies is born with some degree of hearing loss. There are a number of factors that can lead to hearing loss, and about half the time, no cause is found.

The good news is, hearing problems can be treated, if they’re caught early – ideally by the time a baby is three-months old. So it's important to get your child’s hearing screened early, and evaluated on a regular basis throughout life.

Causes of Hearing Loss

was born prematurely
stayed in the neonatal intensive care unit
had high bilirubin requiring a transfusion
was given medications that can lead to hearing loss
has a family history of childhood hearing loss
had complications at birth
had frequent ear infections; had infections such as meningitis or cytomegalovirus
exposed to very loud sounds or noises even of brief duration

When Should My Child's Hearing Be Evaluated?

Most children who are born with a hearing loss can be diagnosed through a hearing screening. But in some cases, the hearing loss is caused by things like infections, trauma, and damaging noise levels, and the problem doesn’t emerge until later in childhood. So it’s important to have your child’s hearing evaluated on a regular basis as he or she grows.

Symptoms of hearing loss in children are easily mistaken, but signs can be that the child:

doesn’t react when called
appears inattentive or prone to daydreaming
listens to the TV at high volumes
talks too loudly
mispronounces words
becomes unsettled in school
is often tired, grumpy, frustrated or over-active

How Do I Know If My Child Is Reaching the Language Development Milestones? Here is a checklist. Talk to your child's doctor about anything that is checked "no."
Birth to 5 months	Yes	No
Reacts to loud sounds.	___	___
Turns head toward a sound source.	___	___
Watches your face when you speak.	___	___
Vocalizes pleasure and displeasure sounds (laughs, giggles, cries, or fusses).	___	___
Makes noise when talked to.	___	___

6 - 11 months	Yes	No
Understands "no-no."	___	___
Babbles (says "ba-ba-ba" or "ma-ma-ma").	___	___
Tries to communicate by actions or gestures.	___	___
Tries to repeat your sounds.	___	___

12 - 17 months	Yes	No
Attends to a book or toy for about two minutes.	___	___
Follows simple directions accompanied by gestures.	___	___
Answers simple questions nonverbally.	___	___
Points to objects, pictures, and family members.	___	___
Says 2-3 words to label a person or object (pronunciation may not be clear).	___	___
Tries to imitate simple words.	___	___

18 - 23 months	Yes	No
Enjoys being read to.	___	___
Follows simple commands without gestures.	___	___
Points to simple body parts such as "nose."	___	___
Understands simple verbs such as "eat," "sleep."	___	___
Correctly pronounces most vowels and n, m, p, h.	___	___
Says 8 to 10 words (pronunciation may still be unclear).	___	___
Asks for common foods by name.	___	___
Makes animal sounds such as "moo."	___	___
Starting to combine words such as "more milk."	___	___
Begins to use pronouns such as "mine."	___	___

2 - 3 years
Knows about 50 words and says around 40 words at 24 months.	___	___
Knows some spatial concepts such as "in," "on."	___	___
Knows pronouns such as "you," "me," "her.", and some descriptive words	___	___
Speech is becoming more accurate but may still leave off ending sounds.	___	___
Answers simple questions.	___	___
Begins to use more pronouns such as "you," "I."	___	___
Speaks in two to three word phrases.	___	___
Uses question inflection to ask for something (e.g., "My ball?").	___	___
Begins to use plurals such as "shoes" or "socks" and regular past tense verbs	___	___

3 - 4 years	Yes	No
Groups objects such as foods, clothes, etc.	___	___
Identifies colors.	___	___
Uses most speech sounds but may distort difficult ones: l, r, s, sh, ch, th, y,v, z	___	___
Strangers are able to understand much of what is said.	___	___
Able to describe the use of objects such as "fork," "car," etc.	___	___
Has fun with language. Enjoys poems and recognizes absurdities such as, "Is that an elephant on your head?"	___	___
Expresses ideas/feelings rather than just talking about the world around.	___	___
Uses verbs that end in "ing," such as "walking," "talking."	___	___
Answers simple questions such as "What do you do when you are hungry?"	___	___
Repeats sentences.	___	___

4 - 5 years	Yes	No
Understands spatial concepts such as "behind," "next to."	___	___
Understands complex questions.	___	___
Speech is understandable but makes mistakes pronouncing long, difficult, or complex words such as "hippopotamus."	___	___
Says about 200 - 300 different words.	___	___
Uses some irregular past tense verbs such as "ran," "fell."	___	___
Describes how to do things such as painting a picture and defines words	___	___
Answers “why” questions.	___	___
Lists items that belong in a category such as animals, vehicles, etc.	___	___

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