and language are the skills we use to communicate with others. We form these
skills during the first years of life. By age 6, most children learn the
basics. Try to talk and read to your child often to boost these skills.
Speech is making the sounds that become words—the physical act of
Language is our system of using words to communicate. It
includes using words and gestures to say what we mean, and understanding
what others say.
learning in the womb, where they hear and respond to familiar voices. The
fastest learning occurs from ages 2 to 5 years.
language milestones help tell whether a child is developing as expected.
Milestones are certain skills, such as babbling, saying "mama" or "dada," or
putting two words together. Usually, a child needs to master one milestone
before reaching the next.
Babies usually start cooing at around 2
months and are babbling by about 6 months. A child usually speaks in gibberish,
called jargon, by the first birthday. At 15 to 18 months, a typical toddler
understands much more than he or she is able to put into words. Starting around 18 months, many children have a burst in talking. By 24 months, children tend to use at least 50 words and are also starting to use two-word phrases.
Keep in mind that the age at which children reach
milestones varies from child to child. Some children, especially girls, are
advanced. Others develop more slowly.
child who is surrounded by speech and language all the time usually learns
language skills faster. Talking to and reading to your child will have a big
effect on how well your child is able to communicate later. Children who are
seldom spoken to or read to usually learn to talk later than other children
Sometimes there is a reason that a child has a speech and language problem. For instance, a child may have a language delay because of trouble hearing or because of a developmental disorder such as autism. Often, there is not a clear cause.
important to track your child's speech and language development. A child can
overcome many speech and language problems with treatment, especially when you
catch problems early.
doctor will check your child's speech and language skills during regular
well-child visits. But call your doctor anytime you have concerns about how
your child is developing.
Mild and temporary speech delays can occur. Some
children learn new words faster than others do. But if your child is not saying
words by 18 months, or says fewer than 50 words by 24 months, talk with your
Learning about speech and language development:
Although speech and language continue
to develop through adolescence, children usually reach major milestones in
predictable stages by 6 years of age. The exact pace at which speech and
language develop varies among children, especially the age at which they begin
Communication skills are often categorized as receptive
language and expressive language. Receptive language is the understanding of
words and sounds. Expressive language is the use of speech (sounds and words)
and gestures to communicate meaning.
milestones can be described according to age.
Mild and temporary speech delays can occur in some children.
Some children learn new words faster than others do. If your child is not
saying words by 18 months, or can say fewer than 50 words by 24 months, talk with
your doctor. All children with a speech delay should have their
Keep in mind that many
different things determine a child's speech development. Be aware of the
common misconceptions about what causes speech and
language delays, such as laziness or developmental differences between boys and
girls. Even if some of these things contribute to a child's speaking slightly
later than others of the same age, they are not the cause of significant speech
delays. True delays are related to developmental or health issues, such as some
types of hearing loss or a family history of speech and language delay.
Red flags for speech and language developmental delays
are generally based on established speech and language milestones. Talk to your
child's doctor any time you have concerns. It is critical to identify
speech and language delays early and rule out other conditions, such
as difficulty hearing. Early diagnosis allows the doctor to recommend
treatments that can help prevent long-term problems.
While they learn and master new
language skills, children sometimes talk in ways that are demanding or
impolite. For example, a child may say "Give me!" when he or she wants a toy.
Often this behavior is the result of children's inability to find
the words that fit their feelings, or they are simply repeating what is being
said around them. Gently remind your child to use an appropriate voice and
manners. And consistently model polite speech and behavior.
parents think that their child is constantly talking or chattering. This is a
child's way of practicing. It is not necessary for parents to listen and
respond to everything a talkative child says, but don't completely tune out
your chatterer either. Singing and dancing with your child and playing music or
reading stories geared toward children will help your child learn to listen and
to express himself or herself.
Most children make developmentally
"mistakes" when they first learn to talk. For example,
children commonly mispronounce words, such as saying "pasghetti" for
"spaghetti." As children listen to other people, they often correct their
mistakes. They learn to say words clearly and use grammar correctly through
well-child visits, the doctor uses various methods to test your child's development.
You'll often answer questions about whether your child has reached milestones
for his or her age. And the doctor will use your comments to assess your
child's speech and language development. If your child is suspected of having a
speech or language delay, the doctor will refer your child to a
speech-language pathologist to have
specific tests that measure nonverbal intelligence,
language skills, and vocabulary.
Hearing problems can be an
important cause of speech and language delays in children. For this reason,
hearing tests are an essential part of any suspected
speech and language developmental delay. Hearing problems that are caught and
treated within 6 months after birth may help prevent some developmental
problems, including those related to speech and language development.1
United States Preventive Services Task Force
recommends that all newborns be screened for hearing loss.2 Most newborns in the U.S. are screened for hearing loss
before leaving the hospital. Call your doctor if at any time you think your
child may have a hearing problem. Even if the newborn test did not show hearing
loss, hearing problems could arise.
Call your doctor any time you
or another caregiver has concerns about your child's speech and language
development. Be aware of
red flags that point to a possible
developmental delay, such as when your child does not
make sounds that are expected for his or her age.
Your doctor will conduct a physical exam and ask questions about your child's
medical history. This information can help your doctor identify
developmental patterns and assess whether any other conditions, such as
hearing loss, are interfering with development.
Your doctor may also recommend other tests to:
The following health professionals can
diagnose speech and language problems and may work with other health
professionals to treat them:
Other professionals may
be involved in the care of children with speech and language delays:
Talking and reading to your baby and,
later, encouraging conversation are vital contributions to your child's speech
and language development. The size of a 2-year-old's vocabulary is directly
related to how much parents and other caregivers have spoken to that child from
Newborn babies are programmed to learn, and most parents
are naturally excellent language teachers. The kinds of interactions and
conversations parents normally engage in with their children, from "baby talk"
to repeating words, happen to be perfect language lessons. Talking, reading,
listening, and responding to babies and young children usually are all that is
needed to help them learn to talk.
Teaching sign language to babies 6
months or older could also help them in several ways. Signing gives babies a way to
express their wants and needs when they can't talk. And it gives you another
way to bond with your child. Using sign language has not been shown to get in
the way of language development.3
reading to your child before he or she is 6 months old. And continue to read to
your child each day. Reading to your young child is an especially important
learning activity for several reasons. While reading, you and your child share
a comforting closeness. You also both focus on the same picture and the same
concept. Your child can ask you questions, and you can reinforce his or her
observations. Reading provides opportunities for children to learn new words
that they would not normally come across in everyday conversation. Reading
frequently to your child may help with his or her speech development, later
reading abilities, and school performance.
If you have concerns
about your own reading skills, seek out an adult reading program at your local
library or public school system. You can also see America's Literacy Directory
online to find reading programs in your area. The website address is
To encourage and support your child's speech and language
The American Speech-Language-Hearing Association (ASHA)
promotes the interests of and provides services for professionals in audiology,
speech-language pathology, and speech and hearing science. ASHA also advocates
for people who have communication disabilities. The website has information on
related health topics, self-help groups, and finding a professional in your
NCBDDD aims to find the cause of and prevent birth
defects and developmental disabilities. This agency works to help people of all
ages with disabilities live to the fullest. The website has information on
many topics, including genetics, autism, ADHD, fetal alcohol spectrum
disorders, diabetes and pregnancy, blood disorders, and hearing loss.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Dissemination Center for Children with
Disabilities (NICHCY) is the national information and referral center that
provides information on disabilities and disability-related issues for
families and professionals. The focus is on children and
youth, birth to age 22.
The National Institute on Deafness and Other
Communication Disorders, part of the U.S. National Institutes of Health,
advances research in all aspects of human communication and helps people who
have communication disorders. The website has information about hearing,
balance, smell, taste, voice, speech, and language.
Morton CC, Nance WE (2006). Newborn hearing screening—A silent revolution. New England Journal of Medicine, 354(20): 2151–2164.
U.S. Preventive Services Task Force (2008). Universal Screening for Hearing Loss in Newborns: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf08/newbornhear/newbhearrs.htm.
Simms MD, Schum RL (2011). Language development and communication disorders. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 114–122. Philadelphia: Saunders Elsevier.
Council on Communications and Media, American Academy of Pediatrics (2011). Media use by children younger than 2 years. Pediatrics, 128(5): 1–6.
Other Works Consulted
American Academy of Pediatrics (2008). Promoting child development. In JF Hagan et al., eds., Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed., pp. 39–75. Elk Grove Village, IL: American Academy of Pediatrics.
Coplan J (2011). Language delays. In M Augustyn et al., eds., The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed., pp. 258–262. Philadelphia: Lippincott Williams and Wilkins.
Duursma E, et al. (2008). Reading aloud to children: The evidence. Archives of Disease in Childhood, 93(7): 554–557.
Goldson E, Reynolds A (2012). Child development and behavior. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 73–112. New York: McGraw-Hill.
Joint Committee on Infant Hearing, American Academy of Pediatrics (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120(4): 898–921. Also available online: http://pediatrics.aappublications.org/cgi/reprint/120/4/898.
Law J, et al. (2003). Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database of Systematic Reviews (3). Oxford: Update Software.
Newman BM, Newman PR (2012). Toddlerhood (ages 2 and 3). In Development Through Life: A Psychosocial Approach, 11th ed., pp. 195–237. Belmont, CA: Wadsworth Cengage Learning.
Sosinsky LS, et al. (2007). The preschool child. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 261–267. Philadelphia: Lippincott Williams and Wilkins.
U.S. Preventive Services Task Force (2006). Screening for speech and language delay in preschool children: Recommendation statement. Available online:
December 21, 2012
Susan C. Kim, MD - Pediatrics
& Louis Pellegrino, MD - Developmental Pediatrics
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