“Is she saying at least 10 words?” the doctor asks.
“Yes, of course,” you quickly reply as you try to shush the 18 month old on your lap. He continues to ask similar questions as you quickly reply, not reading too much into the questions being posed. Or maybe you’re a first time mother who over analyzes everything he is asking. She only says 8 words, she is behind!
During lunch the other day with my friend Sarah, a speech language pathologist and mother of three, we sat across from a young mother with an adorable little boy. My friend struck up as conversation with the little boy and toward the end of their conversation she asked the mother how old he was. “He is three,” the mother replied. My friend identified herself as a speech language pathologist and informed the mother her son’s language skills were very advanced. The mother went on to explain that she did not realize that his language was far more advanced than expected. He was her first child, therefore she had no other child with whom to compare his development.
This encounter led to our conversation about how parents are ill informed on developmental norms for language and comprehension. Sarah explained that at well visits, the pediatricians or their nurses perform quick screens that are suppose to help identify children who may be behind in language development. However in her experience with her children, she found that during these “interrogations,” doctors do not thoroughly explain why they are asking these questions and why your responses are important. At first I thought maybe it was because they knew she was a speech therapist and figured she would know what to look for with developmental language delay. But then I thought about my own experience with my son, and realized I had encountered the same brief questions without much of an explanation. So let’s discuss why these questions are important.
Your pediatrician has been given language milestones that your child should be meeting. The questions they ask at your child’s wellness checks are to determine if there appears to be any sign of a delay in language development. This is why your answers to these questions are important. I realize that having a child that is behind can be scary, but lying and saying your child is meeting the expected milestones when they aren’t only hurts your child in the long run. Therefore, with the help of my friend, I have compiled a summary of milestones your child should be meeting based on their age. My hope is that it will help you recognize any delay in your child so that you can seek assistance as early as possible.
It is important to remember that language development does not focus solely on your child’s expressive ability. Ability to hear and understand language and interact with others also plays a major role in language development. Also note that all children are different as is their development. If your child’s motor skills have developed quickly, it would not be surprising that his/her language may develop a little more slowly. Or if the child begins speaking relatively early, his/her motor skills are likely to lag behind. It is rare that you will see a child master language and motor skills at the same pace. If you have a child born prematurely, you should look for these milestones to occur at your child’s adjusted age. For example, if your child is born two months prematurely, you should not expect your child to be meeting the one year milestones until they are 14-15 months old.
The first sign of language development in typical babies is cooing. These sweet little sounds should be happening by around 3 months of age. Between 4-6 months, your baby should begin to babble. More typical babbling sounds include pa, ma, ba. Your child should begin saying 1-2 words somewhere between 7-12 months. Mama, dada, baba (bottle) tend to be typical high frequency first words. What many people do not realize is that anything is considered a word as long as the child uses is repetitively in reference to the same object. It also does not have to resemble the actual spoken word for it to be recognized as a word for developmental purposes. For example, instead of calling a bottle a baba, the child may call it momo. If the child uses momo every time when referring to a bottle, then momo is considered a word.
Auditory comprehension development in the first year includes recognizing mom and dad’s voices, recognizing sound and using their eyes to track towards the sound, and recognizing words such as “no” and “come here.” They should also begin to look when you point at an object, point to objects on their own, turn when they hear their name called, and play games with your such as peek-a-boo and pat-a-cake.
Between 1-2 years, toddlers become very curious. They begin to ask questions such as “What’s that?” “Who’s that?” or “Where’s dada?” By the age of two, their vocabulary will be somewhere around 40-50 words, and they will begin putting 2 words together such as “big dog,” “more milk,” and “no bed.” As their vocabulary increases, so will the sounds that they are able to produce. In this period, the p, b, m, h, and w sounds will likely be the first to develop because they are able to see the way these sounds are produced when others talk. You may also notice that as you are reading to your toddler, he/she begins to name pictures in the book.
As far as understanding language at this age, your little one should begin to identify body parts when you ask and point to pictures you name when reading a book. He/she will follow one step directions like “Throw the ball” or “Give me the cup.” and may also understand simple questions such as “Where is your toy?” and “Who is that?”
This phase may seem like the most trying because the word “Why” is developed in this year. If this is your first child, you will understand what I mean when you answer your 100th “why” question. But don’t let me scare you! This phase is actually one of my favorites because it feels like your tiny baby has become a tiny adult with whom you can now converse. During this year, your child should have a word he uses for familiar faces and talks about those people when they aren’t in the room. He/she will also start stringing 3 or more words together. For example “Sissy go outside.” A milestone to watch for is talking during pretend play. Does your child say “choo choo” when playing with a train or make a siren noise when playing with a police car or fire truck? The next set of sounds that start to develop are k, g, f, t, d, and n. Last but not least, he/she starts to recognize and use the words in, on, and under.
By this point, comprehension is expanding exponentially. New words are learned very quickly and children start to understand opposites like go-stop, big-little, and up-down. They should be able to follow simple two step directions by the age of three, as well. For example, “Get the towel and bring it to me.”
Talk about language explosion! By year four you may be wishing you could go back to when your child only knew a few words. I know that was the case with my son as he began to talk non-stop by this point. You should fully be able to have a conversation with your child by the age of four. Children should be answering simple who, what, when, where questions, telling you about their day using roughly 4-5 sentences at a time, and asking when and how questions. You should also see them begin to utilize the plural form of words (toys, cars, dogs) and pronouns such as I, you, me, they, and we. Do not stress if their sentences are not 100% correct. They will likely still be utilizing an incorrect verb tense at times such as “I goed to the store.”
Comprehension at this phase begins to become more focused on understanding words for shapes, colors, and even letters. When you call them from another room, they should respond. They will also understand words for family. If your child’s brother’s name is Billy, your child should understand that when you say “Here comes your brother,” Billy should be there in just a second.
School is just around the corner! In order for your child to succeed, especially with reading, he/she should be able to name all the letters as well as numbers the 1-20. The more difficult sounds are developing, though they may not be mastered yet. Those include l, s, r, v, z, j, ch, sh, and th. Your child is likely telling you all kinds of stories whether they be made up or stories that happened during the day. He/she should be able to speak in different ways depending on the setting: louder when he is outside and using shorter sentences when talking to his younger friends.
By this point children should understand most of what is said at home and at school. They begin to develop understanding of words that represent time like yesterday, today, and later, as well as words for order such as first, second, after, and last.
My child is behind! What do I do?
Take a deep breath, Mom. First, remember that the above are guidelines to help you track your child’s development. If your child isn’t meeting these guidelines by the target age, it is ok! Don’t rush to call your pediatrician. My friends said she usually recommends you allow a 3-6 month window past the guideline before seeking out assistance. No need to worry unless little Johnny still doesn’t have 50 words at 2 years 6 months. Remember this is based on your child’s adjusted age. If little Johnny was born three months early, giving him until 2 years 8 months to reach the two year milestone is acceptable.
Don’t be surprised if your child has what they call a language explosion. This happened to Sarah’s daughter. As she neared the 2 year mark, Sarah didn’t feel that her daughter had anywhere close to 50 words in her vocabulary, and she definitely wasn’t stringing two words together. Three weeks later, the child was having short conversations with my Sarah! It really can happen that quickly. However, there are children that have a delay in their language development. If you are tracking your child’s development and you feel he is six months behind where he should be, seek out a speech language pathologist. Schedule an appointment with your pediatrician and voice your concerns. The pediatrician can give you a list of therapy clinics in your area and write you an order to have your child evaluated by a licensed speech therapist. Speech therapy can begin at any age, so don’t be fooled that your child is “too young” to accomplish anything in therapy.
What about the cost?
As a medical professional, I am aware that there are parents that may delay getting their child the help he needs due to cost. I can’t emphasize enough that the early years of your child’s life are crucial in not only his development of language, but also his ability to learn to read. The longer you delay getting him the help he needs, the more likely he will struggle when they start school. There are many programs available to help families financially afford the services their child needs. Reach out to all the clinics in your area. Most will likely have a pay scale that is based upon income, some may offer payment plans and there may be state or federal assistance for which you can apply. You won’t know until you seek help!
My child can do all that, but no one but me can understand him!
You have the child that reaches the above milestones with ease, but no one but you is aware of that because people can’t understand your child. Unfortunately, it sounds like therapy is likely still in your future. The above guidelines are strictly about the learning and understanding of words. There is another list of guidelines relating to what sounds your child should be developing based on age and when those sounds should be “mastered.” Mastery of a sound leads to improved intelligibility of speech. Until we have a chance to review those guidelines, know that your child should be mostly intelligible to an unfamiliar listener (someone that does not speak with your child often) by the age of four. Seek an evaluation by a licensed therapist if you find yourself or others asking your child to repeat himself often.
I encourage you to utilize these guidelines to track your child’s development. Write down examples of each milestone as you observe them occurring. That way you have a clear example of what your child can do when you pediatrician asks. It will also help you recognize if/when your child requires the assistance of a professional.