In Utero

  • Hearing acuity develops prior to birth

1-3 months old

  • Awakens to sounds
  • Startles to loud, abrupt noise
  • Blinks or widens eyes in response to noise

3-6 months old

  • Able to locate where sounds come from and turn head to find the source of the sound
  • Quiets to mother’s voice
  • Makes sounds such as ooooh, aaah, bababa

6-10 months old

  • Responds to name and familiar sounds (e.g. phone ring)
  • Responds to music and singing
  • Enjoys musical toys
  • Begins to imitate speech and non-speech sounds, such as lip-smacking, raspberry, tongue clicks

10-15 months old

  • Points to familiar pictures in book when named
  • Repeats simple sounds and words
  • Understands ‘no’ and ‘bye-bye’

15-18 months old

  • Locates sounds from any direction
  • Follows simple spoken directions

18-24 months old

  • Joins in nursery rhymes and songs
  • Responds when called from another room
  • Points to body parts when named

Red Flags in Speech & Language Development

0-6 months

  • Does not startle to or awaken to loud sounds or has been identified as hearing-impaired
  • Does not respond to changes in tone of voice
  • Has been identified with a neuro-developmental disorder or motor delay

9 months

  • Is still making only vowel sounds, with no speech-like consonants (e.g., “aaa” instead of an occasional “mmm” or “bah”.)

12 months

  • Is not babbling (saying “ba-ba-ba” or “dee-dee”)*
  • Is not using eye gaze or gestures like pointing and showing, to communicate interests or needs*
  • Has infrequent eye contact or little interest in interaction*
  • Does not respond to own name, or common words like “no”, “bye-bye”, etc.

18 months

  • Is not saying 10 single words
    (don’t have to be pronounced perfectly)

24 months

  • Does not say at least 50 single words
  • Is not combining words into two-word phrases* (e.g., “mommy go”, “daddy ball”)
  • Does not follow simple directions (e.g., “Roll the ball”)
  • Does not point to named body parts or pictures
36 months

  • Says only one or two words at a time (e.g., “kick ball” instead of “I kick ball to daddy”)
  • Cannot answer “what” or “who” questions.
  • Does not initiate conversations; speaks only when spoken to, or only repeats what others say*
  • Strangers understand less than half of what child says

4 years

  • Talks only about the “here and now” rather than events in the past and future, objects/people that are not present, etc
  • Puts words in the wrong order in sentences, and /or leaves out little words (in, the, of) and word endings (-ing, -ed,–s)
  • Does not follow two-step directions
  • Cannot listen to 2-3 lines of a story and answer simple questions about it
  • Speech is still hard to understand (i.e., many sound errors)

5 years

  • Uses only 3-4-word sentences to talk about “here and now”
  • Talks a lot, but does not engage in reciprocal conversation and/or make comments relevant to the situation*
  • Cannot answer “how” and “why” questions, or questions about past or future events
  • Except for r, l and th, cannot say most sounds correctly

*Signs of possible autism spectrum disorder

Also see – Child Health Notes