Speech and Language Development

Topic Overview

What is speech and language development?

Speech 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.

What is the difference between speech and language?

Speech is making the sounds that become words-the physical act of talking.

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.

When do speech and language begin?

Infants start learning in the womb, where they hear and respond to familiar voices. The fastest learning occurs from ages 2 to 5 years.

Speech and 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.

What helps a child learn speech and language?

A 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 their age.

Why do speech and language problems develop in some 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.

It's 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.

When should you talk to your child's doctor?

Your 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 doctor.

Frequently Asked Questions

What Is Normal

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 to talk.

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.

Developmental milestones can be described according to age.

• Birth to age 1:
  • Babies start to process the communication signals they receive and learn to vary their cries to communicate their needs. During the first months of life, a baby is usually able to recognize his or her mother's voice and actively listen to language rhythms. By 6 months of age, most babies express themselves through cooing. This progresses to babbling and repeating sounds.
  • By the first birthday, babies understand and can identify each parent, often by name ("mama," "dada"). They repeat sounds they hear and may know a few words.
• Ages 1 to 3:
  • After the first birthday through age 2, a toddler's speech and language foundation grows rapidly. During that time, 1-year-olds learn that words have meaning. They point to things they want, and often use one- or two-syllable sounds, such as "baba" for "bottle." By age 2, children usually can say at least 50 words and recognize the names of many objects, including those in pictures. They also understand simple requests and statements, such as "all gone."
  • Many 2-year-olds talk a lot. They usually can name some body parts (such as arms and legs) and objects (such as a book). Not all their words are intelligible; some are made-up and combined with real words. In addition to understanding simple requests, they can also follow them (such as "put the book on the table"). They should be able to say at least 50 words. They usually can say about 150 to 200 words, some of which are simple phrases, such as "want cookie." Pronouns (such as "me" or "she") are used, but often incorrectly.
  • Some children are naturally quieter than others. But a child who consistently uses gestures and facial expressions to communicate should be evaluated by a doctor. These children are at increased risk for having speech problems.
• Ages 3 through 5:
  • More sophisticated speech and language develops from ages 3 through 5. By age 3, most children learn new words quickly and can follow two-part instructions (such as "wash your face and comb your hair"). They start to use plurals and form short complete sentences. And most of the time their speech can be understood by others outside of their family. "Why" and "what" become popular questions.
  • Most 4-year-olds use longer sentences and can describe an event. They understand how things are different, such as the distinction between children and grown-ups. Most 5-year-olds can carry on a conversation with another person.

Common Concerns

Speech and language delays

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 hearing tested.

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.

Behavioral issues

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.

Some 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.

Normal mistakes

Most children make developmentally appropriate "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 practice.

Routine Checkups

During routine 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 very important when there is any suspected speech and language development 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.

The United States Preventive Services Task Force recommends that all newborns be screened for hearing loss.^{footnote 1} 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.

When To Call a Doctor

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:

• Rule out other conditions. For example, hearing tests done by an audiologist may be recommended to rule out hearing loss.
• Assess speech and language developmental progress. Questionnaires and evaluations by a speech-language pathologist can help define where your child's abilities are in relation to other children of the same age.
• Find out whether other problems, such as behavioral difficulties or developmental delays in other areas, are also occurring.

Who to see

The following health professionals can diagnose speech and language problems and may work with other health professionals to treat them:

• Family medicine doctor
• Pediatrician
• Nurse practitioner
• Physician assistant
• Speech-language pathologist

Other professionals may be involved in the care of children with speech and language delays:

• Hearing specialist (audiologist)
• Ear specialist (otolaryngologist)
• Mental health professional (psychologist, psychiatric nurse, social worker, professional counselor)
• Occupational therapist and physical therapist
• Teacher

Building Skills at Home

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 infancy.

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.

Start 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 www.literacydirectory.org.

To encourage and support your child's speech and language development:

• Nurture your baby's speech and language development. Talk, read, sing, and play with your baby. Interaction and a loving environment will help engage your child's curiosity, build confidence, and foster a familiarity with language. These traits provide a strong foundation for speech and language development.
• Nurture your child's speech and language development, ages 1 to 2. Involve your child in conversations, and talk about the names of favorite toys and other common objects around the house. Speak slowly and clearly, and praise your child's attempts to speak. To help your child's brain develop, play or read together instead of letting your child watch TV, watch movies, or play games on a screen. When you play or read with your child, leave the TV off. Even a show playing in the background can distract you and your child.
• Nurture your child's speech and language development, ages 2 to 4. When feasible, gently encourage your child to talk to others, including other children near the same age. Correct your child's speech in positive ways by rephrasing, repeating, and relabeling. Read to your child every day and set limits on TV viewing. The American Academy of Pediatrics advises parents to limit TV time to 2 hours a day or less.