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 has two parts: 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 between 2 and 5 years of age.

Speech and language milestones help tell whether a child is developing normally. 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. This lag in spoken language is often followed by a burst of talking between 18 and 24 months.

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?

Some types of hearing loss can cause speech delay. All children with a speech delay should have their hearing tested. Developmental disorders such as autism can also cause a delay.

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.

Speech and language problems are estimated to occur in about 6 out of every 100 children.¹ That means that 94 out of 100 children develop normally.

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 can say fewer than 50 words by 24 months, talk to 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.

Details of the developmental milestones can be evaluated according to age.

• Birth to age 1:
  • Babies begin to process the communication signals they receive and learn to vary their cry to communicate their needs. During the first months of life, they are usually able to recognize their mother's voice and actively listen to language rhythms. By 6 months of age, most babies express themselves through cooing with vowels and one or two consonants. This progresses to babbling and repeating sounds.
  • By their 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 between 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. However, 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.
• Age 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 directions (such as "wash your face and put your shoes away"). 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

Speech and language difficulties are estimated to occur in about 6% of children.¹ Mild and temporary speech delays can occur in some children. And 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 to your doctor. All children with a speech delay should have their hearing tested.

Keep in mind that many different factors 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 factors 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 health professional any time you have concerns. It is critical to identify speech and language delays early and rule out any underlying conditions, such as difficulty hearing. Early diagnosis allows health professionals 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 seemingly bad 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

Schedule routine well-child visits with your child's doctor. During these 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 done by an audiologist are an essential part of any suspected speech and language developmental delay. Many health experts claim that screening is critical in infancy because 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.²

The United States Preventive Services Task Force recommends that all newborns be screened for hearing loss.³ 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 indicate a possible developmental delay, such as when your child does not make sounds that are expected for his or her age.

Your health professional will conduct a physical exam and ask questions about your child's medical history. This information can help your health professional identify developmental patterns and assess whether any underlying conditions, such as hearing loss, are interfering with development.

Your health professional may also recommend other tests to:

• Rule out underlying conditions. For example, hearing tests done by an audiologist may be recommended to rule out hearing loss.
• Specifically 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.
• Determine 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, either one who specializes in the care of the family (family nurse practitioner) or in the care of children (pediatric nurse practitioner)
• Physician assistant

Speech-language pathologists treat children with speech and language delays.

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

Home Treatment

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. Also, teaching sign language to babies 6 months or older could 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.⁴

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 Web site 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, it's best to talk, play, sing, or read together instead of letting him or her watch TV.
• 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.

Other Places To Get Help

Online Resource

Organizations

Related Information

• Alcohol Effects on a Fetus
• Asperger's Syndrome
• Autism
• Dyslexia
• Growth and Development, Ages 1 to 12 Months
• Growth and Development, Ages 12 to 24 Months
• Growth and Development, Ages 2 to 5 Years
• Growth and Development, Newborn
• Hearing Loss
• Hearing Tests
• Stuttering
• Tongue-Tie

References

Citations

1. 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.

2. Morton CC, Nance WE (2006). Newborn hearing screening-A silent revolution. New England Journal of Medicine, 354(20): 2151-2164.

3. U.S. Preventive Services Task Force (2008). Screening for newborn hearing loss. Available online: http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm.

4. Capone NC, McGregor KK (2004). Gesture development: A review for clinical and research practices. Journal of Speech, Language, and Hearing Research, 47(1), pp. 173-186.

Other Works Consulted

• Duursma E, et al. (2008). Reading aloud to children: The evidence. Archives of Disease in Childhood, 93(7): 554-557.

• Goldson E, Reynolds A (2007). Normal development section of Child development and behavior. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 65-84. 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.

• Lyon GR, et al. (2007). Specific language and learning disabilities. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 150-161. Philadelphia: Saunders Elsevier.

• Roberts J, et al. (2004). Otitis media, hearing loss, and language learning: Controversies and current research. Journal of Developmental and Behavioral Pediatrics, 25(2): 110-122.

• Sosinsky LS, et al. (2007). Language section of The preschool child. In A Martine, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 261-262. Philadelphia: Wolters Kluwer, Lippincott Williams and Wilkins.

• U.S. Preventive Services Task Force (2006). Screening for speech and language delay in preschool children: Recommendation statement. Pediatrics, 117(2): 497-501.

• White KR (2004). Early hearing detection and intervention programs: Opportunities for genetic services. American Journal of Medical Genetics, 130(1): 29-36.

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