Parental concerns – Early intervention services

Many parents question whether their child is at an appropriate level and if they are meeting their milestones. You might wonder if your child is a late talker or if they have a developmental delay. The question is how do you know if you should seek help? I believe if you have concerns then you should always follow your gut and talk with your child’s primary care provider about your concerns. They can then refer you for a speech and language evaluation. Be cautious, some doctors may dismiss your concerns and label your child a late talker. If you feel differently then seek a certified speech-language pathologist. The speech-language pathologist can assess whether your child will benefit from services and can give you some parental education to help boost their speech and language development at home.

Some parents may go through private practice and others may be eligible for child development services. Child development or early intervention services provide pediatric therapy services (speech, OT, PT, etc.) to the population of 0-3 years in their home. This is funded at the federal level and each state has a different name for their early intervention organization. For example, in California we have regional centers that provide these services and in Maine it is the CDS (child development services) department. Your primary care provider should be able to inform you about these services.

Click on the following link for more information about early intervention services near you.

Services in your state for Infants and Toddlers

Speech and Language Developmental Milestones

There are numerous developmental checklists that can be found for all of your child’s milestones – feeding, gross motor movements, fine motor movements, cognitive skills and speech and language. I will focus solely on speech and language. Now as a reminder, children will vary, so these developmental checklists should be used as a guideline. The general consensus is that children should say their first word around their first birthday (12 months) and should start putting 2 words together by their second birthday (around 24 months). If your toddler is almost 24 months old and does not yet speak then I highly suggest you consult your pediatrician or a speech-language pathologist.

Here is a brief summary of speech and language milestones up 36 months (3 years old):

Receptive language development

0-3 months

  • Responds to loud sounds
  • Recognizes your voice

4-6 months

  • Looks toward sound
  • Attends to toys with sound and music

7-12 months

  • Enjoys routine predictive games (i.e. peek-a-boo)
  • Recognizes words from common items
  • Begins to respond to simple requests (i.e. “come here”)

12-18 months

  • Understands 100-150 words in context
  • Points to body parts
  • Listens to songs, stories, rhymes

18-24 months

  • Understands 150-200+ words
  • Follows simple commands
  • Understands simple questions
  • Identifies pictures in books by pointing

24-36 months

  • Understands 200-500+ words
  • Follows 2-step directions
  • Understand one, all, in, on, under,
  • Understands differences in meaning (i.e. go/stop),
  • Starts to understand many aspects of language including grammar
  • Listens to longer stories

Expressive speech, language and social development

 0-3 months

  • Cooing
  • Different cries for different needs
  • Smiles when spoken to/sees you

4-6 months

  • Babbling sounds (p,b,m)
  • Laughs
  • Vocalizes pleasure/displeasure

7-12 months

  • Varied babbling
  • Uses speech/sounds to get attention
  • Imitates speech sounds
  • Produces first meaningful word

12-18 months

  • Uses gestures for intentional communication
  • Uses many different consonant sounds
  • Rapid increase in vocabulary daily

18-24 months

  • Says 50-150 words
  • Names common items
  • Starts to put 2 words together

24-36 months

  • Says 100-250+ words
  • Uses 2-4 word phrases
  • Uses sounds (k ,g, f, t, d, n)
  • Requests objects by name
  • Starts to use grammar rules of language

The American Speech and Hearing Association (ASHA) offers great resources for parents and SLPs about speech and language development. Click on the following link for a complete list of speech, language and hearing developmental charts up to age 5.

ASHA Speech and Language Developmental charts

The majority of the information provided by the internet about speech and language milestones uses averages met by monolingual children. I found an interesting article on developing bilingualism that describes the language development of a child who is a simultaneous bilingual (learning two languages at once). The speech and language milestones remain the same across ages but are explained in terms of two languages as a single language system. Meaning the bilingual child from 0-36 months does not separate his languages and thinks of them as one entity (e.g. Spanish and English – no difference). As they get older however they start to differentiate between the languages and use them within different contexts. I also came across another site called the Multilingual Children’s Association that discusses language milestones for bilingual children. Receptive language milestones are similar for both monolingual and bilingual children therefore I will focus on the expressive portion.

Here is a combination of the information on bilingual expressive language milestones found from both the article and website:

Bilingual expressive speech and language development milestones

0-3 months

  • Cooing

4-6 months

  • Babbling

6-15 months

  • Produces first meaningful word – may be a bit later than monolingual child but still within normal range

15-24 months

  • Words may consist of parts of words from each language blended into a word
  • Vocabulary of 50-150 words ( combined between the languages)

24-36 months

  • Word combinations – 2 languages used in same phrase (e.g. white gato)
  • Vocabulary of 100-250+ words (combined between the languages)

For more information, click on the following links to the article and website.

Language development in bilingual children: A primer for pediatricians

Multilingual Children’s Association

To sum up, monolingual and bilingual children appear to follow the same milestone trajectory for speech and language development (i.e. 1 word by 1 year and 2 word phrases emerging at 2 years old). Although it is important to note that there will be some differences. For instance, your bilingual child might not be saying 50 words in one language (like a monolingual child) but might be able to say 50 words across two languages, which still meets that vocabulary milestone. Please be cautious when referring to these speech language development charts for your monolingual/bilingual child. If your child truly has a developmental delay or a speech language disorder then your child should exhibit difficulties in each language.

As always, if you are concerned, then consult a medical professional to get peace of mind. The younger children are identified the better because they will make greater gains if they start speech language services at an earlier age, before they enter the academic world.

Stages – Stimulating speech and language development

Stage 1 – Exploration (I can make sounds, smile, and listen)

Infants begin to babble around 4-6 months. At first babbling just sounds like repeated syllables, this is known as reduplicated babbling. All syllables sound the same (e.g. pa pa pa, ma ma ma, bi bi bi). As children develop they start to explore different sounds and patterns. Their babbling transforms into what is called variegated babbling where syllables start to vary (e.g. bee bo bee, mo ma moo mo, pa boo mee ga). As your children are acquiring different sounds and language you can help by engaging in vocal play with your child.

Whenever you engage with your child make sure to be facing them so that they can look at your face and mouth for visual cues as to how sounds are produced. This will also help them understand social cues such as eye contact when interacting with another person. You can engage in vocal play with your child in many ways. If they are babbling you can repeat what they babbled back to them and see if they babble after you do. This will engage them in turn taking – babbling conversation. You can also help stimulate early developing sounds (p, m, b) by modeling those sounds for your child. Even if your child is not yet at the stage where they imitate you, this will still benefit them because they will see and hear those sounds. Sounds p, b, and m are some of the first sounds a child makes because they are the easiest sounds to learn visually as they are made with our lips. You can even help your child gain more awareness of their mouth (lips/tongue) by making silly faces at them and making funny sounds such as rolling lips (i.e. lip trills), making kissy faces, blowing and so on. By engaging them in these activities they will want to imitate your gestures and practice some oral motor exploration.

Remember, communication consists of words, gestures and social expression (i.e. eye contact, smiling, laughing, crying). Infants are absorbing everything you do when interacting with them and the world around them. Therefore use all these different modes of communication – smile and look at your child, use gestures when talking (teach clapping, waving hello/goodbye, blowing kisses, etc.), tickle them and laugh, simplify your language to simple sentences, use your finger to point to items in your environment and so on.

Stage 2 – Intentional communication (I can ask for things)

Usually children reach the stage of intentional communication between 15-18 months old. This is the time period where they move from exploring sounds, gestures and words to using those sounds, gestures and words to voluntarily communicate their needs and wants. Your child will continue to imitate but will also start to voluntarily communicate their desires.

There are many ways that children intentionally communicate. One of the earliest ways is intentionally pointing at an item they want in their environment sometimes paired with some sort of vocalization. For instance, your child may point to an apple and make a sound to get your attention or simply point. This is the perfect opportunity for you to teach your child the words he/she needs for that request (e.g. “apple – give me apple” or “apple please”). If your child is not yet pointing by 18 months then you can help them develop that skill by modeling it for them. Point to the things you are talking about. If you are reading a book, point to the pictures you are naming and take your child’s pointer finger and help them point to pictures. When teaching them vocabulary such as body parts and items of clothing then make a pointing game out of it – point to your nose, point to mommy’s ears, etc. Always model the action and language first and then help your child by taking their finger and making the movement. With a lot of repetition your child will learn this movement and use it intentionally.

One way to facilitate intentional communication is to teach your child simple baby signs as they are developing their language if they are not yet using words. Research shows that teaching baby signs to your children helps stimulate their expressive language skills. Some good general baby signs for intentional communication are signs for “more, all done, give me, open”. You can also teach them more specific signs for items/actions they request on a daily basis “eat, drink, milk, juice, apple”. Make sure to always pair your gestures with words and motivate your child to vocalize when using gestures. For instance, when I teach the sign “more” I always try and have the child at least produce an “m” sound along with the sign and gradually move up to “ma” then shape it into “more”. As a parent I suggest simple emphasizing a slow and clear “more” along with the sign as a model and your child will try to imitate it. Youtube is a great source to learn baby signs!

If your child is using words to communicate their needs and wants then try to expand on what they say. If your child says “milk” then you might say “give me milk”. This way you are modeling some word combinations to help your child more effectively request their wants and needs. A child can say “milk” and the meaning of that utterance can be extensive (e.g. “milk spilled”, “I like milk”, “I want milk”, “mom is drinking milk”). By expanding their utterance to use “give me” or “I want” you will help your child learn the vocabulary required for requesting. Of course be mindful to read the context in which that word was used to give your child the appropriate language model for the situation.

Stage 3 – Language explosion (I learn new words daily and expand my language skills)

Your child is now using more words to communicate and keeps expanding their vocabulary. Here are a few tips to help stimulate their language development (receptive and expressive):

  • Read books. Now when I say read books I don’t mean that you should read all the writing in the books. You can do so for rhyming books and books with little writing. However at this age, books should be used more as an activity to discuss the pictures and story with your child. Talk about what you and your child see, label characters/items/places, label actions – what the characters are doing (e.g. jumping, eating, laughing), label feelings (e.g. happy, sad, mad). Your child may not imitate you right away and label the pictures but that should not stop you from providing a model. With enough repetition they will remember the words and one day name those very same pictures. For both children who imitate and don’t imitate verbal productions, have them imitate the actions and feelings you are discussing so that they internalize the vocabulary.
    • For instance, you could say “Look! Winnie is jumping. Let’s jump.” and then you can both jump up and down and say “I am jumping.” As for discussing feelings you could say “Look! Winnie is smiling. Winnie is happy! Show me your smile!” then you can both smile and say “I am happy!”
  • Simplify and adjust your language – use simple phrases and sentences. This will make it easier for your child to imitate. As your child uses more words in combination you should increase your sentence length so that they also have a model of correct grammar forms.
    • For example – if your child only says single words you can help increase use of verbs by using simple phrases such as “eat apple”, “go play”, “wash hands”. If your child is producing 2 words in combination then you will want to expand your sentences to include higher grammatical forms such as “I am eating an apple”, “I want to go play”, “I am washing my hands.”
  • Be descriptive – discuss where you find items, what they are used for (function) and what they look/sound/feel/taste/smell like.
    • For example – playing with toy animals. You can talk about their different colors, the sounds each animal makes, what each animal eats, their size/shape and where you find them. “The cow says moo. This is a big cow. The cow is black and white. A cow makes milk. Cows live on a farm.” If your child only says “cow” this is the time to expand on what they say by saying something like “You’re right! I see a big brown cow.”
  • Talk about what you are doing in your daily routines so that they use/hear language associated with breakfast, cooking, getting dressed, taking a bath, playing at the park, going to grandparents’ house, getting ready for bed, etc.

The previous tips can be used in combination, in any language and at any time throughout your child’s development so don’t wait until your child is saying words to start modeling language in your daily routine.

There are numerous strategies out there to help your child’s speech and language development.  Please let me know what further strategies you are most interested in learning about and what areas of concern you may have in the comments below. Enjoy engaging your little ones and watching them grow!