It’s exciting to wonder what your baby’s first word will be. But what if that first word doesn’t come? Or what if the first few words came but nothing else? You may wonder if your child has a speech or language delay.
“The earlier that we can catch a delay, the better,” says UNC Health pediatrician Rebecca Chasnovitz, MD. “When a child can’t be understood by their peers or their family, that’s hard. It can cause poor confidence, behavior issues and disrupt the parent-child relationship.”
Your child’s doctor can help you determine what’s normal in your child’s speech and language, as well as when they might need some extra help and support. Dr. Chasnovitz explains milestones to know and ways to help your child communicate.
Communication and Language Milestones in Babies and Toddlers
Your baby communicates long before they speak any words. As a new parent, you may learn in the first few weeks to distinguish a hunger cry from a dirty diaper cry, and around the 2-month mark, you will start to hear your baby cooing.
“It’s all vowels at first, because consonants will be harder for babies to form,” Dr. Chasnovitz says. “At 4 months old, they might be babbling, using some consonants.”
It takes your baby time to develop the ability to manipulate their tongue and lips to make certain sounds. But even as your child is still developing that physical capacity to form words, you can practice communication skills with them.
“From the time they’re 2 to 4 months old, infants can socially communicate by mirroring,” Dr. Chasnovitz says. “When you look at them directly, making eye contact, you can make a sound and they’ll repeat something back. If you stick out your tongue, they might stick their tongue back out at you.”
You can expect your baby’s first word around their first birthday, though some children say it as early as 9 months old and some not until 15 months. While your baby may mimic “mama” or “dada” in their first year, Dr. Chasnovitz says that you should consider their first word one that they use with understanding. For example, saying “meow” while pointing to a picture of a cat has more meaning than a child babbling “mama” over and over without acknowledging their mother.
Once your child says their first word, you should expect to see gradual and steady progress in the number of words they say.
“Between 1 and 2 years old, children mostly use single words,” Dr. Chasnovitz says. “At 2 years, they can usually put two words together for a phrase, like ‘me jump’ or ‘mama milk.’ By 3, they should have simple sentences of a couple of words, and by 4, they should be talking in full sentences and using the pronoun ‘I’ instead of their own name.”
Children should become more understandable over time. You may only understand a 2-year-old about half the time and a 3-year-old 75 percent of the time, but at the age of 4, it should be fairly clear what the child is saying, Dr. Chasnovitz says.
While these are the general milestones your child’s doctor looks for, Dr. Chasnovitz says it varies by child. Instead of comparing your toddler to another one, focus on whether your child is using more words or showing growth in how they put together a sentence.
When to Be Concerned About a Speech Delay
While every child will develop differently, there are some signs that may concern your child’s doctor.
“If a baby is mirroring interactions with their face but not making any sounds, we screen for hearing loss,” Dr. Chasnovitz says. “If they’re making sounds, but there’s no good eye contact or the social piece isn’t developing, then we’d screen for autism, with a goal of diagnosing by age 2.”
If your child doesn’t say their first word by 15 months or show progress in how many words they use when they start speaking, their doctor will work with you to figure out why.
Children who have a lot of ear infections in their first two years may struggle with picking up speech because it’s harder to hear when they have fluid in their ears. Developmental disorders and some oral anatomy issues can cause delays. Sometimes, there may be no discernible cause, and a child will just need some extra one-on-one help.
If your child is older than 15 months and not speaking very much, consider how often they have the opportunity.
“If you have a toddler who has their pacifier in their mouth while they play during the day, that could be limiting their ability to practice speech,” Dr. Chasnovitz says, noting that pacifier use in babies younger than a year does not hamper speech development. “You might have to make their mouth available to practice those movements and making sound.”
Children with chatty older siblings aren’t exempt from meeting these milestones.
“Parents will say, ‘He doesn’t talk because he’s the youngest, so others talk for him,’ but that shouldn’t make more than a month or two of difference,” Dr. Chasnovitz says.
When there’s concern about a child’s speech, your child’s doctor will refer them to an audiologist for a hearing exam and to a speech therapist for a consult.
How to Help Your Child Develop Language
From the time your child is born, you can help them develop language.
“Language learning comes from exposure, so make sure you’re talking to your baby,” Dr. Chasnovitz says. “Read to them, sing to them, narrate what you’re doing or what’s happening. That person-to-person interaction is important.”
It’s fine to use baby talk or nonsense when your child is younger than 6 months, when they’re babbling and mirroring you; even repeating nonsense back and forth teaches your child how conversations will eventually go.
A toddler on the go may be harder to converse with, so it will require more concentrated effort.
“With a toddler, you have to get down on their level so you can make eye contact and so they can see your mouth,” Dr. Chasnovitz says. “Slow down and enunciate. Encourage them to use their words. You may know that they’re pointing to their milk or what a certain grunt means, but encourage them to say it or narrate for them that you’re handing them their milk.”
While exposure to language is important, there’s one source of language that isn’t helpful for children under 2—the language that comes from videos.
“We don’t recommend screens—television, tablets or phones—for children younger than 2 years, even if it’s a program that seems interactive, because it doesn’t activate the same neurons in the brain as talking to a person,” Dr. Chasnovitz says. “Even when it’s on in the background, a young infant can pick up on that screen noise and focus on that to the exclusion of other things in their environment.”
Video chatting with loved ones is OK.
Of course, you won’t be perfect on screen time or anything else, so don’t beat yourself up or fear talking to your child’s doctor about a potential speech delay.
“Some parents worry about the stigma of a delay, but this isn’t about a label or a diagnosis,” Dr. Chasnovitz says. “It’s about helping children communicate as early as possible, because that makes their life easier. When we catch a delay early and treat it, I’m not worried about their ability to catch up to other kids, and there is help and support.”
If you’re concerned about your child’s development, talk to their doctor or find one near you.