What to do if you suspect your toddler's language is delayed
My morning office hours were filled with kids of all ages showing signs and symptoms of common infectious diseases. Tucked between these cases was an active 2-year-old boy, in with his mother for his annual well checkup. A truly welcome change of pace on a cold winter's day.
I reviewed the boy's growth chart as well as his eating habits and important developmental milestones. Just as I asked mom if her son seemed to hear those around him, a timer went off in the distant nurses' station, and the little boy turned to us and said, "Uh, oh!" He was very interactive, made great eye contact, and most importantly, according to his mother's observations, readily understood others and easily followed commands (when he was in the mood).
The toddler was doing well in many respects, but when we got around to the topic of language development, his mother appeared worried. She expressed some concerns about her son's speech, or rather his lack of speech. By 2, he was only saying five words, and mom felt he had not gained any vocabulary over the previous few months. Though the little boy was doing fine in all other areas, I agreed that he appeared to have some level of speech delay. His mother eagerly accepted my recommendation to contact the Illinois Child and Family Connections Early Intervention program at (800) 323-GROW to set up a developmental evaluation.
Afternoon office hours brought more illness, but once again, I had a break in the action with another cute 2-year-old, this one a girl who not only had an expansive vocabulary, but was able to fluently string together three-word phrases. The mother reported that the little girl chattered away from morning til night, and jokingly asked me if I could help her locate the talkative toddler's "on-off" switch.
Language skills vary a lot among children, with the range of typical speech development extending over many months. The National Institutes of Health outlines expected developmental milestones and notes that over the first five months of life, infants react to loud noises and begin to vocalize when talked to. Sometime between 6 and 11 months, these babies will babble and try to repeat sounds made by caregivers.
Toddlers 12 to 17 months old typically say a few words and are able to point to objects and close family members. At the next stage, children 18 to 23 months are expected to say at least eight to 10 words, start using some pronouns, and be able to point to simple body parts when asked. A 2- to 3-year-old's vocabulary will consist of about 50 words, which he will learn to use in combination to create two- to three-word phrases.
By 4 to 5 years of age, a typical preschooler will have 200 to 300 words in her repertoire. She can also define many of these words using speech that is easily understood, even by those outside of the immediate family. Finally, the 5-year-old kindergarten student is able to understand more than 2,000 words, speak in sentences as long as or longer than eight words, and engage in clear, conversational speech.
Speech acquisition will vary among little children, but as with motor skills, the key to typical development is in the progression of this skill building. If a toddler says six words at 17 months, he should not be limited to this six-word vocabulary by the time he reaches his second birthday. It's a good idea to keep track of your child's developing vocabulary to use as a point of discussion during well-baby checkups. One of the many reasons health maintenance visits are recommended at the frequent intervals of 12, 15, 18 and 24 months is to follow toddler development, including the important progression of language skills.
The American Speech-Language-Hearing Association advises parents and caregivers to encourage speech and language development starting in the newborn period and continuing as the child grows. Make small talk even while doing everyday activities such as bathing, feeding and dressing your little one. Point out colors, count while doing daily chores, use gestures in addition to words when conversing, and read to your child, even if "reading" sometimes has to be limited to enjoying the pictures due to baby's limited attention span.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.