Speech and Language from 12 to 36 Months: Milestones and Support

Your baby's first word holds a special place in your heart. Then comes a new word every day, followed by the first sentences. The most common question during this time is: Is my child talking on time? This guide is based on information from the US Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).

What do milestones tell you? According to the CDC, developmental milestones are things most children, meaning 75 percent or more, can do by a certain age. The AAP also reminds parents that children develop at different rates and that milestones are only a guide. That is why you may see small differences between sources: the AAP says most children say about 50-100 words at age 2, while the CDC places about 50 words at 30 months because it uses the point reached by at least 75 percent of children. Compare your child with these milestones, not with other children.

At 18 months (CDC):

• Tries to say three or more words besides "mama" and "dada."
• Follows one-step directions given without gestures. For example, hands you a toy when you say "Give it to me."

At 2 years (AAP):

• Puts together a few two-word phrases, such as "Daddy go," "my baby" or "all gone."
• May also say a few three-word sentences, such as "I want water."
• Can say about 50-100 words.
• Points to many body parts and common objects.
• Follows a one-step direction without gestures, such as "Put your cup on the table."
• Can be understood by others about half the time.

At 30 months (CDC):

• Says about 50 words.
• Puts two or more words together, with one being an action word, such as "Doggie run."
• Names things in a book when you point and ask "What is this?"
• Uses words like "I," "me" or "we."

At 3 years (CDC):

• Talks with you in a conversation with at least two back-and-forth exchanges.
• Asks "who," "what," "where" or "why" questions.
• Says what is happening in a picture or book, such as "running" or "eating."
• Says their first name when asked.
• Talks clearly enough for others to understand most of the time.

Growing up bilingual does not cause delays: If more than one language is spoken at home, rest easy. According to the AAP, hearing more than one language does not cause delays in communication development or speech disorders, and it does not confuse children. The milestones are the same no matter how many languages a child hears. When counting a bilingual child's words, count both languages together: the total number of words should be about the same as that of a child the same age learning one language. Mixing languages in one sentence is normal, and according to the AAP, children can usually separate their languages by around age 3. The AAP recommends that parents speak to their child in the language they are most comfortable with.

How can you support language? Recommendations from the CDC and the AAP:

• Talk, play and read books together a lot.
• Build on what they say: if they say "Woof," say "Yes, that is a dog. The dog says woof woof."
• When you can, turn toward them and get down to their eye level when you talk.
• Ask questions like "What is this?", "What is happening in the picture?" or "What will happen next?"
• Teach simple songs and nursery rhymes.
• The CDC does not recommend screens for children under 2, other than video calls. At 30 months and 3 years, it recommends limiting screen time to no more than 1 hour a day of a children's program watched with an adult, and at 3 years not putting a screen in your child's bedroom.

Don't forget hearing: According to the AAP, a language delay can sometimes be a sign of hearing loss, a delay in other areas of development or autism spectrum disorder. So the doctor may order a hearing test and refer your child to a speech-language therapist. For example, if your child seems to hear a car horn or a cat meowing but does not respond when you call their name, that is a sign you should share with the doctor.

When to see a doctor? The CDC says "Don't wait." Contact your pediatrician or family doctor and ask for a developmental screening if:

• Your child has not reached one or more of these milestones, for example, at 18 months is not trying at least three words besides "mama" and "dada"
• They have lost a skill they used to have, such as stopping talking
• They do not seem to notice when you are in the room or do not respond to certain sounds
• They prefer to play alone and ignore others
• They can recite the alphabet or commercial jingles but cannot ask for something they want with words
• You have any other concern

According to the AAP, even if the doctor says "don't worry, they will catch up," if you are not at ease, it is right to get a second opinion or see a speech-language therapist. The AAP stresses that even when there is a delay, early support can make a big difference.

Dear mom, every conversation you have with your child, every story you read and every lullaby you sing is a word added to their language treasure. You know them best. If you have a question, do not hesitate to ask, and never forget how much your voice matters.