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{Professional Insight} Speech and Language Developmental Milestones: When to Ask for Help

Hispanic Mom with Baby


The dreaded developmental milestones.  Before your child is enrolled in school, these milestones feel like benchmark testing or a report card to rate your child compared to the expectations of his or her chronologically same-aged peers.  As parents, I feel like we always have a desire to check each box the second it is expected or sooner!  Little Johnny turned 1 year old today, why isn’t he walking across the house?!  When in reality, developmental milestones should represent an age range where a specific set of skills might emerge.  Every child is different and will develop at their own rate.  This cannot be emphasized enough for a child born prematurely. 

When a baby is born prior to 40 weeks, their nervous system, along with the rest of their tiny body, has not had proper time to mature to prepare them for the outside world.  Therefore, the way they detect and respond to their environment will most likely be different than a full term baby.  The developmental expectations for an infant born prematurely will be adjusted according to their individual length of gestation for the first two years of their life (often called adjusted age).  Here are the speech, language, play, and communication developmental milestones for an infant born prematurely as outlined by Emory University School of Medicine (I like this list, in particular, because they also list possible complications that could impact a child’s mastery of a particular skill.  For example, if your child came home on oxygen.)

From 2 to 5 Months

  • smile and coo.
  • watch a person’s face intently.
  • follow people and objects with her eyes.
  • laugh out loud.
  • startle when she hears a loud sound. 

From 6 to 9 Months

  • babble and begin to combine vowel consonant sounds. For example, “dadadada.”
  • turn to locate the source of a sound.
  • respond to her name. 

From 10 to 12 Months

  • carry out a simple action on verbal request. For example, wave “bye” when she hears the word. She no longer has to see someone wave first.
  • purposefully say “mama” and/or “dada” as a greeting or to call a parent to her.
  • play with an object with both hands while sitting independently.
  • independently move herself across the floor to get a desired object.
  • try to communicate by pointing or reaching for what she wants.
  • turn the pages of a board or thick plastic book.
  • visually and manually explore toys, revealing a growing curiosity.
  • indicate recognition of familiar people by facial expression or by physically approaching the familiar person. 

From 13 to 18 Months

  • be able to scribble with a large crayon (if she can keep from putting it in her mouth).
  • use a vocabulary of four to ten words.
  • follow simple verbal directions to perform a single task. For example, “Give me the ball.”
  • coordinate the use of both hands well. For example, hold a container in one hand while putting something into it with the other.
  • respond to her name.
  • “talk” in long, jabbering sentences as if holding an understandable conversation with you.
  • point to at least two pictures on request.
  • use her thumb and first finger easily to pick up a very small object.
  • throw a ball easily. 

By two years of age, your baby should experience a burst of verbal language development.  They should demonstrate strong communicative intent to let you know what they want or need using a vocabulary between 50 and 250 words.

Your pediatrician can help you to determine if your child is meeting his or her communication developmental milestones.  If a concern is present, your pediatrician will likely refer you to a speech-language pathologist.  In addition, trust your “gut” and if you feel your child is behind for their age or is developing in an atypical manner, be persistent when talking with your child’s physician regarding a referral for a speech and language evaluation.  It can never hurt to learn more information about your child’s development or discover new strategies to help them grow their ability to communicate with you and the world.  If an issue is identified, early intervention offers the best prognosis for success!

Guest Blogger

Julie WahrenbergerJulie Wahrenberger, M.S., CCC-SLP owns and operates Spring Branch Speech Therapy. She is nationally accredited by the American Speech, Language, and Hearing Association (AHSA) and licensed by the Texas State Board of Examiners. Julie has practiced in a pediatric outpatient therapy setting for one of the nation’s premiere children’s hospitals. She has also served as an independent contractor at both the elementary and middle school levels for the second largest school district in Texas. Within these unique settings, Julie has had the pleasure of working with a diverse caseload of patients. She has served children with autism, receptive and expressive language disorders, articulation disorders, feeding problems, hearing impairments and cochlear implants, motor speech disorders, stuttering, craniofacial disorders, neurological impairments, and genetic disorders. Julie received her undergraduate degree from Texas A&M University with a major in Communications and a minor in Linguistics. She earned her Master’s of Science degree in Communication Disorders from the Callier Center at the University of Texas in Dallas. Write to Julie at Julie@springbranchspeech.com.


  1. Jill Himli says:

    My son will be 17 months old tomorrow (36-weeker). He is meeting all the milestones on your list for 13-18 month olds except for saying 4-10 words. He has one word in his vocabulary, Dada. Though I know he understands many more words than that. He makes noises and uses hand gestures like pointing for most things. Do you think I should contact early intervention that followed his 4yo brother, a (27-weeker)?

  2. Hi Jill, Thanks for your question. By 2 years we look for kids to have 50-250 words. Little boys are notorious for being on the lower end of that spread. With that being said, I think you would be safe to give him another 2-3 months to develop on his own. During that time, I would push him to vocalize for things he wants throughout the day. They may not sound like true words, but as long as he attempts to make sounds for his request go ahead and give it to him. For example, during snack, show him two choices, “Do you want apples or pretzels?” He might point but also encourage him to imitate the name for the food. Do your best to incorporate this strategy as many times during your day as you can. Once he learns his words are powerful to get him what he wants, you will not be able to get him to be quiet :). Let me know if you have any more thoughts or questions!

  3. Jill Himli says:

    Thanks Julie for your response! And excellent Facebook chat the other night. My second son is much more advanced than my first was at this age, so I’m pretty proud. Just wish he’d say Mommy, cup & brother instead of t-sounds & pointing. If he hasn’t improved by the time school starts I will talk to the early intervention speech therapist that worked with his brother at the school. Thanx again!

  4. My twin preemie grandsons (26 weeks) are now 18 months (actual age). they are not saying any words except for mama, dadda, and babbling. they can follow directions sometimes. one is walking the other pulling up and grazing.
    their pediatrician is not referring to speech (!). What is your opinion> thanks in advance.
    A worried Grandmom

  5. Hi Worried Grandmom,
    I’m assuming when you say “actual age” your grandsons are 18 months old or 14-15 months adjusted? If their adjusted age is 14-15 months, they are right on track with first words. Some other things to look at would be- how are they playing? Do they use toys appropriately? Do they prefer toys or other objects? If anything about their playing seems strange, take note of this and bring it up to their pediatrician. Also, how well are they following directions (I know you said sometimes)? Can they find familiar and common items out of their immediate sight? If you have to give instructions multiple times or offer physical assistance when following routine requests, this might be another concern to bring up to their pediatrician. Communication can be meausured in many ways other than just the number of words being used. If you feel something is off, you could be on to something and that deserves a second look by a professional. If the speech language pathologist feels therapy is warranted, early intervention can save your grandsons a lot of frustration. I hope this helps. Feel free to contact me with further questions!

  6. My son 16 months adjusted, born at 32 weeks seems to be having difficulty with speech. He has been attempting to say many of the same words for several months. However, his pronunciation is very poor and never seems to improve, not only is his speech not intelligible to people outside our immediate family, most of his words sound very familiar to each other, so much so that I am not convinced even we could tell what he is saying most of the time outside of context.
    Additionally, none of his words are names. He has never tried to call anyone including mom and dad by name.
    I am concerned but his pediatrician wants to wait until 18 months to explore a possible problem. Dies this seem reasonable? If there is a problem I don’t want to waste precious time in starting an intervention.
    His comprehension of language seems good, the difficulty seems to be in speech only.


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