Information for Medical Professionals

Normal Speech and Language Development for Medical Professionals

The ability to communicate is important for all activities of daily living, including the ability to learn and develop social relationships. Children learn to communicate in stages, with articulation and language developing independently, but together. To understand verbal communication development, it is important to understand the difference between speech (articulation) and language.

Speech (Articulation) - the physical production of sounds to form spoken words.
Language - the message conveyed back and forth in talking. This includes the ability to understand the speech of others (receptive language) and the ability to express thoughts through words and sentences (expressive language).

Although normal children vary in their rate of development, speech and language skills generally occur as follows:

2 months

Watches the speaker’s face.
Cries are differentiated by needs.Coos with vowel sounds.

4 to 6 months

Localizes to sound.
Coos with intonation.
Vocalizes to others.

6 to 9 months

Responds to name.
Recognizes names of family members.
Responds to simple commands accompanied by a gesture.
Uses gesture for communication (pointing, reaching, waving for hi/bye).
Imitates actions (as in Peek-a-Boo).
Babbles using early developmental consonants (i.e. b, m, w, d, n, g).

10 to 12 months

Begins to point to some body parts following a command.
Follows simple, one part commands (i.e. Get your shoe.)
Gives objects to others upon verbal request.
Jargons with different sound combinations.
May begin to use first words.

12 to 18 months

Can identify many objects and pictures following a verbal command.
Follows commands easily.
Listens more to the meaning of conversations.
Uses several single words.
Communicates with a combination of words and gestures.

18 to 24 months

Understands concepts (adjectives, pronouns, plurals).
Follows compound and complex commands.
Uses two to three word combinations.
Tries to tell about experiences.
Begins to use more speech sounds such as fricatives (f, s, sh).

2 to 3 years

Shows interest in explanations for “why” and “how” questions.
Uses phrases and short sentences for communication.
Begins to use more complex morphological and syntactical forms.

3 to 4 years

Uses long and structurally complex sentences.
Tells stories and relates experiences from the past.
Errors in syntax include regularization of irregular forms.Speech is understandable to all listeners, although minor articulation errors are noted.

For additional information:

Kummer AW. Normal speech and language development. In RC Baker (Ed.), Handbook of Pediatric Care. Boston: Little, Brown and Company, 1995.
Kummer AW. Assessment of speech and language disorders in children. In RT Cotton, CM Myer, III (Eds.), Practical Pediatric Otolaryngology, Philadelphia: Lippencott-Raven Publishers, 1998.
Kummer AW. Speech and language disorders. In R. Baker (Ed.) Pediatric Primary Care: Well-Child Care, Lippincott, Philadelphia: Williams & Wilkins, 2001.
Kummer AW. Communication disorders in children. (2002). In C Rudolph, A Rudolph, MK Hostetter, G Lister and NJ Siegel (Eds). Rudolph’s Pediatrics, 21st Edition, New York: McGraw-Hill.