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Speech and Language : Causes, Milestones and Suggestions

By Kimberly A. Powell, Ph.D.

Speech is a skill that children begin to develop with the first sounds they make as babies. For most children, their first words are made up of simple sounds such as Mama, Dada or bye-bye. Gradually children begin to use their speech skills, or sounds, to form language. Language refers to the use of words and sentences to convey ideas. As children begin to develop more complicated language, they produce longer words that require more fine motor control. By the time they are ready to go to school, most children have speech that is easily understood by an unfamiliar listener. However, some children take longer to develop their speech to a level where everything they say can be understood. These speech or language delays can occur for a variety of reasons.


According to Elizabeth M. Prather, Ph.D, “Finding the exact cause or causes of your child's speech problem can be difficult. Each child's speech is influenced by many factors, including the ability to hear, the physical development of the mouth and throat, and the abilities the child inherits.” Some of the most common causes of delay she discusses are:

1. Hearing Loss: Children learn to speak by hearing others speak. So when repeat ear infections or other hearing problems occur children can not hear speech correctly so cannot learn to speak correctly. For example, "cat", "hat, "sat" may all sound the same to a hearing impaired child. From 12 months to 4 years of age language development is at its peak, so repeated ear infections during this time may affect speech and language.

2. Language Delay: Children may have difficulty learning the meaning of words and how to use words in sentences. Learning delays affect language acquisition.

3. Genetic Inheritance: It is common but not inevitable that late speech development runs in families. One or both parents, or any number of relatives may have had speech problems when they were young. However, children with slow speech development do not always have parents who had the same problem.

4. Bad Speech Habits: When children are beginning to speak they say many words incorrectly. If a child repeats an incorrect pattern long enough they learn it as a habit. For example, a child may say “bor if” instead of “for if.” If uncorrected the bad speech will become habit.

While these are the most common, they are by no means the only causes for speech or language delays. A physician can help you determine if a delay is due to physical or other causes.


Usually, there is concern about a child's speech and language skills if there is no speech by the age of 1 year, if speech is not clear, or if speech or language is different from that of other children of the same age. Though a physician or speech therapist should be the final source for determining if a child has a speech delay, the following milestones may help you do an initial evaluation.

3 MONTHS: A baby should become startled at loud noises, soothed by calm, gentle voices, cry, gurgle, and grunt.

6 MONTHS: Baby watches your face when you talk, tries to "talk" to you, coos and squeals for attention.

1 YEAR: The child understands some common words when used with gestures, like "bye, bye", and tries to say words like- "ba ba", "ma, ma."

18 MONTHS: One-year-old children should be able to understand a variety of words and should be using a few single words. The child should be babbling, understanding simple questions/statements such as "where is your nose?, and "give me".

2 YEARS: By age two, words should be combined into two and three-word phrases and sentences, such as "more milk", "all gone", "my turn". The child also understands "where is mommy/daddy?" and simple directions such as, "get your coat". Two year olds understand more words than they can speak. A two-year-old understands approximately 300 words.

3 YEARS: A three-year-old can follow simple directions such as, “time to take a bath,” "tell him your name.” She can also put an object in, under, or on top of a table when asked. She can also answer simple questions about objects such as “which one is bigger?” By age three a child understands approximately 900 words and speaks 200 words clearly.

4 YEARS: A four-year-old can follow two-step directions such as "close the book and give it to me". She also knows her first and last name, can answer reasoning questions such as, "What do we do when we're cold?", and can tell a short story such as, "two kids played ball." Sentences are usually 4 to 5 words long. By four a child is giving directions such as "put my shoes on" and asking many questions. A four-year-old understands 1500-2000 words and can use the following pronouns: he, she, you, me, I, mine.

5 YEARS: A child this age can follow 3 related directions such as "get your crayons, make a picture and give it to the baby". Most letters are pronounced accurately except perhaps for L, R, S, K, TH, CH, SH, TH. A five-year-old can describe objects and events and can tell you the meaning of words. A five-year-old typically understands 2500-2800 words, speaks in 5-8 word sentences, uses 1500-2000 words and tells long stories accurately.

6 YEARS: By this age a child understands 13,000 words, understands opposites, classifies according to form, color and use, and uses all pronouns correctly.

7 YEARS: A child this age can now understand 20,000-26,000 words, understands time intervals and seasons of the year, and is aware of mistakes in other peoples’ speech.


1. Be honest when you do not understand what your child says. Don't pretend that you understand by saying "OK" or "Yes, that's right." Encourage, but don’t force, your child to try to tell you again. When you do understand what your child says letting her know will encourage good language use.

2. Model good speech. When your child makes errors repeat what she attempted to say correctly. Children learn correct speech by listening to you talk and read correctly.

3. Read to your child. Children acquire vocabulary and speech sound production gradually. Capitalizing on a child’s desire to repeatedly read the same book increases familiarity with language. The more she hears the words and sentences the more likely she is to retain and use the language.

4. Consult a professional if you have any concerns about your child’s speech or language. Your physician should be able to refer you to a speech therapist or speech pathologist if further evaluation is necessary. If there is a problem, early attention is important. If there is no problem, you will be relieved of worry. No child is too young to be helped and language is an important life tool, so if you are in doubt have your child’s language and speech evaluated.

NOTE: This article is simply a guideline and should not be used to diagnose speech delays. Each child is different so a diagnosis can ONLY be confirmed by a registered Speech Therapist or Speech Pathologist. Always have a licensed professional make a diagnosis.

Copyright 2000 Kimberly Powell

Kimberly Powell is mother to three-year-old Senia, a former 1 pound, 15 ounce, 28 weeker. She compiled, wrote and edited “Living Miracles: Stories of Hope from Parents of Premature Babies” (St. Martin’s Press, April 2000) with Kim Wilson . Professionally she is professor and department chair of Communication/Linguistics at Luther College in Decorah, Iowa. See reviews of recommended speech books.

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