caused by hearing loss, while other times it may be due 

to a speech or language disorder. 

What is the difference between a speech 

disorder and a language disorder?

Children who have trouble understanding what others 

say (receptive language) or difficulty sharing their 

thoughts (expressive language) may have a language 

disorder. Specific language impairment (SLI) is a language 

disorder that delays the mastery of language skills. Some 

children with SLI may not begin to talk until their third or 

fourth year. 

Children who have trouble producing speech sounds 

correctly or who hesitate or stutter when talking may 

have a speech disorder. Apraxia of speech is a speech 

disorder that makes it difficult to put sounds and 

syllables together in the correct order to form words. 

How do speech and language develop?

The first 3 years of life, when the brain is developing 

and maturing, is the most intensive period for acquiring 

speech and language skills. These skills develop best in 

a world that is rich with sounds, sights, and consistent 

exposure to the speech and language of others. 

There appear to be critical periods for speech and 

language development in infants and young children 

when the brain is best able to absorb language. If these 

critical periods are allowed to pass without exposure to 

language, it will be more difficult to learn. 

What are the milestones for speech and 

language development?

The first signs of communication occur when an 

infant learns that a cry will bring food, comfort, and 

companionship. Newborns also begin to recognize 

important sounds in their environment, such as the 

voice of their mother or primary caretaker. As they 

grow, babies begin to sort out the speech sounds that 

compose the words of their language. By 6 months of 

age, most babies recognize the basic sounds of their 

native language. 

Children vary in their development of speech and 

language skills. However, they follow a natural 

progression or timetable for mastering the skills of 

language. A checklist of milestones for the normal 

development of speech and language skills in children 

from birth to 5 years of age is included on the following 

pages. These milestones help doctors and other health 

professionals determine if a child is on track or if he or 

she may need extra help. Sometimes a delay may be 

NIDCD Fact Sheet

Speech and Language 

Developmental Milestones

u.s. department of health & human services ∙ national institutes of health ∙ National Institute on Deafness and Other Communication Disorders voice, speech, language language

What are voice, speech, and language? 

Voice, speech, and language are the tools we use to 

communicate with each other. 

Voice is the sound we make as air from our lungs is 

pushed between vocal folds in our larynx, causing 

them to vibrate. 

Speech is talking, which is one way to express language. 

It involves the precisely coordinated muscle actions of 

the tongue, lips, jaw, and vocal tract to produce the 

recognizable sounds that make up language. 

Language is a set of shared rules that allow people to 

express their ideas in a meaningful way. Language may be 

expressed verbally or by writing, signing, or making other 

gestures, such as eye blinking or mouth movements.
Researchers sponsored by the NIDCD have discovered 

one genetic variant, in particular, that is linked to SLI, 

a disorder that delays children’s use of words and 

slows their mastery of language skills throughout their 

school years. The finding is the first to tie the presence 

of a distinct genetic mutation to any kind of inherited 

language impairment. Further research is exploring the 

role this genetic variant may also play in dyslexia, autism, 

and speech-sound disorders.

A long-term study looking at how deafness impacts 

the brain is exploring how the brain “rewires” itself 

to accommodate deafness. So far, the research has 

shown that adults who are deaf react faster and more 

accurately than hearing adults when they observe 

objects in motion. This ongoing research continues to 

explore the concept of “brain plasticity”—the ways in 

which the brain is influenced by health conditions or life 

experiences—and how it can be used to develop learning 

strategies that encourage healthy language and speech 

development in early childhood. 

A recent workshop convened by the NIDCD drew 

together a group of experts to explore issues related to 

a subgroup of children with autism spectrum disorders 

who do not have functional verbal language by the 

age of 5. Because these children are so different from 

one another, with no set of defining characteristics 

or patterns of cognitive strengths or weaknesses, 

development of standard assessment tests or effective 

treatments has been difficult. The workshop featured 

a series of presentations to familiarize participants with 

the challenges facing these children and helped them 

to identify a number of research gaps and opportunities 

that could be addressed in future research studies.

What should I do if my child’s speech or 

language appears to be delayed?

Talk to your child’s doctor if you have any concerns. Your 

doctor may refer you to a speech-language pathologist, 

who is a health professional trained to evaluate and 

treat people with speech or language disorders. The 

speech-language pathologist will talk to you about your 

child’s communication and general development. He or 

she will also use special spoken tests to evaluate your 

child. A hearing test is often included in the evaluation 

because a hearing problem can affect speech and 

language development. Depending on the result of 

the evaluation, the speech-language pathologist may 

suggest activities you can do at home to stimulate your 

child’s development. They might also recommend group 

or individual therapy or suggest further evaluation by 

an audiologist (a health care professional trained to 

identify and measure hearing loss), or a developmental 

psychologist (a health care professional with special 

expertise in the psychological development of infants 

and children).

What research is being conducted on 

developmental speech and language 

problems? 

The National Institute on Deafness and Other 

Communication Disorders (NIDCD) sponsors a broad 

range of research to better understand the development 

of speech and language disorders, improve diagnostic 

capabilities, and fine-tune more effective treatments. 

An ongoing area of study is the search for better ways 

to diagnose and differentiate among the various types 

of speech delay. A large study following approximately 

4,000 children is gathering data as the children grow to 

establish reliable signs and symptoms for specific speech 

disorders, which can then be used to develop accurate 

diagnostic tests. Additional genetic studies are looking 

for matches between different genetic variations and 

specific speech deficits. 
Birth to 3 Months 

4 to 6 Months 

7 Months to 1 Year 

1 to 2 Years 

YES NO

Knows a few parts of the body and can 

point to them when asked

2 to 3 Years 

NIDCD Fact Sheet

Speech and Language

Developmental Milestones

voice, speechlanguage

YES NO

Reacts to loud sounds

Calms down or smiles when spoken to

Recognizes your voice and calms down 

if crying

When feeding, starts or stops sucking in 

response to sound

Coos and makes pleasure sounds

Has a special way of crying for 

different needs

Smiles when he or she sees you

YES NO

Enjoys playing peek-a-boo and pat-a-cake

Turns and looks in the direction of sounds

Listens when spoken to

Understands words for common items such as 

“cup,” “shoe,” or “juice”

YES NO

Follows sounds with his or her eyes

Responds to changes in the tone of your voice

Notices toys that make sounds

Pays attention to music

Babbles in a speech-like way and uses many 

different sounds, including sounds that begin 

with p, b, and m

Laughs

Babbles when excited or unhappy

Makes gurgling sounds when alone or playing 

with you

YES NO

Has a word for almost everything

Uses two- or three-word phrases to talk 

about and ask for things

Uses k, g, f, t, d, and n sounds

Speaks in a way that is understood by family 

members and friends

Names objects to ask for them or to direct 

attention to them

Follows simple commands (“Roll the ball”) 

and understands simple questions (“Where’s 

your shoe?”)

Enjoys simple stories, songs, and rhymes

Points to pictures, when named, in books

Acquires new words on a regular basis

Uses some one- or two-word questions 

(“Where kitty?” or “Go bye-bye?”)

Puts two words together (“More cookie” or 

“No juice”)

Uses many different consonant sounds at the 

beginning of words

Responds to requests (“Come here” or “Want 

more?”)

Babbles using long and short groups of sounds 

(“tata, upup, bibibi”)

Babbles to get and keep attention

Communicates using gestures such as waving 

or holding up arms

Imitates different speech sounds

Has one or two words (“Hi,” “dog,” “Dada,” or 

“Mama”) by first birthday
voice, speech, and language. Please see the list of 

organizations at http://www.nidcd.nih.gov/directory.

Use the following keywords to help you search for 

organizations that can answer questions and provide 

printed or electronic information on speech and 

language development:

• Early identification of hearing loss in children

• Language

• Speech-language pathologists 

For more information, additional addresses and phone 

numbers, or a printed list of organizations, contact:

NIDCD Information Clearinghouse

1 Communication Avenue

Bethesda, MD 20892-3456

Toll-free Voice: (800) 241-1044

Toll-free TTY: (800) 241-1055

Fax: (301) 770-8977

E-mail: nidcdinfo@nidcd.nih.gov

3 to 4 Years 

4 to 5 Years 

This checklist is based upon How Does Your Child Hear and Talk?, 

courtesy of the American Speech–Language–Hearing Association.

Where can I get more information? 

The NIDCD maintains a directory of organizations 

that provide information on the normal and 

disordered processes of hearing, balance, smell, taste, 

NIDCD supports and conducts research and research training on the 

normal and disordered processes of hearing, balance, smell, taste, 

voice, speech, and language and provides health information, based 

upon scientific discovery, to the public.

voice, speech, languagehearing, balancesmell, taste

NIDCD Fact Sheet: Speech and Language Developmental 

Milestones

NIH Publication No. 10-4781

September 2010

For more information, contact:

NIDCD Information Clearinghouse

1 Communication Avenue

Bethesda, MD 20892-3456

Toll-free Voice: (800) 241-1044

Toll-free TTY: (800) 241-1055

Fax: (301) 770-8977

E-mail: nidcdinfo@nidcd.nih.gov

Internet: http://www.nidcd.nih.gov

The NIDCD Information Clearinghouse is a service of the 

National Institute on Deafness and Other Communication 

Disorders, National Institutes of Health, U.S. Department 

of Health and Human Services.

YES NO

Pays attention to a short story and answers 

simple questions about it

Hears and understands most of what is said 

at home and in school

Uses sentences that give many details

Tells stories that stay on topic

Communicates easily with other children 

and adults

Says most sounds correctly except for 

a few (l, s, r, v, z, ch, sh, and th)

Uses rhyming words

Names some letters and numbers

Uses adult grammar

YES NO

Hears you when you call from another room

Hears the television or radio at the same 

sound level as other family members

Answers simple “Who?” “What?” “Where?”

and “Why?” questions

Talks about activities at daycare, preschool, 

or friends’ homes

Uses sentences with four or more words

Speaks easily without having to repeat 

syllables or words