Speech and language development in children aged 0–3 years

What is speech and language?

Many parents and caregivers wonder about their child’s speech and language development. ‘Speech’ refers to how we make and combine sounds to say words. ‘Language’ refers to the words we use and how we use them to communicate. Language is often divided into two categories:

1. Receptive language: how we understand what is said to us
2. Expressive language: how we share our own thoughts, needs and ideas (this can be verbal or non-verbal)

What does early speech and language development look like?

Early speech and language development can look different for every child. However, there are general milestones that can be used to track your child’s speech and language development. These milestones look at a child’s speech, receptive language, expressive language and overall communication.

Milestones from 0–3 years 

(Adapted from Toronto Preschool Speech & Language Milestones)

By 6 months

• Startles in response to loud noises
• Turns to look where a sound is coming from
• Makes different sounds for different states (e.g., happy, hungry, tired)
• Watches your face while you talk to them
• Smiles or laughs when you smile or laugh
• Imitates some sounds
• Coos or babbles with simple sounds (“pa”, “ba”, “ma”)

By 9 months

• Responds to their name
• Uses some functional gestures (e.g., reaching to be picked up)
• Enjoys social games (e.g., peek-a-boo, tickle games)
• Enjoys being around people
• Understands “no” (although they may not always follow)
• Babbles and repeats sounds (e.g., “bababa”, “mamama”, “dadada”)

By 12 months

• Can follow simple one-step directions (e.g., “sit down”) (they may not always follow!)
• Follows a point
• Gets your attention using sounds, gestures, pointing
• Uses intentional gestures (e.g., waving hi/bye, shaking head for “no”)
• Combines different sounds together (e.g., “abada baduh abee”)
• Uses 3–5 words consistently

By 18 months

• Understands simple prepositions (e.g., in, out, on, off)
• Can point to at least two body parts when asked
• Uses 20 words consistently
• Responds with gestures or words to simple questions (e.g., “where is teddy?”)
• Makes at least four different consonant sounds (p, b, m, n, d, g, w, h)
  
• Points to pictures with one finger

By 2 years

• Follows two-step directions (e.g., “go find your shoes and put them on”)
• Uses 100–150 words
• Combines 2–4 words (e.g., “red car”, “ball go down”)
• Is understood about 50% of the time
• Begins to engage with other children (e.g., sharing toys, imitating actions/words)
• Engages in early pretend play (e.g., giving teddy a drink, pretending bowl is a hat)

By 2.5 years

• Understands size concepts (e.g., big/little) and quantities (e.g., a lot/a little, more)
• Uses over 350 words
• Uses a variety of action words (e.g., run, spill, fall, eat, sleep, go)
• Participates in some turn-taking activities with other children
• Puts sounds at the beginning of most words
• Uses words with two or more syllables or beats (e.g., “pu-ppy”, “ba-na-na”)
• Remembers and understands familiar stories

By 3 years

• Understands who, what, where and why questions
• Uses sentences of five to eight words
• Talks about past events (e.g., what they did at day care, trip to the zoo)
• Tells simple stories
• Is understood most of the time by people outside of family
• Enjoys playing with peers and has preferred playmates
• Engages in multi-step pretend play (e.g., pretending to cook a meal)

What are some strategies I can use to support my child’s speech and language development?

Face to face

Getting face to face with your child allows them to watch your mouth while you speak to see how you form sounds and lets you see each other’s facial expressions for better interactions. Get on your child’s level by lying down with them on the floor during tummy time, sitting them facing you on your lap or pulling up a chair facing them when they are in their highchair.

Imitate gestures, sounds and words

Imitating your baby can help them learn how to imitate you. This is how your baby learns to make different sounds and words. Watch your baby and copy their actions, sounds, and words—they may start to catch on and copy back-and-forth with you!

Show

Using visuals can help support your child’s understanding of language. Try using pictures, gestures and facial expressions to help support your spoken language. This will help your child follow and learn new words.

Model short words and phrases

Keeping language short and simple can help children understand you and learn to imitate you. If your baby is not using any words yet, try using one word to label actions, people and objects (e.g., “up!”, “mama”, “ball”). If your baby uses one word, try modeling simple two-word combinations (e.g., if they say “ball”, try “big ball”; if they say “milk”, say “more milk”). Try to stay one word ahead of their current level.

Word choice

The words you use matter! Children are more likely to try words that help them get what they want (think common requests such as “more”, “milk”, “up”) or words that are fun (think animal sounds like “moo” or “baa”, or words like “boom”, or “uh oh!”). Children may also have an easier time with one-syllable words and words with simple sounds such as /m/ and /b/.

What should I do if I have concerns about my child’s speech or language development?

If you are concerned about your child’s speech or language development, get in touch with your local Preschool Speech & Language Program (PSL) to access a speech-language pathology assessment. Visit https://www.ontario.ca/page/preschool-speech-and-language-program to find your local PSL and for information on how to self-refer. You do not need a doctor’s referral to access your local PSL—families can refer themselves online. If you have extended health coverage, you may also check with your insurance provider to see if private speech and language therapy is covered.

At SickKids

If your child is a SickKids inpatient (i.e., they are admitted overnight at SickKids) and you have concerns about their speech or language development, ask your health-care team about an inpatient speech-language pathology referral. An inpatient speech-language pathologist (SLP) may be able to consult with you to provide strategies—or in some cases, offer assessment and ongoing support for your child—and help with any community referrals upon discharge.

Your child may be able to access inpatient speech-language pathology support if:

• They are 0–3 years old and admitted for >3 weeks.
• They have baseline speech or language delays and are not connected to community supports.
• They are any age and have had a change to their speech or language associated with their illness or hospital stay.
• They need support in accessing communication (e.g., if they have a tracheostomy, if they are intubated, or if they need devices to help them communicate).

If your child meets any of the above criteria, or if you have further questions about speech and language support in hospital, ask your health-care team for an inpatient speech-language consult.

Helpful links

Communication checklists in 21 different languages — Surrey Place

Speech & language: Help your child now — City of Toronto

Family resources to promote children’s growth and development — Zero to Three

Hanen Tips for Parents — The Hanan Centre  

Activities to encourage speech and language development —American Speech-Language-Hearing Association