For the first installment of our new Expert Series, we caught up with Kim Christensen, M.S., a Speech-Language Pathologist and owner of SF Speech for Kids! in San Francisco. We chatted with her about typical speech/language milestones for young kids; what parents can do to help promote healthy speech/language development; and what to do if you are concerned that your child may not be “on track.”
Q: What are the key speech/language milestones to look out for in babies & toddlers? What behavior is considered normal at different ages?
A: The American Speech-Language Hearing Association (ASHA) website has helpful milestone charts available for birth to five years. But in a nutshell:
By 6 months, your baby should respond to sounds, be interactive with you, and smile and laugh. You should hear babbling with both consonant and vowel sounds (“mamama, bagamaga” etc). If your child is not making much eye contact with you, or doesn’t seem to notice or respond to you, you should check in with your child’s pediatrician. You can also get in touch with a speech-language pathologist — we don’t get many calls from parents of six month olds, but are well versed in early communication development and would love to help!
Around 12 months, first words emerge. Fifteen months is considered late for first words. By the time first words emerge, your child should already be a very good nonverbal communicator — using gestures like waving and reaching for “up,” understanding the names of things in his environment, and following some simple directions. If your child does not seem to understand simple words or directions (e.g. “come here,” “give me,” “get ___”), make many sounds, use many gestures, try to communicate often, or produce a first word by 15 months, give us a call. Tip: A “word” is anything your child says that has meaning, even if it’s not pronounced correctly! “Baba” used to mean “bottle” absolutely counts.
Age 18-24 months is typically when we expect a child’s vocabulary to explode and for two-word phrases to emerge. You should be hearing things like “more milk,” “no doggie,” “hi cat” (my daughter’s first phrase at 14 months!), “daddy car,” or “mommy up.” During this stage, your child’s listening skills should advance and your child should be able to sit and listen to a short story and engage with you while reading (e.g. pointing to pictures you name, some commenting on the pictures). Your child should be able to reliably follow 1-step and some 2-step directions (e.g. “get your shoes and bring them to mommy”). Of course, complying with your requests may be a different story! If your child has trouble understanding what you say or is only using single words, or his vocabulary does not seem to be growing, consult with a speech-language pathologist.
By age 3, your child should be able to understand and say quite a lot! A three year old should be able to follow two-step (and some longer) directions. He should be able to follow along with a story and answer simple questions about it. At this stage, children typically have a word for most things and speak in short sentences. You’ll often start hearing “why?” at this stage. Your child’s speech should be fairly intelligible. It is still normal for your child to mispronounce words, such as saying “tat” for “cat”, “pish” for “fish,” “fum” for “thumb,” “wabbit” for “rabbit.” A possible red flag to look out for at this stage is frustration on the part of your child, which may manifest itself as behavior challenges. Also, while we don’t encourage direct comparisons, if your child doesn’t seem to be understanding or expressing himself as well as his peers, it may be a good idea to consult with a speech-language pathologist.
Q: How can parents best support normal speech/language development? Is there a certain number of words babies should hear per day, or a certain number of books we should read? Should we use baby talk? Is it enough for babies to overhear adults talking, or does communication need to be interactive?
A: There’s no magic number when it comes to how much time to spend talking with your child or how many words per day to expose them to. Instead, focus on quality and interacting as often as possible. It does not have to be designated play time; in fact, many elements of your family’s daily routine provide great opportunities for engagement.
Baby talk is definitely recommended! Children learn to understand intonation before words, so the inflection in your baby talk voice will be sure to capture your little one’s attention and encourage him to chime in. Also, I definitely recommend directing speech at your child, rather than expecting your child to learn from watching a screen, no matter how educational. Interaction is always the best choice!
Q: What are a few of your favorite toys/books/apps for promoting healthy speech/language development in babies (6-18 months), toddlers (18-36 months), and preschoolers (3-4yrs)? How can parents use these tools to get the most out of them?
A: Babies: For younger babies, YOU are the best stimulus! Babies love gazing at their parents’ faces and listening to their voices. Engage your child by talking to him, responding to his noises and facial expressions, and having a loving interaction.
For older babies, a good mix of cause-and-effect toys and dump-and-fill type toys are wonderful. Keep in mind that the more a toy does (blinking lights and sounds), the less exploring and improvising the child will do with that toy. Stacking cups, blocks, balls, shape sorters, and simple form puzzles will keep baby busy and give you opportunities to interact — give him pieces, talk about shapes/colors/pictures, dump out and fill up, and have some “uh oh” moments together that will result in laughs and extended interactions.
I do not recommend apps for babies.
Toddlers: Toddlers are just discovering the world of pretend play, so toys that mimic real life are great: play kitchens, baby strollers, shopping carts, baby dolls, and so on. At this stage, language very much mirrors play: just as children are beginning to combine words to form phrases, they are also combining actions and objects in play. Here are some examples: baby drink, baby(‘s) milk, mommy eat, daddy all done, more milk, bye bye baby, hug baby, mommy hug, daddy hug, cut carrot, push stroller, night night baby. The combinations are endless. You can talk in these two-word phrases during play time to help him your toddler learn to combine words right at his level.
When it comes to apps, I’m not a huge fan during this age group (except for long plane rides!). I can’t stress enough how important interaction is for communication development.
Preschoolers: Preschool is a magical time when a child’s imagination really takes off. Dress-up costumes and props are perfect for this stage, as are dolls and action figures. They don’t have to be well-known characters (e.g. Disney), but if that’s what gets your child going, don’t fight it! Kids just love characters and being a part of their imaginary world. Each one has a backstory, likes and dislikes, adventures and relationships, and it is through those imaginary stories that kids explore so much about the world, their feelings, and how people interact. Also, get in there right alongside with your child and dress up and play in that imaginary world. Last, bringing emotional themes (e.g. pretending to be upset, hurt, excited, scared, confused, lonely, bored) into your joint play can also be really helpful.
Q: If a parent is concerned that their child may potentially be delayed, what should they do? When is it appropriate to “wait and see,’ and when is it appropriate to seek an outside evaluation?
A: That’s always a tricky one to answer. Many pediatricians recommend a “wait and see” approach. Many parents don’t realize they can self-refer rather than needing to rely on a pediatrician’s referral. My best advice for parents is trust your gut and when in doubt, seek an evaluation. There is never any harm in getting an evaluation, even if the result is to find out your child is on-track. The evaluation is usually fun for your child and most insurance plans will cover it. So if taking the “wait and see” approach recommended by your pediatrician is causing you stress, just pick up the phone and make an appointment with a speech-language pathologist! Hint: if you call a small practice, the SLP (rather than a receptionist) may answer the phone and be able to answer some of your questions during that initial conversation.
Q: Any online resources to which you can point parents interested in learning more about speech/language development?
A: The Hanen Centre is great — they digest the latest research and translate it into parent-friendly articles about a wide range of topics related to communication.
Thank you, Kim!
Below are some of Kim’s favorite products for promoting healthy speech/language development in kids. View her full list on TotScoop to read her suggestions for how to use each of these together with your kids to encourage their verbal development!
More on Kim and SF Speech for Kids!:
Kim Christensen has been a practicing pediatric speech-language pathologist since 2007 and has been serving families at her practice SF Speech for Kids! in the Sunset district of San Francisco since 2012. Kim believes in a family-centered approach to intervention with customized therapy plans for each child. Each therapy session is different from the next, depending on the child’s individual goals, interests, sensory preferences and behavioral needs. Kim has built a wonderful small team of therapists to provide high-quality services at SF Speech for Kids! While each therapist brings her own expertise and style to therapy, the collective approach of the practice is to take an analytical approach to evaluations and treatment planning, and a fun, play-based approach to therapy. The key is to make it fun and motivating so the children look forward to coming back each week. On Wednesdays, Kim can be found at JumpStart Learning to Learn, a program of the Autism Center of Northern California (ACNC), providing intensive individualized parent training to families dealing with a recent diagnosis of Autism Spectrum Disorder. When she is not busy “teaching kids to talk” as her daughter understands her work, Kim enjoys spending time exploring the bay area with her husband and five year old daughter, and has even been spotted roller skating and hula hooping (not at the same time – yet). To learn more about Kim and the services her team provides, visit SF Speech for Kids!. You can also follow SF Speech for Kids! on Facebook.