The OPEN minute newsletter / Language Development Red Flags
May 31, 2022

Language Development Red Flags

I remember attending a pediatric conference in 2017 where Dr. Michelle Macias (Professor of Pediatrics and Chief of the Division of Developmental-Behavioral Pediatrics at the Medical University of South Carolina) spoke to the audience about language development in children and some “red flags” to be aware of when assessing their progression. Here is a summary of her suggestions – hope you find this helpful in your own clinical practice.

First, here are some common language development myths:

  • “Boys speak later than girls”
  • “His older sibling speaks for him”
  • “Her language is delayed because her family speaks 2 languages”
  • “Her language is delayed because of multiple ear infections”

But in reality, these are the language development facts:

  • Girls are more talkative than boys, but boys learn words within accepted time frame
  • Language development almost never delayed because the child “doesn’t need to speak”
  • Children learning two languages follow the same pattern of language development
  • Early otitis media is associated with but does not cause early language delay

Red Flags for language development:

  • 2-6 months: no response to sound
  • 6 months: no cooing, interest in social interactions
  • 10 months: no babbling
  • 12 months: no basic gesturing
    waving bye-bye
    holding arms out to be picked up
  • 15-18 months:
    no words other than mama or dada
    no understanding of simple commands
    no pointing or following a point
  • 18-24 months:
    loss of words or communication
    minimal symbolic play
  • 24-30 months:
    <50 words by 24 months
    no 2-word combinations
    no novel phrases
    not following simple commands
    <50% intelligible
  • 3 years:
    no 3-word sentences
    few novel sentences
    frequent echolalia
    unable to follow 2-step command
    <75% intelligible

As clinicians, it is important we monitor and screen all children objectively with developmental screening tools. Those with evidence of speech delay may need to undergo a formal hearing evaluation if appropriate, and families should be given recommendations on how to encourage speech development or be referred for speech therapy. Early intervention in these cases can improve the child’s language development.
Hope this helps!
Best regards,
Dr. Eyal  Ben-Isaac, Children’s Hospital Los Angeles

References and Resources
OPEN Recommended Reading

Subscribe to Our Newsletter

"*" indicates required fields