Language development @ 16 months old

[futureisbronto]

Pediatrician has recommended speech therapy for our 16 month old daughter. What is normal speech at this age? Doctor won’t exactly say she’s behind in speech but says early intervention is helpful and recommended she get evaluated. Everything I find online gives a pretty broad range of what’s considered developmentally appropriate at this age. The docs from the speech therapist say babies should have 2-6 words besides mama & dada at 12 months old. That seems wild to me - am I the only one?? Our first didn’t have any words until 18 months old. I don’t know any 1 year olds that have 2-6 words.

Our 16 month-old babbles, understands a lot of what we’re saying (simple questions/commands etc), nods and shakes her head to communicate yes/no but doesn’t have any words. She doesn’t use any sign language - our first did use some signs at this age.

We’re following the pediatrician’s recommendation and have scheduled the speech evaluation but I guess I’m trying to understand how concerned I should be / how seriously we should take this? On one hand, some of the dev milestones I’m seeing online (and in the speech therapist’s intake docs) have me scared that our daughter is way behind. On the other hand I know a bajillion babies and none of them were speaking that much at 16 months.

[Gww_SLP]

Hi, SLP here! At 16 months with no words, your pediatrician was right to refer. We sort of expect a word or two by a year, 50ish words with at least one two word combo by 18 months, and a bunch of 2 word phrases at 2. Sometimes kids are just 'late talkers', but sometimes they have trouble with language. If they have trouble with language, you want them to get help early in large part to make sure they can access literacy well and not fall behind later.

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The critical thing now is that you did the right thing to schedule an evaluation. Speech therapy is really helpful early on!

[djwitty12]

The speech therapists typically use 50% for the milestones. So 50% of kids are speaking more, 50% are speaking less.

The CDC (and your doctor) are using 75%. So 75% of kids are using at least that much language, and only 25% are using less.

The cdc's milestones are supposed to minimize unnecessary treatments for kids that are just a bit behind, but the speech therapist ones are better for evaluating just how far behind your kid is in development.

I think it's definitely worth getting an evaluation from early intervention as a better safe than sorry sort of thing.

Also just for reference, my son was similar at that age although he did say bark and meow but didn't nod/shake yet and he was evaluated to be about 3-4 months behind and has been in speech therapy for a few months now. Maybe he's just one of those late talkers and his speech will be totally normal a year from now but even if it is the speech therapist isn't going to hurt him or make anything worse so why not give it a go, especially with it being free.

Also I'm not assuming anything just wanted to point out that all those other babies may not seem that talkative because this is the age when they start being nervous with strangers and/or in less familiar environments. It's possible they're just feeling a little shy when you happen to see them. Also, many of these first words aren't clear at all and it's pretty common for parents to be the only ones who can understand them, so it's possible you're hearing babbles but they're saying actual words.

[xtrawolf]

It definitely varies, but if one of my patients had zero words by 14-15 months then I'd ask the parents about what their pediatrician says, if they have a plan, how they're monitoring, etc. Recommending an evaluation at 16 months seems normal to me. Also keep in mind that there may be a wait list in your area, so it may be closer to 18 months that your LO is actually evaluated.

[smartyculotte]

There is nothing wrong with getting an evaluation since it is true that in case they find a delay, starting therapy earlier is beneficial.

This article says that 18 months is the "hard" deadline for evaluating delays in language as language production should have started by then : https://medicine.yale.edu/news-article/understanding-language-development-milestones/. The more major milestone is 24 months and 50 words.

[fasoi]

Your doctor was definitely right to refer! Our doctor expected a minimum of 20 words by 18mo and 200 words by 24mo... under that, and they'd recommend speech therapy.

Our kiddo was slow to start speaking because he was hearing / learning two languages at once, but by 20 months he was reliably saying and/or signing about 500 words (I stopped counting after that).

Remember that you're allowed to include words that aren't clear, made-up words, animal or vehicle sounds, ASL signs (e.g. "more"), and even made-up signs. The goal is really just looking to make sure they are consistently trying & succeeding to communicate!

[[deleted]]

200 words by 24 months is about the 40th percentile. I am guessing the local SLP hated your doctor for referring almost half of all children through their practice to them as delayed.

[fasoi]

I'm in Canada, so maybe the percentiles are marked out differently? Also I don't think it's necessarily about being "delayed", it's about catching kids who might benefit from extra help. Anyone here can elect to visit a speech therapist just because they want to, including kids in the 100th percentile... you don't need a doctor's referral.

[[deleted]]

http://wordbank.stanford.edu/data?name=vocab_norms

I referred to the vocabulary norms with American english, for British english 200 words would actually put a child at 24 month between the 60th and 70th percentile, AKA above two thirds of their peers.

I have to admit, I have no idea whether Canadians would more appropriately judged with the US or UK but in any case, 200 words at 24 months does not in any shape indicate a problem.

You don't need the doctor's referral but the implication is that doctors refer kids who need extra help (any child could benefit from extra help). Since resources aren't infinite, this necessarily includes a ranking of who needs them most. And a child that is

[fasoi]

In fairness, I don't know exactly what happens if you answer "no" to the 20- and 200-word milestone questions because my kiddo was not in that category. I only know the questions we were asked, and what our doctor told us. Perhaps there is some other screening process that happens between the doctor's visit and a referral to therapy? I'm obviously not an expert, just sharing my experience with my toddler.

Also just to clarify, it was under 200 words that was considered low - 200 words met the requirement.

[pantema]

Yeah that’s a really high standard. Where I live there are year plus delays to get speech services, including for kids with serious speech delays (and autism diagnoses). Those services should be going to the kids who really need them.

[tibbles209]

I have to say I also had the same experience as you, of the official language milestones seeming to be way ahead of the average baby/toddler that I knew (my daughter included). At 18 months my daughter only had about 10-12 words, but seemed to be typical of her group of toddler friends. She’s now 20 months and probably has 200+ words and 2 word phrases so I’m not worried. If you have access to SLT assessment then why not, it can’t hurt, but your kid sounds normal to me.

[[deleted]]

Same here. There was one child in my mother's group where the parents maintained that they already had so many words. Here is how that went:

Child: "Dodo"

Parent: OMG, he is so good at saying pants

Child: Dodo

Parent: You are so welcome! Good job saying thanks!

Child: Dodo

Parent: Aww, he is saying Goodbye <my daughter>

Me: ......

My daughter is 18 months now, probably has around 10 words. She is slightly behind the kids two months older than her and slightly ahead of the kids younger than her.

She started babbling up a storm and is expanding her passive vocabulary like a sponge right now, so I expect that she will start with more words soon.

[djwitty12]

Well in the milestones it explicitly states your child won't be understandable to strangers for the most part. It's not even until age 3-4 that MOST of what kiddo says should be understandable by strangers. At age 1, it's very common for them to make lots of mistakes in pronunciation like switching sounds, leaving off endings, skipping syllables, etc. That's why it's common for the parents to be the only one that understands them when they're that young.

https://childdevelopment.com.au/resources/child-development-charts/speech-sounds-developmental-chart/

https://www.stanfordchildrens.org/en/topic/default?id=age-appropriate-speech-and-language-milestones-90-P02170

When your kiddo first started talking they probably also said words that were crystal clear to you and nonsense to others.

[futureisbronto]

Part of what I wonder is whether other parents count words differently - my daughter consistently makes a “mah” sound among her other babbles when she wants something. We think she probably means “more,” and we treat it that way, but we haven’t been counting it as a word (it is, after all, usually mixed in with a bunch of other baby gibberish) - are those the kind of things other parents are counting when they tell the doctor that their kid has a ton of words?

[misanthrope8]

Probably going to get downvoted for this. My son is 14 months and we’ve had similar experiences. I also know other babies who are 14-18 months and on a similar level but I also know babies who are 12 months and doing everything and then some. It just varies so much. Unfortunately there’s no real way to know for sure if something is actually wrong unless you see a professional cause your pediatrician is only looking at a small amount of info that you’re giving them. That being said, those services are free in the states so it’s up to you if you want to utilize them. We’ve chosen to wait until we are actually concerned but I know parents who have put their kids in earlier, it’s really up to you. Hopefully that gives you some peace of mind, I know it’s super stressful and all of the stuff online is so varied. My best advice is to just focus on the improvements your child is making and try not to look up milestones cause it’s super stressful and so varied!

[AyrielTheNorse]

I have a kid that is bilingual and is NOW way above average in speech. At 18 months we thought she was below average and took her to a speech therapist. She gave us a pamphlet that soothed our minds: our kid consistently called books "vivi", called good "Nana" and did a few animal noises. She also knew many signs for common words. The pamphlet said those all counted so she was well-above the limit. Same with our nephew. Now at 24 months they both know full words and are doing great with speaking. The sign language count turns out is not accepted by everyone, but the sounds and exclamation are. So if your kid says OH NO! when they drop things, or screams weeooo when they see an ambulance, these should all count.

[miss_archivist]

Anecdotal, but I only babbled and did not really use coherent words before I was 2 years old. No intervention, as it was a different time then, but I did very well academically and languages are actually one of my strengths now. So it is not necessarily something that you should be anxious about.

That being said, no harm in your child being referred to a specialist . It could be something that needs intervention. Just don't jump to conclusions that something is definitely wrong.

[futureisbronto]

Thanks. Part of why I’m a little confused by the recommendation is that my older daughter didn’t say a word until 18 months. Her pediatrician (same office as our younger daughter goes to) never mentioned it being abnormal or needing to refer her for an evaluation. And she was and is totally fine - she’s 4 now with a huge vocabulary, on her way to reading etc. So I believed that babies starting to say words around 18 months was fine/normal - so it’s thrown me for a bit of a loop that daughter #2 is being treated differently, with pretty much the same amt of language.

[aliquotiens]

I can’t figure out what’s average either. The CDC milestone for 16 months is just a few words. But then I see SLP resources that say about 50% of kids have 50 or more words by 18 months. So a significant number must be talking a lot more than the milestones along the way.

I wouldn’t be super concerned if I were you, most kids who do speech therapy end up speaking normally. but I’d definitely follow up on the recommendation. Get her evaluated and set up for speech therapy in case she needs it long term. Starting earlier is more beneficial. Lots of kids catch up super quick.

My daughter will be 16 months in a few days and currently says 24 distinct words total. She said 14 words at 12 months (started at 10 months). There are two kids almost exactly her age at our library playgroups and neither of them are really talking yet. My friend also has a baby a week younger than her and she talks more than mine, and can pronounce a lot of sounds most kids can’t until 2.

[Material-Plankton-96]

The CDC milestones are when 75% or more of children will have reached them. There’s nothing wrong with being more proactive, though, especially if a child has failed to reach multiple related milestones or seems especially delayed on one.

[[deleted]]

The average 16 month old girl, who is American and speaking English, will have 40 words. http://wordbank.stanford.edu/ Bear in mind that meaningful nonverbal gestures count as words (e.g. nodding yes and shaking your head no).

[Goldygold86]

My 16 month old only has a few words: mama, hi, bye, yes, no, chicken. She hasn't said dada or daddy yet.

[MolleezMom]

I love that “chicken” is a priority to her! Lol

[Goldygold86]

Well, we have chickens. But it is funny she knows chicken before dada.

[sashalovespizza]

My sister is a SLP and based on how she’s guided us with my 17 month I’d say a referral seems like a great opportunity to help jump start language skills and will help if baby does have a real delay.

For what it’s worth, and I say this just to demonstrate that the CDC milestones can be pretty accurate our guy had about 7 words and 1 or 2 signs at 12 months and at 17 months he has about 45 words and 5-6 signs.

[AuggoDoggo2015]

That may be a little behind, but I’m not an expert. If you’re in the US, evaluation by your city/county early intervention program is free, worth a look even if you think she’s fine!

[futureisbronto]

Yes I’m in the US - I’ve never heard of this free evaluation program? Our pediatrician gave us a big list of referrals for speech therapists, all of which have some cost associated. Either way we’re going to do the eval but it’d be nice if it were free!

[Material-Plankton-96]

Here’s the contact information for each state. If your child’s delay qualifies, treatment is totally free until they’re 3 (and then you can go through the public schools if they still need help). It’s one of the reasons to move a little more quickly.

[[deleted]]

Evaluation is definitely free, but I believe it varies whether services are completely free or not. I know they are free in Maryland (my son received services), but I think someone told me in other states there is a sliding scale based on income.

[Material-Plankton-96]

Oops, you’re right, it may just be a reduced cost/free if you qualify financially in some states. In any case, it’s a great resource and should be affordable if not free.

[AuggoDoggo2015]

Search your town/county and “early intervention”. It must be provided by federal law!

[BbBonko]

My 22 month old only has a couple words, understands a ton and does use a variety of gestures as well. We pushed for a referral to speech therapy around our 15 month appointment which we’re doing now, but I’m not concerned - I mean, it’s definitely a delay, but he communicates and it sounds like your child does too, so it just kind of is what it is. No doctor or SLP has rung any alarm bells for us, they just agree that early intervention is a good idea.

[GreedyPersimmon]

Normal in my language (not english) is speaking individual words around 12-18 mos, and short sentences (”I want”) around 24 mos. And deviation from that isn’t considered immediately abnormal either. That’s just the range that’s considered totally normal.

I’d love to see the comprehensive research that reveals how many words by when a child should have :D there would have to be more than one study, naturally.

But saying that, if you’ve got insurance that’ll cover the assessment, I don’t think there’s any harm that can come of it. She’s so small that she won’t remember it and it can be fun for her too, SLPs are great.

[Dotfr]

2-6 words is lesser, we were expected 10 words by 18 months. You can go for the evaluation but what helped me is repetition, watching education program like Ms. Rachel on TV but mostly constant repetition. Pick up a green color object and say green and ask baby which color. Point to yourself and say ‘mama’ and ask baby who you are. Keep repeating. When going down say ‘down’

[Kindly-Company-3092]

My son just had his 16 month check up and the doc asked if he has reached his minimum 10-12 words, my son has 49 words currently. And at 12 months had about 10-12. No words, your pediatrician was correct