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Red Flags/When to Call/Speech and Language Milestones

12 Months

  • Limited or no babbling 
  • Does not gesture – such as waving or clapping
  • Does not respond to name
  • Not pointing at objects of interest
  • Does not understanding common words such as mama, dada, milk
  • No back and forth sharing of sounds and smiles

18 Months

  • Does not respond to “no” or “bye-bye”
  • Does not use at least 8-10 words meaningfully
  • Does not follow simple commands, such as "give me the ball"
  • Is not playing pretend with items, such as a phone

By Age Two

  • Less than 50% intelligible
  • Does not use at least six consonant sounds
  • Does not follow two step directions
  • Cannot point to pictures of items in books when asked
  • Has a vocabulary of less than 50 words
  • Relies on gestures and grunting to communicate
  • No two-word meaningful phrases

By Age Three

  • Deleting consonants at the end of words and/or beginning of words
  • Less than 75% intelligible – strangers can’t understand child
  • Has not mastered the following sounds: p, m, h, n, and w
  • Not using three-word phrases
  • Difficulty understanding and therefore answering a variety of questions


By Age Four-Five

  • Is not 90-100% understandable to strangers despite age appropriate articulation errors (may not be able to say /r, sh, ch, l, or th yet)
  • Is not asking a variety of questions to gain information (who, what, where, why and when)
  • difficulty with grammar or pronoun use
  • Cannot tell a simple story on topic
  • Has difficulty answering simple who, what, where and why questions
  • Is not yet able to name a few  letters, numbers, and rhyming words

My Child Benefit From Therapy if...

  • Not meeting the expected developmental milestones during the first 15-24 months of life (i.e., cooing, babbling, producing first word(s)
  • Difficulty coordinating and planning oral motor movements (tongue, lips) to formulate sounds/ syllables or have weak oral motor movements (i.e., weak jaw and/or tongue strength)
  • Not putting two words together to produce phrases and short sentences
  • Articulation difficulties where their speech consists of substitutions ( i.e., “f ” for “th,” “w” for “l”), distortions (i.e., the “s” sound may be a lisp or sounds messy), omissions (i.e., the word “cat” is produced “ca.”)
  • Weaknesses in receptive language skills or the ability to understand Language. (includes following simple directions, identifying spatial and temporal concepts, understanding prepositions, identifying antonyms, synonyms, multiple meaning words, etc.)
  • Weaknesses in expressive language skills or the ability to communicate through words, facial expressions, gestures, or other nonverbal forms
  • Difficulties in social situations, such as appropriate turn-taking skills, eye-contact, understanding a communication partner’s feelings, introducing and maintaining a topic, etc.
  • Limited food repertoire or have a food repertoire that is limited to certain textures, such as puree
  • Numerous disfluencies where they may repeat a sound, word, or phrase before completing a sentence