Voice, speech, and language are the tools we use to communicate with each other.

Voice is the sound we make as air from our lungs is pushed between vocal folds in our larynx, causing them to vibrate.

Speech is talking, which is one way to express language. It involves the precisely coordinated muscle actions of the tongue, lips, jaw, and vocal tract to produce the recognizable sounds that make up language.

Language is a set of shared rules that allow people to express their ideas in a meaningful way. Language may be expressed verbally or by writing, signing, or making other gestures, such as eye blinking or mouth movements.

The first 3 years of life, when the brain is developing and maturing, is the most intensive period for acquiring speech and language skills. These skills develop best in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

There appear to be critical periods for speech and language development in infants and young children when the brain is best able to absorb language. If these critical periods are allowed to pass without exposure to language, it will be more difficult to learn.

The first signs of communication occur when an infant learns that a cry will bring food, comfort, and companionship. Newborns also begin to recognize important sounds in their environment, such as the voice of their mother or primary caretaker. As they grow, babies begin to sort out the speech sounds that compose the words of their language. By 6 months of age, most babies recognize the basic sounds of their native language.

Children vary in their development of speech and language skills. However, they follow a natural progression or timetable for mastering the skills of language. A checklist of milestones for the normal development of speech and language skills in children from birth to 5 years of age is included below. These milestones help doctors and other health professionals determine if a child is on track or if he or she may need extra help. Sometimes a delay may be caused by hearing loss, while other times it may be due to a speech or language disorder.

Children who have trouble understanding what others say (receptive language) or difficulty sharing their thoughts (expressive language) may have a language disorder. Developmental language disorder (DLD) is a language disorder that delays the mastery of language skills. Some children with DLD may not begin to talk until their third or fourth year.

Children who have trouble producing speech sounds correctly or who hesitate or stutter when talking may have a speech disorder. Apraxia of speech is a speech disorder that makes it difficult to put sounds and syllables together in the correct order to form words.

Talk to your child’s doctor if you have any concerns. Your doctor may refer you to a speech-language pathologist, who is a health professional trained to evaluate and treat people with speech or language disorders. The speech-language pathologist will talk to you about your child’s communication and general development. He or she will also use special spoken tests to evaluate your child. A hearing test is often included in the evaluation because a hearing problem can affect speech and language development. Depending on the result of the evaluation, the speech-language pathologist may suggest activities you can do at home to stimulate your child’s development. They might also recommend group or individual therapy or suggest further evaluation by an audiologist (a health care professional trained to identify and measure hearing loss), or a developmental psychologist (a health care professional with special expertise in the psychological development of infants and children).

Birth to 3 Months

• Reacts to loud sounds
• Calms down or smiles when spoken to
• Recognizes your voice and calms down if crying
• When feeding, starts or stops sucking in response to sound
• Coos and makes pleasure sounds
• Has a special way of crying for different needs
• Smiles when he or she sees you

4 to 6 Months

• Follows sounds with his or her eyes
• Responds to changes in the tone of your voice
• Notices toys that make sounds
• Pays attention to music
• Babbles in a speech-like way and uses many different sounds, including sounds that begin with p, b, and m
• Laughs
• Babbles when excited or unhappy
• Makes gurgling sounds when alone or playing with you

7 Months to 1 Year

• Enjoys playing peek-a-boo and pat-a-cake
• Turns and looks in the direction of sounds
• Listens when spoken to
• Understands words for common items such as “cup,” “shoe,” or “juice”
• Responds to requests (“Come here”)
• Babbles using long and short groups of sounds (“tata, upup, bibibi”)
• Babbles to get and keep attention
• Communicates using gestures such as waving or holding up arms
• Imitates different speech sounds
• Has one or two words (“Hi,” “dog,” “Dada,” or “Mama”) by first birthday

1 to 2 Years

• Knows a few parts of the body and can point to them when asked
• Follows simple commands (“Roll the ball”) and understands simple questions (“Where’s your shoe?”)
• Enjoys simple stories, songs, and rhymes
• Points to pictures, when named, in books
• Acquires new words on a regular basis
• Uses some one- or two-word questions (“Where kitty?” or “Go bye-bye?”)
• Puts two words together (“More cookie”)
• Uses many different consonant sounds at the beginning of words

2 to 3 Years

• Has a word for almost everything
• Uses two- or three-word phrases to talk about and ask for things
• Uses k, g, f, t, d, and n sounds
• Speaks in a way that is understood by family members and friends
• Names objects to ask for them or to direct attention to them

3 to 4 Years

• Hears you when you call from another room
• Hears the television or radio at the same sound level as other family members
• Answers simple “Who?” “What?” “Where?” and “Why?” questions
• Talks about activities at daycare, preschool, or friends’ homes
• Uses sentences with four or more words
• Speaks easily without having to repeat syllables or words

4 to 5 Years

• Pays attention to a short story and answers simple questions about it
• Hears and understands most of what is said at home and in school
• Uses sentences that give many details
• Tells stories that stay on topic
• Communicates easily with other children and adults
• Says most sounds correctly except for a few (l, s, r, v, z, ch, sh, and th)
• Uses rhyming words
• Names some letters and numbers
• Uses adult grammar

This checklist is based upon How Does Your Child Hear and Talk?, courtesy of the American Speech–Language–Hearing Association.