Pediatric ENT Development Milstones

0 to Six Months
- Repeats the same sounds
- Frequently coos, gurgles, and makes pleasure sounds
- Uses a different cry to express different needs
- Smiles when spoken to
- Recognizes voices
- Localizes sound by turning head
- Listens to speech
- Uses the phonemes /b/, /p/, and /m/ in babbling
- Reaches for objects with one hand but often misses
- Blows bubbles on lips
- Visually tracks people and objects
7 - 12 Months
- Understands ‘No’ and ‘Hot’
- Responds to simple requests
- Understands and responds to own name
- Listens to and imitates some sounds
- Recognizes words for common items (cup, shoe, juice)
- Babbles using long and short groups of sounds
- Uses a song-like intonation when babbling
- Imitates some adult speech sounds and intonation patterns
- Uses speech rather than only crying to get attention
- Listens when spoken to
- Uses sound approximations
- Begins to change babbling to jargon
- Uses speech intentionally for the first time
- Uses nouns most exclusively
- Has an expressive vocabulary of 1 to 3 words
- Understands simple commands
- Attempts to feed self with a spoon
- Attempts to imitate gestures
- Drinks from a cup
- Holds own bottle
- Plays ball with a partner
- Enjoys games like ‘peek-a-boo’ and ‘pat-a-cake’
- Uses a primitive grasp for writing, bangs crayons rather than writes
- Cooperates with dressing, puts foot out for shoe, and places arms through sleeves
13 - 18 months
- Uses adult like intonation patterns
- Uses echolalia (whole or partial repetition of another speaker) and jargon (strings of unintelligible sounds with adult-like intonations)
- Uses jargon to fill in gaps in fluency
- Omits some initial consonants and almost all final consonants
- Produces mostly unintelligible speech
- Follows simple commands
- Receptively identifies 1 to 3 body parts
- Has an expressive vocabulary of 3 to 20 or more words
- Combines gestures and vocalization
- Makes requests for “more” of desired items (more juice, more bubbles)
- Points to recognized objects
- Imitates gestures
- Removes some clothing items (socks, hat)
19-24 Months
- Uses words more frequently than jargon
- Has an expressive vocabulary of 50 to 100 or more words
- Has a receptive vocabulary of 300 or more words
- Starts to combine nouns and verbs
- Begins to use pronouns
- Maintains unstable voice control
- Uses appropriate intonation for questions
- Is approximately 50% intelligible to strangers by 2 years old
- Answers ‘what’s that’ questions
- Enjoys listening to stories
- Knows 5 body parts
- Accurately names a few familiar objects
- Uses pull toys
- Strings beads
- Enjoys playing with clay
- Rotates head while walking
- Reaches automatically with primary concern on manipulation of object
- Seats self in child’s chair
2-3 Years
- Speech is 50-75% intelligible
- Understands ‘one’ and ‘all’
- Verbalizes toilet needs (before, during or after act)
- Requests items by name
- Points to pictures in a book when named
- Identifies several body parts
- Follows simple commands and answers simple questions
- Enjoys listening to short stories, songs and rhymes
- Asks 1-2 word questions
- Use 3-4 word phrases
- Uses some prepositions, articles, present progressive verbs (ex. walking), regular plurals, contractions, and irregular past tense forms (ex. threw)
- Uses words that are general in context
- Continues use of echolalia when difficulties in speech are encountered
- Has a receptive vocabulary of 500-900 or more words
- Has an Expressive vocabulary of 50-250 or more words (rapid growth during this period)
- Exhibits multiple grammatical errors
- Understands most things said to him or her
- Frequently exhibits repetitions-especially starters,’I’, and first syllables.
- Speaks with a loud voice
- Increases range of pitch
- Uses vowels correctly
- Consistently uses initial consonants (some are misarticulated)
- Frequently omits medial consonants
- Frequently omits or substitutes final consonants
- Uses approximately 27 phonemes
- Uses auxiliary is including the contracted form
- Uses some regular past tense verbs (ex. Kicked), possessive, pronouns and imperatives (i.e. commands)
- Begins developing rhythm
- Turns pages one by one or two to three at a time
- Folds paper roughly in half on imitation
- Scribbles
- Drinks from a full glass with one hand
- Chews food
- Undresses self
3-4 Years
- Understands object functions
- Understands differences in meanings (stop-go, in-on, big-little)
- Follows 2- and 3- part commands
- Asks and answers simple questions
- Frequently asks questions and demands detail in response
- Produces simple verbal analogies
- Uses language to express emotion
- Uses 4-5 words in a sentence
- Repeats 6 to 13 syllable sentences accurately
- Identifies objects by name
- Manipulates adults and peers
- May continue to use echolalia
- Uses up to 6 words in a sentence
- Uses nouns and verbs most frequently
- Is conscious of past and future
- Has a 1,200-2000 or more receptive vocabulary
- Has a 800-1,500 or more word expressive vocabulary
- Increases speech rate
- Whispers
- Masters 50% of consonants and blends
- Speech is 80% intelligible
- Sentence grammar improves, although some errors still persist
- Appropriately use is, are, and am in sentences
- Tells two events in chronological order
- Engages in long conversations
- Uses some contractions, irregular plurals (ex. Men), future tense verbs, and conjunctions
- Consistently uses regular plurals, possessives and simple past tense verbs
- Turns pages one at a time
- Runs and plays active games with abandonment
- Traces a square, copies a circle, and imitates horizontal strokes
- Puts on own shoes, but not necessarily the correct foot
- Uses a spoon without spilling
4-5 Years
- Understands concepts of numbers up to 3
- Continues understanding of spatial concepts
- Recognizes 1 to 3 colors
- Has receptive vocabulary of 2,800 or more words
- Counts to 10 by rote
- Listens to short, simple stories
- Answers questions about function
- Uses grammatically correct sentences
- Has an expressive vocabulary of 900-2,000 or more words
- Uses sentences of 4 to 8 words
- Answers complex 2-part questions
- Asks for word definitions
- Speaks at a rate of 186 words per minute
- Reduces total number of repetitions
- Enjoys rhymes, rhythms and nonsense syllables
- Produces consonants with 90% accuracy
- Significantly reduces number of persistent sound omissions and substitutions
- Frequently omits medial consonants
- Speech is usually intelligible to strangers
- Talks about experiences at school, at friends’ homes, etc.
- Accurately relays a long story
- Pays attention to a story and answers simple questions about it
- Uses some irregular plurals, possessive pronouns, future tense, reflexive pronouns, and comparative -er (ex. Faster) in sentences
- Pushes, pulls and steers wheeled toys
- Uses toilet independently
- Skips to music
- Releases objects with precision
- Draws circles, diamonds and crosses
- Enjoys cutting and pasting
5-6 years
- Names 6 basic colors and 3 basic shapes
- Follows instructions given to a group
- Follows 3-part commands
- Asks ‘how’ questions
- Answers verbally to ‘hi’ and ‘how are you?’
- Uses past tense and future tense appropriately
- Uses conjunctions
- Has receptive vocabulary of approximately 13,000 words
- Names opposites
- Sequentially names days of the week
- Counts to 30 by rote
- Continues to drastically increase vocabulary
- Reduces sentence length to 4-6 words
- Reverses sounds occasionally
- Exchanges information and asks questions
- Uses sentences with details
- Accurately relays a story
- Sings entire songs and recites nursery rhymes
- Communicates easily with adults and other children
- Uses appropriate grammar in most cases
- Prints a few capital letters
- Builds complex structures with blocks
- Buttons clothes, washes face and puts toys away
- Reaches and grasps in one continuous movement
- Catches a ball with hands
- Makes precise marks with crayon, confining marks to a small area
6-7 Years
- Names some letters, numbers and currencies
- Sequences numbers
- Understands ‘left’ and ‘right’
- Uses increasingly more complex descriptions
- Engages in conversations
- Has a receptive vocabulary of approximately 20,000 words
- Uses a sentence length of approximately 6 words
- Understands most concepts of time
- Recites the alphabet
- Counts to 100 by rote
- Uses most morphologic markers appropriately
- Uses passive voice appropriately
- Shows reduced interest in writing and drawing
- Draws recognizable man, tree, and house
- Uses adult like writing, but it is slow and labored
- Draws pictures that are not proportional
- Colors within lines
- Indicates well established right or left handedness
- Dresses self completely
- Follows advanced rhythms

Information from: Shipley, K and McAfee, J. (1998)

Assessment in Speech Language Pathology: A Resource Manual 2nd edition.
San Diego: Singular publishing Group, Inc.

Website Links:
American Speech & Hearing Association

Speech

BRIER CREEK

CARY

GARNER

HOLLY SPRINGS

RALEIGH

WAKE FOREST

BRIER CREEK

CARY

GARNER

HOLLY SPRINGS

RALEIGH

WAKE FOREST

Pediatric Development Milestones

BRIER CREEK

CARY

GARNER

HOLLY SPRINGS

RALEIGH

WAKE FOREST

BRIER CREEK

CARY

GARNER

HOLLY SPRINGS

RALEIGH

WAKE FOREST