Speech and Language Pediatric Milestones: NCLEX Chart, Nursing Mnemonic
Developmental milestone chart and mnemonic for speech and language. Pediatric, infant, and child development stages by age. Great for USMLE, NCLEX, and nursing! Includes quiz at the end!
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Pediatric Milestone Chart
Developmental milestones are skills acquired by an infant, baby, or child by a certain age.
The main pediatric milestone categories include:
Physical (gross motor and fine motor skills)
Communication and Language
Social and Emotional
Cognitive
We will focus on the milestones for communication and language in this lecture, which include verbal and nonverbal communication, speech, hearing, and understanding.
Make sure to also check out the trick to remember the pediatric milestones for gross motor development in a previous post.
As with every EZmed lecture, a simple mnemonic/trick will be provided in order to help you learn each milestone and remember the stages of language development.
Still not enough?
There is also an EZmed chart shown below, which includes each milestone by age along with the trick to remember it.
You will learn the speech and language milestones for 3 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, and 4 years old.
If you are a medical, nursing, or healthcare student, then this chart serves as a great checklist and resource for the USMLE, NCLEX, or other medical exams.
Let’s get started!
Pediatric Milestone Chart: Developmental milestones for speech and language by age; 3 months, 6, months, 9 months, 12 months, 18 months, 2 years, 3 years, and 4 years.
Pediatric Milestone Mnemonic
All of the speech and language developmental milestones can be remembered using the age of the child.
As we discuss each milestone below, we will use the following tricks:
3 Months = “3” Letter Word “Coo”
6 Months = “6” Letter Word “Babble”
9 Months = “9” Letter Word “Imitation”
12 Months = “1-2” Words
18 Months = “18” Words
2 Years = “2” Word Phrases
3 Years = “3” Word Phrases
4 Years = “4 or More” Word Sentences
Pediatric Milestone Mnemonic: Developmental milestone trick for speech and language by age.
3 Months = “Coo”
The first milestone on the list occurs at 3 months.
The trick to remember the 3 month milestone is to use the 3 letter word “coo”.
Infants typically make cooing sounds by this age.
They also start to smile at people and make eye contact with others.
The infant begins to recognize familiar voices, and they may even stay quiet or smile when spoken to.
The infant will also cry differently for different needs.
For example, the crying sounds will be different when they are hungry versus tired.
Lastly, the infant vocalizes pleasure and displeasure sounds differently.
They laugh and giggle as a way to communicate happiness, and they cry and fuss as a way to communicate when they are upset.
*As we walk through each milestone, remember they are average timeframes and that some milestones may occur sooner or later.
3 month developmental milestones for speech and language: coos, smiles, recognizes familiar voices, and cries/vocalizes differently for different needs/feelings.
6 Months = “Babble”
Next on the list is 6 months.
The trick to remember the 6 month milestone is to use the 6 letter word “babble”.
Infants typically start to babble and repeat sounds by this age.
They may babble “mama” or “dada” without much meaning.
This is because the repetitive consonant sounds infants tend to produce first when babbling include “B, D, G, M, P, and T”
Giggling and laughing increase, and the infant starts to make gurgling noises.
The infant also uses their own voice and/or speech-like babbling sounds to express pleasure versus displeasure.
This is different from 3 months when laughing, crying, and fussing were the primary methods in which the infant vocalized and communicated pleasure and displeasure.
Finally, the infant notices and recognizes sound more.
Their eyes move in the direction toward sound, they pay attention to music, and they respond to changes in the tone of your voice.
6 month pediatric milestones for speech and language: babbles, laughs more, gurgles, uses own voice to express feelings, and notices/recognizes sounds more.
9 Months = “Imitation”
Next is 9 months and again the infant’s age can be used to remember the milestone.
The trick to remember the 9 month milestone is to use the 9 letter word “imitation”.
This is the start of the baby’s imitation phase.
The infant will imitate speech and non-speech sounds, and they will also imitate actions and gestures.
They may even gesture without being prompted by pointing to objects and showing them to others.
The infant might also look at familiar objects when someone is talking about them.
Lastly, the baby starts to recognize their own name, and the babbling increases as they begin to string longer babbling sounds together.
9 month developmental milestones for speech and language: imitates speech/non-speech sounds, imitates actions/gestures, looks at objects when talked about, recognizes own name, and babbles more.
12 Months = “1-2 Words”
As we move to 12 months, we can again use the age of the child to remember the milestone.
The trick is to take the numbers “1 and 2” in 12 months to remember “1-2 words”
The child usually has a vocabulary of 1-2 words by 12 months of age.
This could be in addition to “mama” and “dada”, and their vocabulary could even be larger depending on the child.
Their use of “mama” and “dada” also has meaning to it now.
Remember during the babble phase they can say “mama” and “dada” without much meaning, however by 12 months of age they start to bring meaning to their words.
There is another trick to remember the 12 month milestone as well.
You can use the 12 to remember the 12 letter phrase “understand me”.
This is the start of the child’s “understanding phase”, in which understanding drastically improves.
Children begin to understand anywhere from 3-50 words, and they start to bring meaning to their vocabulary.
Furthermore, they begin to understand simple phrases, instructions, requests, and commands such as “Come here.” and “Don’t touch.”
The child also starts to understand and answer simple questions nonverbally by nodding and shaking their head, or they might get an object when requested to do so.
Finally they understand and recognize the names and words for common items such as ball, shoe, cup, juice, dog, etc.
The understanding phase is a process and everything listed above will not occur at exactly 12 months of age.
Rather, 12 months is when the child starts to develop the above speech and language skills, and they continue to develop those skills throughout their 2nd year of life.
12 month pediatric milestones for speech and language: vocabulary of 1-2 words, recognizes words for common items, and understands simple requests, instructions, commands, and questions.
18 Months = “18 Words”
Next on the list is 18 months.
We can again use the age of the child to remember the milestone of “18 words”.
By 18 months of age, the child typically has a vocabulary of 10-20 words (“18 words”).
Around 18 months old, or soon after, the child may have a “word spurt” in which their vocabulary drastically increases to 50 words by age 2.
Furthermore, the child begins to repeat words overheard in conversation.
They also become more interactive with their understanding.
For example, they recognize and point to familiar objects and people in pictures, they point to pictures in a book when named by the reader, and they point to familiar body parts when asked (eyes, ears, nose, etc.).
The child’s ability to understand and follow simple commands improves, such as “Put the toy down.” or “Roll the ball.”
Moreover, they continue to understand simple questions like “Where’s your cup?” or “Where are your shoes?”
18 month developmental milestones for speech and language: vocabulary of 10-20 words, repeats words overheard, follows simple commands/questions, points to familiar objects and body parts when asked.
2 Years = “2 Word Phrases”
Moving on to 2 years old, we can use the 2 to remember the milestone of “2 word phrases”.
The child begins to use 2 word phrases in order to talk about or ask for things.
They will put 2 words together like “More milk”, “No juice”, or “Daddy book”.
Furthermore, they will ask 2 word questions like “Where’s doggy?”, “Where’s kitty?”, “Go bye-bye?”, or “What’s that?”
There is another trick to remember the 2 year milestone as well.
You can use the number 2 to remember “2 step directions”.
The child starts to follow 2 step instructions by 2 years of age, such as “Pick up your toy and give it to mommy.”
The child’s vocabulary may be 50 words or more, however the pronunciation is often unclear.
The parents and primary caregiver usually can understand at least half of the speech.
In addition to their vocabulary growth, the child also starts to make animal sounds such as “moo”.
Finally, the child may begin to use gestures and words during pretend play.
2 year developmental milestones for speech and language: uses 2 word phrases, follows 2 step directions, has a 50 or more word vocabulary, uses words/gestures during pretend play, and makes animal noises.
3 Years = “3 Word Phrases”
Similar to how we used “2 word phrases” to remember the milestone for 2 years old, we can now use “3 word phrases” to remember the milestone for 3 years old.
The child begins to use 3 word phrases in order to talk about and ask for things.
Their vocabulary increases to 200 words or more by age 3.
Not only does their vocabulary expand, but their grammar and pronunciation also improve.
Their speech becomes more clear, especially to the parents or primary caregiver.
The child’s thinking and understanding becomes more abstract.
They begin to ask “what” and “where” type questions.
They also begin to understand spatial concepts such as “in”, “on”, or “under”, as well as concepts involving different colors and time.
The child understands and uses more pronouns such as “you”, “me”, “him”, or “her”.
They also understand and use plural words such as cats, dogs, shoes, socks, etc.
3 year pediatric milestones for speech and language: uses 3 word phrases, has a 200 or more word vocabulary, has clearer speech, and understands spatial concepts, pronouns, and plurals.
4 Years = “4 or More Word Sentences”
Last on the list is 4 years old.
The trick to remember the milestone for 4 years old is “4 more or word sentences”.
The child starts to use sentences with 4 or more words, and they may also use 4 or more sentences at a time when talking about their day or telling a story.
They have a deeper understanding of more abstract concepts, and they will understand and ask “how” and “why” type questions.
Furthermore, the child starts to express their ideas and feelings rather than simply talking about the world around them.
They talk more about their day and activities at school, daycare, or home.
Parents and caregivers will understand most (if not all) of the child’s speech, and strangers typically can understand the child without much difficulty as well.
The child can identify colors by 4 years of age, and this skill often occurs even sooner.
Finally, they can group objects into different categories such as food or clothes.
4 year pediatric milestones for speech and language: uses 4 or more word sentences, uses 4 sentences to tell a story, understands “how” and “why” type questions, expresses ideas/feelings, identifies colors, and groups objects.
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