10-Minute Speech Practice That Doesn't Require Sitting Still

Last updated 2026-07-09

What are the CDC speech milestones and why were they updated in 2022?

The CDC, working with the American Academy of Pediatrics (AAP), released a major revision to its developmental milestone checklists in February 2022. ^[1] The old milestones, used since 2004, were based on when 50 percent of children reached a skill. The new ones are based on when 75 percent of children reach it. That shift sounds technical, but it changes what gets flagged in a well-child visit in a real way.

Some milestones moved earlier. The "first words by 12 months" expectation stayed the same, but the bar for 2-year-olds got stricter: the old chart accepted 50 words by 24 months as a mid-range figure; the new one sets 50 words as a minimum that 75 percent of 2-year-olds already have. ^[1] The AAP stated the goal was to identify children who need support sooner, because early intervention is far more effective than waiting.

The revision also added clearer red-flag language. Where old materials said "talk to your doctor if you're worried," the new checklist says more specifically what to watch for and at what age to act. That's a meaningful change for parents who've been told "he'll catch up" for months.

What are the CDC speech and language milestones by age?

Here's the full picture from birth through age 5, drawn directly from the CDC's 2022 checklist. ^[1] These describe what most children (around 75 percent) can do by each age, not a ceiling or an average.

Two things worth noticing. Receptive language (understanding) almost always runs ahead of expressive language (talking). A child who understands but doesn't talk is in a different category than one who doesn't seem to understand either. And the 24-month row is the one pediatricians most often use as a referral trigger, because 50 words plus 2-word combinations is a concrete, checkable threshold. ^[2]

What speech milestones should a 12-month-old have?

At 12 months the CDC expects a child to say at least 1 or 2 real words (not counting "mama" and "dada" used as general sounds, but counting them when used with meaning). ^[1] The child should also be babbling with different consonant-vowel combinations, more than vowel sounds.

Just as telling: the child should be responding to their own name consistently, following a simple direction paired with a gesture like "give me" with a held-out hand, and pointing or gesturing to communicate wants. Gestures matter. A 12-month-old who points, waves, and shows objects is communicating even without words, and that's a healthy sign. A 12-month-old who isn't doing any of that alongside having no words is a reason to refer, not to wait. ^[2]

The red flag the CDC specifically names at 12 months: no words at all, and no gestures like waving or pointing. If both are absent, that's a referral to a speech-language pathologist (SLP), not a "check back in 3 months."

What speech milestones should a 2-year-old have?

The 24-month mark is the most researched and most debated milestone in speech-language development. The CDC's 2022 checklist sets 50 words and 2-word original phrases (more than memorized chunks like "thank you") as the expectation for 75 percent of 2-year-olds. ^[1]

The American Speech-Language-Hearing Association (ASHA) describes 2-year-olds as typically having a vocabulary of 200-300 words by age 2, with a wide range, but notes that below 50 words at 24 months is the clinical threshold for "late talker" evaluation. ^[3] Those two numbers (50 from the CDC checklist, 200-300 from ASHA's typical range) aren't in conflict. They mark the floor and the middle of the distribution.

What strangers should be able to understand: about 50 percent of a 2-year-old's speech. Parents usually understand more because they have context. If a stranger understands almost nothing, that's worth documenting.

The phrases have to be novel combinations. A child who says "thank you" and "all done" has memorized phrases. A child who says "more cracker" or "mommy go" is combining words creatively, which is the actual skill being measured. The distinction matters clinically. ^[3]

For kids showing language delays at 2, early intervention services under IDEA Part C (for children under 3) are free through your state's early intervention program. You don't need a doctor's referral to request an evaluation. ^[4] Learn more about how that process works in our guide to early intervention.

What speech milestones should a 3-year-old have?

By age 3, the CDC expects most children to use 2-3 sentence conversations, have strangers understand the majority of what they say (roughly 75 percent intelligibility is the clinical benchmark cited by ASHA ^[3]), and ask basic questions like "why" and "what."

Articulation is part of this picture. Three-year-olds should be able to say most vowels correctly, and consonants like p, b, m, n, h, w, k, g, t, d should be consistent. Sounds like r, l, s, z, ch, sh, and th are not expected to be fully correct at 3, and errors on those aren't a red flag in isolation. ^[5]

A 3-year-old who speaks mostly in single words or short, incomplete phrases and is hard to understand even for caregivers warrants a speech-language evaluation. Stuttering-like disfluency (repeating sounds or words) is common and often normal between 2 and 5, but if it's accompanied by physical tension, eye-blinking, or the child avoiding talking, that's worth raising with an SLP. ^[6]

What are the red flags for speech delay at any age?

Some signs cut across age groups and are worth knowing regardless of which milestone birthday is next.

The clearest red flag at any age: a loss of skills. If a child was saying 10 words and drops back to 3, that regression needs prompt evaluation, not watchful waiting. The CDC explicitly flags regression as something to act on immediately. ^[1]

Other age-specific red flags:

• No babbling by 9 months
• No words by 12 months
• No 2-word phrases by 24 months
• Speech that's largely unintelligible to strangers by age 3
• Inability to follow simple 2-step directions by age 3

For children on the autism spectrum, early communication differences often show up in the pre-verbal period. Limited joint attention (looking back and forth between an object and another person), no pointing by 12 months, and no response to name by 9-12 months are signs that often appear before speech differences become obvious. ^[7] Our guide to autism spectrum speech therapy covers what evaluation and support can look like for those kids.

The phrase you'll hear from some pediatricians, "boys talk later, wait until 2," is not supported by the research. The sex difference in language development is real but small: studies show girls average slightly more words at 24 months, but the difference is about 10-20 words, not a clinically meaningful gap that justifies delaying evaluation. ^[8]

How do I use the CDC milestone checklist at home?

The CDC publishes free, printable "Learn the Signs. Act Early." milestone checklists for ages 2 months through 5 years. ^[1] You can download them at cdc.gov/ActEarly. Each checklist is one page and designed to be filled out before a well-child visit.

Bring the completed checklist to the appointment. Pediatricians see a lot of patients in short visits. A pre-filled checklist focuses the conversation and makes it harder for concerns to be minimized or forgotten.

A few tips for filling it out honestly. Check a box only if you've seen the skill clearly and more than once, not if you think your child probably can do it. Check it even if they do it inconsistently, as long as you've seen it. The checklist is a snapshot, not a pass/fail test.

If your pediatrician dismisses a real concern you have, you can request a referral to a speech-language pathologist directly, or contact your state's early intervention program (for children under 3) without any referral at all. ^[4] The legal right to request that evaluation is yours.

What is the difference between a speech delay and a language delay?

These terms get used interchangeably in parent conversations, but they describe different things clinically.

Speech refers to the physical production of sounds: articulation, fluency, voice. A speech delay or disorder means the sounds a child makes are unclear, inconsistent, or physically difficult to produce. Apraxia of speech and childhood apraxia of speech are examples of speech disorders where the motor planning for speech is the problem.

Language refers to the system of words and rules we use to communicate: vocabulary, grammar, understanding, and use of language in social contexts. A language delay means a child has fewer words than expected, struggles to understand directions, or can't combine words into phrases on schedule.

A child can have one without the other. A child with a speech disorder might be a good communicator who is hard to understand. A child with a language delay might speak clearly but have a very small vocabulary. Most children referred for speech concerns have some mix, which is why a full evaluation from an SLP covers both. ^[3]

If the language delay is paired with limited eye contact, repetitive behaviors, or unusual sensory responses, autism spectrum disorder is one possibility an evaluation should explore. ^[7]

What happens if a child doesn't meet CDC speech milestones?

Missing a milestone means evaluation, not panic. Most children who miss a milestone have a treatable delay. Many catch up with therapy, some catch up on their own, and the ones who have more complex needs are better off identified early.

For children under 3, the Individuals with Disabilities Education Act (IDEA) Part C guarantees the right to a free evaluation and, if eligible, free early intervention services through the state. ^[4] The law says states must serve children from birth through age 2 who have developmental delays or conditions likely to cause them. You can refer your own child by calling your state's early intervention hotline. No doctor order is needed.

For children 3 and older, IDEA Part B takes over and your local school district is responsible for evaluation and services. ^[4] Again, parents can request this directly in writing.

Private speech therapy is also an option at any age if you have insurance coverage or can pay out of pocket. ASHA maintains a "Find a Professional" directory at asha.org. ^[3] Our guide to speech therapy and speech therapists walks through how to find and vet a provider.

For families who want a low-barrier way to practice speech goals between therapy sessions, tools like the Little Words app offer structured, play-based language activities designed for neurodivergent kids. It's not a replacement for therapy, but daily practice at home is one of the things SLPs consistently recommend. Take a quick quiz to see if it fits your child's situation.

Are the CDC milestones accurate for bilingual children or children with autism?

Bilingual children. Research consistently shows bilingual children reach language milestones at the same rate as monolingual children when you count words across both languages. ^[8] A child who knows 30 words in Spanish and 25 in English has 55 words and is not delayed. Assessments that look only at one language will undercount vocabulary and can produce false positives for delay. If your child is bilingual, make sure the evaluator knows this and assesses both languages.

Children with autism. The CDC milestones are population norms, and autism involves a different profile of communication development. Some autistic children are early talkers who struggle with the social use of language. Others are late talkers. Some go through a period of using words and then stop, which is called regression and is a specific finding that changes the evaluation pathway. ^[7] Echolalia (repeating phrases from TV or other speakers rather than generating original speech) is common in autism and is not simply a delay. It's a different kind of communication that requires different support. See our article on echolalia for a detailed breakdown.

The milestones are a screening tool, not a diagnostic instrument. Missing them prompts evaluation. Only a full evaluation by a qualified team can diagnose anything.

How do CDC milestones compare to what speech therapists actually use in practice?

SLPs in clinical practice use the CDC checklists as a starting point, but they also rely on standardized assessments that weren't possible to replicate in a one-page checklist.

For toddlers, common tools include the MacArthur-Bates Communicative Development Inventories (CDI), a parent-report vocabulary checklist with strong normative data from thousands of children ^[9], and the Preschool Language Scale (PLS-5), a direct assessment tool with norms by age in months. ^[10] These give percentile scores rather than pass/fail, which helps distinguish a mild lag from a significant delay.

The CDC milestones represent roughly the 25th percentile after the 2022 revision (the point where 75 percent of children have the skill, meaning 25 percent haven't reached it yet). A child just below the CDC threshold is different from a child who is two standard deviations below the norm on a standardized test. Both deserve evaluation, but the findings shape different recommendations.

One more thing SLPs assess that the CDC checklist doesn't capture well: pragmatic language, the social use of communication. Asking for things, commenting, sharing attention, taking turns in conversation. These skills matter enormously and are often where autism-related language differences first show up. ^[7]

When should I call a doctor or speech therapist about my child's speech?

The honest answer: sooner than most parents do, and sooner than many pediatricians prompt you to.

The AAP recommends developmental screening at 9, 18, and 30 months, and autism-specific screening at 18 and 24 months, using validated tools. ^[2] But screening is different from evaluation. A failed screen means the next step is a full evaluation, which the CDC and ASHA both say should not be delayed.

Call your pediatrician now if your child:

• Has lost skills they previously had at any age
• Is not babbling by 9 months
• Has no words by 12 months
• Has fewer than 50 words or no 2-word phrases by 24 months
• Is hard to understand even for you by age 3

Call or self-refer to early intervention (for children under 3) if your pediatrician tells you to wait without scheduling a follow-up or referral. You have the legal right to request a state evaluation. ^[4]

For children 3 and older, you can contact your school district in writing to request a special education evaluation under IDEA Part B. The district has 60 days (timelines vary by state) to complete it. ^[4]

Early is genuinely better here. The research on early intervention in speech and language is clear: children who receive services before age 3 tend to have meaningfully better outcomes than those who start later. ^[11] A Little Words quiz can also help you understand your child's specific communication profile before or between professional evaluations: start here.

Frequently asked questions

What are the CDC speech milestones for a 18-month-old?

The CDC's 2022 checklist expects an 18-month-old to use at least 10 words, point to familiar things when named, and point to at least 1 body part when asked. They should also try to say words you say and look at a book with you. Fewer than 10 clear words at 18 months is a reason to refer for a speech evaluation, not to wait until 24 months.

Did the CDC change the speech milestones in 2022?

Yes. In February 2022, the CDC and AAP revised the milestone checklists for the first time since 2004. The biggest change: milestones now reflect what 75 percent of children can do (not 50 percent), which moved some benchmarks earlier. The 24-month vocabulary threshold of 50 words became more explicit, and the checklists added clearer language about when to act rather than wait.

Is it normal for a 2-year-old to not talk much?

If "not much" means fewer than 50 words or no 2-word combinations, it's outside what the CDC and ASHA consider typical for 75 percent of 2-year-olds. That doesn't mean something is seriously wrong, but it does mean evaluation is appropriate rather than waiting. Some late talkers catch up quickly; others have underlying delays that respond well to early therapy. Waiting past 24 months before evaluating reduces the window for the most effective intervention.

What is the difference between a speech delay and being a late talker?

"Late talker" is an informal term for a toddler (usually 18-30 months) with fewer words than expected but otherwise typical development: good comprehension, normal hearing, and typical social skills. A speech or language delay is a clinical finding from an evaluation. Some late talkers catch up without intervention; research suggests about 70-80 percent of 2-year-old late talkers do. The rest have persistent delays that benefit from speech-language therapy.

How do I get a speech evaluation for my child for free?

Children under 3 are covered by IDEA Part C. Contact your state's early intervention program directly; no doctor referral is needed. The evaluation is free by law. For children 3 and older, contact your local school district in writing and request a special education evaluation under IDEA Part B. That evaluation is also free. Private evaluations through insurance or out-of-pocket are a parallel option at any age.

Are CDC milestones the same for boys and girls?

The CDC uses a single set of milestones regardless of sex. Research does show girls, on average, say slightly more words than boys at 24 months, but the difference is small (roughly 10-20 words) and doesn't justify using a lower threshold for boys. A boy with fewer than 50 words at 24 months meets the criteria for evaluation, same as a girl. "Boys talk later" is not a clinically valid reason to delay referral.

Can I use the CDC milestones for bilingual kids?

Yes, with one adjustment: count words from both languages together. A bilingual child who has 25 words in English and 30 in Spanish has 55 total words and is not delayed. When seeking an evaluation, find an SLP who can assess in both languages or who uses parent-report tools that account for dual-language exposure. Evaluating only in one language tends to underestimate a bilingual child's true vocabulary.

What should a 3-year-old be saying?

By age 3, the CDC expects most children to have conversations using 2-3 sentences, ask why and what questions, say their first name when asked, and be understandable to strangers most of the time. ASHA sets intelligibility at roughly 75 percent for unfamiliar listeners by age 3. Sounds like r, l, s, and th don't have to be perfect yet; errors on those are still typical at this age.

Does watching TV or using tablets affect speech milestones?

The AAP recommends no screen media other than video chatting for children under 18 months, and limited high-quality programming for ages 2-5, watched with a caregiver who talks about what's happening. Background TV and passive screen time are associated with reduced parent-child conversation, which is the primary driver of vocabulary growth. Screens aren't the cause of every speech delay, but high screen time combined with low conversational exposure is a real risk factor.

What if my child was premature? Do the CDC milestones still apply?

For premature babies, most clinicians use corrected age (subtracting weeks of prematurity from chronological age) for milestones through 24 months, sometimes through age 3 for very preterm infants. A baby born 10 weeks early who is 12 months old by calendar is developmentally closer to 10.5 months corrected. Ask your child's neonatologist or pediatrician which age to use when checking milestones, and note that preterm infants are at higher risk for language delays regardless.

What is the CDC's "Learn the Signs. Act Early." program?

"Learn the Signs. Act Early." is a CDC public health campaign that provides free developmental milestone resources for parents and healthcare providers, including the printable milestone checklists updated in 2022. The materials are available at cdc.gov/ActEarly in English and Spanish. The program focuses on early identification of autism and other developmental differences, encouraging action rather than waiting when a milestone is missed.

Can a speech therapist help a child who isn't talking at all?

Yes. SLPs work with children who are entirely pre-verbal as well as those with partial language. For very young or minimally verbal children, therapy often focuses on building the foundation for communication: joint attention, gesture use, play skills, and understanding of language. For some children who aren't developing speech reliably, augmentative and alternative communication (AAC) can be introduced alongside speech goals, not instead of them. See our guide to AAC devices for more.

How accurate are the CDC speech milestones for children with autism?

The CDC milestones are population norms, and autism involves a different developmental profile, so the milestones work as a screening prompt rather than a complete picture. Autistic children may show early social-communication differences (limited pointing, reduced response to name, less back-and-forth) before speech differences are obvious. Missing milestones prompts evaluation. Only a full assessment by a qualified team can diagnose autism or rule it out.

What is the earliest age speech therapy can start?

Speech-language therapy can start from birth if there's a clinical indication, such as feeding and swallowing difficulties in a newborn. For speech and language delays, early intervention services under IDEA Part C can begin from birth through 36 months. The earlier therapy starts for most language delays, the better the outcomes, based on what we know about the brain's sensitivity to language input in the first three years of life.

Sources

1. CDC, Learn the Signs. Act Early. — Developmental Milestones (2022 revised checklists): CDC and AAP revised milestone checklists in February 2022 to reflect when 75 percent of children reach each skill; checklists cover ages 2 months through 5 years
2. American Academy of Pediatrics — Developmental Surveillance and Screening: AAP recommends developmental screening at 9, 18, and 30 months, and autism-specific screening at 18 and 24 months
3. American Speech-Language-Hearing Association (ASHA) — Late Blooming or Language Problem: ASHA describes fewer than 50 words at 24 months as the clinical threshold for late talker evaluation; typical 2-year-old vocabulary is 200-300 words; strangers should understand roughly 50 percent of 2-year-old speech
4. U.S. Department of Education — IDEA Individuals with Disabilities Education Act, Parts B and C: IDEA Part C guarantees free developmental evaluation and early intervention services for children birth through age 2; Part B covers children 3 and older through the local school district; parents can self-refer without a doctor's order
5. ASHA — Speech Sound Disorders: Articulation and Phonology: Consonant sounds p, b, m, n, h, w, k, g, t, d expected by age 3; r, l, s, z, ch, sh, th develop later and errors not a red flag in isolation at age 3
6. ASHA — Stuttering: Disfluency is common and often normal between ages 2 and 5; physical tension, eye-blinking, or avoidance of talking alongside disfluency warrants SLP evaluation
7. CDC — Autism Spectrum Disorder, Signs and Symptoms: Limited joint attention, no pointing by 12 months, and inconsistent response to name by 9-12 months are early communication signs associated with autism spectrum disorder; regression of language skills is a specific finding that changes the evaluation pathway
8. Byers-Heinlein K & Lew-Williams C (2013), Language and Bilingualism, Perspectives on Psychological Science: Bilingual children reach language milestones at the same rate as monolingual peers when vocabulary is counted across both languages; sex differences in 24-month vocabulary are real but small (approximately 10-20 words)
9. MacArthur-Bates Communicative Development Inventories — CDI Advisory Board: MacArthur-Bates CDI is a validated parent-report vocabulary tool with normative data used clinically to assess toddler vocabulary
10. Zimmerman IL et al. — Preschool Language Scales, Fifth Edition (PLS-5), Pearson Clinical: PLS-5 is a direct assessment tool with norms by age in months used by SLPs to measure receptive and expressive language skills in children
11. National Institute on Deafness and Other Communication Disorders (NIDCD) — NIDCD Fact Sheet: Speech and Language Developmental Milestones: Children who receive speech-language services before age 3 have meaningfully better outcomes than those who start later; early identification and intervention are recommended
12. American Academy of Pediatrics — Media and Young Minds (Council on Communications and Media, 2016): AAP recommends no screen media other than video chatting for children under 18 months; for ages 2-5, limited high-quality programming watched with a caregiver is recommended; background TV is associated with reduced parent-child conversation