“When should he say his first words?”
“My friend’s child walked earlier. Should I be worried?”
“She understands what I say but doesn’t talk much. Is that normal?”
A child’s development is a fascinating process — but it is often also a source of worry for parents.
From the first smile and babbling to the first steps, words and pretend play, every new skill is part of a complex developmental journey.
But children do not all develop at exactly the same pace.
That is why developmental milestones are valuable as reference points, but should not be treated as a strict “timetable” every child must follow.
What are developmental milestones?
Developmental milestones are skills and behaviours that usually appear at certain periods of childhood.
They are not only about speech or walking. We monitor development across different areas:
- movement and motor skills
- language and communication
- thinking, learning and problem-solving
- social and emotional development
- play and interaction with others
The CDC defines milestones as skills that most children — about 75% or more — can do by a certain age. Milestone checklists help monitor development, but do not replace developmental assessment with validated tools when there is a concern.
Around 12 months
By the first birthday, impressive changes have already taken place.
Most babies start to join in simple social games such as peek-a-boo, use gestures such as waving “bye-bye”, understand a simple “no” and call a parent “mama”, “dada” or another special name.
They also look for an object they saw being hidden, pick up small objects between thumb and index finger, pull up to stand while holding on to something, and many start to move around holding on to furniture. CDC
What matters especially is not only how many words the child says, but the overall way they communicate: whether they make eye contact, use sounds and gestures, share their attention with the parent and show interest in interacting.
Around 18 months
At 18 months communication becomes more complex.
Most children point to something interesting to share it with the parent, look at a few pages of a book together with them, and move away to explore while checking that the parent is still nearby.
In speech, they usually try to use three or more words besides “mama” and “dada” and can follow a simple one-step instruction without the adult having to accompany it with a gesture.
In terms of movement, most children now walk without support, try to use a spoon and can climb on and off a low sofa or chair without help.
Around 2 years
By the second birthday, language and play take another important step forward.
Many children now use several dozen words and start to combine two or more words, such as “want water” or “mummy come”. Between 19 and 24 months, children usually use and understand at least 50 different words and begin to combine them.
Pronunciation does not yet need to be clear. At two years it is completely expected that many words are not pronounced the way an adult would say them.
At the same time, the child understands more and more, follows simple instructions and uses play, gestures and words to communicate their wishes and interests.
We don’t just count words
This is perhaps one of the most important messages for parents.
Language development is not assessed simply by counting how many words a child says.
We are also interested in whether they understand speech, respond to sounds and to their name, use gestures, point to ask for things but also to share something interesting, seek communication, and whether their skills are progressing over time.
A child who says few words but understands well, uses gestures and tries hard to communicate shows a different developmental picture from a child who struggles with expression as well as understanding or social communication.
That is why the assessment must always look at the child’s whole developmental profile.
“His dad was a late talker too.” Should we wait?
Some children start talking later and then catch up. But there are also children in whom a language delay is the first sign that they need more support.
A delay may be related to different factors, such as a hearing problem, developmental language disorder, broader developmental delay or autism spectrum disorder.
That is why the approach “let’s wait until he’s three and he’ll talk” is not always appropriate.
When there is a real concern, assessment does not harm a child who turns out to be developing normally. On the contrary, it can significantly help a child who really does need intervention.
When is it worth talking to the pediatrician?
Parents don’t need to try to decide on their own whether a behaviour is a “red flag”.
There are, however, some situations in which we should not simply wait. Talk to the pediatrician early when the child is not reaching several of the expected milestones for their age, does not respond consistently to sounds or there are doubts about their hearing, has significant difficulties with communication or social interaction, or when something about their development worries those who care for them.
Loss of skills is particularly important. If a child stops using words, gestures, social or motor skills they had already mastered, this should be discussed with the pediatrician without delay. Prompt assessment is recommended when a child loses skills they had previously acquired.
If speech is delayed, should hearing be checked too?
Usually, yes.
Hearing is fundamental to the development of speech and language. A child may react to some sounds and yet have a hearing problem that affects how they take in speech.
So when there is a significant speech delay or a suspicion that the child does not hear as expected, a hearing assessment is an important part of the investigation.
Do two languages at home cause speech delay?
No.
A child growing up in a bilingual or multilingual environment may spread their vocabulary across the different languages, but
exposure to more than one language does not in itself cause a speech or language disorder.
Parents can speak to the child in the languages they know best. Families are encouraged to communicate with their child in the languages they feel most comfortable with.
What can parents do at home?
Special “exercises” are not needed for every healthy child.
Everyday life offers plenty of opportunities for development. Talk to your child about what you see and do, read books together, sing, play, name the things that interest them and give them time to answer.
When they say a word, you can expand on it. If they say “dog”, you can reply “Yes, a big dog!”. If they point at something, follow their interest and talk about it.
Monitoring doesn’t just mean “waiting”
Development is a core part of preventive pediatric care.
The pediatrician doesn’t just check whether the child walks or how many words they say. They follow progress over time, taking into account the history, the clinical picture and all areas of development.
Developmental surveillance, carried out at every visit, is different from standardised developmental screening with appropriate tools. American Academy of Pediatrics recommendations, as summarised by the CDC, provide for standardised developmental screening at 9, 18 and 30 months and specific autism screening at 18 and 24 months, as well as whenever a parent or health professional has a concern.
When there are indications, a hearing assessment or referral to a developmental pediatrician, speech and language therapist, pediatric neurologist or other appropriate professional may be needed, depending on the type of difficulty.
Don’t compare children — follow your own child’s progress
Development is not a race, and reaching a milestone a few weeks earlier does not mean a child is “smarter” or will do better.
There is normal variation in when many skills are acquired.
On the other hand, “every child has their own pace”
should not be used to ignore a real developmental difficulty.
Parents know their child better than anyone. When they feel that something in their communication, movement, play or social responsiveness is not progressing as they expected, it is worth discussing.
There is no need to panic, but there is also no need to wait without an assessment.
Recognising a difficulty early can lead to the right support at a time when the child is developing extremely fast.
And very often, the assessment simply leads to something equally important: reassuring parents that their child’s development is following its own normal course.
For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.