Milestones are ranges, and the ranges moved

In February 2022 the CDC revised its developmental milestone checklists, and the change matters for how you read any list of ages. Previously milestones sat at the age by which about half of children achieved them. Now, in the CDC's own words, "milestones were placed at ages by which at least 75% of children would be expected to exhibit them, in an effort to make even one missing milestone more 'actionable' ... This change is intended to reduce the 'wait and see' approach often taken when a child is missing an average age milestone."

So a CDC milestone is not an average. It is a threshold three quarters of children have crossed. The CDC is equally clear about what the checklists are not: they "are not developmental guidelines or standards for children's development. They should not be used as screening or diagnostic tools to detect developmental delays."

What most children are doing, by age

By 18 months

The CDC's language items are short: "tries to say three or more words besides 'mama' or 'dada'" and "follows one-step directions without any gestures, like giving you the toy when you say, 'Give it to me.'" Its social list includes one that speech and language therapists watch closely: "points to show you something interesting."

The HSE's Irish milestones fill in the shape between. At 14 months most toddlers "say 1 word at a time", "use lots of loud babble and point to items at the same time", and use a few single words that only family can understand. By 16 months, "a vocabulary of 5 to 10 words" and understanding of single words and simple phrases such as "stop" and "shoe". By 20 months, "around 15 to 20 single words" and attempts to put two together, such as "bye dada", plus pointing to different body parts.

By 2 years

The CDC lists four language milestones at 24 months: points to things in a book when asked; "says at least two words together, like 'More milk'"; points to at least two body parts when asked; and "uses more gestures than just waving and pointing, like blowing a kiss or nodding yes."

The HSE's 24-month picture is similar but adds a usefully concrete intelligibility measure: a toddler will "have 50 or more words in their vocabulary", "be able to say 2 or 3 word sentences", and "use more speech sounds but their words may still be unclear - you should understand at least half of what they are trying to say."

That last figure is worth holding on to. At two, half of what your child says being unclear is expected, not a warning sign.

By 30 months

The CDC's 30-month checklist is the most language-heavy of the set: "says about 50 words"; "says two or more words together, with one action word, like 'Doggie run'"; "names things in a book when you point and ask, 'What is this?'"; and "says words like 'I,' 'me,' or 'we.'" On the cognitive side it expects a child to follow two-step instructions such as "put the toy down and close the door."

By 3 years

By three the CDC expects conversation rather than labelling: "talks with you in conversation using at least two back-and-forth exchanges"; asks who, what, where or why questions; says what action is happening in a picture; says their first name when asked; and, the milestone with the most practical weight, "talks well enough for others to understand, most of the time."

What helps, according to the NHS

The NHS publishes stage-by-stage suggestions rather than programmes. From 12 to 18 months: if your child gets a word wrong, say it properly rather than correcting them — "if they point to a cat and say 'Ca!' you should respond with, 'Yes, it's a cat'. Do not criticise or tell them off for getting the word wrong." Offer choices to build vocabulary: "do you want an apple or a banana?"

From 18 to 24 months: repeat words across a sequence ("Where are your shoes?", "Are you wearing blue shoes today?", "Let's put your shoes on"), keep instructions short, and ask "where's your..." to build body-part vocabulary. From 2 to 3 years: expand what they say rather than replacing it — "if they say, 'sock off', respond with 'yes, we're taking your sock off'" — and give them time to answer after a question.

Two environmental points from the NHS are easy to action. First, background noise: "switch off the television and radio - background noise makes it harder for your child to listen to you", and limit daily TV time because "playing and listening to stories is more helpful when they're learning to talk." Second, dummies: "it's hard to learn to talk with a dummy in your mouth. Aim to stop using dummies completely by 12 months."

On bilingual households the NHS is reassuring and specific: growing up with more than one language "can be an advantage to children in their learning", and the important thing is "to talk to your child in whatever language feels comfortable to you", including one parent using one language and the other using a different one.

The real red flags

The CDC's instruction is the same on every checklist page, and it is deliberately low-threshold: "if your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early. Talk with your child's doctor, share your concerns, and ask about developmental screening."

Loss of previously acquired skills is a referral flag at any age. That is not a softening. The HSE repeats "loses skills they had before" as a reason to contact a GP or public health nurse at 14 months, 16 months, 20 months, 24 months, three years, four years and five years — every single age band it publishes. A child who had ten words and now has four, or who used to point and no longer does, needs to be seen, regardless of whether they look otherwise on track.

Beyond that, the specific speech and language flags the HSE names by age are:

Around 14 months: does not say words that have meaning; does not point to objects; does not give much eye contact; shows little interest in other people.
Around 20 months: cannot speak at least 6 words.
Three years and beyond: cannot communicate their needs; cannot follow straightforward commands.

No pointing is on that list for a reason. Pointing to share something interesting, rather than just to demand it, is one of the earliest social-communication behaviours, and both the CDC and the HSE treat its absence as worth a conversation. The NHS's description of autism in young children includes children who "start to speak at a later age than other children", "not respond to their name", "not speak much or use single words", "repeat words and phrases" and "use eye contact less often".

How to get seen

In the UK the NHS route is straightforward: "if you're worried about your child's speech or language development, talk to your GP or health visitor. If necessary, they'll refer your child to your local speech and language therapy department." Crucially it also says: "if you prefer, you can refer your child to a speech and language therapist yourself." You do not have to wait for permission to be granted.

There is also a scheduled opportunity. The NHS offers a health and development review at 2 to 2.5 years, usually with a nursery nurse or health visitor, covering "general development, including movement, speech, social skills and behaviour, and hearing and vision". You will be sent an Ages and Stages Questionnaire (ASQ-3) to complete beforehand, and the review can be done at nursery or with a childminder if that is easier.

Two practical notes. If your child was born prematurely, the NHS calculates developmental age from your original due date rather than the birth date until they are 2. And hearing sits underneath all of this: any concern about speech should prompt a question about whether hearing has been checked recently, because hearing problems are common at this age and often treatable.

What is worth letting go of

League tables. A child who talks late and catches up is a common story. A child who loses words, or who never points, is a different story, and the difference is worth knowing.

Toddler Speech and Language Milestones