Red Flags In The First 5 Years

Early Childhood Communication – What should I look out for?

We have just finished a series of articles discussing how a child’s speech, language and play develop from 12 months to five years. We love seeing young children reach their milestones and begin to explore their environments. However, another common question I am frequently asked (by friends or associates with young children) is, “What should I look out for?” While this takes a fairly ‘negative’ approach, sometimes it’s good to know about ‘red flags’ – things that are happening (or not happening) that may signal that further help is needed.

Below are some general ‘red flags’ to be mindful of. It is important to remember that each child is an individual and if you have any concerns (or are just not sure!), we recommend seeking an individual assessment from a qualified speech pathologist.

12 months

Baby doesn’t seem to listen or attend to you.
Limited responsiveness to smiles and facial expression (post 9 months).
Limited or no sharing of gesture (e.g. reaching, waving, pointing).
Baby does not enjoy sounds or respond to them.
Baby does not babble, vocalise or coo.
Baby does not respond to their name (e.g. turn head).

18 months

Baby is not using a range of words (at least 8-10 meaningful words – even though they may not be perfectly pronounced!)
Baby is having difficulty understanding basic instructions (e.g. stop, no, touch your ears, and come here)
Baby does not engage in simple games with you or others.
Does not “pretend” with toys (e.g. gives the toy monkey a drink, talks on pretend phone)
Avoids playing with other children

2 years

A child is not using any two-word phrases independently (i.e. without imitating you)
Difficulty naming objects in pictures, books or photos
Difficulty identifying/naming basic body parts and clothing
Limited word use (should have around 50 words plus)
Has difficulty following basic two-step instructions
Speech is always difficult to understand – Speech is less than 50% intelligible (or understandable)
Has difficulty identifying/pointing to common objects/pictures when named (i.e. where’s the cat?)
A child has an ‘unusual’ (or ‘husky’/‘hoarse’) voice

3 years

Limited word use (should have upwards of 450 words)
Limited word types – i.e. only using names (should be using a variety of nouns, actions, places and describing words)
Difficulty relating recent experiences
Difficulty putting four word phrases together
Difficulty asking basic questions
Difficulty understand two-step instructions
Difficulty understanding spatial concepts such as ‘on, in, off, out’
Speech should be 75-100% intelligible (or understandable) to others
A child is showing signs of frustration that they are not understood
Struggles to sit for an activity without prompting

4 years

Limited vocabulary (should have upwards of 1000 words)
A child is not using four to five word sentences
Difficulty predicting (e.g., what will happen next?)
Difficulty explaining how an object is used
A child is showing signs of frustration that they are not understood
Has difficulty answering simple “wh” questions – i.e. “who, where, what?”
Speech is difficult to understand – Speech is less than 50% intelligible (or understandable) by two years or 75% by 3 years.
A child is leaving the beginning or end sounds off most words
Has difficulty engaging in play with other children
A child has an ‘unusual’ (or ‘husky’/‘hoarse’) voice