My 2-year-old only says about 20 words. Is that a concern?

Most 2-year-olds say at least 50 words and are beginning to put two words together. Twenty words is below the typical range for this age, so it is worth mentioning to your child's doctor at your next visit — or sooner if you prefer. An early assessment gives you useful information and, if support is helpful, the earlier it begins the better. This is not a verdict; it is a check-in.

We speak two languages at home. Could that be why my child is a late talker?

Bilingualism does not cause speech or language delays. First words, babbling, and word combinations occur at the same ages in bilingual and monolingual children. A bilingual child may appear to have fewer words when counted in just one language, but their total vocabulary across both languages is typically comparable to their monolingual peers. If you have concerns, an evaluation that counts words in all languages your child uses will give you an accurate picture.

My child used to say a few words and seems to have stopped. Should I wait to see if it comes back?

Loss of previously acquired words or communication skills is something to raise with a doctor sooner rather than later — it is one of the signs that guidelines from the CDC and AAP recommend acting on promptly, rather than waiting for a scheduled visit. Bring it up now rather than at the next routine check.

When does the doctor check for speech delays, and what does that involve?

The AAP recommends standardised developmental screening at the 9-, 18-, and 30-month well-child visits, and autism-specific screening at 18 and 24 months. NICE recommends a formal speech and language assessment at around 24 to 30 months. In practice, your doctor will ask about language milestones and may use a short questionnaire. If a concern comes up between scheduled visits, you do not need to wait — raise it at any appointment.

Do I need a referral from a doctor to get a speech assessment?

In many settings, no. For children under 3, parents can often contact their area's early intervention programme directly and request an evaluation without a doctor's referral. For children aged 3 and older in the United States, free evaluations are available through local school districts. Your child's paediatrician can also refer you, but you do not need to wait for them to suggest it — you can ask.

Development

Is My Child's Speech on Track? Language Milestones and Early Signs

How language develops and when a delay is worth checking.

6 min read · Reviewed against official sources

You have probably heard "every child is different" so many times it has stopped feeling useful. It is true — but it is only half the picture. Children do move at their own pace, yet they also follow a remarkably consistent sequence of language development: cooing before babbling, babbling before words, words before sentences. Knowing that sequence, and knowing what to expect at each age, gives you something concrete to look for — and a clear sense of when it is worth checking in early rather than waiting.

From first sounds to full sentences: how language builds

Language development begins much earlier than the first word. As early as 2 to 4 months, babies produce soft cooing and vowel sounds. By 6 to 9 months, they are already recognising familiar phrases in context and producing babbling sequences like "dada" and "mama" — even if they do not yet attach meaning to those sounds. This period, roughly 6 to 12 months, is considered a sensitive window for phonetic learning, and peer-reviewed research suggests that what a child learns during these months is a reliable predictor of later speech and language ability.

By 12 months, most babies wave "bye-bye," use at least one word with intention (calling a parent "mama" or "dada"), and understand "no" — pausing or stopping when they hear it. At this age, understanding is just as important as output. A child who understands well but is not yet speaking many words is in a different position from one who neither speaks nor responds to language.

Age-by-age language expectations

The milestones below are drawn from the CDC's Learn the Signs. Act Early. programme, the American Academy of Pediatrics (AAP), and Great Ormond Street Hospital NHS. They describe what most children are doing by each age — not every child, every time.

12 months: Waves bye-bye, uses "mama" or "dada" with meaning, understands "no," and takes conversational turns with caregivers.
15 months: Tries one or two words beyond "mama" and "dada" (such as "ba" for ball), looks at a familiar object when it is named, follows directions given with both words and a gesture, and points to ask for things.
18 months: Uses 10 to 20 words including people's names, follows simple one-step directions without a gesture ("Give it to me"), and begins combining two words such as "all gone" or "daddy bye-bye."
2 years: Says at least 50 words (most sources cite roughly 50 to 100), uses two-word phrases regularly ("More milk," "Daddy go"), points to things in a book when asked, and uses gestures like nodding yes or blowing a kiss. Some NHS sources cite a vocabulary of 100 to 200 words by this age across children.
3 years: Holds short back-and-forth conversations with at least two exchanges, asks simple questions ("What's that?", "Where go?"), says their first name when asked, and is understood by unfamiliar adults most of the time.
4 years: Uses sentences of four or more words, recalls words from a song or story, talks about something that happened during their day, and answers simple questions about how things work.
5 years: Tells a short story with at least two events, answers questions about a book or story, keeps a conversation going across more than three exchanges, and recognises simple rhymes (bat-cat).

1 in 5children learn to talk or use words later than their peers, making language delay the most common form of developmental delay. (AAP / HealthyChildren.org, 2024)

Growing up bilingual does not cause a language delay

This myth is persistent and worth addressing clearly: learning more than one language does not cause or worsen a speech or language delay. Babbling, first words, and first word combinations occur at the same ages in children raised with one language and in children raised with two or more. The AAP is direct on this point.

What can look like a delay in a bilingual child is often a counting problem. A 2-year-old in a bilingual household might have 25 words in each language. Measure only one language and you see 25 — seemingly below the 50-word threshold. Count both languages together and the total is 50, which is on track. Assessors and parents should always count vocabulary across all languages a child is regularly exposed to.

Mixing languages within a sentence before age 3 — sometimes called code-switching — is also a normal developmental behaviour, not a sign that something is off. By around age 3, most multilingual children can keep their languages separate and choose which one to use depending on who they are speaking with. NICE guidance specifically notes that a language difference at home should not be assumed to account for a concern about a child's speech development — bilingualism is not a reason to skip an evaluation.

Signs that are worth looking into

None of the signs below mean something is definitively wrong — they mean this is a good time to ask a professional to take a look. Early assessment is information, not a verdict.

Not meeting one or more of the age-expected language milestones listed above.
Not responding to their name, or appearing unaware of familiar voices and sounds.
Not returning smiles or showing social responsiveness.
Loss of words or communication skills a child previously had. This is the one sign that is worth raising with your doctor sooner rather than later — any regression deserves prompt attention regardless of age.
Very limited pointing, gesturing, or back-and-forth interaction by 12 months.
Not using any words by 15 months, or no two-word combinations by 24 months.

Simple routines that support language every day

The most powerful language tool a child has is a responsive caregiver. The WHO Nurturing Care Framework identifies responsive caregiving — talking, singing, making eye contact, and play — as one of five essential components for healthy child development, and recommends these interactions from birth. There is no special programme required.

Talk as you go. Narrate what you are doing during bath time, cooking, or a walk. "Now I am putting on your sock. One sock. Two socks." This kind of running commentary builds vocabulary without any effort beyond doing what you already do.
Read together, starting young. The AAP recommends shared reading beginning at birth and continuing through at least kindergarten. Reading aloud stimulates brain circuitry, strengthens the parent-child bond, and supports vocabulary and language development. The Bright Futures guidelines recommend that doctors bring this up at every health visit from birth to 5 years.
Name things. Point to objects and name them simply and clearly. Books with pictures of everyday objects are especially useful for this.
Follow your child's lead. When your child points at something, name it and expand slightly: "Yes, dog. A big brown dog."
Pause and wait. Give your child time to respond. Silence feels long to adults but children often need a few extra seconds to form a response.

Why earlier is better than waiting

The brain's neural circuits are most adaptable during the first three years of life. These connections form the foundation for learning, behaviour, and health, and become progressively harder to reshape over time — which is why early support tends to be significantly more effective than the same support given later. NICE quality standards reflect this directly: children with communication difficulties who are identified and supported early are much more likely to catch up with their peers than those who are not.

"Wait and see" remains one of the most common responses parents receive when they raise a speech concern. The CDC, AAP, and NICE all advise against it as a default. Expressing concern and requesting an evaluation does not commit you to a particular pathway — it simply gets you information while the window when that information is most actionable is still open.

Hearing first: the step that is often missed

Hearing loss is one of the most common and most treatable contributors to speech and language delays. The CDC recommends that all infants be screened for hearing loss before 1 month of age. Those who do not pass the initial screen should receive a full diagnostic evaluation by 3 months, and if hearing loss is confirmed, be enrolled in early intervention by 6 months. Peer-reviewed research shows that early identification and support for hearing loss before 6 months of age has a meaningful positive effect on vocabulary, grammar, and speech across a child's development.

Any evaluation for a speech or language concern should include a hearing check. It is the most straightforward step and rules out one of the most common underlying causes early.

How to get an assessment

You have more options than you may realise, and in many settings you do not need to wait for a doctor's referral.

At the well-child visit. The AAP recommends standardised developmental screening at the 9-, 18-, and 30-month visits, and autism-specific screening at 18 and 24 months. NICE recommends formal speech and language assessment at the 2 to 2.5 year integrated review (24 to 30 months). If you have concerns at any visit, raise them regardless of the scheduled agenda.
Early intervention (children under 3). In many countries, parents can contact their local early intervention programme directly and request an evaluation — a doctor's referral is not required. The CDC suggests a simple, direct ask: "I have concerns about my child's development and I would like to have my child evaluated."
School-based services (children aged 3 and older). In the United States, free speech and language evaluations are available through local school districts.
Private speech-language pathology. The American Speech-Language-Hearing Association (ASHA) maintains a searchable directory of certified speech-language pathologists at ASHA ProFind.
Your child's doctor. If you are unsure where to start, your paediatrician or family doctor can guide you to local resources and initiate a referral.

Key takeaways

Language development follows a consistent sequence: cooing, babbling, first words, two-word phrases, then sentences — with clear expectations at each age from 12 months to 5 years.
About 1 in 5 children learn to talk later than their peers; a language delay can be expressive (what a child says), receptive (what a child understands), or both.
Bilingualism does not cause speech or language delays. Bilingual children should always be assessed with vocabulary counted across both languages.
Any loss of words or communication skills a child previously had is worth raising with a doctor promptly, rather than waiting for a scheduled visit.
Hearing loss is a common, treatable contributor to speech delays and should be checked as part of any evaluation.
Early support is more effective than later support. Parents can often self-refer to early intervention programmes without waiting for a doctor's referral.

Questions parents ask

My 2-year-old only says about 20 words. Is that a concern?: Most 2-year-olds say at least 50 words and are beginning to put two words together. Twenty words is below the typical range for this age, so it is worth mentioning to your child's doctor at your next visit — or sooner if you prefer. An early assessment gives you useful information and, if support is helpful, the earlier it begins the better. This is not a verdict; it is a check-in.
We speak two languages at home. Could that be why my child is a late talker?: Bilingualism does not cause speech or language delays. First words, babbling, and word combinations occur at the same ages in bilingual and monolingual children. A bilingual child may appear to have fewer words when counted in just one language, but their total vocabulary across both languages is typically comparable to their monolingual peers. If you have concerns, an evaluation that counts words in all languages your child uses will give you an accurate picture.
My child used to say a few words and seems to have stopped. Should I wait to see if it comes back?: Loss of previously acquired words or communication skills is something to raise with a doctor sooner rather than later — it is one of the signs that guidelines from the CDC and AAP recommend acting on promptly, rather than waiting for a scheduled visit. Bring it up now rather than at the next routine check.
When does the doctor check for speech delays, and what does that involve?: The AAP recommends standardised developmental screening at the 9-, 18-, and 30-month well-child visits, and autism-specific screening at 18 and 24 months. NICE recommends a formal speech and language assessment at around 24 to 30 months. In practice, your doctor will ask about language milestones and may use a short questionnaire. If a concern comes up between scheduled visits, you do not need to wait — raise it at any appointment.
Do I need a referral from a doctor to get a speech assessment?: In many settings, no. For children under 3, parents can often contact their area's early intervention programme directly and request an evaluation without a doctor's referral. For children aged 3 and older in the United States, free evaluations are available through local school districts. Your child's paediatrician can also refer you, but you do not need to wait for them to suggest it — you can ask.

Sources

CDC (Learn the Signs. Act Early.) — CDC's Developmental Milestones (2024)
CDC (Learn the Signs. Act Early.) — Why Act Early if You're Concerned about Development (2024)
CDC (Learn the Signs. Act Early.) — Early Intervention (2024)
CDC (Hearing Loss in Children) — EHDI 1-3-6 Benchmarks (2024)
AAP / HealthyChildren.org — Language Delays in Toddlers: Information for Parents (2024)
AAP / HealthyChildren.org — Young Children Learning Multiple Languages: Parent FAQs (2024)
AAP / HealthyChildren.org — How to Raise Concerns about a Child's Speech and Language Development (2024)
AAP (American Academy of Pediatrics) — Literacy Promotion: An Essential Component of Primary Care Pediatric Practice (Policy Statement) (2024)
AAP (American Academy of Pediatrics) — Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening (2020)
NICE (National Institute for Health and Care Excellence) — Quality Statement 2: Speech and Language — Early Years: Promoting Health and Wellbeing in Under 5s (QS128) (2022)
NICE (National Institute for Health and Care Excellence) — Suspected Neurological Conditions: Recognition and Referral (NG127) (2019)
WHO / UNICEF / World Bank Group — Nurturing Care for Early Childhood Development: A Framework for Helping Children Survive and Thrive (2018)
WHO — Improving Early Childhood Development: WHO Guideline (2020)
Great Ormond Street Hospital NHS Foundation Trust — Speech and Language Development 12 to 24 Months (2024)
AAP (Bright Futures) — Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (2022)
PubMed / NCBI (peer-reviewed) — Effect of Early Intervention on Language Development in Hearing-Impaired Children (PMC4735612) (2016)
PubMed / NCBI (peer-reviewed) — Acoustic-Lexical Characteristics of Child-Directed Speech and Their Impact on Toddlers' Phonological Processing (PMC8497969) (2021)

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