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Identifying Red Flags for Hearing, Speech, and Language Development

​​​When Should I be Concerned about my Child's Hearing, Speech, or Language Development?

Parents, you know your child better than anyon​​e. So it is important to act right away if you have concerns about how your child communicates or if your child:

2 months​

  • Doesn't respond to loud sounds
  • Doesn't smile at people
  • Doesn't watch things as they move

4 months

  • Doesn't coo or​ make sounds
  • Doesn't move her eyes in the direction of sounds
  • Doesn't smile at you to get your attention

6 months

  • Doesn't respond to sounds around him
  • Doesn't make vowel sounds like “ahhh" or “eeee"
  • Doesn't laugh or make squealing sounds
  • Doesn't look at people when she hears voices

9 months

  • Doesn't babble using the same sounds over and over (“buhbuhbuh," “dadada")
  • Doesn't respond to his own name
  • Doesn't seem to recognize familiar people
  • Doesn't look where you point

1 year

  • Doesn't babble using different sounds together (“badagee")
  • Doesn't use gestures like waving bye-bye, pointing, or shaking head for 'no'
  • Doesn't clearly let you know in some way when he wants something or needs help
  • Doesn't participate in back-and-forth games like peekaboo, tickle games, or rolling a ball

15 months

  • Doesn't understand simple words like “no," “up," “hi," and “mommy"
  • Doesn't say any words on his own
  • Doesn't respond to 'where' questions like “Where's mommy?" by pointing or looking
  • Doesn't point to an object and then look at you to see if you are looking at the same thing

18 months

  • Doesn't understand simple commands like “Come here" or “Give it to me"
  • Doesn't use at least 10-20 words on her own
  • Doesn't point to 2-3 major body parts when asked questions like “Where are your feet?" or “Show me your nose."
  • Doesn't make 2-3 different consonant sounds in vocal play or words (“buh," “mama," “ahnee")

2 years

  • Only uses single words or common phrases, like “all done" or “thank you"
  • Doesn't put together words to make new phrases, like “Mommy sock" or “ball go"
  • Doesn't use at least 50 words on his own
  • Doesn't try to copy actions and words
  • Doesn't follow a direction with one step, like “Put your cup in the sink."

30 months

  • Doesn't use action words like “run," “eat," and “jump"
  • Doesn't copy more than one word of an adult sentence (for example, if you say “The doggie is running" she says only “doggie" or only “run")
  • Hasn't started using any word endings, like -ing in “eating"
  • Doesn't pretend, like pretending to pour water into a cup and drinking from it
  • Uses speech that is often very hard for familiar adults, like parents and daycare providers, to understand

3 years

  • Doesn't speak in sentences
  • Doesn't follow directions that have two steps that are related, like “Wash your hands then sit down at the table."
  • Uses speech that is sometimes difficult for familiar adults, like parents and daycare providers, to understand
  • Doesn't use “I" and “me" correctly

4 years

  • Doesn't ask questions that start with “who," “what," “where," “when," and “why"
  • Doesn't understand stories or tell simple stories
  • Doesn't follow three-step directions, like “Go to get your crayons, sit down at the table, and draw a picture."
  • Doesn't use sentences with five or more words
  • Doesn't respond to others in conversation by answering questions or making comments
  • Doesn't talk about things that happened in the past or will happen in the future
  • Uses speech that isn't understood by new people he talks to

5 years

  • Doesn't talk about daily activities or experiences, like “We went to the park and I played on the swings."
  • Doesn't use pronouns like she, him, and hers correctly
  • Doesn't understand or use complicated sentences (“I can't reach it because I'm too short.")
  • Doesn't add -ed to words to indicate it happened in the past, like played
  • Uses speech that is not understood by others
  • Has trouble communicating with other children


  • Has trouble with reading, writing, or math compared to other kids in his grade
  • Seems to memorize words when reading rather than sounding them out
  • Makes grammar errors when talking
  • Has trouble with making friends
  • Gets upset or angry when she has trouble communicating
  • Makes sound errors in speech
  • Has difficulty following directions at home or in school
  • Does not use complicated sentences, like “I hope that I can play outside when I get home from school."

When Should I be Concerned about my Child's Hearing, Speech, or Language Development?

If you have any concerns about your child's hearing, speech, or language, you can talk to your child's pediatrician, call your child's school district or area educational agency, or schedule a clinical hearing or speech-language evaluation. If your child is between 3 and 18 years old, you can also sign up for a free online or in-person hearing and language screening with a speech-language pathologist from Boys Town National Research Hospital. Learn more​ here or by calling (531) 355-5610. The screening will let you know if more hearing or language testing is needed for your child.

If you are interested in scheduling a clinical hearing evaluation at Boys Town National Research Hospital, please call (531) 355-6540 for the Downtown location or (531) 355-6800 for the West location. If you are interested in scheduling a clinical speech-language evaluation at Boys Town National Research Hospital, please call (531) 355-5087.

You can learn more about the developmental milestones your child should be reaching at each age by downloading our milestone handouts. The handouts also have information on how to support your child's development.

​​​​​Hearing and Language Websites​

Boys Town has created in-depth websites to help parents, caregivers​, educators and others caring for children who have been newly diagnosed as Deaf or hard-of-hearing and for individuals of​ all ages with speech-language concerns.

Language and Learning;Child Development;Communication Skills;Speech and Language Speech Therapy