Isolated speech and language delay in a toddler

What it is

Language is one of the milestones followed at a well child visit, and a delay is read against what a child of that age is expected to say.

• 18 months: a 10- to 25-word vocabulary.
• 2 years: vocabulary ≥50 words and 2-word phrases; the child follows 2-step commands and parallel play begins.
• 3 years: 3-word sentences, speech 75% intelligible, knows age and gender.
• 4 years: speech 100% intelligible, cooperative play.
• 5 years: 5-word sentences, counts to 10.

How it presents

A 3-year-old male is brought for a well child visit. He has a vocabulary of about 100 single words and has not begun to speak in 2-word phrases. The ear examination is normal, the parents have no concerns regarding the child's hearing, and they report that the child is interacting with others normally.

Read against the milestones above, a vocabulary of about 100 single words is past the 2-year line of ≥50 words, so it is the phrase length that is behind: he has not begun to speak in 2-word phrases, which is what 2 years asks for, and 3 years asks for 3-word sentences. Hearing and social interaction are not the problem.