# Signs of Speech and Language Delay for Nurses

Canonical: https://pinnacleblooms.org/ask/what-signs-of-speech-and-language-delay-should-a-nurse-watch-for-in-a-young-child
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

Nurses should watch for absent babbling by 9–12 months, few or no words by 16–18 months, no two-word phrases by 24 months, unintelligible speech by 3 years, plus receptive and social signs like not responding to name or limited gesture — and any loss of skills. Hearing is always checked first. AbilityScore® is part of Pinnacle’s developmental assessment. Diagnosis, where needed, requires an appropriately qualified healthcare professional.

*A nurse is often the first trusted eyes on a child's communication — and early notice changes the whole trajectory.*

## In short
Watch for the child who is not babbling by around 9–12 months, has few or no single words by 16–18 months, no two-word phrases by 24 months, or whose speech is largely unintelligible to family by age 3. Equally important are *receptive* and *social* signs — not responding to name, not following simple instructions, or limited gesture and eye contact. Any loss of words or skills already gained, or persistent parental concern, warrants prompt screening — and a hearing check is always the first step.

## Red flags by age
- **By 9–12 months:** no babbling or jargon, no pointing or waving, no response to name, no shared joy or eye contact.
- **By 16–18 months:** no single meaningful words; not following simple one-step requests; not using gestures to communicate wants.
- **By 24 months:** vocabulary under ~50 words; no spontaneous two-word combinations ("more milk"); relies on pulling or leading an adult rather than words.
- **By 36 months:** speech hard for unfamiliar listeners to understand; cannot follow two-step directions; sentences not emerging.
- **At any age:** *regression* — loss of previously acquired words or social skills — needs urgent referral; and a child who does not startle or orient to sound needs an audiology check first.

## What to do as a nurse
Use a standardised milestone tool (CDC "Learn the Signs. Act Early." checklists or the RBSK developmental screen) at every contact, document gestures and comprehension as carefully as spoken words, and rule out hearing loss early. Take parental concern seriously — it is a strong predictor. Refer for audiology and a speech-language assessment rather than adopting a "wait-and-see" stance, as early intervention markedly improves outcomes.

## The Pinnacle way
AbilityScore® is part of Pinnacle’s developmental assessment. Diagnosis, where needed, requires an appropriately qualified healthcare professional — never from a screen alone. Our [structured clinician-led assessment](/ask/what-is-the-abilityscore-and-how-is-it-calculated) profiles receptive, expressive and social communication, and pairs with targeted [speech and language therapy](https://www.pinnacleblooms.org/top-speech-therapy-center-india-proven-improvement-rate). [Explore how we support families](/) across 70+ centres in 4 states.

## Trusted sources
WHO ICD-11 (6A01, developmental speech or language disorders); CDC "Learn the Signs. Act Early." milestone checklists; Indian Academy of Pediatrics developmental guidance; American Academy of Pediatrics (HealthyChildren.org); RBSK developmental screening.

**Next step —** Spotted a concern? Refer the family to [book a Pinnacle speech and language assessment](https://www.pinnacleblooms.org/top-speech-therapy-center-india-proven-improvement-rate) after a hearing check.

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- WHO ICD-11 · Developmental speech or language disorders: https://icd.who.int/browse11
- CDC — Learn the Signs. Act Early.: https://www.cdc.gov/child-development
- American Academy of Pediatrics (HealthyChildren.org): https://www.healthychildren.org

## Connected topics and perspectives
- Conditions: https://pinnacleblooms.org/ask/conditions
- Nurse: https://pinnacleblooms.org/ask/lens/stakeholder/nurse
- Adaptive: https://pinnacleblooms.org/ask/lens/domain/adaptive
- Support: https://pinnacleblooms.org/ask/lens/intent/support
- Plan: https://pinnacleblooms.org/ask/lens/lifecycle/plan
- Speech Therapy: https://pinnacleblooms.org/ask/lens/route/speech-therapy
- Family Empowerment: https://pinnacleblooms.org/ask/lens/empowerment/family_empowerment

## Related question paths

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