What should I do if my 18-month-old child has not said 7 words yet?

What to Do When Your 18-Month-Old Has Not Said 7 Words

Your 18-month-old should be speaking 10-15 words by now, so having fewer than 7 words represents a delay that requires immediate action—specifically, you need to arrange for a formal hearing test and developmental screening right away. 1, 2

Immediate Actions Required

1. Hearing Assessment (First Priority)

• Schedule a formal audiological evaluation immediately to rule out hearing loss, which is one of the most common and treatable causes of speech delay 1, 3
• Do not rely on your pediatrician's office observations or your own assessment of whether your child "seems to hear"—formal audiometry is essential even if the child appears to respond to sounds 3
• At 18 months, the audiologist will use behavioral testing methods appropriate for this age, including visual reinforcement audiometry 4

2. Developmental Screening

• Request standardized developmental screening using validated tools like the Ages and Stages Questionnaire or Parents' Evaluation of Developmental Status—clinical observation alone misses 45% of children who need early intervention 1
• The screening should assess not just speech, but also cognitive, motor, and social-emotional development, as speech delay may signal broader developmental concerns 1

3. Early Intervention Referral

• Contact your local early intervention services immediately (typically through your school district or state early childhood services) for a comprehensive needs assessment 1
• Do not wait for the results of hearing or developmental testing to make this referral—these processes can run in parallel 1

Red Flags That Require Extra Urgency

Beyond the word count, watch for these concerning signs that warrant even more immediate evaluation:

• Loss of previously acquired words or skills (regression) 2
• Poor eye contact or limited social engagement 2
• Inability to follow simple one-step commands (like "come here" without gestures) 2
• Lack of communicative intent—not trying to communicate through gestures, pointing, or vocalizations 2
• No response to their name being called 4

These signs may indicate autism spectrum disorder or other developmental conditions requiring specialized evaluation 4

What Intervention Looks Like

Speech-Language Therapy

• Speech therapy has strong evidence for effectiveness, particularly for expressive language disorders like your child likely has 1
• Therapy will assess oral-motor function, articulation, and both expressive and receptive language abilities 1
• For severe delays, alternative communication systems (like picture boards or sign language) may be introduced while working on verbal skills 1

Parent-Implemented Strategies (Start These Now)

While waiting for formal services, implement these evidence-based strategies:

• Respond immediately to all vocalizations—even babbling—and expand on what your child expressed (if they say "ba," you say "Yes, that's a ball!") 5, 2
• Provide adequate pause time after you speak, giving your child 5-10 seconds to process and attempt a response 5
• Practice turn-taking in "conversations," modeling the back-and-forth rhythm even if your child only vocalizes 5
• Read books together daily and narrate daily activities with rich, varied vocabulary 5, 2
• Never correct errors directly—instead, model the correct form (if they say "doggy go," you respond "Yes, the doggy is going away") 5

Expected Timeline and Prognosis

• Normal 18-month-olds speak 10-15 words, and by 19-24 months typically combine two words and reach approximately 50 words 2
• Early intervention is critical—children who receive services early show significantly better outcomes in vocabulary, receptive and expressive language, syntax, speech production, and social-emotional development 5
• Speech and language delays left untreated can cause learning and socialization difficulties lasting into adolescence and beyond 6
• Long-term follow-up is essential, as preschool speech delays often signal ongoing developmental challenges requiring support through school years 3

Common Pitfalls to Avoid

• Do not adopt a "wait and see" approach—the evidence strongly supports immediate action rather than waiting to see if the child "catches up" 1, 6
• Do not skip the hearing test even if you think your child hears fine—this is the single most important diagnostic step 3
• Do not rely solely on your pediatrician's clinical impression without standardized screening tools 1
• Do not delay intervention while waiting for a definitive diagnosis—services can begin while evaluation is ongoing 1