The eighteen-month check, and why we ask about words

Why this one is different

Most childhood reviews are largely physical: growth, feeding, immunisations, a look at how a body is putting itself together. The eighteen-month check is the first where a good part of the appointment is about communication, and parents are often surprised by how much of it is us watching rather than measuring.

There is a reason for the timing. Eighteen months is early enough that support makes a large difference and late enough that the range of normal has narrowed to something useful.

What we are actually listening for

Not the number of words, though we will ask. What matters more is whether your child is trying to communicate at all, and in how many ways: pointing at something to show you rather than to get it, bringing you a toy, meeting your eye, following where you point, responding to their own name, copying what you do.

A child with ten words who points, shares and looks is in a very different position from a child with ten words who does none of those. The words are the visible part; the reaching-out underneath is the part we care about.

The range really is that wide

At eighteen months some children have six words and some have sixty, and both are ordinary. Later talkers with warm, back-and-forth communication very often catch up entirely without any help at all.

What is worth raising is loss — a child who had words and has stopped using them, or who used to respond to their name and no longer does. That pattern is worth a conversation whatever the count is.

What helps, and what does not

Narration helps more than anything else: saying what you are doing while you do it, naming things you are both looking at, leaving a gap for a reply even before there is one. Reading the same book for the two-hundredth time helps. Responding to a point by naming the thing helps.

Screens do not, at this age, and there is reasonable evidence that background television makes the useful kind of talk less likely by cutting into it. Flashcards and apps that promise vocabulary do not either.

If we do raise something

The first step is usually a hearing test, because glue ear after repeated infections is common and easy to miss, and it is the single most treatable cause of slow language. After that it is a speech and language referral, which is support rather than a diagnosis.

Bring what you have noticed to the appointment even if it feels small. Parents are right far more often than they expect to be, and eighteen months is a good time to be listened to.