A mother reports her 18-month-old child has not spoken any words yet. The child makes eye contact, points to objects, and plays peek-a-boo. Which is the MOST appropriate next step?

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Nursing QUESTION #9273

Question 1

Reassure the mother that boys speak late — normal variation
Refer for formal speech and language evaluation and hearing test✔️
Order MRI brain immediately
Begin oral motor exercises at home only

Correct Answer Explanation

Language Development Milestones:

Age	Expected Language
2 months	Coos, social smile
6 months	Babbles (ba, da, ma)
9 months	Mama/dada (non-specific)
12 months	1–3 meaningful words (mama, dada specific)
18 months	Minimum 10–20 words; points to body parts
24 months	2-word phrases; 50+ words
3 years	3-word sentences; strangers understand ~75%

Red flag at 18 months: No single words = speech delay — requires formal evaluation.

Critical distinction:

This child maintains eye contact, points, plays peek-a-boo = social development intact → less likely autism
Speech delay without social communication deficits suggests: hearing loss, expressive language delay, bilingual exposure, or oral-motor issues

First step: Formal hearing test (audiometry) — hearing loss is the most common correctable cause of speech delay. Concurrent speech-language evaluation.

Reassurance without evaluation at 18 months is inappropriate — early intervention improves outcomes significantly.

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