One month before the two-year visit. This is the moment to observe clearly and act quickly if something needs attention. The 24-month visit checks for 50 words and two-word combinations as clinical milestones. If your toddler doesn't have them by the visit, a referral for evaluation will be generated. That's the right outcome if needed — but if you're at 23 months with 30 words and no combinations, calling your pediatrician now gives you more time before the formal check.
The 24-month visit also includes the second M-CHAT screening. Most parents approach it having thought about the questions in advance. The parents who walk in having observed their toddler intentionally in the prior month get more from the visit.
Language Milestones at 23 Months
- Approaching or past 50 words — The clinical target for 24 months. At 23 months, 50–150 words is the normal range. Wide variation is expected.
- Two-word combinations consistent — Regular and varied. The 24-month visit will specifically ask about this. Note three or four recent examples.
- Pronouns used regularly — "I," "me," "mine," "you." Still sometimes confused. Confusion at 23 months is normal.
- Names pictures in books — Should be naming familiar objects in books reliably when asked.
- Following 1-step instructions reliably — Consistent compliance with simple instructions across different settings.
- 200-word window open and building — The next vocabulary milestone — 200 words — has a window through about 27 months. Keep labeling.
⚠️ Fewer than 50 words at 23 months
Call your pediatrician this week. The 24-month visit will require evaluation if these milestones are absent. Getting a referral started four weeks early means the process begins sooner. The CDC's clinical thresholds are: no two-word combinations by 24 months, and fewer than 50 words by 24 months — both require follow-up. You have four weeks. Use them.
Cognitive Milestones at 23 Months
- Matches shapes and colors — Simple sorting: put the red block with the red ones. This is abstract categorization, not just perception.
- Understands mine/yours — The concept of ownership is developing. They understand "that's mine" and "that's yours" — even if they don't always accept the implications.
- Function of objects — Knows what things are for: spoon is for eating, cup is for drinking, hat goes on the head. These functional categories are the foundation of later reasoning.
- Complex pretend play — Multi-step scenarios now. Puts the baby to sleep, wakes it up, feeds it, takes it for a walk. The narrative structure in pretend play predicts story comprehension at school age.
What the 24-Month Visit Will Actually Do
The 24-month well-child visit includes:
- M-CHAT-R/F — Second autism screen. Parent questionnaire. Same questions as at 18 months, but your toddler is two months older and some behaviors are now more established.
- Vocabulary and language check — Pediatrician will ask about word count and two-word combinations. Be ready with examples.
- Motor assessment — Walking, running, stairs, throwing. They may observe directly or ask parent report.
- Blood lead level screen — Recommended at 24 months, especially if the 12-month screen indicated elevated risk.
- Growth measurement — Height, weight, head circumference.
With First Son, I showed up at the 24-month visit having no idea what to expect. With Second Son I knew the checklist in advance and came prepared to discuss language progress specifically. Same visit, much more useful conversation.
What to Do Right Now
- Do a word count this week. Sit with paper for 10 minutes and list every consistent word your toddler uses. If you're at fewer than 30, call your pediatrician before the visit for an early speech referral.
- Note three examples of two-word combinations. "More juice," "daddy home," "my shoe" — real examples heard this week. Bring them to the visit. Pediatricians ask for examples, not abstractions.
- Observe M-CHAT behaviors intentionally. Does your toddler point to share interest and look back at you? Do they respond reliably to their name? Do they show you objects just to share them? Note what you observe this month — it makes the M-CHAT questionnaire more accurate.
The two-year visit is a milestone visit. Come prepared and you'll get more from it.
Scout tracks what's opening month by month
Every month, on your child's monthly birthday, Scout sends an email timed to their exact developmental age — what windows are open, what's closing, and exactly what to do. Plus a calendar invite so nothing slips.
Try Scout Free →Frequently Asked Questions
What milestones should a 23-month-old be hitting?
Approaching or past 50 words, consistent two-word combinations, pronouns in regular use, names pictures in books, matching shapes and colors, multi-step pretend play, running and jumping. The 24-month visit is four weeks out — this is preparation month.
My 23-month-old isn't talking much. Should I wait for the 24-month visit?
No. Call your pediatrician now. Getting an evaluation or referral process started four weeks early means more time before the clinical milestones are formally assessed. If your toddler has fewer than 30 words or no two-word combinations at 23 months, earlier is better. Speech therapy referrals at 23 months produce better outcomes than the same referral at 25 months.
What should I bring to the 24-month visit?
A word count (rough is fine), specific two-word combination examples, and any behaviors that have concerned you in the last six months. Also: your M-CHAT observations from this past month. The M-CHAT questionnaire will be given to you at the visit, but thinking about the questions in advance produces more accurate answers. The most important questions: pointing to share interest, response to name, showing objects to share, and pretend play.
Is it normal that my 23-month-old still doesn't play with other kids?
Yes. Cooperative play — actually playing with other children — doesn't typically develop until 24–30 months. At 23 months, parallel play (playing near other kids, watching them, occasionally imitating them) is the expected social mode. If your toddler shows no interest in other children at all — doesn't watch them, doesn't react to them — note it for the 24-month visit, as social interest is one of the M-CHAT assessment areas.