The First Words K.A.R.E. model for speech

and language intervention in young children: 


Know the signs. 

Act early. 

Refer. 

Educate.

In your intervention with babies – whether at early pediatric visits, the 12-month visit, during a NDDS screening visit or the enhanced 
18-month well-baby visit – please consider using the K.A.R.E. model as described below:


Know the signs.
The parent is concerned. Research shows that parents know their babies best. Even a general concern about the child’s communication development should be verified and followed-up.
  • Baby is not babbling by 10 months and is not using 3 to 5 words by 12 months. Babbling (simple “da, ba, ma”, repetitive “ba-ba-ba, ma-ma-ma” or the canonical “bada”) appears around 6 to 7 months, and is well-established by 10 months. Babbling is crucial to language development; it leads to word production. If a baby is not reaching these milestones, don’t wait; refer to First Words.
  • Baby doesn’t respond to their name by 12 months or to simple questions by 18 months. These are important “markers” of receptive language. If absent or late to appear, these should warrant further investigation – with First Words and audiology (Infant Hearing Program, CHEO audiology services or private clinics).
  • The child no longer uses sounds or words previously in their repertoire. Any loss of language and/or social skills should warrant an immediate referral to the CHEO Development and Rehabilitation Services via the CHEO Access Team at 613-737-2757.

Act Early. Refer.
Based on your observations and pediatric tools (starting with our Communication Milestones, Rourke Baby Record or the Looksee Developmental Screen), you may want to refer the child.
  • Screening through the First Words Communication Checkup, a free online screening tool.
  • Directly to the CHEO Access Team by calling 613-737-2757 or by faxing a referral to 613-738-4839.

Educate parents:
To help any baby develop speech and language, parents need to be engaged and responsive. When a six-month-old is lying on the floor kicking their legs and making sounds, parents should get involved and follow the child’s lead. This kind of interaction – when the parent is responding to the baby’s energy level, interest, and curiosity – is the best way to promote social communication. 

Advise parents of the following:
  • Be chatty with the baby. Talk to your baby when dressing or feeding them; tell them about what you’re doing, seeing (e.g. “I’m putting on your shirt with funny bunnies.”), and use descriptive words (e.g. “Wow, that water is cold!”). Repeat the words often.
  • Talk back. When baby babbles, take a turn. Imitate their sounds, add words and gestures, and comment on their story. When they wiggle or reaches for things and vocalizes, interpret and let them know the point has been made (e.g. “You want the big ball? Let’s go get the ball!”).
  • Play, sing, read. Babies learn socialization, turn-taking skills, and new words during simple games like “peek-a-boo.” Sing songs and nursery rhymes. Read often to your baby: point to objects in pictures. Talk about what you see in books.
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