PEDIATRIC DEVELOPMENTAL MILESTONES
Below we have compiled a list from the American Speech-Language-Hearing Association. This list is a very brief overview of some of things to expect at various ages. If you have ANY concerns that may or may not be listed, it is better to seek help early. One of our therapists would be more than happy to setup a free consultation with you and discuss your child’s unique situation.
Research shows that the earlier the intervention, the quicker and easier, the remediation of a delay or disorder will be. Please don’t hesitate to call. Our promise is to tell you our professional opinion based on years of education in the field and working with 1,000’s of children, and leave the final decision up to you.
SPEECH MILESTONES
Startles to loud sounds, quiets/smiles when spoken to, makes pleasure sounds (cooing ‘ahhh’ ‘eee’), cries differently for different needs
OCCUPATIONAL THERAPY MILESTONES
Self Help
Naps frequently
Sleeps four-ten hour intervals at night
Opens/closes mouth in response to food stimulus
Social/Emotional
Draws attention to self when in distress
Smiles reflexively
Gross Motor
Kicks reciprocally
Extends both legs
Rolls from their side to their back
Fine Motor
Moves arms symmetrically
Activates arms at sight of toy
Cognitive
Watches speaker’s eyes and mouth
Inspects both hands
Reacts to disappearance of slowly moving object
SPEECH MILESTONES
moves eyes in direction of sounds, responds to changes in tone of your voice, notices toys that make noise, babbling sounds more speech-like with many different sounds including p, b, and m
OCCUPATIONAL THERAPY MILESTONES
Self Help
Places both hands on bottle
Social/Emotional
Enjoys social interaction
Explores adult features
Gross Motor
Circular pivoting while on belly
Sits momentarily leaning on hands
Bears almost all weight on legs
Fine Motor
Reaches with one hand
Transfers object from hand to hand
Drops/recovers objects
Bangs objects on table
Cognitive
Finds partially hidden object
Explores objects with hands and mouth
“Red Flags”
Not trying to get things within reach
Does not respond to sounds around them
Shows no affection for caregivers
SPEECH MILESTONES
Enjoys games like peek-a-boo, listens when spoken to, recognizes words for common items like “cup”, “shoe”, or “book”, uses gestures like waving or holding arms up to be picked up, has at least one real word
*PREMATURE – babies born premature (before 38 weeks gestation) are expected to meet these milestones based on full-term due dates. (i.e. baby born at 30 weeks gestation would not be expected to meet 12 month milestones until 22 (12+10) months old.
“Red flags” (when to refer)
- Child doesn’t respond to noises
- Not yet babbling (consonant-vowel combinations) by 9 months
OCCUPATIONAL THERAPY MILESTONES
Self Help
Cooperates with dressing by extending arm or leg
Holds spoon
Finger feeds self
Holds own bottle
Social/Emotional
Explores environment enthusiastically
Extends toy to show others, not for release
Tests parent responses to behaviors
Responds playfully to mirror
Gross Motor
Walks with both hands held
Goes from sitting to belly
Stands momentarily
Fine Motor
Uses pincer grasp
Bangs two cubes in hands
Puts objects into container
Pokes with index finger
Cognitive
Knows what “no no” means and reacts
Unwraps a toy
Moves to rhythms
“Red Flags”
Does not crawl
Does not point to things
Loses skills they once had
SPEECH MILESTONES
Points to a few body parts, follows simple directions (like “Kiss the baby,” or “Where’s your shoe?”), approximately 50 different words, begins to say two words together like “baby go” and “mama up”
*PREMATURE – babies born premature (before 38 weeks gestation) are expected to meet these milestones based on full-term due dates. (i.e. baby born at 30 weeks gestation would not be expected to meet 18-month milestones until 28 (18+10) months old.
“Red flags” (when to refer)
- Child does not respond to his name
- Child has 10 words or less by 18 months
OCCUPATIONAL THERAPY MILESTONES
Self Help
Removes socks
Indicates discomfort over soiled pants
Holds and drinks from cup with some spilling
Brings spoon to mouth
Social/Emotional
Separation anxiety increases
Begins to show defiant behavior
Gross Motor
Walks alone
Pulls toys while walking
Fine Motor
Turns over container to pour out contents
Spoons feeds
Uses open and sippy cup
Cognitive
Responds to one step command without gestures
Points to body parts
Points to object or picture when named for them
“Red Flags”
Does not copy others
Does not know what familiar things are for
Is not walking
SPEECH MILESTONES
Parent is able to understand what the child says at least 50% of the time, uses a variety of consonant and vowel sounds, uses 2-3 word phrases, approximately 150 different words
*PREMATURE – babies born premature (before 38 weeks gestation) are expected to meet these milestones based on full-term due dates. (i.e. baby born at 30 weeks gestation would not be expected to meet 18 month milestones until 28 (18+10) months old.
“Red flags” (when to refer)
- Is not using two word phrases by 24 months
OCCUPATIONAL THERAPY MILESTONES
Self Help
Gives up bottle
Removes shoes when laces are undone
Unzips/zips large zipper
Social/Emotional
Expresses affection
Shows wide variety of emotions
Engages in parallel play (same activity next to another child)
Gross Motor
Picks up toy from floor without falling
Throws overhand within 3 feet of target
Carries large toy when walking
Fine Motor
Imitates vertical stroke
Builds tower using 6 cubes
Imitates circular scribble
Cognitive
Identifies 6 body parts
Matches sounds to pictures of animals
Recognizes self in photograph
Assembles four nesting blocks
“Red Flags”
Does not copy actions/words
Does not follow simple directions
Skill regression
SPEECH MILESTONES
- Understands some differences in meaning like “go-stop,” “in-on,” “up-down,” “big-little”
- Follows two step directions (“get the book and put it on the table”)
- Listens and enjoys hearing stories for longer periods of time
- Has a word for almost everything
- Uses 3 words at a time
- Uses /m,p,b,t,d,n,k,g,s,h,w/ consonant sounds
- Speech is understood most of the time (at least 80%) by others
- Begins to ask “why?”
“Red flags” (when to refer)
- Child does not use 2 and/or 3 word phrases consistently
- Limited speech sounds in inventory (prefers certain sounds versus a variety)
- Child is difficult to understand (less than 80%) by adults familiar with the child’s speech
- Repeating words, phrases, and sounds can be typical at this age. Find out more about typical versus atypical stuttering in toddlers-preschoolers here.
OCCUPATIONAL THERAPY MILESTONES
Self Help
Dresses self with assistance with fasteners
Buttons large buttons
Uses toilet with assistance, has day time control
Uses fork
Social/Emotional
Takes pride in achievements
Begins to respect simple rules
Separates easily from parents in familiar setting
Gross Motor
Catches 8 inch ball
Uses pedals on tricycle
Jumps a distance of 24-34 inches
Walks upstairs alternating feet
Hops on one foot
Fine Motor
Snips with scissors
Imitates a cross
Builds 9 cube tower
Folds paper in half
Strings 1/2 inch beads
Cognitive
Matches similar pictures of objects
Sorts basic shapes
Completes inset puzzles with 3-4 pieces
Understands concept of two
Plays house
“Red Flags”
Does not make eye contact or want to play with others
Does not play pretend or make believe
Loses skills they once had
SPEECH MILESTONES
- Hears you when you call from another room
- Understands some colors and shapes
- Talks about what happened during the day, using ~4 sentences at a time
- Answers simple “who?”, “what?”, and “where?” questions
- Asks “why?”, “when?” and “how?” questions
- Uses pronouns, like I, you, me, we, they
- Uses plural -s (cats, toys)
- Uses 4+ words at a time
“Red flags” (when to refer)
- Does not respond to her name
- Difficulty following directions with more than one step
- Difficulty answering simple questions
- Limited vocabulary or short sentences (most sentences are less than 4 words)
- Difficulty being understood by those not familiar with the child’s speech
- Repeating words, phrases, and sounds can be typical at this age. Find out more about typical versus atypical stuttering in preschoolers here.
OCCUPATIONAL THERAPY MILESTONES
Self Help
Is potty trained with infrequent accidents
Serves self at table without spilling
Closes snaps on clothing on self
Puts socks on completely
Puts shoes on correct feet
Can use fork and spoon without spilling
Social/Emotional
Tells own age
Sits quietly when listening to stories, music, TV, etc.
Requests help for spills
Transitions from one activity to another when asked to do so
Takes turns
Gross Motor
Balances on each foot for 5 seconds
Bounces and catches large 10″ ball
Stands on tip toes for 10 seconds
Fine Motor
Holds writing utensil with a three finger grasp
Cuts out circle within 1/2″
Folds paper 3 times
Builds tower of more than 9 blocks
Stabilizes paper while drawing
Cognitive
Remains on task when distractions are present
Draws face with eyes, nose, and mouth
Counts to 4
Sings parts and phrases of familiar songs
“Red Flags”
Has trouble scribbling
Resists dressing, sleeping, and toileting
Cannot follow 3 step directions
SPEECH MILESTONES
- Understands words for order like first, next, and last
- Understands words for time like yesterday, today, and tomorrow
- Hears and understands most of what is said at home and in school
- Uses all speech sounds in words but may make mistakes on harder sounds like /l, s, r, v, z, ch, sh, th/
- Responds to “What did you say?”
- Talks without repeating sounds or words most of the time
- Tells a story
- Keeps conversation going
- Talks in different ways depending on the listener and place. May use short sentences with younger children or talk louder outside than inside.
“Red flags” (when to refer)
- Difficulty being understood by those not familiar with the child’s speech
- Difficulty saying the following sounds /m, p, b, t, d, n, f, k, g, ng, s, w, h/
- Difficulty telling and/or retelling a short story
- Difficulty maintaining conversation
- Difficulty with pronouns and/or verb tenses (past/present tenses)
- Repeating words, phrases, and sounds can be typical at this age. Find out more about typical versus atypical stuttering in preschoolers here.
OCCUPATIONAL THERAPY MILESTONES
Self Help
Blows into tissue
Spreads with knife
Puts on clothing with correct orientation
Ties shoes by end of age 5
Social/Emotional
Adjusts behavior for various situations
Participates in conversation/discussion
Quiets down after active period
Comforts playmates in distress
Gross Motor
Gallops 10 feet
Somersaults
Swings keeping momentum
Fine Motor
Copies squares
Draws diagonal lines
Draws picture of person with at least 8 body parts
Places paper clip on paper
Cognitive
Counts aloud to 10 while pointing to objects
Knows left from right
Can attend without supervision for 10 minutes
Matches coins, names name of coin