TheraTree Pediatric Therapy

Successful Developmental Milestones, Occupational Therapy Can Help! 

By - Jessica
09.02.21 03:59 PM

By: Kaitlin Kralj, MS, OTR/L, ACSM-EP

Children develop many important life skills during the first 5 years of life. These skills are commonly referred to as “developmental milestones.”


Skills such as rolling over, smiling for the first time, babbling, waving goodbye, pointing, and taking first steps are examples of just a few of these developmental milestones. 


Even though children will develop at their own pace, most kids will reach these developmental milestones at around the same age. When a child is consistently reaching the developmental milestones at the normative age, it can be a good indicator that the child is developing as expected.

Performance Areas: 

Developmental milestones include several performance areas, such as:

Fine Motor Skills

- Small movements that are made with the fingers, wrist, toes, lips, and tongue

- Needed for eating, drawing, dressing self, writing, playing, etc.

Gross Motor Skills

- Moving, controlling, and coordinating our arms and legs with large muscle groups
- Important for sitting, standing, walking, running, balance, etc.


- Thinking, learning, reasoning, remembering and problem solving

Social and Emotional Skills

- The ability to relate to others and express emotions
- Important for developing relationships, cooperating with others, and responding to the feelings of others.

Daily Living Activities

- Personal hygiene, eating, dressing, toileting


- Using body language, gestures, and speech

Common Developmental Milestones: 

3 Months 

  • Raise their head and chest while laying on their stomach
  • Turn their head towards a sound
  • Bring hands to mouth
  • Swipe at dangling objects with hands
  • Begin to imitate sounds or babble

6 Months

  • Roll both ways
  • Use their voice to express pleasure and displeasure
  • Sit with support
  • Respond to others’ emotions and enjoy social games (such as peek-a-boo)

1 Year

  • Pull up to stand on furniture

  • Use simple gestures (shaking head no, waving bye)
  • Poke with index fingeroke with index finger

2 Years

  • Use simple phrases
  • Walk without assistance
  • Point at objects
  • Follow simple instructions
  • Pull toys behind him or her while walking

3 Years

  • Begin sorting by shapes and colors
  • Play make-believe
  • Uses simple phrases
  • Walk up and down stairs
  • Run  
  • Pedal a tricycle

4 Years

  • Follow 3 step commands
  • Draw circles and squares
  • Name some colors
  • Understand counting
  • Share and take turns with others
  • Dress and undress themselves
  • Know opposites (big and small; hot and cold)

The cause of developmental delay is not always known. Some common factors include heredity, pregnancy complications, and premature birth.


Signs and symptoms of developmental delay will often vary. While signs can sometimes be recognized in infancy, there are also instances where the delay is not noticeable until the child is in school.

Reaching milestones earlier than expected means that a child may be advanced in comparison to peers of the same age. When a child is not reaching milestones during the expected time frame, or if they are reaching milestones later than their peers, their development may be termed as “delayed.”  A developmental delay is more than being “a little behind” their peers. Children that are facing challenges with reaching developmental milestones may require extra support to help them reach their full potential.

Occupational Therapy Can Help

Occupational therapy practitioners work with children of all ages throughout the rehabilitative process. After collaborating with caregivers to identify the child’s needs and any potential barriers that may be impacting functional performance, the intervention process begins. Occupational therapy practitioners possess the skill and knowledge required to provide skilled intervention, parent education, and make equipment recommendations as needed to help your child’s development. Occupational therapists have skilled training in helping your child develop motor skills, self-help skills, problem solving skills, social interactions skills, and play skills.  

An occupational therapy practitioner will teach skills and/or strategies to help children and their families in all aspects of their daily lives. This process may include adaptations of activities, materials, and even environmental conditions so that children are able to participate in a variety of settings (including schools, homes, sporting events, community programs, etc).

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Fine Motor Skills

  • Manipulating toys and puzzles
  • Grasping a pencil
  • Coloring, drawing, tracing, prewriting strokes
  • Handwriting, letter/number formation
  • Cutting with scissors
  • Using silverware at an age-appropriate time
  • Using zippers, buttons, and shoelaces

Gross Motor Skills

  • Coordinating both sides of the body
  • Understanding the concept of right and left
  • Navigating up and down stairs
  • Upper extremity strength
  • Balance
  • Milestones such as rolling, sitting unsupported, crawling, pulling to stand, etc.
  • Using appropriate force
  • Throwing/Catching
  • Core strength
  • Crossing midline play activities and school related taskss

Visual Processing 

  • Recognizing letters, numbers, or shapes
  • Copying shapes or letters
  • Visual tracking
  • Stacking blocks
  • Copying from the board or another paper
  • Completing puzzles
  • Concept of right and left
  • Putting things in appropriate sized containers

Sensory Processing

  • Designing and implementing a sensory diet to decrease things such as toe walking, constantly jumping or crashing,
  • Responsiveness to certain sensations
  • Responsiveness to touch, sound, and movement
  • Calming self when upset
  • Therapeutic listening
  • Copying with change
  • Gravitational insecurities
  • Body awareness

Social Interaction

  • Interacting and engaging with family members and peers
  • Adapting to new environments
  • Coping skills
  • Following instructions
  • Social appropriateness
  • Conversation skills
  • Recognizing emotions
  • Impulse control

Executive Functioning

  • Organization
  • Attention
  • Flexible thinking
  • Problem solving
  • Time management

Play Skills

  • Sharing and turn taking
  • Imaginative play
  • Sustained attention
  • Exploring toys appropriately

Self Care Skills

  • Toileting
  • Bathing
  • Self-Feeding
  • Dressing
  • Tying shoes
  • Brushing teeth
  • Brushing hair

Early identification of developmental delay is key! 

It is important to remember that all children are different, and each child will develop these skill sets at their own pace. However, as a parent, you know your child best! If your child is not meeting the milestones expected for his or her age - Don’t wait! The earlier that a child’s developmental delay is identified and supports are put into place, the better the outcome will be for the child.


 If you are concerned about your child’s development, speak with your physician and check out our developmental screening tool here: 

Click Here: Developmental Screening Tool