Understanding Developmental Milestones
Understanding Developmental Milestones
Developmental milestones help us understand the skills that typically emerge as children grow. While milestone charts can be useful, Occupational Therapists look at much more than simply whether a child can or cannot perform a particular skill.
We consider how a child moves, uses their hands, coordinates both sides of their body, processes and integrates sensory information, plans new movements, interacts with their environment, and uses these developing abilities to participate in the everyday occupations of childhood.
Importantly, developmental milestones occur across ranges rather than at one exact age. Children develop at different rates, and an individual milestone should always be considered within the context of the child’s overall development.
Milestones by Age
Gross Motor
Develops head control around 2–4 months; rolls around 4–6 months; sits independently around 6–9 months; begins moving across the floor or crawling during the latter part of the first year; may pull to stand and cruise around 9–12 months. Independent walking commonly emerges between 12–18 months.
Fine and Visual-Motor
Develops purposeful reaching and grasping; brings hands together at midline; transfers objects between hands around 6 months; explores objects using both hands; increasingly uses individual fingers; develops a more refined pincer grasp around 9–12 months.
Sensory-Motor Foundations
Learns through touch, movement, vision and exploration. Develops body awareness, postural control and increasingly coordinated responses to movement and sensory information.
Everyday Participation
Begins assisting with feeding, holds and explores toys, participates in social play and increasingly moves independently to explore the environment.
Gross Motor
Independent walking typically develops within this period if not already established. Progresses to more confident walking, squatting to retrieve toys, climbing, pushing and pulling toys and beginning to run.
Fine and Visual-Motor
Stacks blocks, places objects into containers, turns pages, makes spontaneous marks with crayons and begins imitating simple strokes towards the latter part of this period.
Sensory-Motor Foundations
Actively explores through climbing, carrying, pushing, pulling, messy play and movement. Body awareness and motor planning continue to develop through active exploration.
Everyday Participation
Increasingly participates in feeding using fingers and utensils, assists with dressing and begins engaging in simple functional and pretend play.
Gross Motor
Runs more confidently, climbs, begins jumping with both feet and manages stairs with increasing independence, initially using support and a step-to pattern.
Fine and Visual-Motor
Builds increasingly complex block towers, completes simple inset puzzles, turns pages individually and imitates vertical and horizontal lines. Begins developing greater control of crayons and other tools.
Sensory-Motor Foundations
Bilateral coordination develops as the two sides of the body work together more efficiently. Increasing body awareness and motor planning support climbing, playground exploration and learning new movements.
Everyday Participation
Increasing independence with feeding and dressing. Pretend play becomes more developed and children participate in a wider variety of play experiences.
Gross Motor
Runs and climbs confidently, jumps forward, briefly balances on one foot, pedals a tricycle and develops increasing ability to throw and catch a larger ball.
Fine and Visual-Motor
Typically imitates or copies a circle around 3 years, manipulates playdough and small objects, completes increasingly complex puzzles and begins using scissors to snip and cut.
Sensory-Motor Foundations
Improved postural control, bilateral coordination and motor planning support more complex playground and tabletop activities.
Everyday Participation
Participates more actively in dressing, feeding, toileting and other self-care routines. Play becomes increasingly imaginative and interactive.
Gross Motor
Develops improved balance and coordination; hops on one foot, navigates playground equipment more confidently and throws and catches with increasing accuracy.
Fine and Visual-Motor
Copies a cross and progresses towards more complex pre-writing forms; cuts along a line; manipulates smaller construction materials; draws with increasing detail and demonstrates improving pencil control.
Sensory-Motor Foundations
Increasingly integrates information from the body and environment to support balance, coordination, motor planning and participation in more complex activities.
Everyday Participation
Increasing independence in dressing, eating, toileting, play and classroom routines. Begins managing more complex sequences of everyday tasks.
Gross Motor
Runs, jumps, hops and balances with greater control; develops skipping and participates in increasingly complex ball games and playground activities.
Fine and Visual-Motor
Develops increasing pencil and scissor control; copies more complex shapes and letters; draws recognisable pictures; manipulates small objects efficiently and manages an increasing range of clothing fasteners.
Sensory-Motor Foundations
Postural control, bilateral coordination, motor planning and visual-motor integration increasingly work together to support classroom learning, playground participation and self-care.
Everyday Participation
Greater independence with dressing and personal care. Increasingly manages classroom tools, routines, play activities and age-appropriate responsibilities.
The OT Perspective: Looking Beyond “Can They Do It?”
Development does not occur in isolated areas. Think about something as seemingly simple as cutting with scissors. A child needs sufficient postural stability to sit at the table, one hand to manipulate the scissors while the other stabilises and turns the paper, visual information to guide the cutting direction, tactile and proprioceptive information from their hands, motor planning to organise the movements, and fine motor control to open and close the scissors.
Similarly, climbing a jungle gym requires far more than gross motor skills. It involves balance, postural control, body awareness, bilateral coordination, motor planning, visual-spatial information and the integration of vestibular, proprioceptive and tactile input.
This interconnectedness is an important part of the Occupational Therapy perspective on development.
Milestones Are Guides, Not Deadlines
There is a broad range of typical development, and children do not all acquire skills in exactly the same sequence or at exactly the same age. A single skill developing slightly later than expected does not automatically indicate a developmental difficulty.
Occupational Therapists are particularly interested in the overall developmental picture.
Further assessment may be appropriate when a child:
- ✓Shows significant or persistent delays across one or more areas of development
- ✓Loses skills that they had previously acquired
- ✓Has ongoing difficulty learning new motor or functional skills
- ✓Consistently avoids or struggles with age-appropriate activities
- ✓Has difficulty keeping up with the demands of home, school or play
- ✓Requires significantly more assistance than expected for everyday activities
Developmental milestones tell us something about what a child is learning to do. An Occupational Therapy lens goes one step further by asking:
How are they doing it? What underlying skills are supporting them? And, most importantly, how are these abilities helping them participate in the everyday occupations of childhood?
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