Understanding Developmental Milestones and Knowing When Your Child Needs OT

Posted: February 2, 2025

Understanding Developmental Milestones and Knowing When Your Child Needs OT

As parents, we often look at developmental milestone charts, waiting for that moment when our child reaches the next “big thing”—from rolling over to walking, to feeding themselves. These milestones are helpful, but they can also feel overwhelming. Every child’s development is unique, and while milestones give us a helpful guide, there is a wide range of what is considered typical. Knowing when to seek help—specifically when your child may benefit from occupational therapy (OT)—can be challenging.

Trusting Your Instincts and Your Team

When milestones don’t align with what you’ve seen or what others have experienced, it’s natural to worry. Trusting your gut is important, but so is trusting the team around you—your pediatrician, teachers, and health professionals. They can help guide you, offering support and reassurance. And when it’s time for a more in-depth assessment, an occupational therapist (OT) can work with you and your child to address specific challenges and promote development.

Developmental Milestones: A Closer Look

Children develop skills at different rates, and milestones are a general guide to help us understand where they may be. Below is a breakdown of key developmental areas that occupational therapists focus on:

Play Skills:

Birth-6 months: Exploratory play
- Sensorimotor play predominates; manipulates and explores objects
- Focused on attachment and bonding
- Social: smiles/laughs in response to play
6-12 months: Exploratory play
- Sensorimotor play evolves to functional play
- Social play with parents and others; peek-a-boo
- Claps when prompted
- Extends toys to others
12-18 months: Relational and functional play
- Simple pretend play (pretend eating, pretend sleeping)
- Imitative play from model
18-24 months: Functional play
- Has toy preferences
- Likes repetitive actions (i.e. putting objects in and out of boxes)
- Plays next to other children but does not play with them
- Imaginative play
2-3 years: Symbolic and constructive play
- Links multiple schema combinations into meaningful sequences of pretend play
- Uses objects for multiple pretend ideas
- Plays out drama with stuffed animals or imaginary friends
- Plays house, assigning roles to others
- Drawing, puzzles
- May begin cooperative play
3-4 years: Complex imaginary play, constructive play, rough and tumble play, social play
- Creates scripts for play in which pretend objects have actions that reflect roles in real/imaginary life
- Creates arts and crafts projects
- Enjoys physical play, swinging, going down slides at playground, jumping, running
- Puzzles and blocks
- Associate play; play with other children, sharing, talking about play goal
- Plays with mechanical toys
- Takes turns with other children
4-5 years: Games with rules, constructive play, social/dramatic play
- Begins group games with simple rules
- Organized play with prescribed roles
- Participates in organized gross motor games
- Shows interest in the goal of the activity
- Constructs complex structures
- Participates in role play/dress up with others
- May change the rules of a game as the activity progresses
5-6 years: Games with rules, dramatic play, sports, social play
- Board games
- Computer games
- Competitive and cooperative games
- Elaborate imaginative play
- Role plays stories and themes related to seasons or occupations
- Emphasis is on reality; reconstructs real world play
- Participates in ball play and group activities
6-10 years: Games with rules, crafts and hobbies, organized sports, social play
- Computer/card games that require problem-solving and abstract thinking
- May have hobbies
- Cooperative and competitive play in groups or teams
- Play includes talking and joking
- Winning and skill emphasized
- Peer play predominates at school and home
- Plays with consistent friends

Gross Motor:

Rolling
- 4-5 months: side to side, initially with body righting reaction; prone to supine
- 6 months: roll over in both directions *more common to roll prone to supine before supine to prone
Crawling
- 7-9 months: forward crawling
- 10-12 months: crawl rapidly over various surfaces/ up and down inclines *backward crawling in prone position typically happens first
Sitting
- 6 months: sitting propped forward on hands with wide base of support
- 7 months: independently, hands free to play with toys
- 8-9 months: unsupported for several minutes
- 9-10 months: gets in and out of seated position from prone
Standing
- 5-6 months: supported by holding onto someone’s hands
- 9-10 months: pulls up on furniture
- 11-12 months: stands independently
Walking
- 7-8 months: cruising on furniture
- 11-13 months: with frequent falls *some babies walk earlier or later than the norm, typically walking by 15 months
Running:
- 18-24 months
Bike Riding:
- 2-3 years: tricycle
- 3-4 years: bicycle with training wheels
- 5-6 years: bicycle without training wheels
Jumping jacks:
- 5-6 years

Feeding:

6-9 months
- Wants to help with feeding
- Starts holding and mouthing large crackers/cookies
- Plays with spoon, grabs/bangs spoon, puts both ends in mouth
- Holds a bottle with both hands
- Uses a cup with help
9-13 months
- Finger feeds soft foods and foods that melt quickly
- Enjoys finger feeding
12-14 months
- Dips spoon in foods
- Moves spoon to mouth but is messy and spills
- Holds cup with both hands takes a few sips without help
15-18 months
- Scoops food with a spoon and self feeds
- Uses a straw
2-3 years
- Stabs food with fork
- Uses spoon without spilling
- Drinks from cup without lid without spilling
3-5 years
- Eats independently

Dressing:

1 year
- Takes off socks
- Helps in dressing by pushing arms through sleeves and legs through pants
2 years
- Takes off shoes
- Takes off simple clothing (i.e. pushing down pants)
- With shirt over head, able to find and push arms through shirt opening
2.5 years
- Attempts to don socks
- Unbutton large buttons
- Puts on easy clothing such as jackets, open front shirts w/o fastening
3 years
- Puts on t-shirt with min A
- Puts on shoes, orientation may be incorrect
- Puts on socks with min A for orientation of heel
- Zips/unzips jacket with fastener already started
- Buttons large front buttons
3.5 years
- Unzips jacket and completely removes fastener
- Buttons 3-4 buttons
- Finds front side of clothing, dresses with supervision
4 years
- Begins to connect zippers on jackets
- Puts on socks with appropriate orientation
5 years
- Dresses independently

When to Seek Help

Recognizing delays in these areas can be difficult, but it’s important to remember that it’s okay to ask for help. If you notice your child struggling with activities like dressing, feeding, or playing with others, and these struggles persist past typical developmental stages, it may be time to consider occupational therapy. An OT can assess your child’s unique needs and develop a personalized plan to help them build the skills they need to thrive in daily life.

Addressing the Challenges Parents Face

For many parents, the realization that their child may need extra support can be difficult. There may be feelings of uncertainty, fear, or even guilt. But it’s important to remember that seeking help is a proactive step toward your child’s success and well-being. Therapy can provide more than just skill development; it also builds confidence, independence, and a positive sense of self-worth.

At ACT Therapy, we take a holistic approach to support each child. Our therapists see children not just for their challenges, but for their unique strengths and potential. The goal is not to “fix” the child, but to provide support so they can reach their fullest potential, at their own pace.

The Added Benefits of Therapy

In addition to helping children develop specific skills, occupational therapy fosters increased self-confidence. When children experience success in areas where they’ve struggled—like dressing themselves or playing with peers—they gain a sense of accomplishment and independence. These successes not only help them feel more confident but also improve their overall well-being and social interactions. Therapy helps children build the skills they need to navigate the world around them with confidence.

Final Thoughts

Milestones are helpful tools to understand your child’s development, but they aren’t the whole story. Every child moves through milestones at their own pace, and that’s okay. What’s important is recognizing when support is needed. If your child struggles with milestones like play, gross motor skills, feeding, or dressing, occupational therapy can provide the support they need to thrive. Trust your instincts, work with your child’s team, and know that seeking help is a positive step in their journey. As always, we're here to support you! Give us a call with any questions. ACT Therapy Services Charlotte (tel: 980-237-3132 ) or Raleigh (919-747-9022)

Source: Milestones by age provided by our own ACT Therapy Services Lead OT, Alix Stewart, OTR/L