Occupational Therapists in pediatric practice work on helping patients achieve developmental milestones. In the U.S. alone, the CDC states that approximately 1 in 6 children have at least 1 developmental delay. The purpose of developmental milestones is to help assess where a child is when compared to his/her peers to indicate necessary support further as well as how to approach treatment. Developmental milestones are skills children develop within the same time frame as their peers. There is a large range of what is considered normal, but the progress between different milestones is a key indicator of overall child well-being. Currently, researchers are not sure of the cause of many developmental delays, however, some delays may result from environmental factors, including exposure to toxins before and after birth, premature birth, low birth weight, lack of oxygen at birth, nutrition, chronic ear infections, or even severe trauma.
Although there are some environmental causes, neurological causes of developmental delays also exist. This can be seen in diagnoses such as Down Syndrome, Fragile X syndrome, Rett Syndrome, Autism Spectrum Disorder, Prader-Willi Syndrome, and Neurogenerative diseases, but this is not the case for all children. Early intervention and Occupational Therapy as part of that team can assist!
Developmental delays can occur in multiple areas of child development. Cognitive skills, which include learning, thinking, and understanding, social and emotional skills, which include the ability to connect with, express to, and communicate with others, speech and language skills, which include using and understanding language, and fine and gross motor skills, which include the ability to coordinate small (fine motor) and large (gross motor) muscles.
Each developmental delay is treated differently and oftentimes can coincide with one another. These delays can typically be worked through with the help of early intervention. Developmental delays are typically screened for by early intervention specialists: child life specialist, pediatrician, occupational therapist, speech pathologist and physical therapist
Major Developmental Milestones
Fine motor (age 3-5):
3.0 – Does finger plays while singing little songs
3:1- Uses simple art materials
3:3- Uses tools and materials that strengthen arms, wrists, hands, fingers
3:3- Completes an easy puzzle
3:4- Uses fingers to show age
3:5 – Consistently reaches for and grasps objects with 1 hand
- Makes a fist and wiggles thrumb
- Roll clay or play dough on the table to make roles
3:6 – Feels objects without looking and identifies hot and cold, wet and dry
- Grasps pencil with thumb, index, and middle fingers
- Grasps thick marker or large chalk with crude opposition of thumb and fingers
3:11- Buttons and unbuttons quarter-inch buttons
- Make a flat, round cake by pressing and patting dough on the table with your fingers
- Buttons and unbuttons one medium-sized button
4:2- Feels objects without looking and identifies hard and soft
4:5- Feels objects without looking and identifies hard and soft
- Fastens buttons quite well
- Grasps pencil with thumb and index fingers instead of fist
4:6 – Touches the tip of the thumb to each finger
- Grasps pencil with a pad of index finger and thumb as pencil rests on the third joint of the middle finger
- Grasps thick marker or large chalk with thumb and pad of index finger marker rests on thirst joint of the middle finger
- screws and unscrews nuts and bolts
4:9- Feels object without looking and identifies circles squares and triangles
- Uses squeeze tools that strengthen arms wrists, hands, fingers
4:11- moves fingers in fine, localized movements when writing with a marker
- Squeezes bottles
- Places key in and opens the lock
- Place 1 ¼ inch paper clip on the paper
- Hammers
5:0 – Laces shoes
5:5- Feels and identifies different textures
- Touches the tip of the thumb to each finger on the same hand in under 8 seconds
5:6- Prefers to use either right or left-hand
- Uses classroom tools appropriately
- Uses testers and other tools that strengthen arms wrists, hands, fingers
5:9- Cuts well with scissors
- Uses materials and tools that increase finger dexterity
5:11 Can use recipes that strengthen wrist hand fingers
Gross Motor (age 3-5):
3:0- Broad jumps 26 inches
- Pedals a riding toy
- Runs on toes with both feet leaving ground
3:3- Sways claps or otherwise moves to music, not necessarily in time
3:4- Jumps from 12 inch steps, feet together, without falling
- Stands on 1 foot for 5 seconds, then on the other foot without support
- Balances and walks on a 4 inch wide board or beam
- Walks between two parallel lines, 10 inches apart for 15 feet
3:5- Climbs well, but not on ladders yet
- Walks up and down stairs, alternating feet, hand on rail
- Walks 10 feet on 4 inch wide line of tape
3:6- Marches to music, not necessarily with the beat
- Runs 15 yards in 6 seconds or less
3:8- Hops forward on 1 foot, 3 or more hops
- Jumps forward 24 inches, feet together
3:9- Begins to do a forward somersault, but incomplete
- Walks heel to toe
- Walks and runs forward and backward with agility
3:11- Walks backward on a 4-foot 1-inch wide circle; steps off less than twice
- Goes upstairs without support, alternating feet
- When walking on a straight line, will place the heel against the toe of other foot
4:0- Skips on 1 food
4:2- Walks forward on 1 inch wide straight line for 3 yards without stepping off
4:3- Runs around obstacles and turns corners
4:5- Walks down stairs, alternating feet, no rail
4:6- Stands on 1 foot for 10 seconds or longer
- Hops 5 times on 1 foot
- Stands on tiptoes with hands overhead for 8 seconds
4:7- Changes rhythm when music shifts between slow and fask
- Pumps and maintains momentum on a swing
4:8- Somersaults without help or falling off to side
4:9 Begins to jump rope
- Walks on tip toes 15 feet
4:10- Walks 4 feet on 4 inch wide beam without stepping off
4:11- Stands on 1 foot for 10 seconds with hands on hips
- Walks backwards 5 steps on a 4 inch wide beam
5:0-Hops on 1 foot, 8-10 hops
- Jumps over knee-high obstacles with both feet together
- Broad jumps 27 inches
Feeding (age 0-3):
0-3 mo:
- Latches onto nipple or bottle
- Tongue moves forward and back to suck
- Sucks and swallows well
- Liquids only (milk/formula); cannot digest other types of food
4-6 months:
- Shows interest in food & opens mouth when spoon approaches
- Begins to eat cereals and pureed food. Smooth, pureed food (single ingredient only).
- Moves pureed food from front of mouth to back
- Taste preferences rapidly learned
7-9 months:
- In a highchair, holds and drinks from a bottle
- Begins to eat thicker pureed and mashed table foods.
- After the introduction of lumpy solids, infants can coordinate all of their mouth movements; sucking, biting, and up and down munching (Early chewing can develop before the teeth have erupted as the gums are hard from the teeth within them)
- Remains full longer after eating
- Strong reaction to new smells and tastes
10-12 months:
- Finger feeds self
- Eats an increasing variety of food
- Begins to use an open cup and can drink from a straw
- Ready to try soft-cooked vegetables, soft fruits, and finger foods
- Might be ready to start self-feeding with utensils
- Enjoys a greater variety of smells and tastes
12 months +:
- Increases variety of coarsely chopped table foods
- Holds and drinks from a cup
- Improved biting skills
- Uses tongue well to move food from side to side in the mouth
- Imitates adult eating
2 years:
- Swallows well from a cup
- Swallows food well with no loss of food
- Chews with jaw movements in all directions (round and round, up/down and side to side)
- Knows the difference between food and non-food items
- Scoops food with a spoon, with some spills
- Starts to stab food with a fork and bring it to her mouth
- Shows clear likes and dislikes of some foods
2-3 years:
- Eats the same foods as the rest of the family
- Feeds well with utensils
- Has definite food likes and dislikes & refuses certain foods
- Possibly start to become a “picky eater” (see post next week!)
- Wipes own mouth and hands with a napkin or cloth
- Starts to serve themselves at the table with some spills
- Pours liquids into cup from a small container
Speech/Language (age 3-5):
3 year olds
- Follow two-part requests, such as “put your pajamas in the hamper and your slippers in the closet.”
- Learn new words quickly; know the most common object names.
- Understand the concept of “two.”
- Understand gender differences.
- Know their full name.
- Start to correctly use plurals, pronouns, and prepositions more consistently.
- Often ask “why” and “what.”
- Often use complete sentences of 3 to 4 words.
4 year olds
Know the names of colors.
- Understand the difference between things that are the same and things that are different, such as the difference between children and grown-ups.
- Can follow three-step instructions, such as “Go to the sink, wash your hands, and dry them on the towel.”
- Use the past tense of words.
- Use sentences of 5 to 6 words.
- Can describe something that has happened to them or tell a short story.
- Can speak clearly enough to be intelligible to strangers almost all of the time.
5 year olds
- Understand relationships between objects, such as “the girl who is playing ball” and “the boy who is jumping rope.”
- Usually can carry on a conversation with another person.
- Often call people (or objects) by their relationship to others, such as “Bobby’s mom” instead of “Mrs. Smith.”
- Can define words such as “spoon” and “cat.”
