OT Milestones and Considerations
12 Months
Fine and Visual Motor Milestones
- Plays with toys at middle of body
- Points with index finger
- Uses a pincer grasp to pick up small items
- Scribbles on paper
- Drops object into/ take object out of cup or container
- Starting to hold writing utensil with a fisted grasp
Gross Motor Milestones
- Climbs up stairs on hands and knees
- Walks independently
- Climbs down stairs backwards
- Squats to pick up toys
- Flings a ball
Self-Care Milestones
- Feeding: Uses spoon appropriately but messy and holds/drinks from open cup
- Dressing: Cooperates with dressing; starting to take off shoes and socks
- Grooming: Tolerates bathing, diaper changes, and grooming activities
- Toileting: starting to expresses discomfort when diaper is soiled
Consider an Evaluation if:
- Difficulty settling and may wake often during the night
- Difficulties holding onto and drinking from a cup or bottle
- Difficulty tolerating different textured foods or self feeding
- Difficulty socializing with parents and joint attention
- Limited ability to copy and learn from others due to poor understanding and attention
- Difficulties holding onto and drinking from a cup or bottle
- Difficulty tolerating different textured foods
18 Months
Visual and Fine Motor Milestones
- Uses two hands during play
- Turns pages of board books
Gross Motor Milestones
- Runs stiffly
- Starting to walk up and down stairs while holding on
- Starting to climb on jungle gym, slides, and furniture (18-24 mos.)
- Kicks ball forward (18-24 mos.)
Self-Care Milestones
- Feeding: Uses a spoon with spillage
- Dressing: Puts on socks; pushes arms and legs through holes of clothing
Consider an Evaluation if:
- Difficulty using a pincer to pick up small objects
- Difficulty using pointer finger to point to objects (e.g. pictures in a book)
- Difficulty using both hands during play (most children do prefer one hand over the other)
- Difficulty socializing with parents and joint attention
- Limited ability to copy and learn from others due to poor understanding and attention
- Delayed play skills (e.g. show little interest in toys)
- Difficulty tolerating different textured foods
2 years
Visual and Fine Milestones
- Holds and snips with scissors
- Starting to uses a digital grasp on a writing utensil .
- Imitates vertical, horizontal and circular marks
- Completes 3-piece insert puzzle
Gross Motor Milestones
- Begins to throw and kick ball however little accuracy
- Jumps down from a step
- Walks up and down stairs without support (2-2.5 yrs.)
- Starting to catches large ball against chest
Self-Care Milestones
- Feeding: Good use of spoon; beginning to use fork
- Dressing: Able to remove coat when unfastened; helps pull down pants; locates armholes in shirt
- Grooming: Participates in bathing self; assists in brushing teeth; may see some resistance to grooming (i.e. face/hair washing, toothbrushing, nail cutting)
- Toileting: Begins to show interest in toileting
Consider an Evaluation if:
- Difficulty imitating drawing a vertical line
- Still frequently putting toys in his mouth
- Not able to put a simple, large puzzle piece into a wooden puzzle
- Not able to put a simple shape into a shape sorter
- Limited ability to self-feed
- Cannot stack 2-3 blocks on top of one another
- Struggles to copy and learn from others due to poor understanding and attention
- Difficulty tolerating different textured foods (e.g. picky eater)
- Difficulties learning to undress self
3 years
Fine and Visual Motor Milestones
- Cuts on a straight line 6 inches long (3-3.5 yrs.)
- Copies a vertical line, horizontal line and circle
Gross Motor Milestones
- Walks up stairs alternating feet (3- 3.5 yrs.)
- Jumps, climbs, runs (3-4 yrs.)
- Jumps with two feet off floor
- Jumps over objects (3-5 yrs.)
Self-Care Milestones
- Dressing: Puts on front open shirt or jacket; puts on shirt, shoes, socks with little assistance; buttons large buttons; zips/unzips after engaged
- Toileting: Goes to the bathroom independently; may need assistance wiping after a bowel movement
Consider an Evaluation if:
- Difficulties socialising with peers
- May struggle to copy and learn from others due to poor understanding and attention
- Difficulties following instructions at home, childcare, or kindergarten
- Difficulty tolerating different textured foods (e.g. picky eater)
- Difficulties maintaining attention
- Difficulties with toilet training
- Difficulties with dressing and feeding
- Difficulties getting to sleep or sleeping through the night
4 years
Visual and Fine Motor Milestones
- Colors within the lines
- Cuts out a square (4-5 yrs.)
- Copies a cross, diagonal lines, a square, some numbers/letters and may copy name (4-5 yrs.)
- Completes puzzles up to 10 pieces (4-5 yrs.)
Gross Motor Milestones
- Jumps forward
- Gallops proficiently (4-4.5 yrs.)
- Catches ball with two hands without trapping against body (4-6 yrs.)
Self-Care Milestones
- Dressing: Removes pullover garment; buckles shoes and belt; engages and zips zipper; puts on shoes and socks with correct orientation
- Grooming: Requires supervision for brushing teeth and grooming; requires assistance for bathing to manage water, and wash hair and body thoroughly (4-5 yrs.)
- Toileting: Independent with toileting, washing hands, and clothing management (4-5 yrs.)
Consider an evaluation if:
- Delayed play skills
- Difficulty following instructions at home or school
- Difficulty expressing wants, needs, thoughts and ideas
- Difficulty sitting still
- Difficulty tolerating different textured foods (e.g. picky eater)
- Difficulty with self -care tasks such as dressing, feeding and toileting
5 years
Fine and Visual Motor Milestones
- Draws a stick figure
- Completes puzzles up to 20 pieces (5-6 yrs.)
- Copies a triangle, prints own name, and copies most lowercase and uppercase letters (5-6 yrs.)
Gross Motor Milestones
- Stands on each foot for 10 seconds
- Skips proficiently (5-6 yrs.)
- Kicks with accuracy (5-6 yrs.)
Self-Care Milestones
- Dressing: Ties and unties knots; dresses without supervision
- Grooming: Brushes teeth and grooms with supervision; bathes with assistance to set up water, wash hair, and supervision for safety; may need cues for thoroughness (5-6 yrs.)
Consider an Evaluation if:
- Delayed play skills
- Poor attention and concentration
- Difficulty following instructions at home, or school
- Difficulty following routines
- Difficulty expressing thoughts and ideas verbally and in written form
- Distracted and has difficulty sitting still
- Difficulty tolerating different textured foods (e.g. picky eater)
- Demonstrates poor organizational skills.
- Demonstrates delayed fine motor skills
- Demonstrate difficulties coping in busy environments
- Difficulties with self care tasks such as dressing, feeding and toileting