Physical therapy milestones and considerations
0-5 Months
Locomotion Milestones
- Elevates head and upper trunk with weight on forearms
- Brings hands to midline while lying on back
- While laying on stomach, can lift arms and legs off the ground
- Grabs feet and brings toward mouth
- Raises arms and legs smoothly
Stationary Milestones
- Holds head in midline
- Holds head up and moves to follow toy
- Maintains balance while sitting (after 3 months)
Consider an Evaluation if:
- Does not respond to his or her name
- Does not imitate sounds or noises (animal, environmental)
- Has minimal eye contact
- Doesn’t say single words like “mama” or “dada”
- Does not respond to adult interactions and facial expressions
- Does not actively participate in games
- Does not use basic gestures such as pointing, waving or shaking head
- Doesn’t search for things that they see you hide
- Loses skills they once had
6 Months (Order of Typical Aquisition)
Locomotion Milestones
- While laying on stomach, can raise upper trunk and reach for toy
- Rolls back to stomach
- Uses arms to army crawl
- Crawls on hands and knees (after 9 months)
- Takes alternating steps while being supported at the trunk
- Maintain balance while standing independently for 5 seconds
Stationary Milestones
- Maintains balance while sitting to reach for toy
- Pulls up to sitting position while holding adult’s fingers
- Sits independently
- Maintains balances in a sitting position while playing with toys
Consider an Evaluation if:
- Not rolling over
- Not holding head up while laying on stomach
- Not sitting unsupported
- Not crawling
- Not placing weight on legs with support
- Has a flat head
- Shows a regression of skills
12 Months (Order of Typical Aquisition)
Locomotion Milestones
- Walks unsupported for 5 steps
- While standing, picks up toy and takes three steps without losing balance
- Crawls up steps
- Crawls backwards down steps
- Walks backwards 5 steps
- Walks down steps while holding an adult’s finger
Object Manipulation Milestones
- Catches and rolls 8-inch ball on the floor
- Throws small ball by extending arm
Consider an Evaluation if:
- Not pulling up to stand
- Not standing with support
- Shows a regression of skills
- Has low muscle tone
18 Months (Order of Typical Aquisition)
Locomotion Milestones
- Runs forward
- Stands heal to toe with feet within 3 inches of each other
- Walks sideways while leading with the same foot
- Jumps up
- Jumps forward without falling
- Squat to play
- Jumps down 1 step
Object Manipulation Milestones
- Kicks ball forward
- Catches large ball
Consider an Evaluation if:
- Not attempting to walk without support
- Walks mainly on their toes
- Not standing independently
- Shows a regression of skills
- Has loose movements or overly stiff movements
- Difference in tone between left and right sides of body
2 Years old (Order of Typical Aquisition)
Locomotion Milestones
- Walks up stairs with support from rail or wall
- Stands on tiptoes with demonstration
- Rides Tricycle
- Jumps forward 2 feet
- Briefly stand on one foot
- Walks up stairs without support
- Walks down steps one foot at a time
Object Manipulation Milestones
- Catches ball with arms extended
- Throws small ball overhand and underhand for a distance of at least 3 feet
- Throw ball overhand and underhand at least 7 feet away
Consider an Evaluation if:
- Not running
- Not walking up or down stairs
- Show regression in skills
- Has loose movements or overly stiff movements
- Difference in tone between left and right sides of body
3 Years old (Order of Typical Aquisition)
Locomotion Milestones
- Runs around obstacles
- Walks heal to toe on a line
- Balances on one-foot
- Hops on one-foot
- Walks up and down steps with alternating feet
- Climbs independently
- Skips with one foot leading
Consider an Evaluation if:
- Not throwing balls
- Not kicking balls
- Not jumping with feet together
- Show regression in skills
- Has loose movements or overly stiff movements
- Difference in tone between left and right sides of body
4 years old (Order of Typical Aquisition)
Locomotion Milestones
- Walks on a line forward and backwards
- Summersaults
- Skips with alternating feet
- Jumps rope
- Pumps feet to move swing independently
- Climbs ladder on playground
- Jumps backwards
Consider an Evaluation if:
- Not pedaling a tricycle
- Not catching, throwing or kicking balls
- Not balancing well on one foot
- Is awkward when walking, climbing, or running
- Complaints about persistent pain or fatigue
- Not hopping one either foot
- Show regression in skills
- Has loose movements or overly stiff movements
- Difference in tone between left and right sides of body