ChildsPlay Therapy

Milestones & Home Activities

What are Milestones?

Milestones are specific skills that are mastered along a specific developmental sequence. These benchmarks help to tell if a child is developing as expected. Milestones are behaviors that emerge over time, forming the building blocks for growth and continued learning. Although there is a developmental variation amongst children, milestones should be met within a specific time frame. Failure to meet 1 or more milestones may be a “red flag” for a communication delay or disorder.

Child hitting crucial milestone in learning to walk

Speech and Language Milestones

0-6 Months

Hearing & Understanding

  • Startle to loud sounds
  • Quiets or smiles when spoken to
  • Increases or decreases sucking in response to sound
  • Moves eyes toward sound
  • Responds to changes in tone of voice
  • Notices toys that make sounds


  • Makes pleasure sounds (coo, goo)
  • Cries differently for different needs
  • Smiles when sees you
  • Babbling sounds more speech-like with different sounds (p,b,m)
  • Laughs and chuckles
  • Makes gurgling sounds

Red Flags: Child Does NOT…

  • Turn eyes/head toward sound
  • Watch your face when you speak
  • Smile/laugh when you do
  • Have different cries for different needs
  • Make sounds in response to your sounds

7 Months to 1 Year

Hearing and Understanding

  • Enjoys peek-a-boo, pat-a-cake
  • Turns and looks in direction of sounds
  • Listens when spoken to
  • Recognizes words for common items (e.g. juice, shoe)
  • Begins to respond to requests (“Want more?”)


  • Babbling has long and short groups of sounds (tata, upup, bibibibi)
  • Uses speech/non-crying sounds to get attention
  • Uses gestures to communicate (waves bye-bye)
  • Imitates different speech sounds
  • Has 1-2 words around 1 year (may not be clear)

Red Flags: Child Does NOT…

  • Respond to his/her name
  • Babble (baba dadada mamama)
  • Play social games (e.g. peek-a-boo)
  • Follow simple 1 step directions
  • Use gestures (e.g. wave bye bye)
  • Get your attention using sounds and gestures while looking at your eyes.

1 to 2 Years

Hearing and Understanding

  • Points to a few body parts when asked.
  • Follow simple commands and understand simple questions (e.g. “roll ball;” “Where’s your shoe?”)
  • Listens to simple stories, songs and rhymes.


  • Say more words every month
  • Uses some 1-2 word questions
  • Puts 2 words together (e.g. “more cookie” “no juice”)
  • Uses many different consonant sounds at the beginning of words.

Red Flags: Child Does NOT…

  • Identify basic body parts
  • Understand concepts in/out, on/off
  • Point to pictures with 1 finger
  • Say approximately 20 words consistently
  • Use at least 4 consonant sounds (p,b,m,n,d,g,h,w)
  • Pretend to feed doll
  • Use at least 100 words (by 2)
  • Combine two words
  • Enjoy other children
  • Put 2 pretend actions together

2 to 3 Years

Hearing and Understanding

  • Understands differences in meaning (go/stop, big/little)
  • Follows 2 requests (“get the book and put it on the table”)
  • Listens to and enjoys hearing stories for longer periods of time


  • Has a word for almost everything
  • Uses 2-3 words to talk about and ask for things
  • Uses k,g,f,t,d,n sounds
  • Speech is understood by familiar listeners most of the time
  • Asks for or directs attention to objects by naming them

Red Flags: Child Does NOT…

  • Understand Who, What, Where Questions
  • Create longer sentences combining 4-5 words
  • Use some adult grammar (plural –s, possessive ‘s,-ed)
  • Speech is understood 75% of the time
  • Pretends with other children (e.g. have tea party)

3 to 4 Years

Hearing and Understanding

  • Hears you when you call from another room
  • Hears TV and radio at same loudness levels as the rest of the family
  • Answers Wh questions including Why?


  • Talks about activities at school or at friends’ house
  • People outside family understand speech
  • Uses a lot of sentences 4 words or more
  • Talks easily without repeating syllables or words

Red Flags: Child Does NOT…

  • Follow 3 part directions
  • Use sentences with adult type grammar
  • Tell a story
  • Have speech that is understood by strangers most of the time
  • Act out different roles with friends (e.g. going to a restaurant, play house)

4 to 5 Years

Hearing and Understanding

  • Pays attention to a short story and answers questions about them
  • Hears and understands most of what is said at home and at school


  • Uses sentences that give lots of details
  • Tells stories that stick to topic
  • Communicates easily with children and adults
  • Says most sounds correctly except l,r,s,z,v,ch,sh,th
  • Says rhyming words
  • Names some letters, #’s
  • Uses similar grammar to adults

Red Flags: Child Does NOT…

  • Answer questions correctly
  • Has numerous errors in their speech that make them difficult to understand
  • Cannot give his/her first and last name
  • Does not talk about daily activities
  • Having difficulty with learning readiness skills

Red Flags for Autism

  • Insistence on sameness; resists change in routine/transition
  • Severe language deficits (stops talking after developing normally)
  • Difficulty expressing needs (gestures instead of using words)
  • Echolalia
  • Prefers to be alone
  • Laughs, cries, shows distress for no apparent reason
  • Tantrums- extreme distress for no apparent reason
  • Difficulty mixing with other children
  • May not like cuddly interaction
  • Little/No eye contact
  • Sustained Odd play (spins self/objects, lines things up)
  • Inappropriate Attachment/Obsession with objects
  • Apparent over/under sensitivity to pain
  • No fear of danger

Over/Under Reactive to Sensory Input

Gross Motor Development Milestones

Expected Milestones (by age) – able to:

0-3 Months

  • Lift and hold head up when lying on tummy
  • Turn head side to side when lying on tummy
  • Open and close hands
  • Push up on hands/arms when lying on tummy
  • Move arms and legs symmetrically between right and left sides – bend and straighten arms and legs either reciprocally or together

4-6 Months

  • Sit (often relying on support from his or her hands on the ground until 6 months old)
  • Roll (from back to stomach and stomach to back)
  • Prop up on forearms when lying on stomach
  • Accept weight through both legs when standing with support
  • Bring hands together at midline
  • Play with/explore toys with hands
  • Brings feet to mouth or grabs feet with hands

7-9 Months

  • Reach for/lean towards toys in sitting without losing balance
  • Pivots 90 degrees in sitting position
  • Moves into sitting position from laying on tummy or back
  • Creeps/Crawls on hands and knees with alternating leg movements
  • Starting to pull up into standing
  • Demonstrates more control when rolling, sitting, and scooting

10-12 Months

  • Pivot 180 degrees in sitting position
  • Pull up into standing from sitting
  • Bounce in standing by flexing knees
  • Cruise along furniture
  • Stand alone
  • Walks with a push toy (may start to walk independently around this age)
  • Sit unsupported and able to maintain balance when turning head to look at objects
  • Release objects from hand into a container with a large opening

13-15 Months

  • Play in tall kneeling position
  • Walk independently
  • Squat down to the floor to pick up toy and returns to standing without losing balance
  • Stack objects
  • Creep up stairs on hands and knees
  • Creep backwards down steps without support from adult or rail

16-18 Months

  • Walk fast and walk backwards
  • Walk up 4 steps with support from wall/rail or adult
  • Walk down stairs with only 1 finger support from an adult

19-24 Months

  • Run on level surfaces without losing balance
  • Stand on a line with one foot in front of the other
  • Walk sideways (both directions – leading with each foot)
  • Walk on a line without stepping off
  • Jump forward off of 2 feet at least 4 inches without losing balance
  • Jump up off of 2 feet at least 2 inches
  • Jump down from step 7 inches high

2 Years

  • Stand on 1 foot with hands on hips for 3 seconds
  • Walk up 4 steps, placing 1 foot on each step, using wall or rail for support
  • Walk down 4 steps without support (from wall/rail or adult)
  • Walk on tiptoes
  • Jump forward 24 inches with a 2-footed take off
  • Jump down from stable objects at least 18 inches high

3-4 Years

  • Stand on 1 foot with hands on hips for 5 seconds
  • Walk up 4 steps, placing 1 foot on each step without support (from wall/rail or adult)
  • Hop on 1 foot
  • Run with arms moving back and forth, pushing off of balls of feet

5-6 Years

  • Stand on 1 foot for 10 seconds with steady balance without swaying side to side
  • Imitate the body movements (arm and leg motions) of another person
  • Perform 3 sit-ups in 30 seconds
  • Gallop
  • Skip
  • Jump forward 36 inches off of 2 feet
  • Jump and turn around 180 degrees

7-8 Years

  • Perform 5 sit-ups in 30 seconds
  • Perform 8 push-ups in 20 seconds
  • Perform jumping jacks with smooth, continuous, and coordinated movements
  • Walk with heel-to-toe pattern on a line without stepping off
  • Hop side to side on 1 foot quickly
  • Catch and throw various sizes of balls


Peabody Developmental Motor Scales – 2nd Edition

Bruininks-Oseretsky Test of Motor Proficiency – 2nd Edition

Gross Motor Activities

Fine Motor Development Milestones

Expected Milestones (by age) – able to:

Birth to 6 Months

  • Closes fingers in tight grasp around finger
  • Brief grasp and release of rattle
  • Head alignment
  • Mutual finger play
  • Hands to mouth
  • Feet to mouth

6-10 Months

  • Grasping cube first with palm then fingers and thumb opposed
  • Pincer grasp (10 months)
  • Pokes
  • Claps
  • Holds a bottle at midline
  • Holds a rattle/shakes
  • Pushes up on arms while lying on tummy and shifts weight from one arm to the other
  • Starts to roll over (both directions)
  • Sits independently
  • Creeps/crawls on hands hand knees with reciprocal movements

By 12 Months

  • Removes socks by pulling
  • Releases cube voluntarily
  • Easily grasps small cubes
  • Transfers cube from one hand to another
  • Starting to turn pages in a hard cover book
  • Drops and picks up a toy

1-1.5 Year

  • Fisted grasp on crayon
  • Arm moves as a unit
  • Rolling and then throwing a ball
  • Stacks 2-3 cubes
  • Putting toys in a container and dumping
  • Scribbles

2-3 Years

  • Pronated grasp (palm down)
  • Forearm moves as a unit
  • Imitates vertical lines then horizontal lines
  • By 3 years can draw a circle
  • Feeding self with spoon and then fork
  • Snipping with scissors
  • Drink from an open cup
  • Opens a screw on lid

3-4 Years

  • Static tripod grasp
  • Hand moves as a unit
  • Traces
  • Coloring simple pictures
  • Developing skill to manipulate toys
  • Puts on socks and shoes
  • Finger isolation and opposition
  • Copies a cross
  • Stacks 10 cubes
  • Build a train or bridge with cubes
  • Strings beads
  • Lacing
  • Cutting

4-5 Years

  • Develops dynamic tripod grasp
  • More precise finger skillS
  • Copies a square and drawing a person
  • Buttoning
  • Copies diagonal lines
  • Tracing capital letters
  • Writing some letters in name
  • Cutting on a line and some shapes
  • Hand dominance established
  • Holds fork with standard position

Red Flags

  • Keeps hand or hands fisted, thumb in palm
  • Unable to prop self up on hands
  • Unable to pick up toys
  • Keeps head turned to one side
  • Not exploring/reaching
  • Grasp seems weak
  • Frequently switches hands (5 years)
  • Neglect of one side of body or limb
  • Unusual movements/arching
  • Extended crying

Fine Motor Activities