

Physical Therapy
2 MONTHS
Minimal head bobbing when supported upright
Eyes focus on a caregiver when within 12 inches
When lying on tummy, can turn head to each side and does not have a strong preference for head-turning to one side
No flattened areas on the head
4 MONTHS
Takes weight when held in standing but does not take automatic steps
Maintains head in midline for 30 seconds while lying on back
No head bobbing when held upright
Brings hands to midline and bats at toys
Symmetrical body alignments during tummy time and when lying on back
6 MONTHS
Pushes up on arms when on tummy to see things
Rolls to try to get closer to people or an exciting toy or object
Sits with help and holds head steady
Plays with feet while lying on back
Bounces when supported in a standing position
8 MONTHS
Stands at furniture
Rocks back and forth on hands and knees to get ready to crawl
Cruises laterally along the furniture
Crawls to get around on hands & knees or commando crawls
Sits and plays
Moves between sitting and tummy with ease by using side-sit
10 MONTHS
Walks pushing a toy
Cruises along the furniture with one hand able to turn body forward
12 MONTHS
Crawls fast and over objects
Walks holding onto furniture/hand or independently
Squats and returns to stand with control
Pivots 90 degrees in sitting
Hops on one foot with arms swinging and nonsupporting leg remaining behind the body
Broad jumps 36-inch
Dribbles a ball with fingertips (no slapping) 10 consecutive bounces
Kicks a soccer ball with a continuous rapid approach to the ball for > 15-feet distance
Catches an overhand thrown tennis ball with hands only
Overhand throws using an opposing step throw pattern 20'
Hops on one foot with arms swinging and nonsupporting leg remaining behind body
Broad jumps 36”
Dribbles a ball with fingertips (no slapping) 10 consecutive bounces
Kicks a soccer ball with a continuous rapid approach to the ball for > 15’ distance
Catches an overhand thrown tennis ball with hands only
Overhand throws using an opposing step throw pattern 20’
After ten years of age, foundational gross motor skills remain the same.
The child begins to add skill, fluidity, and control to their movements.
All of this is part of coordination which requires appropriate muscle activation, balance reactions, and graded control.
Many skills develop through practice.
Your child might find it more challenging to acquire these higher-level skills to keep up with peers.
Here are some skills that indicate the ability for a child to progress coordination skills with typical practice.
Imitates four cross-body movements without pause; with 1-3 demonstrations
Claps and stomps to various beats (using metronome or music)
Taps a tennis ball up with a racket 20 consecutive times
Able to throw various size and weight balls into a 3-foot target 20 feet away
Jumps rope 20 consecutive times


Occupational Therapy
0-3 MONTHS
Child looks at caregiver’s face while being held
Child grips caregiver’s finger when it’s placed in his or her hand
Child nurses or drinks a bottle without milk leaking out from around his or her mouth
Child is able to be soothed by primary caregiver when all basic needs have been met (child is fed, has a dry diaper, and is not in pain)
RED FLAGS (should be brought to the attention of your doctor):
Child’s eyes do not focus on caregiver’s face when he or she is held
3-6 MONTHS
Child tracks a nearby moving object (such as a toy or book) with his or her eyes
Child brings hands together at the middle of his or her body
Child reaches for a toy with his or her arm and hand
Child becomes visibly excited and/or may open his or her mouth in anticipation when he or she sees bottle, breast, or food
RED FLAGS (should be brought to the attention of your doctor):
Child does not bring his or her hands together at the middle of his or her body
6-9 MONTHS
Child uses all of his or her fingers to pick up a small piece of food (such as a Cheerio, Puff, etc.) to place it in his or her mouth during a meal or snack
Child releases a held toy or piece of food on purpose
Child shows affection or excitement at seeing a familiar person
Child responds to his or her own name by looking in the direction of the person who called him or her
RED FLAGS (should be brought to the attention of your doctor):
Child does not use both arms or hands equally (i.e. has a preferred arm or hand)
9-12 MONTHS
Child puts objects in a container (such as an open shape sorter or toy box) during play
Child uses his or her pointer finger to point toward desired items or to interact with a toy
Child plays with a toy with both hands (such as using both hands to place a ring on a ring stacker, holding both sides of an open book, etc.)
Child feeds himself or herself almost all solid foods during snack or meal
Child plays simple social games with caregiver (such as peek-a-boo)
RED FLAGS (should be brought to the attention of your doctor):
Child does not turn to look when his or her name is said (name may be repeated once or twice)
12-18 MONTHS
Child picks up small objects using his or her thumb and pointer finger
Child stacks 2-3 blocks during play after caregiver demonstration
Child drinks from a straw cup instead of a bottle during meals
Child follows simple 1-step instructions (such as “come here,” “get down,” “hand me that,” etc.)
RED FLAGS (should be brought to the attention of your doctor):
Child does not attempt to pick up small pieces of food to feed himself or herself
18-24 MONTHS
Child holds a utensil (i.e. spoon, marker, chalk) with whole hand
Child attempts to scribble directly on an image instead of all over the page after caregiver demonstration
Child uses both hands to pull apart toys (such as pop beads, Duplo Legos, etc.)
Child dips a spoon into a thick, sticky food (such as yogurt, oatmeal, etc.) and places the spoon in his or her mouth
Child mimics actions he or she regularly sees from caregivers (such as putting a baby doll in bed, holding a toy phone up to his or her ear, etc.) during play
RED FLAGS (should be brought to the attention of your doctor):
Child does not appear to understand or follow simple 1-step instructions
Child is not willing to try unfamiliar foods due to specific, consistent preferences related to foods’ texture, flavor, smell, or temperature
Child holds a utensil (i.e. spoon, marker, chalk) with his or her thumb and 2-4 additional fingers
Child snips along the edge of a piece of paper with scissors following caregiver demonstration and with supervision for safety
Child draws circular scribbles on paper after caregiver demonstration
Child begins and may master toilet training, but continues to need assistance to wipe thoroughly
Child engages in make-believe play (such as pretending a plastic banana is a toy phone, placing blocks in a bowl to stir his or her “food,” etc.)
RED FLAGS (should be brought to the attention of your doctor):
Child melts down when it’s time to transition to a new activity, place, or person
Child is not willing to try unfamiliar foods due to specific, consistent preferences related to foods’ texture, flavor, smell, or temperature
Child holds a utensil (i.e. spoon, marker, chalk) with his or her thumb and 2-3 additional fingers
Child draws the shape of a cross on paper after caregiver demonstration
Child completes a 4-6 piece interlocking puzzle
Child dresses himself or herself with assistance for fasteners and correct orientation (identifying which side is the front/back and top/bottom)
Child creates pretend play schemes where he or she takes on the role of a character (such as he is a firefighter putting out a pretend fire, she is a teacher showing her students what to do, etc.)
RED FLAGS (should be brought to the attention of your doctor):
Child is unable to sequence through familiar dressing and grooming (i.e. tooth brushing, hand washing, etc.) tasks without step-by-step instructions
Child is not willing to try unfamiliar foods due to specific, consistent preferences related to foods’ texture, flavor, smell, or temperature
Child consistently uses one dominant hand during drawing, coloring, eating, and other functional activities
Child copies the letters of his or her first name with good accuracy
Child cuts out simple shapes, managing paper and scissors independently and with supervision for safety
Child dresses himself or herself, including managing buttons, snaps, and zippers
Child collaborates with peers to create elaborate play scheme or game
RED FLAGS (should be brought to the attention of your doctor):
Child hasn’t chosen a dominant hand or frequently switches back and forth between hands during coloring activities, drawing tasks, or meals
Child is not willing to try unfamiliar foods due to specific, consistent preferences related to foods’ texture, flavor, smell, or temperature
Child uses his or her thumb, pointer finger, and middle finger to hold and use a writing utensil throughout a writing, coloring, or drawing activity
Child draws a recognizable person with at least 8 features
Child writes all uppercase and lowercase letters of the alphabet legibly
Child ties his or her shoes independently
Child can ask a peer to use a toy, and then wait for up to 5 minutes for his or her turn without becoming upset
RED FLAGS (should be brought to the attention of your doctor):
Child has difficulty making and keeping friends
Child sits to complete a 30 minute tabletop task (not involving a screen - tablet, phone, etc.) without cues to attend to activity or remain seated
Child can remember and complete a 5-6 step sequence to get ready for the day
Child can resolve a conflict with a peer without adult intervention
RED FLAGS (should be brought to the attention of your doctor):
Child is unable to tie his or her own shoes
Child’s handwriting is much more difficult to read than his or her peers’ at the end of kindergarten
Child writes all letters accurately, with no reversals
Child can read and complete tasks on a list (such as to complete homework assignments, simple chores, etc.)
Child can prepare himself or herself a simple 2-3 step snack (such as a peanut butter sandwich, cereal, etc.) and complete clean up independently
RED FLAGS (should be brought to the attention of your doctor):
Child continues to reverse some letters (such as b/d, p/q) at end of 2nd grade
Child writes all letters accurately, with no reversals
Child can read and complete tasks on a list (such as to complete homework assignments, simple chores, etc.)
Child can prepare himself or herself a simple 2-3 step snack (such as a peanut butter sandwich, cereal, etc.) and complete clean up independently
RED FLAGS (should be brought to the attention of your doctor):
Child continues to reverse some letters (such as b/d, p/q) at end of 2nd grade
Child sits to complete a 60 minute tabletop task (not involving a screen - tablet, phone, etc.) without cues to attend to activity or remain seated
Child can read the instructions and safely prepare a simple meal or snack using the microwave (such as Easy Mac, chicken nuggets, TV dinner, etc.) as well as complete clean up following
RED FLAGS (should be brought to the attention of your doctor):
Child needs parent to continue to supervise the thoroughness of dressing and other self-care activities (i.e. bathing and drying off, tooth brushing, hair brushing, hand washing and drying)
Child sits to complete a 60 minute tabletop task (not involving a screen - tablet, phone, etc.) without cues to attend to activity or remain seated
Child can read the instructions and safely prepare a simple meal or snack using the microwave (such as Easy Mac, chicken nuggets, TV dinner, etc.) as well as complete clean up following
RED FLAGS (should be brought to the attention of your doctor):
Child needs parent to continue to supervise the thoroughness of dressing and other self-care activities (i.e. bathing and drying off, tooth brushing, hair brushing, hand washing and drying)
Child can prepare a shopping list in order to purchase items needed for a meal using a recipe, a craft based on the given instructions, etc.
Child gathers all needed items to take to school and places them in his or her backpack
Child is able to cook simple dishes using the stove or oven safely (such as browning ground beef for spaghetti, boiling pasta, etc), but may occasionally have questions to ensure correct sequencing and/or safety
RED FLAGS (should be brought to the attention of your doctor):
Child frequently forgets to complete school assignments or does not receive credit for completed assignments because he or she does not remember to turn them in, put his or her name on the paper, etc.
Child can prepare a shopping list in order to purchase items needed for a meal using a recipe, a craft based on the given instructions, etc.
Child gathers all needed items to take to school and places them in his or her backpack
Child is able to cook simple dishes using the stove or oven safely (such as browning ground beef for spaghetti, boiling pasta, etc), but may occasionally have questions to ensure correct sequencing and/or safety
RED FLAGS (should be brought to the attention of your doctor):
Child frequently forgets to complete school assignments or does not receive credit for completed assignments because he or she does not remember to turn them in, put his or her name on the paper, etc.
Child completes basic household chores (such as sweeping, mopping, wiping counters, washing dishes, etc.), but may still have occasional questions about correct products to use or where some things are stored
Child initiates and completes tasks that last 60-90 minutes
Child uses money and makes correct change when shopping in a store
RED FLAGS (should be brought to the attention of your doctor):
Child has poor awareness of how his or her choices may be impacting himself or herself as well as others at times (such as staying up too late playing video games may lead to fatigue and a lower test score the next day, gossiping about one’s friends may lead to difficulty maintaining friendships, etc.). Disclaimer: These choices may still occur from time to time, but a typical 13-14 year old should be able to identify the cause of the unwanted consequence.
Child completes basic household chores (such as sweeping, mopping, wiping counters, washing dishes, etc.), but may still have occasional questions about correct products to use or where some things are stored
Child initiates and completes tasks that last 60-90 minutes
Child uses money and makes correct change when shopping in a store
RED FLAGS (should be brought to the attention of your doctor):
Child has poor awareness of how his or her choices may be impacting himself or herself as well as others at times (such as staying up too late playing video games may lead to fatigue and a lower test score the next day, gossiping about one’s friends may lead to difficulty maintaining friendships, etc.). Disclaimer: These choices may still occur from time to time, but a typical 13-14 year old should be able to identify the cause of the unwanted consequence.
Child is trusted to take care of a younger sibling or family member for short periods of time as he or she demonstrates good safety awareness, forethought of potential needs, and can carry out the younger child’s schedule reliably as requested by the primary caregiver
Child completes all advanced self-care tasks (identifying if clothing is clean and seasonally appropriate for the day, if clothing needs to be ironed, flossing teeth, etc.) and many household tasks (sweeping prior to mopping, cleaning the bathroom with the correct products, laundering all clothing, etc.)
RED FLAGS (should be brought to the attention of your doctor):
Child is not able to make purchases in a store from a list of needed items, and/or he or she is not able to keep his or her purchases within a given amount or budget.
Child is trusted to take care of a younger sibling or family member for short periods of time as he or she demonstrates good safety awareness, forethought of potential needs, and can carry out the younger child’s schedule reliably as requested by the primary caregiver
Child completes all advanced self-care tasks (identifying if clothing is clean and seasonally appropriate for the day, if clothing needs to be ironed, flossing teeth, etc.) and many household tasks (sweeping prior to mopping, cleaning the bathroom with the correct products, laundering all clothing, etc.)
RED FLAGS (should be brought to the attention of your doctor):
Child is not able to make purchases in a store from a list of needed items, and/or he or she is not able to keep his or her purchases within a given amount or budget.
Child completes all advanced self-care tasks (identifying if clothing is clean and seasonally appropriate for the day, if clothing needs to be ironed, flossing teeth, etc.) and advanced household tasks (such as planning, shopping for, and cooking a meal; identifying when certain chores need to be completed that may be outside of his or her usual responsibilities; etc.)
Child problem-solves independently through complex scenarios and involves the correct people as appropriate (such as child knows to contact parents, police, and insurance company and can initiate these steps if he or she is involved in a car accident, etc.)
RED FLAGS (should be brought to the attention of your doctor):
Child is not independent in planning for and executing all advanced daily tasks required for success at home, school, work, and meaningful community engagement

Speech Therapy
0-6 MONTHS
Vocalizes in different ways to show hunger, pain, or being tired
Frequently puts fingers, objects, clothing, pacifier into mouth for sucking and mouthing
Breastfeeds and/or bottle feeds
Starts soft, smooth solid foods
7-9 MONTHS
Self-feeds simple, finger foods
Produces sounds which are similar to t,d,n,f,v,z,ch,j,th,sh and s
Makes sound while eating with food in mouth
Reaches for object and looks for caregiver’s reaction
Uses finger to point to things
Tolerates smooth, lumpy solids fed by spoon by 9 months
10-12 MONTHS
Clears food off spoon with upper lip (eats lumpy, mashed foods)
Feeds self with fingers
Babbles using different sounds (nama)
Takes turns vocalizing
Copies sounds and gestures of others
Participates in joint attention activities
Combines 2 words (all done, Daddy bye-bye)
Names at least 5 common items
Retrieves objects from another room when asked
Understands at least 50 words
Asks for “more” and “what’s that?”
Drinks liquids from an open cup independently with limited spillage
Swallows with lip closure
Has precise up and down tongue movement
Eats table foods (includes easily chewed meats and cooked vegetables)
24 MONTHS
Has at least 100 words in vocabulary
Frequently uses 2-word phrases
Is at least 25-50% intelligible to all listeners
Follows simple 2-step related commands (may still require gestural cues)
Drinks from an open cup and from straw without dribbling
Bites through a variety of food thicknesses
Demonstrates verbal turn-taking
Points to things in a book
30 months
Has approximately 450 words in vocabulary
Gives own first name
Answers “where” questions
Uses present progressive -ing
Uses “no” or “not”
Consistently uses 3-4 word phrases/sentences
Identifies simple objects by function
Is 50-75% intelligible
Shares toys and understands simple locations (in, under, out, off)
Responds to greetings
Uses pronouns (my, me, mine, you)
36 months
Is 75% intelligible to all listeners
Has 1000 words in vocabulary
Follows prepositional commands (on, next to, under, etc.)
Begins to use adjectives for color and size
Asks one-word “why” questions
Uses “what”, “where”, “how”, and “whose” when asking questions
Beings to understand time concepts such as soon, later, wait
Chews and swallows majority of adult food
42 months
Uses regular plural –s (socks, shoes)
Uses possessive –s (baby’s bottle)
48 months
Consistently uses 4-5 word sentences, with correct sentence structure
Is 80% intelligible
Asks many questions including “who?” and “why?”
Uses regular and irregular past tense verbs consistently and regular 3rd person
Uses most pronouns
Has 1500+ words in vocabulary
Follows simple multi-step directions without repetition
Uses contractions (can’t, don’t, I’ve)
Identifies colors
Uses a variety of sentences with 6 or more words
Has greater than 2000 words in vocabulary
Uses most speech sounds correctly
Is 90-100% intelligible
Answers “how are things the same or different”
Understands time concepts (yesterday, today, first, then, next)
Asks question to get more information
Inventive spelling when writing
Uses a variety of sentences with 6 or more words
Has greater than 2000 words in vocabulary
Uses most speech sounds correctly
Is 90-100% intelligible
Answers “how are things the same or different”
Understands time concepts (yesterday, today, first, then, next)
Asks question to get more information
Inventive spelling when writing
Uses all speech sounds correctly but "r", "th", and "sh"
Begins to write letters when you give the sounds
Begins to tell the sound that letters make
Imaginitive play schemes with peers
RED FLAGS (should be brought to the attention of your doctor):
Doesn't participate in imaginative play schemes with peers
Uses all speech sounds correctly
Begins to read simple stories with sight words
Begins to make rhyming words
Inquires about people's feelings and thoughts
Can hold conversations with peers and adults
RED FLAGS (should be brought to the attention of your doctor):
Doesn't use all speech sounds correctly
Can't hold conversations with peers and adults
Can agree and disagree in conversations
Problem-solves and strategizes throughout the day and with games like boardgames
Begins to regulate emotions
Follows multi-step directions for daily activities like laundry, cooking, and other daily chores
RED FLAGS (should be brought to the attention of your doctor):
Can't problem-solve and strategize throughout the day and with games like boardgames
Speech sound errors
Can agree and disagree in conversations
Problem-solves and strategizes throughout the day and with games like boardgames
Begins to regulate emotions
Follows multi-step directions for daily activities like laundry, cooking, and other daily chores
RED FLAGS (should be brought to the attention of your doctor):
Can't problem-solve and strategize throughout the day and with games like boardgames.
Speech sound errors.
Can gather details in non-fiction literacy and write conclusions
Respects others with different preferences
Can read educational literature to gather information
Develops complex ideas
RED FLAGS (should be brought to the attention of your doctor):
Can't read educational literature to gather information
Speech sound errors
Can gather details in non-fiction literacy and write conclusions
Respects others with different preferences
Can read educational literature to gather information
Develops complex ideas
RED FLAGS (should be brought to the attetion of your doctor):
Can't read educational literature to gather information
Speech sound errors
Can use their language to persuade and negotiate
Can hold full conversations even on topics that are not their interest
Follows daily routines almost independently
Organizes: clothing, daily chores, food, school, and extra-curricular activiites
RED FLAGS (should be brought to the attention of your doctor):
Can't organize: clothing, daily chores, food, school, and extracurricular activities
Speech sound errors
Can regulate listeners even on topics that are not their interest
Analyzes stories, poems, movies, and summarizes different perspectives
Cites textual evidence
Can hold jobs and can be almost completely independent for daily routines
Can regulate their emotions and help to regulate others'
RED FLAGS (should be brought to the attention of your doctor):
Can't regulate their emotions and help to regulate others'
Speech sound errors
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