Developmental Milestones: Birth to 5 Years

Birth to 5 months

• Looks at faces and begins to mirror facial expressions

• Can self-soothe briefly and enjoys cuddling

• Coos and vocalizes pleasure or displeasure

• Turns head toward sounds and lights up with stimulus

• Reaches for objects using coordinated hand–eye movements

6 to 11 months

• Understands that things continue to exist when out of sight (object permanence)

• Searches for hidden items

• Follows simple commands (e.g. “Come here”)

• Imitates gestures (wave, clap)

• Begins using everyday objects appropriately (cup, hair brush)

• Explores toys with varied actions (shaking, banging, turning)

12 to 17 months

• Enjoys simple games like peek-a-boo and is drawn to picture books

• Uses a few words and attempts to mimic speech

• Shows favorites among people and things

• Follows basic directions and learns through trial and error

• Experiences separation anxiety and may show hesitation with strangers

18 to 23 months

• Continues to find hidden items

• Reaches, drops, or hands objects as part of play

• Grows more independent; pays attention to tasks

• Completes 2–4 piece puzzles and shape sorters

• Shows excitement around other children; plays near others

• Begins matching identical objects

• May display more defiant behaviors

• Separation anxiety may peak

2 to 3 years

• Understands simple mechanical and cause-effect toys

• Sorts by color, size, or shape

• Engages in imaginative and pretend play

• Matches pictures to objects

• Demonstrates empathy (comforting others)

• Follows 2–3 step instructions

3 to 4 years

• Seeks approval from peers and adults

• Plays cooperatively or mimics others’ play

• Expresses feelings verbally

• Carries on conversations in 2–3 word sentences

• Plays make-believe and understands “mine”

• Shows warm relationships with familiar people

• Experiences a broad range of emotions

4 to 5 years

• Sorts items into categories and shows curiosity

• Plays cooperatively with peers

• Understands basic time concepts (morning, later)

• Distinguishes real vs. make-believe

• Uses future tense and complex sentences

• Asks “why?” questions

• Follows rules and speaks clearly

• Shows compassion for others

  
  

Occupational Therapy Skills Checklist

Scissor Skills

• 2 years: snip paper

• 2½ years: cut across paper

• 3–3½ years: cut along a straight line

• 3½–4½ years: cut circles

• 4½–5 years: cut squares

Writing & Drawing Skills

• 10–12 months: scribbles

• 2 years: imitate lines, circles

• 3 years: copy lines, circles

• 4–5 years: copy diagonals, square, letters

• 5–6 years: copy triangle, write name

Grasp & Hand Control

• 1–1½ years: cylindrical grasp

• 2–3 years: digital pronated grasp

• 3½–4 years: static tripod grasp

• 4½+ years: dynamic tripod grasp

Visual-Motor & Fine Motor Skills

• 1½–2 years: turn pages, 3-piece puzzles, stack 4–6 blocks

• 2–2½ years: stack 8–10 blocks, string beads

• 2½–3 years: build block bridge

• 3–3½ years: lace 3 holes

• 4½–5 years: build pyramids or stairs using blocks

  
  

Daily Living Skills (Adaptive Skills)

Toileting

• 1 year: shows discomfort when wet or soiled

• 1½ years: sits on toilet with supervision

• 2 years: dries for 2+ hours, shows interest in toilet

• 2½ years: minimal accidents, tells caregivers

• 3 years: independent toileting with help on hygiene

• 4–5 years: fully independent

Dressing

• 1 year: pulls off socks, helps with arms/legs

• 2 years: removes coat, begins lowering pants

• 2½ years: pulls pants down, unbuttons large buttons

• 3 years: puts on clothing with some guidance

• 3½ years: identifies front of clothing, buttons/unbuttons

• 4 years: fastens shoes, zips and buckles clothing

• 4½+ years: loops belt

• 5 years: ties/unties knots, dresses independently

• 6 years: buttons, snaps, zippers, ties

Feeding

• 1 year: holds cup (some spilling), uses spoon

• 1½ years: more controlled spoon use

• 2 years: holds spoon correctly

• 3 years: self-feeds with minimal spills

• 3½ years: uses fork with better control