Milestone Development
Use the information below to determine whether a child is achieving age-expected developmental milestones. A referral for delayed milestones should only be made if the child is at least 3 months behind their age-related expectations.
3-month threshold does not apply to concerns regarding head control, which should be referred immediately.
Occupational therapy
0 –3 month
- Briefly grasps items when placed in hands.
- Bring hands together at midline.
6 months – Can achieve all before this point
- Reaches for and grasps toys with both hands.
- Transfers objects hand-to-hand.
- Brings toys/objects to mouth.
9 months – Can achieve all before this point
- Emerging thumb and finger grasp
- Inferior pincer grasp by 9 months.
- Finger-feeds food.
12 months – Can achieve all before this point
- Established pincer grasp (thumb + fingertip).
- Places objects in and out of a container.
- Uses spoon, messy but functional.
18 months – Can achieve all before this point
- Builds tower of 2–3 blocks.
- Drinks from cup independently with some spillage.
- Removes shoes/socks.
- Helps with dressing (pushes arms through sleeves).
24 months – Can achieve all before this point
- Builds tower of 4–6 blocks.
- Scribbles spontaneously, imitates lines and circles.
- Feeds self with spoon more accurately.
3 years – Can achieve all before this point
- Can copy simple shapes when drawing
- Turns door handles, unscrews lids.
- Uses fork with some assistance.
4 years – Can achieve all before this point
- Draws simple person (head + body).
- Buttons/unbuttons large fasteners with help.
- Dresses with supervision
4–5 years – Can achieve all before this point
- Dresses independently (zips, large buttons).
- Uses knife for spreading, begins to cut soft food.
- Independent toileting and hand washing.
Physiotherapy
0 – 3 months
- Lifts head briefly whilst lying on their back.
- Able to turn head side to side.
- Spontaneous movements in all 4 limbs.
6 months – Can achieve all before this point
- Rolls independently
- Head control in supported sitting.
9 months – Can achieve all before this point
- Sits without support for short periods
12 months- 18 months – Can achieve all before this point
- Independently mobilises (crawls, commando crawl or bum-shuffle)
- Pulls to stand
- Cruises along furniture or with toys
- Walks independently with wide base of support.
24 months – Can achieve all before this point
- Runs more confidently, fewer falls.
- Kicks a ball forwards.
- Walks upstairs and downstairs with rail (two feet per step).
3 years – Can achieve all before this point
- Runs well with few falls
- Jumps with two feet together
4 years – Can achieve all before this point
- Stands on one foot for several seconds
- Catches a large ball with open arms
4–5 years – Can achieve all before this point
- Walks along a line or narrow beam.
- Hops several times on each foot.
- Throws and catches a ball with accuracy.
Inclusion Criteria / Considerations
- Motor delay: delayed sitting, walking, or fine motor skills. See QR code below for age-related milestones
- Asymmetry: unilateral use of arm/leg, early hand preference (<12 months), asymmetrical crawling/walking, such as one foot turning in.
- Abnormal tone or movement: stiffness, floppiness, persistent toe walking (>2 years), unusual movement patterns.
- Functional difficulties: poor balance, clumsiness, coordination issues, difficulties with dressing/feeding/using hands outside of age related expectations.
See QR code below for age-related milestones - Orthopaedic concerns: persistent intoeing/outtoeing, foot posture affecting function, recurrent falls.
- Developmental conditions: suspected/diagnosed CP, neuromuscular disorders, genetic syndromes.
- Post-injury changes: regression or loss of mobility post-injury.
Exclusion Criteria / Considerations
- Acute medical concerns: requires GP/ A&E (sudden limp <48 hr, fever, swelling, suspected fracture).
- Typical developmental variation - See QR code below for age-related milestones
- Equipment-only requests without therapy need.
- Sensory Difficulties - Please visit Children’s Occupational Therapy for general sensory advice (please note this advice is general and needs adapting to the child’s needs, abilities and preferences).
- Over the age of 5 year old.
RED FLAGS – These require an urgent medical review via GP, 111 or A&E
- Regression in skills
- Sudden change in vision
- Inability or difficulty to get up from the floor
- Neglect of one side of the body / limb
- Sudden or significant change in functional ability
- Sudden and significant onset of pain
- Head control.
The service does not accept referrals for children with sensory difficulties only, please visit Children’s Occupational Therapy for general sensory advice.
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