Milestones Matter: An Occupational Therapist’s Perspective
As an Occupational Therapist, I often talk with families about milestones — those little (and sometimes big) achievements that show your child’s development is moving forward. Milestones are more than just “first steps” or “first words”; they’re building blocks for how children learn, connect, and participate in daily life.
If you’ve ever watched the Bluey episode “Baby Race”, you’ll remember the message: “You’re doing great.” In the episode, Chilli (Bluey’s mum) learns that children develop at their own pace — and that comparing one child’s timeline to another’s can cause unnecessary stress. That’s exactly how milestones work in real life. There’s a range of what’s considered typical, and small variations are perfectly normal.
That said, milestones do give us a helpful roadmap — especially when we see consistent delays or gaps across more than one area. We usually group them into four main clusters: social, language/speech, fine motor, and gross motor.
Social Milestones
Social skills form the foundation for relationships and learning. They’re not just about being “friendly”
— they help children share ideas, solve problems, and navigate emotions.
When to be concerned:
No eye contact or social smile by 3 months.
Limited interest in faces or voices.
No interest in interacting with others by 12 months.
Difficulty engaging in pretend play by age 3.
Preference for playing alone beyond age 4 without joining others.
OT tip:
Just like Bingo in Baby Race, some children are observers before they’re joiners — but if they’re rarely initiating or responding to interaction, it’s worth checking in.
Language & Speech Milestones
Language development includes both understanding (receptive language) and expressing (expressive language). Speech refers to the sounds used to communicate.
When to be concerned:
No cooing or babbling by 9 months.
No single words by 15 months.
Limited understanding of simple instructions by 18 months.
Not combining two words by 2 years.
Unclear speech that’s hard to understand by age 3–4.
OT tip:
Speech and language are influenced by motor skills too — for example, oral motor development (jaw, lips, tongue) affects clarity. Feeding difficulties can sometimes be an early sign of speech development needs.
Fine Motor Milestones
Fine motor skills are all about small muscle movements, especially those in the hands and fingers, that support play, self-care, and school tasks.
When to be concerned:
Persistent fisted hands beyond 3 months.
Difficulty grasping or releasing objects by 12 months.
Limited interest in toys that require hand use.
Trouble feeding self with utensils by 2–3 years.
Avoidance of drawing, puzzles, or small-object play by preschool age.
OT tip:
Like in Baby Race, some children are slower to pick up certain skills but then leap ahead — however, if fine motor skills stay behind over time, it can impact self-care and learning.
Gross Motor Milestones
Gross motor skills use large muscle groups for movements like rolling, crawling, walking, running, and jumping. These skills support independence and participation in daily life.
When to be concerned:
Not holding head up by 4 months.
Not sitting by 9 months.
Not crawling by 12 months.
Not walking independently by 18 months.
Persistent clumsiness, frequent falls, or difficulty keeping up with peers after age 3.
OT tip: In Baby Race, some babies walked at 9 months, others closer to 18 — both were healthy and thriving. But if other delays are present alongside later walking, early intervention is worth exploring.
Final Thoughts
The takeaway from Baby Race is one parents often need to hear: you’re doing great. Milestones aren’t a competition; they’re signposts. While variation is completely normal, consistent delays across one or more clusters may be a sign your child could benefit from early intervention. As OTs, we look at the whole child — their environment, sensory processing, and participation — to help them grow into confident, capable learners and players.
Written by Lauren Dorney
