Delayed Developmental Milestones: When to Be Concerned from an Occupational Therapy Perspective
Children develop at their own pace, but certain milestones serve as important markers for their growth in key areas. When these milestones are significantly delayed, it may indicate the need for further evaluation and support. As occupational therapists, we consider clusters of milestones across verbal, social, gross motor, and fine motor skills to assess a child’s overall development.
Understanding when to be concerned, can help parents seek timely intervention and support their child’s progress.
Understanding Developmental Milestone Clusters
Milestones do not develop in isolation; rather, they emerge as part of a larger network of interconnected skills.
A delay in one area can sometimes signal broader challenges.
Here’s a look at key developmental areas and their markers:
1. Verbal and Communication Milestones
By 6 months: Reacts to sounds, coos, and babbles.
By 12 months: Says simple words like “mama” or “dada” and responds to their name.
By 18 months: Uses at least 10–20 words and begins to combine words.
By 24 months: Can form simple two-word phrases and follow simple instructions.
When to be concerned: Limited babbling by 12 months, no words by 18 months, or difficulty understanding simple commands by age 2.
2. Social and Emotional Milestones
By 3 months: Smiles at caregivers and makes eye contact.
By 6 months: Shows enjoyment in social play, such as peek-a-boo.
By 12 months: Shows preference for familiar people and exhibits joint attention (e.g., looking at an object when someone else points).
By 24 months: Engages in pretend play and shows signs of empathy.
When to be concerned: Lack of eye contact by 6 months, no interest in social interaction by 12 months, or difficulty engaging in simple play by age 2.
3. Gross Motor Milestones
By 3 months: Lifts head when lying on tummy.
By 6 months: Rolls over and begins sitting with support.
By 12 months: Pulls to stand and begins cruising along furniture.
By 18 months: Walks independently and begins to climb.
By 24 months: Runs, kicks a ball, and begins jumping.
When to be concerned: Difficulty holding up the head by 3 months, not sitting by 9 months, not walking by 18 months, or persistent stiffness or floppiness.
4. Fine Motor and Hand-Eye Coordination Milestones
By 3 months: Follows moving objects with eyes and reaches for toys.
By 6 months: Grasps objects and brings them to mouth.
By 12 months: Picks up small objects with a pincer grasp.
By 18 months: Uses a spoon and scribbles with crayons.
By 24 months: Stacks blocks and begins using both hands together for tasks.
When to be concerned: Difficulty grasping objects by 6 months, inability to pick up small items by 12 months, or challenges using both hands together by age 2.
When to Seek Help
While some children may naturally develop at a slower pace, significant or multiple delays in these areas may indicate the need for professional support.
Early intervention is key to helping children build the foundational skills needed for future learning and independence. If you notice persistent delays, consulting an occupational therapist or paediatric specialist can provide valuable insights and guidance.
Supporting Development at Home
Encourage play that fosters motor, social, and verbal skills (e.g., singing, reading, and interactive games).
Provide opportunities for movement and exploration to build motor coordination.
Engage in daily routines that promote independence, such as self-feeding and dressing.
Minimise screen time and focus on hands-on activities that stimulate cognitive and sensory development.
By understanding developmental milestones and recognising when additional support may be needed, parents can take proactive steps to ensure their child’s growth and success.
Written by Lauren Dorney
