Every child develops at their own pace. But understanding developmental milestones helps you recognise when your child may need extra support. This guide outlines key milestones from birth to school age, with guidance on when occupational therapy may help.
What Are Developmental Milestones?
Developmental milestones are skills and behaviours that most children achieve by a certain age. They cover four main areas:
- Gross motor skills — sitting, crawling, walking, running, jumping. Full guide
- Fine motor skills — grasping, pinching, drawing, writing. Full guide
- Self-care skills — feeding, dressing, toileting. Full guide
- Social and emotional skills — sharing, turn-taking, emotional regulation. Full guide
Milestones are guidelines, not strict deadlines. Some variation is normal. But significant delays or difficulties across multiple areas may warrant an assessment.
Milestones: Birth to 6 Months
What to Expect
- Lifts head during tummy time
- Follows objects with eyes
- Brings hands to mouth
- Reaches for and grasps toys
- Rolls from tummy to back
- Transfers objects between hands
- Responds to sounds and voices
When to Be Concerned
- Difficulty holding head up by 4 months
- Does not reach for objects by 5 months
- Very stiff or very floppy body tone
- Does not respond to sounds or visual stimuli
Milestones: 6 to 12 Months
What to Expect
- Sits independently
- Crawls on hands and knees
- Pulls to standing
- Uses pincer grasp (thumb and finger)
- Bangs objects together
- Feeds self finger foods
- Waves bye-bye
When to Be Concerned
- Not sitting by 9 months
- Does not bear weight on legs
- Does not use both hands
- Does not explore objects with hands and mouth
Milestones: 1 to 2 Years
What to Expect
- Walks independently
- Stacks 2-4 blocks
- Scribbles with a crayon
- Drinks from a cup. See: Teaching Your Child to Drink from a Straw
- Uses a spoon (with spilling)
- Takes off shoes and socks
- Points to body parts when named
When to Be Concerned
- Not walking by 18 months
- Cannot stack blocks or manipulate small objects
- Does not attempt to feed self
- Walks only on toes. See: Toe Walking in Children
Milestones: 2 to 3 Years
What to Expect
- Runs, jumps, kicks a ball
- Stacks 6+ blocks
- Turns pages of a book
- Uses a fork and spoon with less spilling
- Pulls up trousers
- Begins toilet training
- Copies vertical and horizontal lines
When to Be Concerned
- Frequent falls or clumsiness. See: Helping Children with Coordination Difficulties
- Cannot hold a crayon or make marks
- Difficulty with basic self-care tasks
- Does not engage in pretend play
Milestones: 3 to 4 Years
What to Expect
- Hops on one foot, climbs stairs alternating feet
- Holds a pencil with a recognisable grip. See: Pencil Grip Development
- Draws a circle and a cross
- Uses scissors to snip paper. See: Scissor Skills: Developmental Stages
- Dresses self with some help. See: Helping Your Child Dress Independently
- Uses the toilet with some assistance
- Plays cooperatively with other children
When to Be Concerned
- Cannot draw basic shapes
- Difficulty using scissors
- Cannot dress or undress with help
- Avoids playing with other children
- Extreme reactions to sensory input (sounds, textures, movement)
Milestones: 4 to 5 Years (Pre-School)
What to Expect
- Catches a ball with both hands
- Writes some letters and their name
- Cuts along a line with scissors
- Dresses independently (including buttons)
- Uses a knife to spread
- Draws a recognisable person
- Follows multi-step instructions
When to Be Concerned
- Cannot hold a pencil functionally. See: Handwriting Readiness
- Difficulty with buttons, zips, or laces
- Cannot sit still for short tasks. See: Attention and Focus Strategies
- Poor body awareness or coordination. See: Body Awareness Activities
- Avoids messy play or certain textures
Milestones: 5 to 7 Years (School Age)
What to Expect
- Writes legibly within lines
- Ties shoelaces
- Uses a knife and fork together
- Rides a bicycle
- Organises belongings and follows classroom routines. See: Executive Functioning in Children
- Manages emotions with increasing maturity. See: Emotional Regulation Strategies
When to Be Concerned
- Handwriting is illegible or extremely slow. See: Supporting Your Child’s Handwriting
- Difficulty keeping up with classroom demands
- Struggles with organisation and planning
- Frequent meltdowns or emotional outbursts
- Avoids physical activity or group play
When Should You Seek Occupational Therapy?
Consider occupational therapy if your child:
- Is significantly behind peers in one or more developmental areas
- Has difficulty participating in daily activities (school, play, self-care)
- Shows signs of sensory processing difficulties
- Has been diagnosed with a condition that affects development
- Is struggling despite support at home and school
Early intervention is key. The earlier difficulties are identified and addressed, the better the outcomes. Do not wait to see if your child will grow out of it.
Read more: 10 Signs Your Child May Need OT
Getting an OT Assessment in Malta
In Malta, you can access occupational therapy through public services (with a referral) or private clinics (no referral needed).
At WonderKids, Ema Bartolo and her team offer comprehensive developmental assessments for children of all ages. Our assessments are thorough, family-centred, and followed by clear recommendations.
Read: What Happens During an OT Assessment | Public vs Private OT in Malta
Book an Assessment
If you have concerns about your child’s development, contact us for an assessment.
- Phone: +356 9987 2936
- Email: [email protected]
- Visit: wonderkids.mt