Do you have questions related to your child’s development in the following areas?

	Motor
	Thinking/Problem solving
	Language/Communication
	Social or emotional
	Self help/adaptive
If so, take a few minutes to read through the Developmental Checklist below. If you have any questions regarding your child’s development, please contact HCEI at 928-776-9285

Month (in purple):
1	Does s/he look at your face while you’re in direct line of vision?
2	Does s/he smile and coo?
3	Does s/he follow a moving object with eyes? Does s/he hold head up while lying on tummy?
4	Will s/he hold a rattle? Does s/he laugh aloud?
5	Can s/he reach for and hold objects? Does s/he smile at mirror images?
6	Does s/he babble and make sounds? Does s/he turn toward sounds? Will s/he sit up with little support? Does s/he sleep all night? Can s/he roll over?
7	Can s/he transfer an object from one hand to another? Can s/he sit momentarily without support? Does s/he imitate speech sounds?
8	Can s/he sit independently for about 5 minutes? Can s/he grasp objects with thumb and two fingers? Does s/he grasp for a toy that is out of reach?
9	Can s/he say “mama”, “dada” or other two syllable combinations? Does s/he respond to “no” most of the time? Does s/he stop when name is called? Does s/he look for toys after they fall from the high chair?
10	Can s/he pull himself up at the side of a chair or couch? Can s/he pick up a cheerio with each hand using index finger and thumb? Does s/he enjoy food with lumps in it?
11	Can s/he crawl on hands & knees from place-to-place?
12	Can s/he wave “bye-bye”? Can s/he walk with one hand held? Can s/he use two meaningful words? Can s/he help with dressing by extending arms and legs? Can s/he feed self a cracker?
15	Can s/he walk on own? Can s/he tell you what s/he wants by pointing and grunting? Can s/he identify one body part? Does s/he shake head “no”?
18	Can s/he build a tower of three blocks? Does s/he say 8-15 words? Does s/he ask “what’s that?” Can s/he make spontaneous scribbles when given pencil and paper? Can s/he manipulate a toy with both hands together?
21	Does s/he point to pictures when named? Does s/he understand “come here”, “sit down”, or other simple commands. Does s/he put on or take off some clothes?
24	Can s/he walk up and down stairs holding rail or wall? Does s/he use 2 word utterances? Can s/he run? Does s/he understand “one”, “big”, “little”? Does s/he refer to self by name? Can s/he refer to self by name? Can s/he identify 3 body parts?
30	Can s/he jump lifting both feet of the ground? Does s/he use pronouns (I, me, mine) to refer to self? Can s/he build a tower of six blocks? Can s/he answer simple questions, name one color?

• Doesn’t lift head in prone position (while lying on their stomach)
• Does not turn head to one side in prone position
• Does not turn head to both sides in supine position (lying on back)

3 Months:

• Does not hold head up 90 degrees in prone (lying on stomach)
• Does not extend both legs or kick reciprocally
• Does not roll to back when placed on their side

4 Months:

• Does not place weight on forearms in prone position
• Does not rotate or extend head
• Is unable to grasp a rattle
• Cannot bring both hands together

5 Months:

• Does not roll over one way
• Does not hold head up when pulled to sitting
• Is unable to hold head steady in supported sitting position
• Does not bear weight on legs

6 Months:

• Is unable to keep head level with body when pulled to a sitting position
• Does not demonstrate balance reactions
• Cannot bear weight on hands in prone position
• Does not move head actively in supported sitting position

7 Months:

• Does not roll over either way
• Does not bear weight on legs
• Cannot lift head or assist when pulled to sitting position
• Demonstrates little balance reactions or protective extension of arms

8 Months:

• Does not roll over both ways
• Cannot sit with little or no support
• Does not hold weight on one hand while in the prone position
• Cannot bear weight on legs and bounce

10 Months:

• Cannot get to sitting position without assistance
• Does not assume crawling position (hand-knee position)
• Does not show interest/motivation to crawl
• Cannot sit on own without hand support

1 year:

• Does not pull to stand using furniture
• Cannot switch positions from sitting to prone
• Does not creep on hands and knees
• Cannot pivot while in sit position to retrieve toy
• Cannot pass an object from one hand to the other
• Cannot stand holding on to someone or something
• Cannot pick up small object

15 Months:

• Does not walk with one hand held
• Cannot stand alone well
• Does not demonstrate balance reaction while in the kneeling position
• Does not walk alone one to two steps
• Does not demonstrate motor planning by climbing on furniture
• Has a hard time picking up small objects

18 Months:

• Does not attempt to creep upstairs
• Does not walk without support
• Cannot throw ball
• Does not bend down to retrieve objects
• Does not demonstrate balance reaction in standing

24 Months:

• Does not run
• Cannot walk upstairs with one hand held
• Cannot carry large toy while walking
• Does not squat in play
• Cannot retrieve toy off of floor from standing position
• Does not climb onto furniture, turn and sit
• Cannot build tower of 6 blocks
• Does not use utensils well

30 Months:

• Does not jump in place with both feet
• Does not stand from sitting by rolling on side
• Cannot catch large ball
• Has difficulty with gait and balance
• Does not walk downstairs using rail for support
• Does not have wide range of movement
• Does not run and stop without holding
• Does not avoid objects when running

36 Months:

• Cannot kick stationary ball
• Is not able to stand on one foot for 2 seconds
• Cannot build tower of 9 blocks
• Cannot complete 5-6 piece puzzle
• Is not using utensils properly
• Does not attempt to ride tricycle
• Does not demonstrate grasp of crayon

In a pediatric setting, Occupational Therapists treat children with a variety of diagnoses and address a variety of skill areas by working with families, as well as during therapy sessions. Some of these include:

Fine motor skills – using the hands, eyes, lips and tongue

Gross motor skills – movement using the large muscles, (i.e., running, jumping, etc.)

Visual motor skills – using the hands and eyes together to accomplish a task

Visual Perceptual skills- understanding depth perception, the visual qualities of objects such as size, shape and color, seeing objects in a complex background such as finding a small item in a drawer full of things, following lines on a page

Self-help skills – the ability to feed, dress, and groom oneself, etc.

Sensory Skills – Using all of the senses to learn. Regulating the senses to sleep well, concentrate on a task, eat a wide variety of foods, tolerate noisy, active environments, and much more.

These are some of the skills you may observe your child doing:

0-3 months

• Moves her arms symmetrically
• Can bring her hands to midline while on her back
• Blinks at sudden visual stimulus
• Grasps toy actively
• Keeps hands open 50 percent of the time
• Turns head to both sides while on her back
• Lifts head while on stomach
• Extends both legs
• Rolls from side to her back
• Opens and closes mouth in response to food
• Naps frequently
• Stays awake for longer periods without crying – usually in p.m.
• Coordinates sucking, swallowing, and breathing

• Follows a moving object with eyes while in supported sitting
• Clasps hands
• Keeps hands open most of the time
• Reaches and grasps object
• Drops object
• Rolls from her back to her side
• Bears almost all weight on legs
• Holds head erect when leaning forward
• Sits momentarily leaning on hands
• Uses her tongue to move food in her mouth
• Recognizes bottle visually, pats bottle
• Sleeps at night, for 10-12 hours with night awakening
• Places both hands on bottle
• Mouths and munches solid foods

• Bangs object on table
• Manipulates toy actively with wrist movements
• Reaches and grasps object with extended elbow
• Releases object voluntarily
• Sits without hand support for 10 minutes
• Crawls forward/backward
• Gets to sitting without assistance
• Makes stepping movements
• Pulls to standing at furniture
• Feeds self cracker
• Bites and chews toys
• Drinks from cup held for her
• Drools less except when teething

• Pokes with index finger
• Bangs two cubes held in hands
• Puts objects in and takes objects out of container
• Uses both hands freely; may show preference for one
• Lowers to sitting from furniture
• Stands momentarily
• Walks holding onto furniture
• Pivots in sitting – twists to pick up objects
• Finger feeds self
• Holds spoon
• Sleeps nights twelve to fourteen hours
• Cooperates with dressing by extending arm or leg

• Marks paper with crayon
• Puts three or more objects into container
• Builds tower using two cubes
• Points with index finger
• Stands alone well
• Falls by sitting
• Throws underhand in sitting
• Walks without support
• Bends over and looks through legs
• Brings spoon to mouth – turns spoon over
• Holds cup handle

• Child scribbles spontaneously
• Turns small container upside down to obtain tiny object
• Puts many objects into container without removing any
• Uses both hands at midline – one holds, other manipulates
• Builds tower using three cubes
• Throws ball forward
• Pulls toy behind while walking
• Stands on one foot with help
• Walks upstairs with one hand held
• Carries large toy while walking
• Indicates discomfort over soiled pants; by verbal/gesture
• Sleeps nights ten-twelve hours
• Naps one in afternoon one-three hours
• Removes socks
• Places hat on head

• Imitates vertical stroke
• Imitates horizontal stroke
• Builds tower using six cubes
• Strings three one-inch beads
• Snips with scissors
• Helps with simple household tasks
• May have definite food preferences
• Unwraps food
• Pulls pants down with assistance
• Unbuttons large buttons
• Goes up and down slide
• Stands on tiptoes
• Walks with legs closer together
• Catches large ball
• Walks upstairs alone – both feet on step

• Imitates a cross
• Folds paper in half
• Builds tower using eight cubes
• Places six square pegs in pegboard
• Walks on tip-toes a few steps
• Jumps backwards
• Jumps sidewards
• Jumps on trampoline with adult holding hands
• Dresses self with assistance
• May reject many foods
• Insists on doing things independently
• Hangs clothing on hook
• Helps with bathing self

• Imitates cross
• Copies a circle
• Snips on line using scissors
• Builds tower using nine cubes
• Climbs jungle gyms and ladders
• Catches eight inch ball
• Runs on toes
• Makes sharp turns around corners when running
• Pours liquid from small container
• Uses fork
• Uses napkin
• Buttons large buttons
• Dries hands

3 Months
-does not follow an object with her eyes
-hands remain closed almost all of the time
-frequently resists being held
-becomes upset when moved, as when being picked up, laid down, or handed
from one familiar person to another

4 Months
-does not swipe at or reach for objects
-does not bring hands or objects to his mouth
-frequently irritable for no apparent reason
-does not place both hands on her bottle while fed

5 months
-does not hold his own bottle
-doesn’t smile at his image in a mirror

6 Months
-involuntarily drops objects after only a few moments
-does not actively grasp large finger foods such as teething cookies when they are
placed on the highchair tray
-is excessively and consistently upset by leaving the home

7 months
-does not transfer an object from one hand to the other

10 months
-not beginning to pick up small objects
-does not poke with index finger
-is not accepting a variety of food textures
-is excessively upset by being dressed, diapered, bathed, or having hair groomed

12 months
-isn’t able to pick up a cheerio or other small object with tip of the thumb and
the tip of the index finger
-is not sleeping through the night most of the time
-is not interested in exploring toys made for one year-olds
-is excessively upset by sound of siren, barking dog, vacuum cleaner, or other
familiar loud noise

15 months
-cannot put a one-inch object into a container with a slightly bigger opening
-cannot stack two cubes
-cannot put a round form into a round shape on a puzzle

18 months
-cannot point to a few of the following body parts: eyes, nose, mouth, hair,
tummy, legs, feet, and hands
-cannot turn pages of a cardboard book, or regular small book two or three pages
at a time.
-cannot stack four blocks
24 months
-play with toys only by tapping, shaking, or throwing
-cannot unscrew top of a one-inch or two-inch bottle
-cannot remove socks, untied shoes, or pull-on pants without help

30 months
-cannot imitate drawing a vertical line or a circular scribble on paper immediately
after seeing an adult draw these lines
-cannot stack eight to ten cubes
-cannot imitate drawing a horizontal line immediately after seeing an adult draw
a horizontal line

36 months
-cannot remove all pull-on clothing after fasteners have been undone
-does not imitate the actions of adults in the home
-does not pretend during play

If your child is allergic to any of the items suggested, then an item of similar texture may be substituted.

Grooming/Hygiene

• Allow child to comb /brush hair.
• Practice playing in water with supervision and exploring toothbrush/toothpaste (with supervision so as not to swallow) in preparation for brushing teeth.
• If your child’s mouth is sensitive when trying to brush teeth, encourage your child to try wiping the mouth with a warm washcloth and to keep doing it before brushing teeth.
• Allow your child to play in water with supervision and rub face and hands in preparation for hand washing.

Dressing

• Children are able to take off their clothes before putting them on. Allow your child to assist in his/her dressing.
• Lay out clothes so that child can explore and “try on” various items. Allow the older child to pick out own clothes to wear.
• Play “dress up” Make dressing FUN!
• Lace an old shoe in preparation for eventual shoelace tying.
• Orient to identifying body parts by pointing and saying names of various parts of the body as you assist your child to dress or bathe.

Bathing

• Never leave a child unattended in the tub, or around water, even with just a little water in the tub.
• Place favorite waterproof toys/bubbles in water so child can explore under your supervision to get used to being in the water.
• Rub child with warm washcloth/towel to minimize fear/intolerance of water.
• Allow your child to play in a little tub of water on the floor under your supervision.

Sensory Learning

• Use bean bag chair during play, music, or reading tasks. This is for calming.
• Allow child to “sandwich” self using beanbag chair/cushions during story time, listening to music, etc. This will help with calming.
• Use headphones and calming music to cut down on auditory distractions.
• Use visor/hat to block visual glare, even indoors, if light is bothering her.
• A visor or hat can also be used to reduce visual distractions in the room if your child is easily distracted. Or try finding a place that is small and separated from the main part of the room as a place to do table activities.
• Encourage exploration of and participation in activities such as finger painting, use of shaving cream, play-doh/clay/putty, digging in dirt, and water, even if messy. This encourages exposure/tolerance to different textures.
• Provide slow rocking/soft lighting to calm or fast rocking to alert.
• Allow for crawling, hopping, and jumping activities to increase awareness of position of body in space.
• During transitions between different activities, gradually shift from activity of interest to the next necessary activity. Example: from playing to getting ready for bed.
• Sing a lullaby to child before bedtime.
• Clap hands/stomp feet to music.

Visual-Perceptual

• Match basic shapes (circle, square, triangle)
• Trace shapes in the sand, shaving cream, with fingerpaints, or on sandpaper.
• Try shape puzzles in preparation for sorting and matching skills.
• Tracking child’s favorite toy/flashlight on wall to improve visual scanning and crossing midline of body.
• Place items in the middle in front of child and allow his/her hand dominance to naturally develop.
• Encourage crossing midline of body with the hands by placement of toys of interest on opposite side to where child is playing so that she will rotate to get them.
• Encourage use of both hands during activities such as play-doh, carrying items, ball toss/catch, and self-care.
• Play pat-a-cake, “Simon Says,” imitating what you do, guiding younger children as needed.
• Rolling ball and toss/catch.

Using Hands and Developing Grasp

• Roll play-doh/clay/putty into a log or small balls with fingertips and squeeze. Child should be well-supervised to avoid swallowing.
• Fill coffee can with clothespins. Then, place clothespins around edge of can and remove again, as your child gets older.
• Pick up cheerios.
• Turn pages of a book.
• Squeeze soft sponge or ball.
• Practice unfastening zippers and unsnapping clothing.
• Press buttons on music box.
• Make a snowman with marshmallows and frostng.
• Build towers with blocks and construction toys (legos, plastic pop beads). Be cautious of size. Small items can cause choking hazard.
• Working on a vertical surface such as an easel or paper taped on the refrigerator or wall for drawing and painting helps to develop a mature grasp.
• Have the child imitate drawing a vertical straight line on a vertical surface like an easel or taped paper on wall.
• Attempt to draw a horizontal line on an upright surface when your child is able to draw a vertical line. Children develop grasp at their own rate. Do not force this.

Seating Suggestions

• Children can learn hand skills best if their feet are flat on the floor while sitting at a table to do activities. If your child’s feet don’t reach the floor, try putting an old phone book or other large book under her feet while she plays at the table.
• Decrease wiggling and sliding using a non-skid mat on seat of chair. These can be found at Wal-Mart, K-Mart, and some grocery stores.

Let your baby get messy when learning to use a spoon. It is natural and necessary to get food on hands, arms and face, so that she can learn more about textures, tastes, and smells. Exploring in this manner will actually heighten his interest in new foods.

Twelve to 15 months: If you want to interest your baby in spoon feeding, ask her to feed you a few bites of pudding with a spoon.

When children are learning to use a spoon, use foods that stick to the spoon, such as pudding, or mashed potatoes.

Introduce strained vegetables to your baby before introducing fruit. If sweet fruits are introduced first, the baby may not be as interested in vegetables.

Children form all of their opinions about what tastes good in the first two years of life. Be sure to expose your baby to a wide variety of healthy foods during this time.

Some toddlers over-stuff their mouths, then have trouble swallowing. If your child does this, put small amounts of food on her plate, a little at a time.

If your child is unstable in the high chair, it will be more difficult to chew and swallow, and to learn to use a spoon. Try placing rolled towels in the chair on both sides of your child to make the chair “hug” him. This will increase sitting balance.

Children benefit from foot support when trying to feed themselves. If your child’s feet do not reach the footrest of the highchair, try taping a shoebox on it. This will allow her to reach the foot support to stabilize posture/feet.

• Does not cry when hungry or uncomfortable
• Does not make comfort sounds or sucking sounds
• Cry does not vary in pitch, length and volume to indicate different needs
• Difficulty establishing/maintaining a rhythmical suck/swallow pattern
• Significant loss of breast milk/formula out of side of mouth during feeding

3-5 Months:

• Vocalizes separately from body movements (sound is not a response to body movement)
• Inability to establish or maintain face to face communication during feeding
• Does not vocalize in response to sound stimulation
• Has not begun to laugh by 5 months in response to play
• Difficulty with feedings such as above

5-7 Months:

• Does not babble during play or in response to stimulation (may suggest a hearing problem)
• Does not use voice to vocalize attitudes other than crying
• Does not respond to sound stimulation (indicative of hearing problem)
• Difficulty with swallowing early solids or other feeding issues

7-9 Months:

• Does not look toward sounds or own name
• Is not babbling double consonants (bababa…)
• Difficulty with textures in foods (gagging, chocking, etc.)
• Is unable to participate in conversations with adults using babbling noises
• Does not say “mama” or “dada” nonspecifically
• Does not use different inflections to produce exclamations

9-12 Months:

• Is unable to successfully eat early finger foods or munch/bite on foods
• Cannot babble single consonants such as “ba” or “da”
• Does not respond to words/language appropriately
• Does not experiment with language when playing independently
• Does not participate in conversations by responding with vocalizations

12-15 Months:

• Does not use inflection during vocalization
• Is not experimenting with language during play
• Is not using 1-3 words spontaneously while repeating additional words
• Does not vocalize or gesture to communicate needs
• Is not using “no” emphatically and meaningfully
• Is not using exclamatory expressions such as “Oh-oh”, “No-no”, “Ta-da”, etc.

15-18 Months:

• Is not attempting to sing songs
• Cannot use 10-15 words spontaneously
• Is not using vocalization in conjunction with gestures
• Does not use language to communicate needs
• Is not repeating sounds or words or imitating environmental sounds
• Is not jabbering tunefully during play
• Continues to demonstrate eating problems (swallowing issues, choking, etc.)

18-24 Months:

• Is not using jargon with good inflection
• Cannot label 2-4 pictures while looking at a book
• Is not putting 2-4 words together to form short sentences or communicate needs
• Does not understand nouns, verbs and modifiers and their uses
• Is not using intelligible words to communicate needs
• Cannot imitate 2-4 word phrases
• Does not relay experiences using jargon, words and/or gestures

24-33 Months:

• Cannot sing phrases of songs
• Is not using three word sentences
• Is not using a wide range of consonant and vowel sounds
• Does not use past tense words (“He runned”)
• Is not expressing frustration at not being understood
• Does not use up to or more than 50 expressive words
• Is not imitating phrases or experimenting with new words

33-36 Months:

• Is not responding to questions when asked things
• Is not producing correct beginning sounds of words
• Is having a hard time understanding prepositions
• Is not speaking in complete sentences
• Does not use plurals to refer to more than one (even if not correct)
• Is not participating in storytelling
• Does not have expressive vocabulary of 200-1000 words
• Is not using expressive vocabulary to communicate all needs
• Is not using sentences to communicate

Children and babies learn through play and interaction with their caregivers, siblings and peers. By nature, they are very repetitive and follow the lead of others around them. They explore their world through touch, sight and sound and learn about the physical properties of all their toys and their own abilities through their intrinsic curiosity and through exploratory play. They develop all of their senses and all of their speech abilities while playing.

What do Speech/Language Therapists do with children from birth to 3 years of age?

We work with families to provide support to children in the areas of language acquisition, articulation, oral motor stimulation, feeding issues and communication skills. These areas may include improving and working with production of sounds, communication skills development (including sign language), increase in the range of sounds, quality of language use, increase in feeding skills, improved oral motor functioning and development of oral motor muscles to improve language use.

We look at the quality of a child’s speech/language such as their pronunciation and articulation, their ability to communicate their needs, their ability to chew and swallow food properly and their families concerns. Speech Therapists are concerned with helping children reach their full developmental potential and realizing their full range of sounds and communication abilities to improve their quality of life.

• After six weeks of age has fairly well-established sleep cycles. Sleeps all night by six months.
• Likes to be held and molds her body to that of the adult holding her.
• Is comfortable when being moved.
• Easily moves from one position to another.
• Has favorite songs or movement games, and anticipates these special interactions.
• Explores toys by putting them in his mouth.
• After six months accepts solid and textured foods when introduced.
• Can attend to more than one stimulus at a time. For instance, can look at a book while listening to a story.
• Has favorite sensory stimuli, such as certain music, finger games, flavors, etc.
• Plays with the two hands in the middle. Transfers toys hand-to-hand.

Concerns: The baby…

• Has not developed predictable sleep/waking cycles; is frequently difficult to calm or get to sleep.
• Arches or attempts to pull away when being held.
• Becomes irritable when moved or position is changed.
• Prefers to stay in one position.
• Avoids novel play situations or interaction with others.
• Avoids mouthing toys.
• Has difficulty with solid or textured foods, “picky” eater.
• “Tunes out” if more than one stimulus is presented.
• Caregivers have difficulty determining baby’s preferences.
• Uses just one hand at a time (after 8 months).

• Enjoys touching textures; plays with food, textured toys, sand, play-doh, etc.
• Enjoys bath time and accepts touch from washcloth. Accepts clothing moving against skin during diapering and dressing.
• Plays in imaginative and unique ways.
• Spends time exploring the various features of toys (the sights, sounds, texture, etc.)
• Understands simple directions without gestures, listens and looks when spoken to.
• Accepts various clothing textures. Accepts clothing that is appropriate to the weather.

Concerns: The toddler…

• Avoids finger feeding, touching textured toys, messy hands.
• Is excessively upset by dressing and diaper changes or by bathing.
• Is “stuck” in play, continues to mouth, bang or throw toys repeatedly.
• Has short attention to new toys, does not independently explore toys’ properties.
• Has poor eye contact: Makes inconsistent responses (actions) when spoken to.
• Is fussy about clothing textures. Avoids wearing shoes, OR insists on wearing shoes on all textured surfaces such as carpeting or grass. Insists on heavy clothing during hot weather, OR avoids clothing, even in cold weather.
• Noises such as thunder, sirens, vacuum cleaners are frightening.