Content:

● DeIayed Milestone
● Oro-facial Problem
● Articulation Problem
● Voice Disorder
● Hearing Impaired
● Stammering / Stuttering Disorder
● Language Disorder
● Phonological Problem
Developmental milestones are skills that most children
achieve by certain ages. They are commonly grouped into
four main areas:
1. Gross Motor – large body movements
2. Fine Motor – hand and finger skills
3. Speech & Language – communication and
understanding
4. Social / Cognitive – interaction, learning, and behavior

Below is a simple developmental milestone guide:

0–3 Months

Gross Motor
• Lifts head when lying on tummy
• Moves arms and legs actively

Fine Motor
• Hands mostly closed
• Grasps finger briefly

Speech & Language

• Makes cooing sounds
• Turns toward sounds

Social / Cognitive
• Smiles at people
• Looks at faces
4–6 Months

Gross Motor
• Rolls from tummy to back
• Sits with support

Fine Motor
• Reaches for toys
• Transfers objects between
hands

Speech & Language

• Babbles (ba, ma, da)
• Laughs and squeals

Social / Cognitive
• Recognizes familiar people
• Responds to emotions
7–9 Months

Gross Motor
• Sits without support
• Begins crawling

Fine Motor
• Uses raking grasp to pick
objects
• Bangs toys together

Speech & Language

• Responds to name
• Understands “no”

Social / Cognitive
• Stranger anxiety begins
• Enjoys peek-a-boo
10–12 Months

Gross Motor
• Pulls to stand
• May take first steps

Fine Motor
• Uses pincer grasp (thumb andfinger)
• Points at objects

Speech & Language

• Says 1–2 words (mama, dada)
• Understands simple commands

Social / Cognitive
• Waves bye-bye
• Imitates actions
1–2 Years

Gross Motor
• Walks independently
• Climbs furniture

Fine Motor
• Stacks 2–4 blocks
• Scribbles

Speech & Language

• Uses 10–50 words
• Combines two words (e.g., “more
milk”)

Social / Cognitive
• Follows simple instructions
• Shows pretend play
2–3 Years

Gross Motor
• Runs and jumps
• Walks up stairs

Fine Motor
• Turns pages
• Builds tower of 6–8 blocks
Speech & Language
• Uses 2–3 word sentences
• Vocabulary about 200+ words

Social / Cognitive
• Plays beside other children
• Begins toilet training
3–5 Years

Gross Motor
• Hops on one foot
• Rides tricycle

Fine Motor
• Draws circles and shapes
• Uses scissors

Speech & Language

• Speaks in full sentences
• Speech mostly understandable

Social / Cognitive
• Plays with peers
•Understands rules and routines
✅ Why milestones are important ?

• Identify speech delay

• Detect autism or developmental
disorders
• Guide speech therapy and
occupational therapy intervention
Delayed Milestone

A delay occurs when a child does not

reach these milestones within the
expected age range, which can impact
their ability to communicate, play, and
perform daily tasks.
Causes
[Link] Delays/Disorders
• Speech sound/ Articulation
disorders:
Difficulty pronouncing sounds past expected age, e.g.
lisping, “wabbit” for rabbit at age 5.
Omission, Substitution, Addition, Distortion.
• Language delay: Late talker, small vocabulary, trouble
forming sentences. Expressive or Receptive problems.
• Childhood Apraxia of Speech: Brain has trouble planning
movements for speech
• Stuttering/Fluency disorders:
Repetitions, blocks, prolongations.
Phonological Disorder: Instead of
isolated sound errors, the child uses
patterns of errors:
Common error patterns:
• Fronting → “cat” → tat
• Backing → “dog” → gog
• Final consonant deletion → “bat” → ba
• Cluster reduction → “spoon” → poon
• Stopping → “sun” → tun
2. Medical/Neurological Conditions

• Autism Spectrum Disorder (ASD):

Social communication challenges,
echolalia, nonverbal. Speech for
communication, OT for sensory +
daily living
• Hearing loss :

Even mild loss

impacts speech
development
3. Voice Disorder :
● Pitch: Too high, too low, or monotone for
age/gender
● Loudness: Too soft to hear, or too
loud/can’t control volume
● Quality: Hoarse, raspy, breathy, nasal,
strained, or “lost voice”
● Other: Voice fatigue, pain when talking,
frequent voice loss
 4. ADHD:
Attention, organization, impulse
control affect school tasks.

Speech for pragmatic

language/social skills, OT for focus
+ organization
5. Cerebral Palsy:

Muscle tone and

coordination impact
independence, as
muscle control affects
lips, tongue, breathing
for speech
6. Genetic syndromes:
Down Syndrome, Fragile X often
include OT needs. Low muscle
tone + cognitive factors impact
speech. Speech for articulation,
OT for low tone + fine motor
7. Prematurity/NICU history:

Higher risk for motor and

sensory delays.
Premature birth: Global
delays affecting speech,
motor, and sensory.
 8. Traumatic Brain Injury or Stroke:

Affects speech/language centers

Self-Care & Daily Living issues :
• Trouble with feeding self,
dressing, toileting, brushing teeth
• Difficulty using utensils, scissors
having difficulty in fine and gross
motor coordination
9. Structural/Physical Issues
• Cleft lip/palate: Changes airflow
and sound production
• Tongue-tie/Ankyloglossia:
Limits tongue movement
• Vocal nodules: Hoarse voice from
vocal abuse
10. Fine Motor & Coordination
Issues
● Developmental Coordination
Disorder/Dyspraxia:
Clumsy, poor handwriting, trouble with
buttons/zippers
● Low muscle tone/hypotonia:
Weak core, slouching, gets tired writing
● Visual-motor deficits:
Trouble copying shapes, spacing letters, cutting.
11. Sensory Processing Differences

• Sensory Processing Disorder:

Over/under-reacts to sound, touch, movement, or
seeks excessive input
• Avoids messy play:
Won’t touch sand, glue, certain food textures
● Constantly moving/crashing:
Needs more movement input to focus
 Treatment
1. Articulation/Phonology Therapy
Goal:
Fix speech sound errors
How ?
● Drill play:
Practice /r/ in words using games –
“Say ‘rocket’ to launch the car”
Phonological patterns:
If child says all back sounds
like “g/k” at front, teach the
rule
2. Oral-motor exercises
Only if muscle
weakness exists,
e.g. straws for lip
rounding
3. Language Therapy
● Goal:
Build vocabulary, grammar, comprehension
● How ?
Expansion/modeling:
● Child: “Dog run.”
● SLP: “Yes, the big dog is running fast!”
● Book-based therapy :
Answer wh-questions, predict, retell
stories
● Narrative skills :
Sequencing with picture cards, story
grammar
4. Fluency/Stuttering Therapy

● Goal:
Easier, less tense speech
● How ?
● Easy onset:
“Smooth starts” – gentle airflow on
first sound
● Rate control:
Pausing, phrasing, using
finger-taps per syllable
● Desensitization:
Reduce fear of stuttering
through voluntary
stuttering
5. Voice Therapy
● Goal:
Healthy pitch/loudness/quality
● How?
● Vocal hygiene plan:
Water schedule, reduce yelling, reflux management
● Resonant voice therapy :
Humming into /m/ to feel vibration in lips
● Lax Vox:
Talking through a straw into water to reduce impact on
vocal folds
6. Social Communication/Pragmatics
● Goal:
Conversation, eye contact, taking turns
How ?
● Social stories:
Script how to join play or ask for help
● Video modeling:
Watch and role-play greetings, topic changes
● Group therapy:
Practice with peers in structured games
7. Feeding/Swallowing Therapy
● Goal:
Safe, varied eating
● How ?
● Oral-motor strengthening:
Chewing on specific tools if weak
● Food chaining:
Go from accepted → similar new foods, step by step
● Swallow strategies:
Chin tuck, pacing, thickened liquids if aspirating
8. Fine Motor Therapy
● Goal:
Hand strength/coordination for school & self-care
● How ?
● Theraputty/clay:
Hide beads to build finger strength
● Handwriting programs:
Handwriting Without Tears, letter formation in sand/shaving
cream
● Tool use:
Adapted pencils, scissors practice, tongs for pincer grasp
9. Sensory Integration Therapy
● Goal:
Regulate responses to sound, touch, movement
● How ?
● Sensory diet :
Scheduled “heavy work” – wall pushes, carrying books,
animal walks
● Swing/vestibular input :
For kids who need movement to focus
● Tactile bins:
Rice, beans, water beads to reduce touch defensiveness
10. Visual-Motor & Visual-Perceptual
Therapy
● Goal:
Coordinate eyes + hands, process what eyes see
● How ?
● Copying designs:
Blocks, geoboards, mazes for eye-hand work
● Visual scanning games:
“I Spy,” hidden pictures for reading skills
● Posture work:
Core exercises so the hand has a stable base to write
11. Activities of Daily Living (ADL)
Training
● Goal:
Independence in self-care
● How ?
● Dressing practice:
Backwards chaining – adult does most, child does last step
● Feeding skills:
Scooping, stabbing, opening containers
● Toileting/hygiene:
Step visuals, adapted seats, wiping strategies
12. Self-Regulation & Executive
Function
● Goal:
Attention, planning, emotional control
● How ?
● Zones of Regulation:
Identify blue/green/yellow/red zone + tools to shift
● Alert Program/How Does Your Engine Run?:
Teach high/low/just-right states
● Organizational systems:
Checklists, timers, breaking tasks into first/then
 13. Adaptive Equipment &
Modifications
● Goal:
Access tasks despite limitations
● How ?
● Seating:
Wiggle cushions, footrests for posture
● Adapted tools:
Pencil grips, slant boards, weighted utensils
● Environmental changes:
Visual schedules, reduced clutter, noise-canceling headphones