DEVELOPMENTAL MILESTONES

An understanding of child development is foundational knowledge for pediatric occupational therapists. Occupational therapists want to know what developmental changes occur in children and how children develop their
unique personhood. The answers to these questions provide essential knowledge for evaluating children and for determining the appropriate materials, activities, and environments to support children’s skill development and participation in their communities. Identifying children with developmental deficits or significant delays remains an important function of physicians, nurses, occupational therapists, and others who
provide early intervention services.

HOW DO CHILDREN DEVELOP NEW PERFORMANCE SKILLS?

• Motivation and self efficacy
• Temperament and emotional development
• Risk and resiliency

CONTEXTS FOR DEVELOPMENT

• Cultural
• Physical
• Social

Children’s Occupations, Performance Skills and Contexts

This section will describe the child’s development of play occupa-

tions as enabled by his or her performance skills and cultural,

physical, and social contexts. For three age groups—infancy, early

childhood, and middle childhood

INFANTS(birth to 6 months)

PLAY OCCUPATIONS

Exploratory play:

Sensorimotor play predominates

Social play:

Focused on attachment and bonding with parents

PERFORMANCE SKILLS

Regulatory/Sensory Organization

• Quiets when picked up
• Shows pleasure when touched and handled
• Relaxes, smiles, and vocalizes when held
• Cuddles
• Listens to a voice
• Uses hands and mouth for sensory exploration of objects

Fine Motor/Manipulation

• Follows moving person with eyes
• Develops accurate reach to object
• Uses variety of palmar grasping patterns
• Secures object with hand and brings to mouth
• Transfers objects hand to hand
• Examines objects carefully with eyes
• Plays with hands at midline

Gross Motor/Mobility

• Lifts head (3–4 months)
• Raises trunk when prone (4–6 months)
• Kicks reciprocally when supine
• Sits propping on hands
• Plays (bounces) when standing with support from parents
• Rolls from place to place

Cognitive

• Repeats actions for pleasurable experiences
• Uses hands and mouth to explore objects
• Searches with eyes for sound
• Bangs object on table
• Integrates information from multiple sensory systems

Social

• Coos, then squeals
• Smiles, laughs out loud
• Expresses discomfort by crying
• Communicates simple emotions through facial expressions

INFANTS (6–12 Months)

PLAY OCCUPATIONS

Exploratory Play: Sensorimotor play evolves into functional play

Functional Play: Begins to use toys according to their functional purpose

Social Play: Attachment to parents and caregivers and Social play with parents and others

PERFORMANCE SKILLS

Regulatory/Sensory Organization

• Enjoys being held up in the air and moving rapidly through the air
• Listens to speech without being distracted
• Finger-feeds self, including a variety of food textures
• Cooperates with dressing

Fine Motor Manipulation

• Mouths toys
• Uses accurate and direct reach for toys
• Plays with toys at midline, transfers hand to hand
• Bangs objects together to make sounds
• Waves toys in the air
• Releases toys into container
• Rolls ball to adult
• Grasps small objects in fingertips
• Points toys with index finger, uses index finger to explore toys
• Crudely uses tool

Gross Motor/Mobility

• Sits independently
• Rolls from place to place
• Independently gets into setting
• Pivots in sitting position
• Stands, holding on for support
• Plays in standing when leaning on support
• Crawls on belly initially, then crawls on all four(10 months)
• Walks with hand held(12 months)

Cognitive

• Responds to own name
• Recognizes words and family member’s names
• Responds with appropriate gestures
• Listens selectively
• Imitates simple gestures
• Looks at picture book
• Begins to generalize from past experiences
• Acts with intention on toys
• Takes objects out of container

Social

• Shows special dependence on mother
• May show stranger anxiety
• Lifts arms to be picked up
• Plays contentedly when parents are in room
• Interacts briefly with other infants
• Plays give and take
• Responds playfully to mirror(laughs or make faces)

INFANTS (12–18 MONTHS)

PLAY OCCUPATIONS

Relational and functional play:

• Engages in simple pretend play directed towards self(pretend eating, sleeping)
• Links 2 or 3 schemes in simple combinations
• Demonstrates imitative play from an immediate model

Gross Motor Play

• Explores all spaces in the room
• Rolls and crawls in play close to the ground

Social Play

• Begins peer interactions
• Parallel play

PERFORMANCE SKILLS

Regulatory/Sensory Organization

• Enjoys messy activities
• Reacts to extreme sensations, such as warm, cold, sweet

Fine Motor/Manipulation

• Holds crayon and makes marks; scribbles
• Holds two toys in hand and toys in both hands
• Releases toys inside containers, even small containers
• Stack blocks and fits toys into form space( places pieces in board)
• Attempts puzzles
• Opens and shuts toy boxes or containers
• Points to pictures with index finger
• Uses two hands in play, one to hold or stabilize and one to manipulate

Gross Motor/Mobility

• Sits in small chair
• Plays in standing
• Walks well, squats, picks up toys from the floor
• Climbs into adult chair
• Flings ball
• Pulls toys when walking
• Begins to run
• Walks upstairs with one hand held
• Pushes and pulls large toys or boxes on floor

Cognitive

• Acts on object using variety of schema
• Imitates model
• Symbolic play with real props
• Understands how objects work
• Understands function of objects
• Uses trial-and-error in problem-solving
• Recognizes names of various body parts

Social

• Moves away from parent
• Shares toys with parent
• Responds to facial expressions of others

TODDLERS(18–24 Months)

PLAY OCCUPATIONS

Functional Play

• Multischeme combinations
• Performs multiple related actions together

Gross Motor Play

• Enjoys sensory input of gross motor play

Pretend or Symbolic Play

• Makes inanimate objects perform actions
• Pretends that objects are real or that they symbolize another object

Social Play

• Participates in parallel play
• Imitates parents and peers in play
• Participates in groups of children
• Watches other children
• Begins to take turns

PERFORMANCE SKILLS

Regulatory/Sensory Organization

• Enjoys solitary play for a few minutes
• Uses PlayDoh
• Enjoys rough and tumble play

Fine Motor/Manipulation

• Completes 4 to 5 piece puzzle
• Builds towers(e.g. 4 blocks)
• Holds crayon in fingertips and draws simple figures(straight stroke or circular stroke)
• Strings beads
• Begins to use simple toys
• Participates in multipart tasks
• Turns pages of book

Gross Motor/Mobility

• Runs, squats, climbs on furniture
• Climbs on jungle gym and slides
• Moves on ride on toy without pedals
• Kicks ball forward
• Throws ball at large target
• Jumps with both feet(in place)
• Walks up and down stairs

Cognitive

• Links multiple steps together
• Has inanimate object perform action
• Begins to use non realistic objects in pretend play
• Continues to use objects according to functional purpose
• Object permanence is completely developed

Social

• Expresses affection
• Shows wide variety of emotions: fear, anger, sympathy, joy
• can feel frustrated
• Enjoys solitary play, such as coloring, building
• Engages in parallel play
• Laughs when someone does something silly

WHY IS IT IMPORTANT?

The development of occupational performance is influenced by many systems and variables in the individual child and in the environment. The various patterns observed in children provide insight into how and why a child follows a certain developmental trajectory.

Sensory, motor, cognitive and social skills support the child’s performance in play occupations. At the same time, a child’s activities are highly influenced by his or her cultural, social, and physical contexts.

REFERENCES

Occupational therapy for children,

Case-Smith

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