Rehabilitation and Developmental Services

The following pages describe the typical sequence of child development. As you read through them, please remember that children develop at different rates and at different ages. What is "normal" can cover a wide range, especially if your child was born prematurely.

Top of page













Developmental Milestones

Click on Age Range you would like to review.


About 0 to 3 Months

About 3 to 6 Months

About 6 to 9 Months

About 9 to 12 Months

About 12 to 18 months

About 18 to 24 Months

About 24 to 36 Months

About 36 to 48 Months

About 48 to 60 Months

About 60+ Months


Top of Page





About 0 to 3 Months__________________________________________________

Receptive Language
● Startles in response to loud noise
● Smiles in response to familiar voice
● Quiets to a familiar voice
● Looks directly at a speaker's face
● Begins to turn head and eyes toward sound
● Anticipates sound associated with feeding
● Maintains brief eye contact during feeding

Expressive Language
● Makes soft, throaty sounds
● Cries differently to express hunger, irritation, and pain
● Expresses pleasure by cooing, squealing, gurgling
● Produces consonant sounds g, k, and b
● Produces vowel sounds eb, ab, and ub
● Enjoys taking turns in vocalizing with parents
● Smiles in response to his/her mirror image

Fine Motor
● Uses eyes to follow an object moving slowly in the direction of up, down, and across
● Holds rattle briefly when placed in hand
● Watches movement of own hands

Gross Motor
● Waves hands and kicks feet while lying on stomach
● Turns from side to back
● Turns head to either side when lying on stomach or back
● Holds head

Back to Developmental Milestones





About 3 to 6 Months___________________________________________________

Receptive Language
● Shows fear of angry voice
● Smiles and laughs at pleasant speech
● Turns head toward sound and human voice
● Responds to his/her name
● Stops crying when talked to

Expressive Language
● Babbles by repeating a series of same sounds
● Laughs during play
● Changes sounds with body positions: p, b, m, n
● Makes tongue clicking sounds
● Blows raspberries through closed lips/tongue movement
● Vocalizes with 4 or more different consonant-vowel syllables (na, goo)
● Begins imitating sounds
● Makes protest sounds when desired objects are removed
● Smiles and waves arms to continue social greeting

Fine Motor
● Holds hands together at midline
● Brings hands together at midline to hold an object
● Bangs objects in play
● Uses fingers and palm to grasp objects

Gross Motor
● Pushes up from floor to bear weight on forearms
● Rolls from stomach to back
● Reaches for feet and brings to mouth
● Pushes self to a sitting position and sits along momentarily

Back to Developmental Milestones





About 6 to 9 Months__________________________________________

Receptive Language
● Looks for Family members when asked, Where's Mommy/Daddy?
● Looks at some common objects when named
● Responds to his/her name more consistently by stopping activity
● Attends somewhat to music
● Responds with gestures to such words as up, bye-bye
● Appears to listen to conversations by looking at each speaker
● Pauses momentarily in response to no-no
● Looks at pictures while someone talks about them

Expressive Language
● Imitates familiar gestures
● Uses 2-syllable babbling (mama, dada, gaga)
● Vocalizes to call attention to himself/herself
● Babbles using singing-like tones, especially to music
● Plays speech-gesture games (pat-a-cake, peek-a-boo)
● Uses some gesture language such as shaking head no
● Often imitates sounds and number of syllables used by others

Fine Motor
● Uses raking motion to obtain an object
● Reaches for and obtains objects 10-12" away
● Transfers objects from one hand to the other
● Claps hands
● Rotates wrist to manipulate toy or object

Gross Motor
● Stretches out arms for protection when in a sitting or upside-down position
● Crawls forward with stomach on floor
● Sits and reaches for toys
● Assists in pulling self to a standing position

Back to Developmental Milestones





About 9 to 12 Months__________________________________________________

Receptive Language
● Understands some simple requests (give me a kiss; open your mouth, etc.)
● Understands simple, over-learned words (bot, so big)
● Responds to simple questions with searching movements
    (Where's your shoe? The ball?)
● Becomes interested in sounds outside the immediate situation
● Responds to music with body movements in rhythmic time to the beat

Expressive Language
● Plays exchange games with adults (handling objects back and forth)
● Initiates games of pat-a-cake and peek-a-boo
● Uses jargon (strings of a wide variety of vowel-consonant combinations with changes in tone/pitch)
● Uses first true word with meaning
● Attempts to imitate new words
● Imitates cough, tongue clicks
● Uses exclamations like bub
● Uses referential words or sounds (woo-woo for dog)
● Converses with people, toys, mirror using jargon

Fine Motor
● Purposely releases an object
● Uses a neat pincer grasp
● Bangs spoon or cup
● Makes mark on paper with pencil or crayon
● Pokes at objects with index finger

Gross Motor
● Creeps forward on hands and knees
● Pulls self to a standing position using stable support
● Walks holding onto furniture
● Walks with support
● Lets go of support and stands alone

Back to Developmental Milestones




About 12 to 18 months_________________________________________________

Receptive Language
● Understands simple 1-step commands
● Recognizes body parts (hair, eyes, hands, mouth)
● Understands names of common objects by bringing them from another place upon request
● Identifies 2 or more familiar objects from a group of 3 or 4 objects by touching/pointing
● Enjoys listening to rhymes and jingles
● Begins to look more selectively at pictures to recognize them when named

Expressive Language
● Attempts to get objects by pointing and vocalizing
● Uses from 3 to 20 simple words meaningfully
● Omits final sounds and words frequently
● Uses words of more than one syllable (bottle)
● Answers questions such as What's this?
● Asks for more
● Uses 2-word-combinations as single words (gimme, c'mere)
● Communicates primarily through true words and gestures

Fine Motor
● Places cubes in a cup
● Holds crayon and scribbles on paper
● Stacks one block on top of another
● Builds tower of 3-4 cubes
● Places ¼" pegs in board

Gross Motor
● Creeps up steps
● Stands alone in the middle of the floor
● Creeps down steps backwards
● Rises to a standing position independently
● Kneels unassisted
● Walks alone

Back to Developmental Milestones





About 18 to 24 Months_________________________________________________

Receptive Language
● Recognizes body parts and clothing articles in large pictures
● Understands simple yes/no questions
● Understands differences in personal pronouns (me/you)
● Follows a series of 2-3 simple related commands with the same object
● Appears to listen to meaning of language, not merely words
● Recognizes many common objects and pictures when named
● Understands spatial concepts in and on by moving his/her body and objects in space

Expressive Language
● Replaces jargon with meaningful words
● Invites animal sounds and other environmental sounds in play
● Refers to self by name
● Uses no frequently
● Uses my to declare ownership
● Begins combining words to form 2-word phrases (go bye-bye, Mommy shoe)
● Asks questions by raising pitch of voice at end of word or phrase

Fine Motor
● Imitates a vertical stroke using a crayon
● Places 3 shapes in a formboard
● Manipulates an object with fingers and thumb
● Turns pages of a book one-by-one

Gross Motor
● Walks up and down steps with support
● Pushes/pulls a light object
● Runs length of the room without falling
● Picks up a toy from the floor while standing

Back to Developmental Milestones





About 24-36 Months___________________________________________________

Receptive Language
● Understands actions in pictures
● Recognizes names of smaller body parts (chin, knee, elbow)
● Understands functions of objects (Which one do we comb hair with? drink out of?)
● Understands size concept (big, little)
● Understands quantities (one, more, all)
● Understands spatial concepts in, on, under
● Becomes aware of a sequence/organization for daily routines (mealtime, bathtime, bedtime)
● Understands question forms who? where? what…doing?
● Understands genders boy, girl
● Likes to listen to short stories

Expressive Language
● Combines words to express:
          Possession-My coat
          Recurrence-More juice
          Action-Go outside
          Location-Want up
          Negation-No eat
● Usually uses 2-4 word combinations
● Asks for help with personal needs (toileting, washing hands)
● Names and talks with his/her drawing
● Can say first and last name when asked
● Can repeat 2 numbers in sequence
● Talks about an event that just happened
● Uses many commands (go get it)
● Uses here, there as adverbs
● Begins using is verb form
● Uses pronouns I, Me, Mine, and You
● Has mastered production of early developmental sounds p, b, m, n, h, w, t, d
● Speech is understood by others 70-80 percent of the time

Fine Motor
● Imitates drawing horizontal/vertical strokes
● Snips paper using blunt scissors
● Completes formboard of 5 or more pieces
● Tries to button/unbutton large buttons

Gross Motor
● Walks up and down steps holding the rail
● Kicks ball forward
● Throws ball overhand
● Balances momentarily on one foot
● Pedals a tricycle
● Runs without falling

Back to Developmental Milestones





About 36 to 48 Months_________________________________________________

Receptive Language
● Understands concepts hard, soft, rough, smooth
● Understands spatial concepts front, back
● Understands question forms What do you do when you're hungry? sleepy? cold?
● Follows 2-step directions involving 2 different actions

Expressive Language
● Asks many who? what? where? and why? questions
● Uses 4-5 word sentences most of the time
● Engages in detailed conversations
● Uses language in imaginative play
● Imitates whispering
● Relates 2 events in correct sequential order
● Completes simple verbal opposites (Daddy is a boy; Mommy is a girl)
● Uses verb forms is, am, are
● Uses contracted forms won't, can't
● Uses regular past tense (walked)
● Uses regular plural forms consistently (blocks)
● Uses pronoun myself for emphasis
● Uses possessives (Mommy's car)
● Uses prepositions in, on, under
● Uses and as a connective word
● Begins using because as an explanation

Fine Motor
● Strings 1/2" beads
● Copies a circle
● Puts together objects requiring eye-hand coordination
● Snips along a straight ¼" lines with a continuous opening/closing motion

Gross Motor
● Catches a bounced ball
● Walks up and down steps alternating feet without support
● Throws Ball over head
● Walks heel-toe along a straight line
● Stands momentarily on balance beam without assistance

Back to Developmental Milestones





About 48 to 60 Months________________________________________________

Receptive Language
● Follows series of 3 unrelated commands
● Identifies 2 or 3 primary colors
● Understands concepts heavy/light, loud/soft, day/night
● Understands directional concepts above/below, top/bottom
● Understands variety of question forms where? when? how? 

Expressive Language
● Combines 4 to 8 words in sentences
● Describes objects according to size, shape, color
● Enjoys retelling stories
● Enjoys asking meaning of new words
● Uses could/would verb forms
● Uses future tense verb forms (will)
● Uses no/not appropriately
● Uses contracted negatives (can't/don't)
● Regularly uses pronouns he, she, they, and possessive pronouns his, her, our, their
● Uses if and so in forming complex sentences
● Uses most consonant sounds consistently and accurately, but hasn't mastered them in all words

Fine Motor
● Can demonstrate hand preference
● Copies shapes (circle, square, triangle, rectangle)
● Draws a stick figure
● Cuts out a circle and other simple shapes

Gross Motor
● Gallops and skips while alternating feet
● Hops on 1 foot
● Catches a Ball with both hands
● Walks on tiptoes for 10 feet
● Kicks rolling ball toward a target

Back to Developmental Milestones





About 60+ Months_____________________________________________________

Receptive Language
● Identifies all primary colors
● Understands concepts same/different
● Understands concepts first/middle/last
● Understands spatial concepts left/right
● Understands more time-related concepts (before/after, yesterday/tomorrow)
● Understands question forms What happens if…?
● Understands question forms How often? How long?

Expressive Language
● Retells a brief story
● Asks meaning of abstract words
● Can tell home address
● Talks about events in the future using will
● Uses pronouns himself/herself
● Compares objects using -er and -est endings (bigger, biggest)
● May distort or substitute for speech sounds s, z, r, tb, and consonant blends pl, tr, sp, etc.

Fine Motor
● Prints capital letters and simple words; some letter/word reversals are evident
● Uses appropriate hand placement while cutting and writing
● Prints numbers 1-5
● Laces own shoes

Gross Motor
● Jumps rope
● Roller skates
● Hops 2-3 yards forward on each foot
● Runs with arms swinging opposite to feet
● Jumps on toes from a height of 12"

Back to Developmental Milestones





Types of Therapy

Behavioral Therapy
Deals with the psychosocial aspects of chronic physical illness, including medical nonadherence and treatment failure, as well as with psychosomatic illness and medically unexplained physical symptoms in children and adolescents. Specialized treatment services, including individual, group and family therapy are available, as well as pediatric behavioral medicine interventions such as biofeedback, behavioral weight control, and the management of other health-related eating problems.

Occupational Therapy
Evaluation and treatment services for children who have monitor or sensory difficulties due to delays in development, traumatic injuries, congenital abnormalities, surgeries, or other medical conditions. Specialized pediatric therapist evaluate and treat the following: upper extremity function-range of motion, sensation, and fine motor skills; activities of daily living-self-feeding, dressing and hygiene skills; splinting needs for the prevention of deformities in upper extremities; perceptual and cognitive development; feeding evaluation and treatment; sensory development, and sensory integration.

Physical Therapy
Evaluation and treatment services for children who have motor or sensory difficulties due to delays in development, traumatic injuries, congenital abnormalities, surgeries or other medical conditions. Specialized pediatric physical therapists evaluate and treat the following: gross motor development and skills; range of motion and joint mobility; muscle strength; analysis of ambulation and gait; ability to transfer; posture evaluation; modalities; and splinting needs for the prevention of deformities in the lower extremities.

Respiratory Therapy
Provides a full range of cardiopulmonary therapeutics for infants, children, and adolescents in both the inpatient and outpatient settings. Services include: mechanical ventilation, non-invasive monitoring, stat blood gas laboratory analysis, oxygen administration, aerosolized drug delivery, and postural drainage/percussion and vibration.

Speech/Language Therapy
Provides audio logy services related to the identification, assessment, and management of hearing impairment and provides comprehensive speech and language services. Patients may have a variety of medical disorders including seizures and other neurological disorders, head injuries, developmental disabilities, tracheotomies, hearing disorders, meningitis, respiratory disorders (ventilator dependency), and/or are at risk for hearing loss or speech and language disorders. Audiologists and speech-language pathologists can provide consultation services including assessment, treatment, and discharge planning involving patient rehabilitative management.

Vision Therapy
Exercises designed to improve eye movement control, focusing control, and eye coordination. Common for conditions such as crossed eyes, lazy eye, and dyslexia. Although controversial in the field of ophthalmology, many families, therapists, and optometrists report effective results.

Top of page





How to Find a Therapist

A therapy program works best when there is a good rapport between the family and the therapist. The recommended services should be accessible for the family-financially and geographically. Often in a good therapeutic experience, families find interactions with their child have become more enjoyable.

The following are some things to consider when selecting a therapist:

Location
The ideal situation is to find a therapist who lives near your home or office. If you are interested in a particular program and transportation is a concern, find out if the program offers transportation services, or if the service provider is knowledgeable about community-based transportation resources.

Cost
Most insurance plans, including Medical Assistance, provide some therapy coverage. Check the benefits of your policy. Some therapy programs have alternative funding resources to help children with inadequate or no insurance. Call the program of your choice to find out what options are available.

Recommendations
A recommendation of a therapist by a "satisfied customer" can be a helpful guide. But remember that each child has different needs, and a therapist who worked well for one family may not be as well-suited for your child's situation.

Family/Therapist Relationship
You should feel comfortable asking the therapist various questions, including the reasons why the therapy is necessary, the techniques that will be used, the length of time the therapeutic program will require, the anticipated results, etc. The answers you receive should be clear, complete, and meaningful. As often as necessary, you should feel welcome to ask for additional clarification, including information in writing. A family should be informed of the overall plan behind the therapeutic approach to ensure that the service is not just a haphazard application of techniques. A good therapist cares about the family's insights regarding the child's condition, along with the family's concerns and goals for the child.

Child/Therapist Relationship
The therapist should be willing to learn about your child's medical condition and any distinct needs or differences that can affect the treatment. A good therapist is sensitive to your child's needs, questions, and comments. The child needs to be told what the treatment involves, with the information presented at his or her level of understanding.

Both the therapist and the family should do all they can to make the child's experience as comfortable as possible.

Confidentiality
Families should be assured that all the issues related to their child's condition and needs will be handled in a confidential manner.

(Source: D.T. Watson Rehabilitation Hospital, The Pediatric Program)

Top of page





Providers of Rehabilitation Services-Index

Albert Gallatin Home Care and Hospice.................................................................................................. 800-753-2425
       ................................................................................................................................................................. 724-438-6660

Allegheny County Department of Human Services................................................................................ 412-350-5706

Allegheny Intermediate Unit 3 (IU 3)......................................................................................................... 412-394-5700

Achieva Early Intervention.......................................................................................................................... 412-995-5000

Child's Way................................................................................................................................................... 412-365-6065

Children's Hospital of Pittsburgh............................................................................................................... 412-692-5325
       Asthma, Allergy and Infectious Disease............................................................................................ 412-692-7885
       Audiology and Communication Disorders ....................................................................................... 412-692-5673
       Dermatology, Pediatric......................................................................................................................... 412-692-6722
       Endocrinology, Diabetes, Metabolism and Nutrition Counseling ................................................. 412-692-6164
       Enterostomal Therapy.......................................................................................................................... 412-692-7580
       Neonatal Intensive Care Unit (NICU) ............................................................................................... 412-692-5050
       Primary Care Center ............................................................................................................................ 412-692-6000
       Rehabilitation Services, Children's Cerebral Palsy and Related Disorders............................... 412-692-5097

The Children's Institute............................................................................................................................... 412-420-2400

The Children's Therapy Center of Washington Hospital....................................................................... 724-942-6100

Citizen Care, Inc........................................................................................................................................... 412-787-2350

DePaul Institute............................................................................................................................................ 412-561-4848

Early Intervention Specialists (EIS)....................................................................................................... 1-877-EIS-5711

The Early Learning Institute (TELI)........................................................................................................... 412-922-8322

Easter Seal Society of Western PA........................................................................................................... 412-281-7244

Family Resources........................................................................................................................................ 412-363-1702

Holy Family Institute.................................................................................................................................... 412-766-9020

The Integrated Care Corporation (The I. Care Corp)............................................................ 1-888-645-LOVE (5683)

Interim Pediatrics......................................................................................................................................... 412-766-9020

Interim Health Care, Mental Health Department..................................................................................... 412-683-2227

Laughlin Center............................................................................................................................................ 412-741-4087

Long Run Children's Learning Center...................................................................................................... 412-469-7240

Multiple Sclerosis Service Society (Serves Southwestern PA)............................................................ 412-469-7240

Muscular Dystrophy Association (MDA) of Southwestern and Midwestern PA................................. 412-823-4094

Pediatric Therapy Professionals, Inc........................................................................................................ 724-656-8814

People's Oakland......................................................................................................................................... 412-683-7140

Pittsburgh Board of Education Program for Students with Exceptionalities
       (Pittsburgh-Mt. Oliver Intermediate Unit 2 (IU2)................................................................................ 412-323-3950

PLEA.............................................................................................................................................................. 412-243-3464

Riding for the Handicapped of Western PA............................................................................................. 724-443-4485

Samaritan Counseling Center of Western Pennsylvania (Play therapy)............................................ 412-741-7430

Sewickley Valley Hospital.......................................................................................................................... 412-741-6600
       Speech Language Pathology Department........................................................................................ 412-749-7097
       Staunton Clinic...................................................................................................................................... 412-749-7330

South Hills Health System.......................................................................................................................... 800-368-4663
       ................................................................................................................................................................. 412-469-7171

Staff Builders Health Care Services......................................................................................................... 412-781-4260

Transitional Infant Care Hospital............................................................................................................... 412-441-0700

UPMC Health System................................................................................................................................. 412-647-8762
       Cleft Palate-Craniofacial Center......................................................................................................... 412-648-8400
       ................................................................................................................................................................. 800-408-7390
       In-Home Services Network.................................................................................................................. 888-860-2273
       Theiss, Matilda H., Health Center...................................................................................................... 412-383-1570
       UPMC St. Margaret............................................................................................................................... 412-784-4000

Verland Foundation, Inc.............................................................................................................................. 412-741-2375

The Watson Institute ................................................................................................................................... 412-741-1800
      
LEAP ............................................................................................................................................................. 412-781-1708

Western Pennsylvania School for Blind Children................................................................................... 412-621-0100

YWCA of Greater Pittsburgh...................................................................................................................... 412-255-1243

Top of page





Providers of Developmental Assessment-Index

Allegheny Intermediate Unit 3 (IU3).......................................................................................................... 412-394-5700
       Project Dart............................................................................................................................................ 412-394-5736
       Pupil Personnel Services (Referrals)................................................................................................ 412-394-5708

The Alliance for Infants and Toddlers, Inc................................................................................................ 412-885-6000

Automated Health Systems, Inc................................................................................................................. 800-543-7633
       ................................................................................................................................................................. 724-543-7633
      
Children's Hospital of Pittsburgh............................................................................................................... 412-692-5325
       Audiology and Communication Disorders........................................................................................ 412-692-5673
       Child Development and Child and Family Counseling Center..................................................... 412-692-5589
       Family Intervention Center.................................................................................................................. 412-692-8664
       Genetics, Medical................................................................................................................................. 412-692-5070
       Healty Feeding, Center for.................................................................................................................. 412-692-5400
       Muscular Dystrophy.............................................................................................................................. 412-692-5520
       Neonatal Intensive Care Unit (NICU)................................................................................................ 412-692-5030
       PKU (Phenylketonuria) Program........................................................................................................ 412-692-8631
       Primary Care Center............................................................................................................................. 412-692-6000

The Children's Therapy Center of Washington Hospital....................................................................... 724-942-6100

Laughlin Center............................................................................................................................................ 412-741-4087

Long Run Children's Learning Center...................................................................................................... 412-751-9022

UPMC Mercy................................................................................................................................................ 412-232-7388
       Adoption Resource Center of Pittsburgh........................................................................................... 412-575-5805
       Developmental and Behavioral Clinic............................................................................................... 412-232-7259
       .................................................................................................................................................... EMER 412-232-7388

Muscular Dystrophy Association (MDA) of Southwestern and Midwestern PA................................. 412-823-4094

Pittsburgh Board of Education Program for Students with Exceptionalities;
       Pittsburgh-Mt. Oliver Intermediate Unit 2 (IU 2)................................................................................ 412-323-3950

Pittsburgh Hearing, Speech, & Deaf Services, Inc................................................................................. 412-281-1375

Pittsburgh Blind and Vision Rehabilitation Services....................................................................... need new number

Sewickley Valley Hospital.......................................................................................................................... 412-741-6600
       Speech Language Pathology Department........................................................................................ 412-749-7097
       Staunton Clinic...................................................................................................................................... 412-749-7330
       .................................................................................................................................................... EMER 412-741-6600

UPMC Health System.............................................................................................................................. 412-647-UPMC

UPMC St. Margaret...................................................................................................................................... 412-784-4000
       .................................................................................................................................................... EMER 412-784-4200

(Source: This chapter was compiled by parent Tina Calabro, along with Julie Hladio of the Alliance for Infants and Toddlers, Inc. Information came from various sources, including the Early Intervention Handbook, The Alliance for Infant and Toddlers, Inc.; the Education Law Center-PA; Children's Hospital of Pittsburgh; and The Watson Institute.)

Top of page