gross motor milestones 2 – 5 years

Gross Motor Gross Motor MilestonesMilestones2 – 5 Years2 – 5 Years

Gross Motor Gross Motor MilestonesMilestones2 – 5 Years2 – 5 Years

Group 1Group 1

Gross Motor Milestones2 – 5 Years

During the Second Year:• Jumps in place with both feet• Jumps down from a bottom step• Kicks a large ball forward• Tosses a large and small ball• Develops a consistent heel strike in gait• True running emerges with a non-support

phase, stops are difficult requiring a large turn area


During the Second Year:• Stands on one foot 1-3 seconds• Catches a large ball using arms and body• Walks on tiptoes• Walks backwards• Goes up and down stairs independently using

a rail• Pushes a riding toy with feet while steering


Gait Pattern Matures During the Third Year:

• Narrower BOS• Feet closer together• Heel toe progression• Shoulders in neutral• Elbows extended• Hips and knees extended• Reciprocating arm swing

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Gait Pattern Matures During the Third Year:• Pelvic rotation• Out-toeing reduced• Consistent heel strike and knee flexion present in early

stance.• Walking velocity for height is consistent with that of an

adult.• Cadence decreases, velocity increases• Step length and stride length increase• Balance mechanisms when walking continue to be

refined as single leg stance balance is immature.


During the Third Year:• Goes up steps alternating feet w/o rail• Goes down steps marking time w/o rail• Climbs up and down slide independently• Makes sharp turns while running• Pedals a tricycle


During the Third Year:• Catches ball with outstretched arms• Balances on toes in standing• Stands with one foot in front of the other• Stands on one foot up to 5 seconds• Hops on one foot 1-3 times


During the Fourth Year:• Gallops• Goes down stairs without w/o a rail alternating

feet• Stands on one foot 8 seconds• Catches smaller balls• Rides 3-wheeled toys• Catches bounced ball most of the time


During the Fifth Year:• Skips• Stands on one foot 10 seconds• Runs on tiptoes• Long jumps• Interested in performing dance steps• Capable of learning complex body

coordination skills like swimming, roller skating, and riding bicycles

•Overhand throwing accomplished

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Balance

• Steady State• Body morphology of child = top heavy =

more sway. COM = T 12 instead of L5-S1.

• Study 2-14 y.o. amplitude of sway and variation of sway decrease with increasing age

• Adult values at 9-12 with eyes open and 12-15 with eyes closed.

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Balance cont.• Dynamic

– Anticipatory• 9 mo-activation of postural muscles of trunk in

most reaching movements while sitting.• 12-15 mo-postural muscles of trunk activate

before reaching in standing.• Postural reactions seen before step initiation

with as little as 1-4 mo of walking experience.• 4-6 years, anticipatory reactions essentially

mature.• Between 1-4 yo, shift from “enbloc” to

“articulated” mode of anticipatory balance

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Balance cont– Head and Trunk Stability

• Until 6 yo - “en bloc” mode - head moves with trunk, reactive balance organized from feet up using proprioceptive and cutaneous clues

• By 7 yo - “articulated” mode - head moves freely, reactive balance organized top down using vision and vestibular info.

– Reactive• Study 15 mo - 10 yo showed younger children

to have increased coactivation and slower, longer, and more variable responses to a moveable platform. Mature responses by 7-10 years.

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Balance cont.

• Activation of monosynaptic stretch reflex until 2.5 yo when reduces and gone by 4 yo

• 4-6 yo responses slower and more variable. Theory due to dimensional growth changes but more likely due to developmental changes in nervous system itself.

• Independent steps do not translate into stepping strategy. Begins with 1- 3 mos walking experience and is refined after 6 mos experience.

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Balance cont.

– Proactive• Has been suggested that children acquire

feedback control of balance before feed forward control

• Very little research

– Run, Gallop, Hop, Skip• develop in order, each requiring additional

strength and balance.• These milestones have been said to be better

indicators of balance development than chronological age.

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Fine Motor/Self Help Fine Motor/Self Help Milestones Milestones 2-5 years2-5 years

Group 1Group 1

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Fine Motor Manipulation Milestones2 – 5 Years

By 2 years of age:• Uses a mature pincer grasp to hold tiny objects• Uses radial palmar grasp to pick up a 1” cube• Pronated finger grasp on cylindrical objects• Able to point isolating the index finger• Beginning in-hand manipulation (finger to palm)• Controlled release of objects (inserts large puzzle pieces, stacks

3-5 blocks)• Scribbles when given a crayon• Uses both hands to hold and carry objects, clap hands together

• Can stabilize with one hand and manipulate with the other• Able to turn pages of a book

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Self Help Milestones2 – 5 Years

By two years of age:Dressing• Dresses/undresses self in simple clothing with assistance

e.g. finds arm hole, doffs socks, shoes, hat, holds leg out to assist with putting pants on, helps doff pants

Toileting• Indicates need to go to the bathroom• Indicates when wet/soiledBathing/Grooming• Enjoys bath time but may resist grooming tasks

Feeding• Uses spoon with minimal spillage and drinks from a sippy cup• Begins to drink from small cup without lid

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By 3 years of age:• In hand manipulation develops (palm to finger

translation)• Controlled release with shoulder, elbow, and wrist

stability• Stacks 4-7 1” blocks• Opens simple containers with lids• Winds wind-up toys• Can string large beads• Copy a simple line and circle• Colors large forms• Snips with scissors

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By three years of age:Dressing• Independent doffing clothing items• Dons front opening shirt/coat, needs assistance to don pullover clothing• Unfastens large buttons and zippers

Toileting• Assistance for clothing management and hygiene• Daytime control, night time requires diapers

Bathing/Grooming• Participates in washing self but not independent• Washes hands at sink with supervision and cues• Assists with but often resists grooming

Feeding Able to self-feed independently

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By four years of age:• In hand manipulation improves rapidly (moves small objects

efficiently with one hand, can hold small objects in palm and move objects with fingers-translation with stabilization)

• Able to manipulate large buttons• Mature tripod or quadropod grasp on a pencil (clear hand

preference)• Cuts out large shapes with scissors• Colors in the lines• Copies simple shapes

• Stacks tower of 9-10 blocks• Draws tadpole images of people

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• By four years of age:Dressing:• Independently undresses • Occasional cues for clothing orientation for pull over clothing• Dons shoes and socks independently• Manipulates zippers independently after set-up (zipper is engaged), able to fasten large

buttons

Toileting:• Day and night time control• Assist may be needed for appropriate hygiene and to manage fasteners

Bathing/Grooming:• Supervision in the bathtub, needs assist to wash hair• Independently washes hands/face at the sink• Assists with grooming tasks (tooth brushing, nose wiping, brushing hair)

Feeding:• Able to use a fork independently, • Arranges items on table correctly

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By five years of age:

• Hand dominance is usually established• Draws a person with 6 parts• Can print their name, copy some numbers, and simple

words

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• By age five:Dressing:• Assistance with clothing selection, belts, back zippers• Learns to tie shoelaces (between ages 5-6)Toileting:• Complete independenceBathing/Grooming:• Set-up and supervision for bathing (for safety)Feeding:

• Manages soup with a spoon• Can drink from an open cup without spilling

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Speech/LanguageSpeech/LanguageDevelopmental MilestonesDevelopmental Milestones

Speech/LanguageSpeech/LanguageDevelopmental MilestonesDevelopmental Milestones

Group 1Group 1

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Speech and Language Milestones2-5 years

• By the age of 2:– Points to a few body parts when asked– Follows simple commands and understands

simple questions (ex. “Roll the ball,” “Kiss the baby,” “Where is your shoe?”)

– Listens to simple stories, songs, and rhymes– Points to pictures in a book when named– Says more words every month

– Uses some one- or two- word questions (ex. “Where’s kitty?” “Go bye-bye?”)

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• By 2 years of age (cont):– Puts two words together (ex. “more

cookie”, “no juice”, “mommy book”)– Uses many different consonant

sounds at the beginning of words.

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• By 3 years of age:– Understands differences in meaning

• Ex. “go-stop”, “in-on”, “big-little”, “up-down”– Follows two requests

• Ex. “Get the book and put it on the table.”– Listens to and enjoys hearing stories for

longer periods of time.– Has a word for almost everything– Uses 2- or 3- words to talk about and ask

for things.

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• By 3 years of age (cont):– Uses /k, g, f, t, d, and n/ sounds.– Speech is understood by familiar

listeners most of the time.– Often asks for or directs attention to

objects by naming them.

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• By 4 years of age:– Hears you when you call from another room– Hears television or radio at the same

loudness as other family members– Answers simple “who?”, “what?”, “where?”,

and “why?” questions– Talks about activities at school or at

friends’ homes– People outside of the family usually

understand the child’s speech

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• By 4 years of age (cont):– Uses a lot of sentences that have 4 or

more words– Usually talks easily without repeating

syllables or words

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• By 5 years of age:– Pays attention to a short story and answers

simple questions about it– Hears and understands most of what is said

at home and in school– Makes voice sounds clear like other

children’s– Uses sentences that give lots of details (ex.

“I like to read my books.”)– Tells stories and are able to stay on topic

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• By the age of 5 years (cont):– Communicates easily with other children

and adults– Says most sounds correctly (except perhaps

certain ones such as /l, s, r, v, z, ch, sh, th/)– Uses the same grammar as the rest of the

family

Reference: http://www.asha.org

/public/speech/development/language speech.htm

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Social and Emotional Milestones2-5 years

• By the end of 2 years:– Imitates behavior of others, especially adults

and older children– Is more aware of self as separate from

others– Is more excited about the company of other

children– Demonstrates increasing independence– Begins to show defiant behavior

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• By the end of 2 years (cont):– Separation anxiety increases toward

midyear then fades

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• By the end of 3 years:– Imitates adults and playmates– Spontaneously shows affection for familiar

playmates– Can take turns in games– Understands the concept of “mine” and

“his/hers”– Expresses affection openly– Expresses a wide range of emotions

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• By the end of 3 years (cont):– Separates easily from parents– Objects to major changes in routine

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• By the end of 4 years:– Interested in new experiences– Cooperates with other children– Plays “Mom” or “Dad”– Increasingly inventive in fantasy play– Dresses and undresses– Negotiates solutions to conflicts– More independent

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• By the end of 4 years (cont):– Imagines that many unfamiliar

images may be “monsters”– Views self as a whole person

involving body, mind, and feelings– Often cannot tell the difference

between fantasy and reality

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• By the end of 5 years:– Wants to please friends– Wants to be like his/her friends– More likely to agree to rules– Likes to sing, dance, and act– Shows more independence and may even

visit a next-door neighbor by self– Aware of gender– Able to distinguish fantasy from reality

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• By the end of 5 years:– Sometimes demanding, sometimes

eagerly cooperative

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Typical Typical Developmental SkillsDevelopmental Skills

2 – 5 year olds2 – 5 year olds

Typical Typical Developmental SkillsDevelopmental Skills

2 – 5 year olds2 – 5 year olds

ReferencesReferences

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References

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References

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• Eisenberg A, Hathaway SE, & Murkoff HE. What to Expect: The Toddler Years. New York: Workman Publishing; 1994.

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• Oeseterreich L. (1995). National Network for Childcare. Ages & Stages – Five-Year-Olds. Available at: http://www.nncc.org/Child.Dev/ages.stages.5y.html. Accessed on: 04/27/09.

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References

• Powell ML. Assessment and Management of Developmental Changes and Problems in Children. 2nd ed. St. Louis: C.V. Mosby Company; 1981.

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References

• Tecklin JS. Pediatric Physical Therapy. 3rd ed. Baltimore: Lippincott, Williams & Wilkins; 1999:22-25.

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gross motor milestones 2 – 5 years

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