How Physical, Occupational, and Speech Therapy Help With Developmental Milestones

What are developmental milestones?

Developmental milestones are skills such as taking a first step, smiling for the first time and waving bye-bye, and children reach them in how they play, learn, speak, act and move.⁠² On the CDC’s checklists, which an American Academy of Pediatrics expert group helped rewrite in 2022, each milestone is something most children (75% or more) can do by that age. The checklists are a guide for watching and for talking with the doctor, not a screening test.⁠^1,18

The four areas the checklists cover

The CDC groups milestones into four areas, and a delay can show up in one or several. Federal early intervention law counts five: cognitive, physical (including vision and hearing), communication, social or emotional, and adaptive development.⁠^18,19,20

• Social and emotional

  Calms when spoken to or picked up by 2 months; joins other children to play by 3 years.⁠^18,21

• Language and communication

  Reacts to loud sounds by 2 months; says two words together by 2 years.⁠^18,22

• Cognitive

  Looks at a toy for several seconds by 2 months; draws a circle when shown how by 3 years.⁠^18,21

• Movement and physical

  Holds head up on the tummy by 2 months; hops on one foot by 5 years.⁠^18,23

What changed in the 2022 milestone checklists?

The CDC and an AAP expert group rewrote the checklists to use evidence-informed milestones, make clear when most children reach each one, and discourage a wait-and-see approach. Many milestone lists give the average age for a skill, when half of children are not expected to have it yet, and in CDC focus groups parents of children with disabilities said their child’s delay was found late because they were told to wait.⁠¹

Taking a few steps alone is now a 15-month milestone and walking without holding on an 18-month one, and crawling does not appear on the checklists at all.⁠^24,25,26,27 Other lists may give different ages, because ages for the same milestone are inconsistent across sources.⁠¹

My child is behind on a milestone. Does that mean they need therapy?

Not by itself. A missed milestone is a reason to talk with your child’s doctor and ask about developmental screening, and screening, then an evaluation if needed, decides whether therapy would help.⁠^2,8 Lagging on one milestone does not always mean a developmental delay, and a child not yet doing a skill usually catches up; sometimes it is a sign of a health condition.⁠^3,19

Read the ages exactly. A child not walking at 14 months has not missed anything yet, because taking a few steps alone is a 15-month milestone.⁠²⁴ Once the age has passed, the checklists were built for asking, not waiting: their authors agreed that a child not meeting a milestone should be considered for screening.⁠¹

A pattern raises the concern. A developmental delay is diagnosed when there is a significant delay in more than one area, a lost skill is a reason to act early, and a delay that persists or comes with new problems may warrant a full assessment.⁠^2,19,28 A persistent feeling that something is off counts too: the CDC’s advice covers other concerns as well as missed milestones.⁠²

Track itDevelopmental milestones by ageMilestone tracker

Which therapy does my child need: PT, OT, or speech?

Often you do not have to decide: an early intervention evaluation looks at every area of development, and the assessment that follows identifies the services your child needs.⁠²⁹ Still, the division is worth knowing. Physical therapy works on gross motor skills such as rolling, sitting and walking; occupational therapy on fine motor and self-care skills such as feeding, picking up small objects and buttoning; speech-language therapy on understanding and using language, and on swallowing.⁠³

The three overlap. A speech-language pathologist usually leads the feeding team, with an occupational or physical therapist on it; the law’s definition of occupational therapy includes motor and postural development, and physical therapy covers perceptual and motor development.⁠^4,9 In early intervention one service coordinator, from the profession most relevant to your child’s needs, coordinates the services.⁠³⁹

CompareOT vs PT for kidsSpeech therapy vs OT

Motor milestones by age, and how physical therapy helps at each

The movement milestones on the CDC checklists, beside what a pediatric physical therapist typically works on when a skill is late. The therapist sets up the practice and coaches you to carry it into the day, because family who practice daily with a child have the greatest impact on each new skill.⁠^2,19

When a movement milestone is late, the therapist first works out why: low muscle tone, muscle shortening or weakness, trouble planning movement, sensitivity to touch, fear of new movements or a skeletal problem; high muscle tone is a reason for the doctor to look for a cause.⁠^19,42,43

Related guidesDelayed motor milestonesPT for babies and toddlersPT for preschoolers

Tummy time: how much a baby needs, and why it matters

Tummy time is supervised play on the stomach while your baby is awake. It builds the muscles and skills babies need for later milestones, and it is the daytime half of the advice that babies sleep on their backs.⁠⁴⁰ Avoiding it can slow how fast babies reach movement milestones.⁠¹⁹

1. Start early. You can begin the day your baby comes home from the hospital.⁠⁴⁰
2. Short and often. Two to three times a day for 3 to 5 minutes at first.⁠⁴⁰
3. Build up. Work up to 15 to 30 minutes a day by 7 weeks as your baby enjoys it.⁠⁴⁰
4. Give a reason to lift up. A toy or your face at eye level, or your baby on your chest looking up at you.⁠^18,40
5. Add reaching. Toys in a circle around your baby build the muscles to roll, scoot and crawl.⁠⁴⁰
6. Never leave them alone. If your baby seems sleepy, move them onto their back in a safe sleep space.⁠¹⁸

The research supports tummy time as part of motor development, not a cure-all: a 2020 review of 16 studies with 4,237 babies linked it to gross motor and overall development and to rolling and crawling, found no link with fine motor skills or communication, and was mostly observational.⁠⁴⁴ Time in seats is the other side: babies who spend a lot of time in chairs, carriers and swings are at higher risk of motor delays, and seats press on the back of the head.⁠^19,40 The 2018 physical therapy guideline on torticollis, a tight neck muscle that tilts the head, recommended supervised tummy play at least three times a day; it was updated in 2024.⁠^32,45

Related guidesFlat head (plagiocephaly)Torticollis in babies

What does a pediatric physical therapist actually do?

Less exercise than parents picture, and more practice built into play and daily routines. A pediatric physical therapist assesses your child’s strengths and needs, asks about your routines and home, then builds motor skills one step at a time toward specific goals.⁠¹⁹

The therapist sets things up so your child has to use the missing skill to get what they want: a toy just out of reach for a baby who is not rolling, safe furniture to pull up on, a push toy for a new walker.⁠^26,27,33 During visits they guide your child’s movement, then coach you on how to encourage it, teach you the cues to use, and suggest changes to your home.⁠¹⁹

Physical therapists also watch for what needs a doctor. Stiff or floppy muscles, trouble holding the head steady, using only one side of the body, or a skill going backward are reasons to see the pediatrician.⁠^3,10 The AAP’s motor-delay report puts special weight on muscle tone and tells doctors to pursue diagnostic tests while referring to early intervention at the same time.⁠⁴³

They treat the orthopedic side of development too. Toe walking is often present from the first steps until walking matures and usually lasts no more than six months after them; a physical therapist can test for the causes of toe walking that continues.⁠⁴²

Related guidesToe walkingW-sittingPhysical therapy for children

Occupational therapy milestones: hand skills, self-care and feeding by age

Occupational therapy milestones are the hand, self-care and feeding skills on the same checklists: reaching, finger feeding, cup, spoon and fork, dressing, drawing and buttoning.⁠^2,3 The foundation of everyday occupations such as eating, dressing and play is laid in early childhood, and the AOTA’s practice guideline covers children from birth to 5.⁠³⁰

Feeding milestones: from breast or bottle to fork and spoon

Feeding develops in order, from sucking and swallowing to chewing and self-feeding, and a delay can surface at any change along the way: a new texture, a cup, a spoon.⁠^34,47 ASHA’s feeding milestones:⁠⁴⁸

The CDC advises breast milk or formula only for about the first 6 months, and asking your baby’s doctor when to start solids; the AAP’s readiness signs include good head control in a high chair and opening the mouth when food comes.⁠^18,33,52 A pediatric feeding disorder, eating that is not appropriate for age along with a medical, nutritional, feeding-skill or psychosocial problem, is assessed across all four, usually by a team that a feeding specialist speech-language pathologist leads, with an occupational or physical therapist and a dietitian; a review of pediatric occupational therapy rated feeding interventions among those that work.⁠^9,34,46

Related guideFeeding therapy

What does a pediatric occupational therapist actually do?

The word occupational confuses everyone. For a young child the occupations are eating, dressing, play, learning, social participation, sleep and small chores, and occupational therapy covers the hands, the senses and the routines those depend on.⁠³⁰ Under early intervention law it addresses adaptive development and behavior, play, and sensory, motor and postural development, so a child can do tasks at home, at school and in the community.⁠⁴

For a toddler that might mean the grasp for finger feeding, tolerating the textures of a varied diet, or stacking, scribbling and using a spoon; for a preschooler, buttons, a pencil grip, cutting or dressing.⁠^{3,21,25,34,36} The AOTA guideline found interventions that support cognitive, social-emotional, motor and self-care skills, some of which parents can carry out after training.⁠³⁰

Occupational therapists also most often use sensory-based therapies, for children who have difficulty tolerating or processing sensations such as touch, sound or movement. The AAP notes that this difficulty is seen in many conditions, including autism, ADHD and developmental coordination disorder, and that research on sensory integration therapy is limited and inconclusive; it can be one part of a wider plan, with a set trial period and a way to judge whether it works.⁠³⁷ And occupational therapy is not only handwriting for school-age children: feeding, dressing and play are core occupations from birth.⁠³⁰

Related guidesOccupational therapy for childrenOT for babies and toddlersTesting for sensory processing differences

Speech and language milestones by age, and how speech therapy helps

Speech and language milestones track how a child understands, communicates and, later, talks in sentences. The CDC lists what most children do by each age; ASHA covers age ranges with more detail and suggests also looking at the ranges either side of your child’s age.⁠^18,53

How speech therapy helps at each stage

1. Babies: back-and-forth sounds

   Therapy coaches parents to respond to each attempt to communicate and to copy and expand sounds; the CDC suggests copying your baby’s sounds and seeing how long the back-and-forth lasts.⁠^18,28

2. Toddlers: first words

   For a late talker with no other delays the usual course is monitoring or indirect help: activities and language models for you, with gestures, signs and pictures alongside speech.⁠²⁸

3. When a delay persists

   Direct therapy is indicated when a delay persists or comes with other conditions, such as hearing loss or autism.⁠²⁸

4. Preschoolers: sentences and sounds

   Therapy turns to grammar, speech sounds and storytelling, often through play or shared reading.⁠^28,59

Related guidesSpeech therapy for childrenSpeech delay in toddlersSpeech and language milestones, birth to 7Toddler speech check

Articulation milestones: which speech sounds to expect, and when

Children learn speech sounds in a broadly predictable order and have most of their language’s consonants by about 5: across 64 studies of 26,007 children in 27 languages, 5-year-olds said at least 93% of consonants correctly.⁠¹⁴ For American English, a 2020 review of 15 studies covering 18,907 children gives these ages, when 90% of children say a sound correctly:⁠⁶⁰

ASHA’s milestones line up: p, b, m, h, w, d and n between 2 and 3; t, k, g, f, y and -ing between 3 and 4; and by 4, speech most people understand, with mistakes still likely on later sounds such as l, r, s, sh, ch and th.⁠^38,57 A child who speaks another language or a dialect may carry its sound rules into English, and that does not indicate a speech sound disorder.⁠⁵⁹

How much of a child’s speech should strangers understand?

Less, and later, than older rules of thumb suggest. In a study of 538 typical children whose speech was written down by unfamiliar adults, an average child’s sentences were 50% understood by about 34 months, 75% by 46 months and 90% by 62 months, more than a year later than estimates from parents’ impressions.⁠¹⁵

• About 34 months

  Strangers understand half of an average child’s words in sentences.⁠¹⁵

• About 46 months

  Strangers understand about three-quarters of them.⁠¹⁵

• About 62 months

  Nine in ten; single words stay harder to understand than sentences.⁠¹⁵

The study’s floor: at least 50% intelligible to strangers by 48 months.⁠¹⁵ Speech-language pathologists use intelligibility to judge severity and the need for therapy.⁠⁵⁹ Parents rate their child as easiest to understand for themselves and hardest for strangers, so the CDC’s “talks well enough for others to understand, most of the time” at 3 and ASHA’s “people can understand most of what they say” by 4 are looser measures than a stranger’s score.⁠^15,21,38 Speech sound disorders are common: 2.1% to 23% of 4- to 6-year-olds by different estimates, about twice as common in boys in grade school, and 40% come with a language impairment.⁠⁵⁹

Related guidesChildhood apraxia of speechSpeech therapy for preschoolers

What does a speech-language pathologist actually do?

Three things that are easy to run together. Speech is the sounds: pronouncing them clearly, and fluency, including stuttering. Language is the meaning: understanding what is said or signed and getting ideas out. Feeding and swallowing is the mouth’s other job, and speech-language pathologists treat that too, along with social communication.⁠³¹

ASHA describes a toddler with few words as having late language emergence: a late start to language with no other diagnosed disability, seen in slow vocabulary growth and often slower sentences and articulation.⁠²⁸ Therapy for it looks nothing like drilling sounds. It looks like the therapist playing on the floor around the child’s interests, responding to every attempt to communicate, expanding the child’s words, waiting for a reply, and coaching you to do the same all day.⁠²⁸

Two things are worth knowing. About 50% to 70% of late talkers reach normal language by late preschool or school age, and those whose understanding is normal do better; but at the start it is difficult to tell which ones will, because the distinction can only be made after the fact.⁠²⁸ And signs, picture boards and speech-generating devices do not appear to hold speech back: in the 27 cases studied with enough rigor, none lost speech and 89% gained, mostly modestly, and ASHA adds they may aid natural speech.⁠^28,61

A hearing check belongs in the picture: ASHA advises considering hearing loss when a child talks late, chronic ear infections can affect speech, and speech-language pathologists can do a quick hearing screening.⁠^19,28,31

Related guidesHelping your toddler talkStuttering in childrenSpeech therapy for babies and toddlers

Developmental screening: what your child’s doctor checks, and when

Two things happen at checkups. Developmental surveillance is the doctor watching and asking about milestones at every well-child visit; developmental screening uses a formal, research-based questionnaire and is recommended for all children at set ages.⁠^8,12

A missed visit or screening should be done at the next visit, and you can ask for one if the doctor does not check.⁠⁸ Screening is not a diagnosis: a concern should lead to developmental and medical evaluations and, where needed, early intervention.⁠¹² Autism has its own screen because it is common, can be diagnosed as young as 18 months, and has evidence-based interventions; late talking alone is a different diagnosis, though it can later turn out to be part of autism or another condition.⁠^13,28

Related guidesSpeech therapy for autistic childrenDoes my child need an evaluation?

Premature babies: milestones by corrected age

For a baby born early, judge milestones by corrected age, not birth date, for the first two years; it gives a better idea of when your baby should reach common developmental goals.⁠⁶²

1. Count the weeks early. Subtract the week of pregnancy your baby was born in from 40.⁠⁶²
2. Subtract them from your baby’s age. Take your baby’s age in weeks and subtract the weeks early.⁠⁶²
3. Use it with the checklists. A baby born at 32 weeks is 8 weeks early, so at 16 weeks old they are expected to have a 2-month-old’s skills.⁠⁶²

Babies born before 37 weeks may develop later than others the same age and are at higher risk of cognitive and motor problems.⁠^3,16 Early intervention programs for them probably improve cognitive and motor outcomes in infancy and improve cognitive outcomes at preschool age.⁠¹⁶ Tell the doctor if your baby was born early; the CDC checklists ask.⁠¹⁸ Each state may also choose to serve babies at risk of a delay, not only those who have one.⁠²⁰

When should I refer instead of wait?

The table is a shortlist, not the full milestone list: signs late or specific enough to act on the day you notice them, each a CDC milestone most children have by that age or a sign the AAP says to raise with your pediatrician.⁠^2,3,10 The full lists are on our developmental milestones page.

Boys talk later. My uncle did not walk until two. The pediatrician said give it six months. Each has some truth, and none changes the arithmetic. Boys are about three times as likely to be late talkers, and a family history raises the odds, but those are risk factors, not reasons to wait.⁠²⁸ If you or the doctor are still concerned, the CDC’s advice is to ask for a referral to a specialist and call early intervention; the evaluation is free, and waiting is what the 2022 checklists were designed to discourage.⁠^1,2,6

How do I get a free developmental evaluation?

In the US, if your child is under three, you can refer them yourself. The Part C regulations of the Individuals with Disabilities Education Act list parents among the primary referral sources, and the CDC is plain that a doctor’s referral is not necessary.⁠^5,11 The evaluation and assessment must be carried out at public expense, with no fees to parents, and with the first planning meeting they must be completed within 45 days of the program receiving the referral.⁠^6,7

Find your program on the CDC’s state list or ask your pediatrician. The names differ: Early Steps in Florida, First Steps in Indiana, the Birth to Three Program in Connecticut, Early Childhood Intervention (ECI) in Texas, Early Start in California, Babies Can’t Wait in Georgia.⁠⁶⁴ When you call, the CDC suggests saying: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”⁠⁵

Eligibility rules vary by state. A child qualifies with a measured delay in one or more areas, or a diagnosed condition likely to cause one, and each state sets its own definition of developmental delay.⁠^19,20 Evaluators must also use informed clinical opinion, which can establish eligibility even when test scores do not.⁠²⁹

If your child is found not eligible

The program must give you written notice, including your right to dispute the decision through mediation, a due process hearing or a state complaint.⁠⁶⁵ You can still see a therapist privately: every state allows some direct access to physical therapy, and ASHA’s directory lists certified speech-language pathologists.⁠^31,66

CompareEarly intervention or private therapy?How to get a free therapy evaluation

What changes at age 3

At three, responsibility shifts to the school district under Part B. For a child already in early intervention, the program holds a transition conference with your approval and sets a transition plan at least 90 days, and up to 9 months, before the third birthday, and an individualized education program should be in place by that birthday.⁠^67,68 A child 3 or older who is new to services is evaluated through any local public elementary school, even one they do not attend, within 60 days of your consent or your state’s own deadline.⁠^5,69

Next stepSample letter: requesting a school evaluation

What happens at an early intervention evaluation?

Before

You will be asked about your concerns, your child’s history and a typical day; the evaluation includes a history taken partly from you, and the family assessment asks about your resources, priorities and concerns.⁠^19,29 Write down what you have noticed and when. Does not say much is less useful than has about eight words, no two-word combinations, and does not point to show me things; the CDC offers a record-keeping worksheet for this.⁠⁶³

During

Two or more professionals from different disciplines take part, though one person qualified in two can cover both.⁠⁷⁰ They observe your child, use a standardized tool that also looks at skills such as play and feeding, and identify your child’s level in each area: cognitive, physical, communication, social or emotional, and adaptive.⁠^19,20,29 No single test decides eligibility, they ask you questions throughout, and the evaluation must be in your child’s native language unless that is clearly not feasible.⁠²⁹

After

If your child is eligible, a meeting writes the Individualized Family Service Plan (IFSP): your child’s present levels, the measurable outcomes you are aiming for, and each service with its length, frequency, intensity, method and location.⁠³⁹ Services happen in natural environments, settings typical for a child that age, such as your home or a community setting like child care, to the maximum extent appropriate, and are built around the family’s needs as well as the child’s.⁠^4,71 The plan is reviewed at least every six months, sooner if you ask, and evaluated once a year.⁠⁷²

Does early therapy work?

For the problems it has been tested on, yes, with the usual caveat that therapy is not one thing and the evidence is stronger for some outcomes than others.⁠^16,17

The pattern across the evidence is that parents matter. Programs for babies born preterm that focused on both the parent-infant relationship and the baby’s development were more likely to help than standard care; in the Cochrane review of speech and language therapy, trained parents did as well as clinicians; and a meta-analysis found parent-implemented language intervention effective.⁠^16,17,73 That is why early intervention is built around supporting families in everyday settings, and why a therapist who gives you a home program is doing the job rather than shirking it.⁠^4,46

What therapy cannot do is change a child’s underlying condition or guarantee they will catch up. Outcomes vary; acting as soon as a delay is found can help a child catch up or prevent further delay, and for a lasting condition the aim is the most participation in everyday life the child can have.⁠^19,46 The preterm review found that by school age the programs may not improve cognitive or motor outcomes; in early intervention, progress is checked against the plan’s goals at least every six months.⁠^16,72

What does therapy look like week to week?

In early intervention, how often your child is seen, for how long and where are written into the IFSP, and services happen at home, in child care or another everyday setting wherever that can work.⁠^39,71 The therapist plays with your child, shows you what they are working on and why, explains how much to practice, and helps you fit it into daily routines.⁠¹⁹ Bath time becomes a chance to play with sounds, a walk a chance to name what you see, and every point a chance to answer with words.⁠^27,55

Private or outpatient therapy follows the same principles: goals set after an evaluation, a clear amount and kind of practice, and a level of service, from direct sessions to mostly guidance for parents, set for each child and family.⁠^19,28

The honest measure of whether it is working is not whether your child enjoys the session but whether the skill in the plan is moving. In early intervention the outcomes are measurable and reviewed at least every six months, and you can ask for a review sooner; if a skill is not moving, ask why and what will change.⁠^39,72

Related guidesIn-home therapyEarly intervention or private therapy?

How to help your child reach milestones at home

Most of the practice happens between sessions, in ordinary routines, which is where family practice has the most effect.⁠¹⁹ Each CDC checklist ends with tips for parents, and ASHA publishes its own for talking and eating; these come from those lists.⁠^33,48,53

• Moving

  Floor time every day for babies, on the tummy and the back, with limited time in swings and bouncy seats; for toddlers, push toys, balls and the park.⁠^{22,25,33,35,41}

• Hands and self-care

  Blocks, crayons, playdough and puzzles; let your child feed themselves and button or pour, even imperfectly.⁠^21,22,23,24

• Talking and understanding

  Talk about what you are doing, add a word to what your child says, read daily and wait for an answer; say sounds correctly rather than correcting them.⁠^24,27,53,55

• Eating

  Offer new foods many times, without bribing or pushing, and let your child learn their own hunger and fullness cues.⁠⁴⁸

Do I need a doctor’s referral, and does insurance cover therapy?

For early intervention, no: parents can refer their own child, and the evaluation is free.⁠^5,6,11 For private physical therapy, every state, the District of Columbia and the U.S. Virgin Islands allow some form of direct access, but the limits differ, and as of July 1, 2025 some states still attach conditions to treatment without a referral.⁠^66,74 For speech therapy, ASHA suggests asking your primary care provider, or finding an ASHA-certified speech-language pathologist through ProFind or your local school.⁠³¹

Your insurance plan may still require a referral for a visit to be covered, so ask the clinic and your plan both questions at once.

Early intervention services are free unless a state runs a system of payments by families, such as a sliding fee scale; even then, a family unable to pay by the state’s definition must receive every service at no cost, and the program generally needs your consent to bill your private insurance.⁠^4,6,75 Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment benefit covers medically necessary services for enrolled children under 21.⁠⁷⁶

CostsDoes insurance cover therapy for kids?Therapy without insuranceCost of speech therapyCost of OTCost of PT

Finding milestone therapy near you

Under three, start with your state’s early intervention program; from three, your local public school district.⁠⁵ For private therapy, ASHA’s ProFind lists certified speech-language pathologists, the APTA’s Find a PT tool searches physical therapists by credential, and the DrSensory directory lists pediatric physical therapists, occupational therapists and speech therapists by state.⁠^19,31

Related on DrSensory

More on milestones, the three therapies and how to pay for them.

• Developmental milestones by age

  Birth to 3, area by area, with the signs worth raising with your doctor.

• Milestone tracker

  A printable checklist to tick off what your child does at each age.

• OT vs PT for kids

  Where the line between the two therapies falls.

• Helping your toddler talk

  What works at home, and when to refer.

• Does insurance cover therapy for kids?

  What plans cover for OT, PT and speech therapy, and how to check yours.

• Therapy without insurance

  Free and low-cost routes to therapy for children.

• Early intervention or private therapy?

  How the two routes compare, and how to choose.

• Delayed motor milestones

  Signs and causes of a motor delay, and what happens next.

• Find a pediatric physical therapist

  Search the DrSensory directory by state.

Sources

1. Zubler JM, Wiggins LD, Macias MM, Whitaker TM, Shaw JS, Squires JK, et al. Evidence-informed milestones for developmental surveillance tools. Pediatrics. 2022;149(3):e2021052138. doi:10.1542/peds.2021-052138 (PMID 35132439).
   Show the passageHide the passage

   The CDC and AAP revision, read in full: milestones “most children (≥75%) would be expected to achieve” by each visit age, chosen “to discourage a wait-and-see approach”; “lists based on median (50th percentile) age milestones might encourage a wait-and-see” approach; parents told to wait; “a child not meeting a milestone should be considered for screening”; warning signs eliminated; new 15- and 30-month checklists; a 26.4% reduction, from 22 to 13 milestones per checklist; “One third of the retained milestones were transferred to different ages”, 67.7% of them to older ages; “Approximately 80% of the final milestones had normative data.”
2. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. CDC’s Developmental Milestones. Checked October 7, 2026.
   Show the passageHide the passage

   “Children reach milestones in how they play, learn, speak, act, and move”; “If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early”; “The American Academy of Pediatrics recommends that children be screened for general development using standardized, validated tools at 9, 18, and 30 months and for autism at 18 and 24 months or whenever a parent or provider has a concern.” Twelve checklists, 2 months to 5 years.
3. American Academy of Pediatrics, HealthyChildren.org. Is Your Baby’s Physical Development on Track?. Checked October 7, 2026.
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   Signs of a gross motor delay include “Difficulty holding head and neck steady” and “Muscles seem stiff or floppy”; “Usually, a child who is not doing certain skills will catch up to other children their age”; “A child with delayed gross motor skills like rolling over, sitting or walking may be referred to a physical therapist”; language and swallowing to speech therapy, fine motor and self-care to occupational therapy; babies born before 37 weeks may develop later.
4. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.13 Early intervention services. Checked October 7, 2026.
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   Services are provided at no cost except “where Federal or State law provides for a system of payments by families, including a schedule of sliding fees”; they meet the child’s needs “and the needs of the family”; “To the maximum extent appropriate, are provided in natural environments”; occupational therapy addresses “adaptive development, adaptive behavior, and play, and sensory, motor, and postural development”; physical therapy includes “perceptual and motor development” and identifying “movement dysfunction”; speech-language pathology and family training are listed.
5. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Early Intervention. Checked October 7, 2026.
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   “Each state, territory, or commonwealth has its own early intervention program and rules about eligibility and services”; “A doctor's referral is not necessary”; the suggested words when you call; from age 3, “call any local public elementary school (even if your child does not go to school there)” to ask for a preschool special education evaluation.
6. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.521 System of payments and fees. Checked October 7, 2026.
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   “The following are required functions that must be carried out at public expense, and for which no fees may be charged to parents”, among them evaluation and assessment and service coordination; a family unable to pay must have “all part C services at no cost.”
7. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.310 Post-referral timeline (45 days). Checked October 7, 2026.
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   The initial evaluation, the initial assessments and the initial IFSP meeting “must be completed within 45 days from the date the lead agency or EIS provider receives the referral of the child”, except for documented exceptional family circumstances or while parental consent is pending.
8. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Developmental Monitoring and Screening. Checked October 7, 2026.
   Show the passageHide the passage

   “A missed milestone could be a sign of a developmental delay”; screening tools are “formal questionnaires or checklists based on research”; “If your child misses one of these well-child visits, or a screening was not done at those times, it should be completed at the next visit”; you can ask for screening if the doctor does not check periodically.
9. American Speech-Language-Hearing Association. Pediatric Feeding and Swallowing (Practice Portal). Checked October 7, 2026.
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   Signs include gagging and coughing, noisy breathing, frequent respiratory illness, limited tolerance for age-appropriate textures, mealtime distress and failure to advance to an age-appropriate diet; “A team approach is necessary for appropriately diagnosing and managing pediatric feeding and swallowing disorders”; “SLPs who specialize in feeding and swallowing disorders typically lead the professional care team.”
10. American Academy of Pediatrics, HealthyChildren.org. Movement Milestones: Birth to 3 Months. Checked October 7, 2026.
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    Talk with your pediatrician “if your baby's development is going backwards or consistently stopped”; “If your baby only uses one hand or one side of his body, talk with your pediatrician”; bouncer seats “don't let her practice using her muscles as much”; “most babies don't take their first” real steps until about a year.
11. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.303 Referral procedures. Primary referral sources include “Parents, including parents of infants and toddlers.” Checked October 7, 2026.
12. Lipkin PH, Macias MM; Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. Promoting optimal development: identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics. 2020;145(1):e20193449. doi:10.1542/peds.2019-3449 (PMID 31843861).
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    The AAP clinical report: surveillance at every health supervision visit and “the administration of standardized screening tests at the 9-, 18-, and 30-month visits”; concerns followed by screening or direct referral; “Special attention to surveillance is recommended at the 4- to 5-year well-child visit”; problems lead to developmental and medical evaluations and early intervention.
13. Hyman SL, Levy SE, Myers SM; Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics. 2020;145(1):e20193447. doi:10.1542/peds.2019-3447 (PMID 31843864).
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    “Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care”, because autism is common, can be diagnosed as young as 18 months and has evidence-based interventions.
14. McLeod S, Crowe K. Children’s consonant acquisition in 27 languages: a cross-linguistic review. American Journal of Speech-Language Pathology. 2018;27(4):1546–1571. doi:10.1044/2018_AJSLP-17-0100 (PMID 30177993). 64 studies of 26,007 children: most consonants acquired by 5 years; “By 5;0, children produced at least 93% of consonants correctly.”
15. Hustad KC, Mahr TJ, Natzke P, Rathouz PJ. Speech development between 30 and 119 months in typical children I: intelligibility growth curves for single-word and multiword productions. Journal of Speech, Language, and Hearing Research. 2021;64(10):3707–3719. doi:10.1044/2021_JSLHR-21-00142 (PMID 34491793).
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    538 children transcribed by unfamiliar adults: “We expect multiword intelligibility to have reached 50%, 75%, and 90% thresholds by 34, 46, and 62 months, respectively”; “Children should be at least 50% intelligible by 48 months”; thresholds reached more than a year later than parent impressions suggested.
16. Orton J, Doyle LW, Tripathi T, Boyd R, Anderson PJ, Spittle A. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database of Systematic Reviews. 2024;(2):CD005495. doi:10.1002/14651858.CD005495.pub5 (PMID 38348930).
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    “Forty-four studies met the inclusion criteria (5051 randomly assigned participants)”; infants born preterm are at increased risk of cognitive and motor impairments; “Early developmental intervention programmes for preterm infants probably improve cognitive and motor outcomes during infancy (low-certainty evidence) while, at preschool age, intervention is shown to improve cognitive outcomes (high-certainty evidence)”; “the long-term benefits remain unclear”; read in full: “By school age, the intervention may not improve cognitive or motor outcomes”; “Interventions that focus on both the parent-infant relationship and infant development are more likely to have an effect.”
17. Law J, Garrett Z, Nye C. Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database of Systematic Reviews. 2003;(3):CD004110. doi:10.1002/14651858.CD004110 (PMID 12918003).
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    25 trials: effective for phonological and vocabulary difficulties, less evidence for receptive difficulties; “No significant differences were shown between clinician administered intervention and intervention implemented by trained parents”; noted in 2015: “This review is being updated and replaced by a new protocol.”
18. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 2 Months. Checked October 7, 2026.
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    “Developmental milestones are things most children (75% or more) can do by a certain age”; the materials “are not a substitute for standardized, validated developmental screening tools”; milestones include “Holds head up when on tummy” and “Reacts to loud sounds”; the doctor is asked whether the baby “was he/she born prematurely”; tips: “Lay your baby on his tummy when he is awake and put toys at eye level in front of him”; “Babies are not ready for other foods, water or other drinks for about the first 6 months of life”; “Screen time is not recommended for children younger than 2 years of age.”
19. American Physical Therapy Association, ChoosePT. Physical Therapy Guide to Developmental Delay. Checked October 7, 2026.
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    “While lagging on one milestone may cause concern, it does not always mean a child has developmental delay”; the diagnosis needs a significant delay in multiple areas; “Physical therapists help children build motor skills one step at a time to reach specific goals”; coaching, cues and home changes; “Family who can practice daily with a child have the greatest impact on that child's development toward achieving each new skill”; a fear of new motor skills can keep a child off the playground; “The outcomes of treatment also vary”; “Research shows avoiding tummy time can slow the rate of achieving movement milestones”; too much time in baby equipment raises the risk of motor delay; look for a board-certified pediatric clinical specialist.
20. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.21 Infant or toddler with a disability. Checked October 7, 2026.
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    A child under three with a developmental delay “as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas” (cognitive, physical, communication, social or emotional, adaptive), or a diagnosed condition that “Has a high probability of resulting in developmental delay”; at-risk infants and toddlers at a state’s discretion.
21. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 3 Years. Milestones include “Talks well enough for others to understand, most of the time”, “Uses a fork” and “Notices other children and joins them to play”; playdough “builds her hand and finger muscles for writing, buttoning, and cutting.” Checked October 7, 2026.
22. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 2 Years. Checked October 7, 2026.
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    Milestones include “Says at least two words together”, “Kicks a ball” and “Eats with a spoon”; tips: “Give your child balls to kick, roll, and throw”; screen time of “no more than 1 hour a day of a children's program with an adult present.”
23. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 5 Years. Milestones include “Hops on one foot”, “Buttons some buttons” and “Writes some letters in her name”; “Let your child do things for himself, even if he doesn't do it perfectly.” Checked October 7, 2026.
24. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 15 Months. Checked October 7, 2026.
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    Milestones include “Takes a few steps on his own”, “Uses fingers to feed herself some food” and “Points to ask for something or to get help”; tip: “wait a few seconds to see if he makes any sounds before handing it to him.”
25. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 18 Months. Milestones include “Walks without holding on to anyone or anything”, “Follows one-step directions without any gestures” and “Points to show you something interesting”; tip: “Give toys that your child can push or pull safely.” Checked October 7, 2026.
26. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 9 Months. Checked October 7, 2026.
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    Milestones include “Sits without support”, “Looks when you call her name” and “Moves things from one hand to her other hand”; tips: “Place toys on the ground or on a play mat a little out of reach and encourage your baby to crawl, scoot, or roll to get them”; “Let him practice feeding himself with his fingers and using a cup with a small amount of water.”
27. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 1 Year. Milestones include “Pulls up to stand” and “Picks things up between thumb and pointer finger, like small bits of food”; tips: “Let your baby push things around”; “Baby walkers are not recommended”; “Build on what your baby tries to say.” Checked October 7, 2026.
28. American Speech-Language-Hearing Association. Late Language Emergence (Practice Portal). Checked October 7, 2026.
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    Late language emergence is a delay in language onset with no other diagnosed disability; “At the onset, it is difficult to distinguish children with LLE from late bloomers because this distinction can be made only after the fact”; “Approximately 50%–70% of children with LLE are reported to catch up to peers”; “Prevalence estimates of LLE in 2-year-old children primarily range between 10% and 20%”; “Males are 3 times more likely than females to exhibit LLE”; “An extensively used set of criteria for LLE is an expressive vocabulary of fewer than 50 words and no two-word combinations by 24 months of age”; indirect and direct intervention; “Research shows that the use of augmentative and alternative communication may in fact aid in the development of natural speech and language”; “Bilingualism has not been shown to inhibit language development or therapeutic outcomes in the presence of language disorders.”
29. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.321 Evaluation of the child and assessment of the child and family. Checked October 7, 2026.
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    “Taking the child's history (including interviewing the parent)”; the child’s level of functioning in each area; “no single procedure may be used as the sole criterion for determining a child's eligibility under this part”; “informed clinical opinion may be used as an independent basis to establish a child's eligibility under this part even when other instruments do not establish eligibility”; the family-directed assessment of resources, priorities and concerns; the native language.
30. Clark GF, Kingsley KL. Occupational therapy practice guidelines for early childhood: birth–5 years. American Journal of Occupational Therapy. 2020;74(3). Article 7403397010. doi:10.5014/ajot.2020.743001 (PMID 32365324).
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    The AOTA practice guideline: “Early childhood (birth-5 yr) is a critical period in which the foundation of key life occupations is developed”, such as eating, dressing and play; interventions support cognitive, social-emotional, motor and self-care skills, and some “can be implemented by parents after training.”
31. American Speech-Language-Hearing Association; Communication Health Support Association. Who Are Speech-Language Pathologists, and What Do They Do?. Checked October 7, 2026.
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    “Speech-language pathologists (SLPs) are professionals who help people communicate effectively and eat and swallow safely”; speech sounds, language, social communication, fluency, feeding and swallowing, hearing screening and augmentative communication; “You can also locate a professional near you through the ASHA ProFind directory or through your local school.”
32. Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the APTA Academy of Pediatric Physical Therapy. Pediatric Physical Therapy. 2018;30(4):240–290. doi:10.1097/PEP.0000000000000544 (PMID 30277962).
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    Torticollis is typically a head tilt to one side with the head turned to the other, from a shortened neck muscle; “Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified”; parents of newborns taught “supervised prone/tummy play when awake 3 or more times daily”; linked to early motor delays.
33. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 6 Months. Checked October 7, 2026.
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    Milestones include “Rolls from tummy to back”, “Leans on hands to support herself when sitting” and “Reaches to grab a toy she wants”; tips: “Encourage her to roll over to reach the toys”; “Playing on the floor or play mat with your baby every day helps him to move, learn, and explore”; “Talk with your baby's doctor about when to start solid foods.”
34. Goday PS, Huh SY, Silverman A, Lukens CT, Dodrill P, Cohen SS, et al. Pediatric feeding disorder: consensus definition and conceptual framework. Journal of Pediatric Gastroenterology and Nutrition. 2019;68(1):124–129. doi:10.1097/MPG.0000000000002188 (PMID 30358739).
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    Pediatric feeding disorder is “impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction”; “Feeding disorders require comprehensive assessment and treatment of 4 closely related, complementary domains”; a feeding delay can become evident at “texture transitions, and transitions in feeding/drinking utensils.”
35. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 30 Months. Milestones include “Says about 50 words”, “Jumps off the ground with both feet” and “Uses things to pretend”; tip: “When she gets good at lines, show her how to draw a circle.” Checked October 7, 2026.
36. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 4 Years. Milestones include “Catches a large ball most of the time”, “Holds crayon or pencil between fingers and thumb (not a fist)” and “Says sentences with four or more words”; “Try to make time for active play each day.” Checked October 7, 2026.
37. Section on Complementary and Integrative Medicine; Council on Children with Disabilities; American Academy of Pediatrics; Zimmer M, Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012;129(6):1186–1189. doi:10.1542/peds.2012-0876 (PMID 22641765).
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    Sensory-based therapies “are increasingly used by occupational therapists”; difficulty tolerating or processing sensory information is seen in autism, ADHD, developmental coordination disorder and anxiety; “the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive”; a trial period and a way to judge it.
38. American Speech-Language-Hearing Association. Communication Milestones: 3 to 4 Years. Checked October 7, 2026.
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    “Correctly produces t, k, g, f, y, and –ing in words”; “By age 4 years, your child speaks so that people can understand most of what they say”; later sounds include l, j, r, sh, ch, s, v, z and th; “By age 4 years, your child talks smoothly.”
39. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.344 Content of an IFSP. Checked October 7, 2026.
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    Present levels in each area, measurable results or outcomes, and the services with “The length, duration, frequency, intensity, and method of delivering the early intervention services” and their location; “the name of the service coordinator from the profession most relevant to the child's or family's needs.”
40. American Academy of Pediatrics, HealthyChildren.org. Back to Sleep, Tummy to Play: Give Your Baby a Safe, Strong Start. Checked October 7, 2026.
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    “Tummy time is for babies who are awake and being closely supervised”; 2 to 3 times a day for 3 to 5 minutes at first; “Work up to 15 to 30 minutes each day by 7 weeks”; start the day your baby comes home; toys in a circle build the muscles to roll, scoot and crawl; “Limit time spent in freestanding swings, bouncy chairs and car seats.”
41. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Milestones by 4 Months. Checked October 7, 2026.
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    Milestones include “Holds head steady without support when you are holding him”, “Pushes up onto elbows/forearms when on tummy” and “Turns head towards the sound of your voice”; tips: “Try not to keep your baby in swings, strollers, or bouncy seats for too long”; “Give your baby safe toys to play with that are easy to hold.”
42. American Physical Therapy Association, ChoosePT. Physical Therapy Guide to Toe Walking. Toe walking is often present from a child’s first steps until walking matures; “It usually lasts no longer than six months after the first steps”; muscle shortening or weakness and skeletal conditions are among its causes; the physical therapist tests for underlying conditions. Checked October 7, 2026.
43. Noritz GH, Murphy NA; Neuromotor Screening Expert Panel. Motor delays: early identification and evaluation. Pediatrics. 2013;131(6):e2016–e2027. doi:10.1542/peds.2013-1056 (PMID 23713113). The AAP report on motor delays: “formal developmental screening at the 9-, 18-, 30-, and 48-month well-child visits”; emphasis on muscle tone; “The importance of pursuing diagnostic tests while concurrently referring patients to early intervention programs is emphasized.”
44. Hewitt L, Kerr E, Stanley RM, Okely AD. Tummy time and infant health outcomes: a systematic review. Pediatrics. 2020;145(6):e20192168. doi:10.1542/peds.2019-2168 (PMID 32371428). Sixteen studies, 4,237 healthy infants: tummy time “was positively associated with gross motor and total development” and with rolling and crawling; “No association was found for fine motor development and communication”; most studies observational.
45. Sargent B, Coulter C, Cannoy J, Kaplan SL. Physical therapy management of congenital muscular torticollis: a 2024 evidence-based clinical practice guideline from the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatric Physical Therapy. 2024;36(4):370–421. doi:10.1097/pep.0000000000001114 (PMID 39356257).
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    The current update: “Congenital muscular torticollis (CMT) is a postural condition evident shortly after birth”; it covers prevention, screening, referral and treatment.
46. Novak I, Honan I. Effectiveness of paediatric occupational therapy for children with disabilities: a systematic review. Australian Occupational Therapy Journal. 2019;66(3):258–273. doi:10.1111/1440-1630.12573 (PMID 30968419). 129 reviews and trials; “Paediatric occupational therapy seeks to improve children's engagement and participation in life roles”; rated ‘do it’: coaching, family-centered care, feeding interventions, goal-directed training, handwriting task-specific practice, home programs and parent education.
47. American Speech-Language-Hearing Association. Feeding and Swallowing Milestones: Birth to 1 Year. “Turns head towards nipple and opens mouth”; “Opens mouth for spoon”; “Brings foods to mouth with hands and starts to feed self”; “Begins chewing food on both sides of mouth”; what to eat and drink at each stage. Checked October 7, 2026.
48. American Speech-Language-Hearing Association. Feeding and Swallowing Milestones: Age Ranges. “Have your child try a new food many times”; “don't bribe or push your child too much”; learn hunger and fullness cues; cook together; don’t wait to get help with breastfeeding, bottle-feeding or solids. Checked October 7, 2026.
49. American Speech-Language-Hearing Association. Feeding and Swallowing Milestones: 12 to 18 Months. “Feeds self with utensils or fingers”; “Drinks from straw without help and without spilling.” Checked October 7, 2026.
50. American Speech-Language-Hearing Association. Feeding and Swallowing Milestones: 18 to 24 Months. “Consistently chews food on both sides of mouth”; harder foods still cut small “to prevent choking.” Checked October 7, 2026.
51. American Speech-Language-Hearing Association. Feeding and Swallowing Milestones: 2 to 3 Years. “Feeds self with fork and spoon, although often still uses fingers”; “Drinks from an open cup without spilling”; avoid choking risks “like popcorn, hotdogs, or grapes.” Checked October 7, 2026.
52. American Academy of Pediatrics, HealthyChildren.org. When Can Babies Start Solid Foods? Readiness & Feeding Tips. Readiness signs: “Your baby should be able to sit in a high chair, a feeding seat or an infant seat with good head control”; opening the mouth when food comes; moving food from a spoon to the throat. Checked October 7, 2026.
53. American Speech-Language-Hearing Association. Communication Milestones: Age Ranges. Checked October 7, 2026.
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    “When reviewing the milestones, also consider the age ranges below and above your child's age”; “Communicate with your child in the languages that you are most comfortable using”; “Don't interrupt your child to correct their speech sounds”; “Have your child's hearing tested if you find yourself repeating a lot or using a loud voice.”
54. American Speech-Language-Hearing Association. Communication Milestones: Birth to 1 Year. Birth to 3 months “Alerts to sound”; 4 to 6 months “Giggles and laughs”; 7 to 9 months “Babbles long strings of sounds”; 10 to 12 months “Points, waves, and shows or gives objects”; “Sing, tell stories, or read to your child every day.” Checked October 7, 2026.
55. American Speech-Language-Hearing Association. Communication Milestones: 13 to 18 Months. Follows directions like “Give me the ball”; “Identifies one or more body parts”; play with sounds at bath time; “Learning multiple languages will not cause speech or language problems.” Checked October 7, 2026.
56. American Speech-Language-Hearing Association. Communication Milestones: 19 to 24 Months. “Uses and understands at least 50 different words for food, toys, animals, and body parts”; “Puts two or more words together”; “Follows two-step directions.” Checked October 7, 2026.
57. American Speech-Language-Hearing Association. Communication Milestones: 2 to 3 Years. “Correctly produces p, b, m, h, w, d, and n in words”; speech “may not be understandable to unfamiliar listeners.” Checked October 7, 2026.
58. American Speech-Language-Hearing Association. Communication Milestones: 4 to 5 Years. “Produces most consonants correctly, and speech is understandable in conversation”; “Produces grammatically correct sentences.” Checked October 7, 2026.
59. American Speech-Language-Hearing Association. Speech Sound Disorders: Articulation and Phonology (Practice Portal). Checked October 7, 2026.
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    Sound rules carried over from another language or dialect: “These influences do not indicate an SSD”; “Overall, 2.1%–23% of 4- to 6-year-old children were estimated to have SSDs”; about 2:1 boys to girls in grade school; 40% with a language impairment too; “SLPs frequently use intelligibility to judge the severity of the child's speech problem and to determine the need for intervention.”
60. Crowe K, McLeod S. Children’s English consonant acquisition in the United States: a review. American Journal of Speech-Language Pathology. 2020;29(4):2155–2169. doi:10.1044/2020_AJSLP-19-00168 (PMID 33181047). Fifteen studies, 18,907 children: “Most consonants were acquired by 5;0 (years;months)”; the ages for each consonant at the 90% criterion, as tabled on this page.
61. Millar DC, Light JC, Schlosser RW. The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: a research review. Journal of Speech, Language, and Hearing Research. 2006;49(2):248–264. doi:10.1044/1092-4388(2006/021) (PMID 16671842).
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    “None of the 27 cases demonstrated decreases in speech production as a result of AAC intervention”; 11% showed no change and 89% gains, mostly modest.
62. American Academy of Pediatrics, HealthyChildren.org. Corrected Age For Preemies. “During the first 2 years, using your baby's corrected age will give you a better idea when he or she should reach common developmental goals”; subtract the weeks born early from the age in weeks; the 32-week example. Checked October 7, 2026.
63. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Concerned About Your Child’s Development?. Checked October 7, 2026.
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    “You do not need to wait for a doctor's referral or a medical diagnosis to make this call”; a free evaluation is requested “At the same time as you ask the doctor for a referral to a specialist”; “Use this recordkeeping worksheet to help you keep track of your notes”; simple things to do while you wait.
64. Centers for Disease Control and Prevention, Learn the Signs. Act Early.. Early Intervention Contact Information. Each state’s early intervention program and telephone number, among them Early Steps (Florida), First Steps (Indiana), the Birth to Three Program (Connecticut), Early Childhood Intervention (Texas), Early Start (California) and Babies Can’t Wait (Georgia). Checked October 7, 2026.
65. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.322 Determination that a child is not eligible. “the lead agency must provide the parent with prior written notice”, including the right to dispute the decision through a due process hearing, mediation or a state complaint. Checked October 7, 2026.
66. American Physical Therapy Association. Direct Access By State. “While all 50 states, the District of Columbia and the U.S. Virgin Islands, provide some form of direct access to physical therapist services, the specific provisions and limitations differ across jurisdictions.” Checked October 7, 2026.
67. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.209 Transition to preschool and other programs. With the family’s approval, a transition conference, and a transition plan in the IFSP, “not fewer than 90 days—and, at the discretion of all parties, not more than 9 months—before the toddler's third birthday.” Checked October 7, 2026.
68. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.124 Transition of children from the Part C program to preschool programs. “By the third birthday of a child described in paragraph (a) of this section, an IEP” (or an IFSP) has been developed and is being implemented. Checked October 7, 2026.
69. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.301 Initial evaluations. A parent may request an initial evaluation, which “Must be conducted within 60 days of receiving parental consent for the evaluation”, or within the state’s own timeframe. Checked October 7, 2026.
70. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.24 Multidisciplinary. “the involvement of two or more separate disciplines or professions”, which for the evaluation “may include one individual who is qualified in more than one discipline or profession.” Checked October 7, 2026.
71. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.26 Natural environments. “settings that are natural or typical for a same-aged infant or toddler without a disability, may include the home or community settings.” Checked October 7, 2026.
72. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.342 Procedures for IFSP development, review, and evaluation. Checked October 7, 2026.
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    “A review of the IFSP for a child and the child's family must be conducted every six months, or more frequently if conditions warrant, or if the family requests such a review”; a meeting at least annually to evaluate the IFSP.
73. Roberts MY, Kaiser AP. The effectiveness of parent-implemented language interventions: a meta-analysis. American Journal of Speech-Language Pathology. 2011;20(3):180–199. doi:10.1044/1058-0360(2011/10-0055) (PMID 21478280). 18 studies of children 18 to 60 months: “parent-implemented language interventions have a significant, positive impact on receptive and expressive language skills.”
74. American Physical Therapy Association. Direct Access Advocacy. “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment”; “some provisions tied to treatment absent a referral still persist in a number of states.” Checked October 7, 2026.
75. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.520 Policies related to use of public benefits or insurance or private insurance to pay for Part C services. Checked October 7, 2026.
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    “The State may not use the private insurance of a parent of an infant or toddler with a disability to pay for part C services unless the parent provides parental consent”, or a listed exception applies.
76. Centers for Medicare & Medicaid Services, Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment. The benefit “provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid”; states must furnish appropriate and “medically necessary services needed to correct and ameliorate health conditions.” Checked October 7, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. If your child has lost skills they previously had, contact their doctor.