Delayed Motor Milestones: What's Typical and When to Ask

• 75%or more of children reach each CDC milestone by the age it is listed⁠²
• 9, 18, 30months: the well-child visits with a standardized developmental screen⁠⁹
• $0for an early intervention evaluation, with no doctor’s referral needed⁠^5,6

What are delayed motor milestones, and what counts as a motor delay?

Motor milestones are the movement skills children gain in a fairly predictable order: head control first, then the upper body, then sitting, standing and walking, with hand skills such as grasping developing alongside. A milestone is delayed when a child has not reached it by the age most children (75% or more) do.⁠^2,13

The AAP’s motor delay tool puts it from a parent’s side: a child not doing a skill you expect, moving differently from children their age, struggling with a skill others manage, or no longer doing one they could. A delay is a reason for a closer look, not a diagnosis.⁠^2,4

For early intervention, a child under three qualifies with a delay in physical development (including vision and hearing) or another area, or with a diagnosed condition likely to cause one; each state sets the level of delay that counts.⁠^14,15

Is it a gross motor delay or a fine motor delay?

Gross motor skills use the large muscles: rolling, sitting, walking and jumping. Fine motor skills use the hands: grasping a toy, picking up small food between thumb and finger, scribbling, buttoning. A child with delayed rolling, sitting or walking may be referred for physical therapy, and one struggling with fine motor or self-care skills may benefit from occupational therapy.⁠^13,16,17,18

What if my child struggles with buttons, zippers or getting dressed?

Dressing comes in stages on the CDC’s checklists: most children put on some clothes by themselves, such as loose pants or a jacket, by 3; unbutton some buttons by 4; and button some buttons by 5.⁠^18,19,20 Taking clothes off is learned before putting them on, and undoing a fastening before doing it up.⁠²¹

Dressing draws on several skills at once: balance while changing position, both hands working together with one leading and one helping, reaching behind and over the head, and knowing where body parts are without looking.⁠²¹ Note which part is hard, such as balance, using both hands or the order of the steps; an assessment for developmental coordination disorder includes watching a child dress and undress.⁠²²

To practice at home:

• Pick a calm time. Practice in the evening or on a weekend rather than in the morning rush, in the same place and order each time, with your child seated and supported if needed.⁠^21,23
• Teach the last step first. In backward chaining you do most of the task and your child finishes it, such as pulling a T-shirt down to the waist, then takes on one earlier step at a time, so every try ends in success.⁠^21,23
• Start big, and off the body. Practice large buttons first, on a garment laid on a table or hung on a chair, before buttons on your child’s own clothes; vertical buttonholes are easier than horizontal ones.⁠²¹
• Make fastenings easy. Start with easy-fit clothes, and choose buttons or zippers in a color that stands out from the fabric.⁠²¹
• Let it be imperfect. The CDC suggests letting a 5-year-old button their own shirt, celebrating it, and not fixing what does not need fixing.⁠¹⁸
• Build the hands in play. Squishing, pressing and pinching playdough builds the hand and finger muscles used for buttoning.⁠¹⁹

Most children who are behind on a skill catch up, but sometimes it is a sign of a health condition, and what you notice at home is an important part of the pediatrician’s evaluation.⁠¹³ Talk with your child’s doctor if your child is not meeting a milestone, has lost a skill, or you have other concerns; the CDC’s advice is not to wait.⁠¹⁸ A child struggling with buttoning clothes may benefit from occupational therapy, and the recommended therapy for developmental coordination disorder trains daily tasks, including personal care, directly.⁠^13,22 If coordination is hard well beyond dressing, see dyspraxia; for trouble reaching across the body, see crossing the midline.

Which motor milestones come at which age, and what if they're late?

The ages below are the movement milestones on the CDC’s Learn the Signs. Act Early. checklists, revised in 2022 by an expert group the AAP convened. Each is something at least 75% of children do by that age, so the list is deliberately later than an average, and the experts agreed that a child not meeting a milestone should be considered for screening.⁠²

So the honest reading is neither “every child is different, don’t worry” nor “your child is behind.” It is that most children are doing this by now, so it is worth a conversation. The right-hand column is what that conversation looks like.

How much time is normal before a late milestone becomes a motor delay?

Three different ages get quoted for every milestone. The median age is when half of children do it. The CDC age is when most (75% or more) do: if half of children reach a skill at 11 months and 90% by 16 months, it goes on the 15-month checklist. The late end is the edge of normal variation.⁠²

The WHO measured that edge for six gross motor milestones in 816 healthy children in Ghana, India, Norway, Oman and the US; the windows run from the 1st to the 99th percentile.⁠⁷

The practical rule: a child past the CDC age is due a screen, not a diagnosis, and a child past the end of a WHO window is later than 99% of the healthy children in that study, which the WHO says should signal the need for screening. For a baby born early, count from the due date.⁠^2,7,31

Do children with delayed motor milestones catch up?

Many do. The AAP says a child who is not doing certain skills usually catches up, though sometimes a delay signals a health condition, and most preterm babies reach the typical range by 2. But a third of children with cerebral palsy have the mildest form and may hit their early milestones on time, and autistic children in one large study had not outgrown their motor difficulties by adolescence.⁠^10,11,13,32

What matters more than the exact date?

Four things tell a clinician more than which week a skill arrived. Write them down before an appointment, because parent observations are part of the evaluation.⁠¹³

• Direction of travel

  A child still gaining skills, even late, is a different picture from one who has stalled; watch for progress such as pulling up, then standing, then walking.⁠¹¹ What to do: note the date of the last new skill. “Nothing new since March” tells a clinician more than “he seems behind.”

• The overall picture

  The CDC’s checklists cover play, learning, speech, behavior and movement.⁠³ A motor delay with typical talking and play raises different questions from delays across several areas, such as global developmental delay. What to do: check the other areas before the appointment.

• Symmetry

  Hand function asymmetry should prompt standardized checks for cerebral palsy, and the CDC lists reaching with one hand while the other stays fisted among the signs after 6 months.⁠^10,25 What to do: film 30 seconds of your child reaching for a toy placed in front of them.

• Quality, not just achievement

  Warning signs include a rounded back that persists in supported sitting, being stuck in sitting, and little variety in how the child moves.⁠¹⁰ What to do: describe how your child moves, not just whether a milestone happened.

What are the early signs of a motor delay in a baby or toddler?

Book an appointment if your child:

• Is not rolling from tummy to back by 6 months⁠²⁶
• Is not sitting without support by 9 months⁠^10,27
• Is not pulling up to stand by 12 months⁠¹⁶
• Is not walking without holding on by 18 months⁠¹⁷
• Uses one hand, or one side of the body, much more than the other⁠¹⁰
• Feels unusually stiff or floppy, or struggles to hold the head steady⁠¹³
• Keeps the hands fisted, or reaches with one hand while the other stays fisted⁠^10,25
• Bears weight on the toes and cannot stand with the heels down, or keeps toe walking alongside other delays⁠^10,33
• Struggles to stay balanced, or walks or runs with an unusual gait⁠¹³

None of these means something is wrong. Each means asking now rather than at the next visit, as the AAP’s motor delay tool advises.⁠⁴

What should you do about a motor delay, step by step?

If you are concerned today, this order gets a child seen fastest, with the steps running side by side: the AAP stresses medical tests and an early intervention referral at the same time.⁠³⁴

1. Write down what you have noticed, with dates

   The last new skill, what the movement looks like, and whether one side differs. Take a short video. Parent concern is a valid reason to start investigations and an early intervention referral.⁠¹⁰

2. Under three, refer to early intervention yourself

   Call your state program directly; no doctor’s referral is needed. Parents are primary referral sources in the federal rules, and the evaluation and first planning meeting must happen within 45 days.⁠^6,8,35

3. Three or over, ask the school district in writing

   Contact any local public elementary school, even one your child does not attend. If the district agrees to evaluate, it must do so within 60 days of your consent (or the state’s timeframe); if it refuses, it must explain why in writing.⁠^6,36,37

4. See the pediatrician, and ask for a standardized screen by name

   The AAP recommends screens at 9, 18 and 30 months and whenever there is a concern, and its motor delay report adds one at 48 months.⁠^9,34

5. Ask what is being ruled out

   First steps include a neurologic exam focused on muscle tone, brain MRI for a child with high tone and a creatine kinase blood test for one with low tone.⁠³⁴

How do you use corrected age for a premature baby’s motor milestones?

For a baby born preterm, judge milestones by corrected age, the age they would be had they been born on the due date, for the first 2 years. Subtract the weeks born early from actual age: a baby born at 32 weeks, 8 weeks early, has a corrected age of 2 months when 4 months old and is compared with 2-month milestones.⁠³¹

By age 2, most preterm children have caught up to the typical range; one who has not may need support for longer. Ask your baby’s doctor about early intervention, as the AAP suggests.⁠¹¹

A 2024 Cochrane review of 44 trials with 5,051 preterm infants found that early developmental programs after discharge probably improve cognitive and motor outcomes in infancy (low certainty) and improve cognitive outcomes at preschool age (high certainty), but probably not motor outcomes at that age. Prematurity is a reason to watch more closely, not to wait longer.⁠³⁸

What causes delayed motor development in babies and toddlers?

Many late milestones are normal variation; some are the first sign of a health condition, and the cause changes what happens next.⁠¹³

• Normal variation

  Walking alone starts anywhere from 8.2 to 17.6 months in healthy children.⁠⁷ What it changes: nothing but reassurance, from an assessment rather than from waiting.

• Prematurity

  Milestones are judged by corrected age until 2.⁠³¹ What it changes: the comparison; correct the age first.

• Low muscle tone

  Hypotonia is reduced resistance when a joint is moved, not weakness, and a baby with it may feel floppy. Most cases (60 to 80%) have a central cause, in the brain or spinal cord rather than the nerves or muscles, and about half are diagnosed from the history and examination alone. What it changes: tests run alongside an early intervention referral, and the AAP advises a creatine kinase blood test for a child with low tone.⁠^34,39

• Cerebral palsy

  The most common motor disability of childhood, in about 2.4 per 1,000 US 8-year-olds; delayed milestones are its main early sign, and it can now be diagnosed before 6 months’ corrected age. What it changes: speed, because the 2017 guideline recommends CP-specific early intervention as soon as CP or a high risk of it is identified.⁠^10,25

• Developmental coordination disorder

  An estimated 5 to 6% of children have it, about half of them with ADHD too, and a formal diagnosis before 5 is recommended only for severe cases. What it changes: the target becomes daily activities, through activity- and participation-oriented therapy.⁠²²

• Genetic, metabolic and neuromuscular conditions

  A diagnosed condition likely to cause delay qualifies a child for early intervention before any delay is measured.⁠¹⁴ What it changes: your pediatrician decides on genetic tests, imaging or a creatine kinase test.⁠^34,39

• Too little time to practice

  Long stretches in swings, strollers and bouncy seats replace floor play.⁠^12,24 What it changes: this one you can fix today.

• Vision

  In a study of 40 blind children, motor development was delayed in all 10 skills examined.⁠⁴⁰ What it changes: ask for a vision check if your child does not seem to look at faces or follow toys.

Can delayed motor milestones be a sign of autism?

Sometimes, but not specifically. The CDC lists delayed movement skills among characteristics many autistic people have, and a 2021 review found early motor differences in children later diagnosed with autism, growing with age, while findings in other conditions were mixed. Autism has its own screening at 18 and 24 months.⁠^3,41,42

How can you support a motor delay at home, and what should you skip?

None of this replaces an assessment if you are concerned, and the home changes cost nothing while you wait.

How much tummy time does a baby need?

The WHO recommends at least 30 minutes of tummy time a day for babies not yet mobile, spread across waking hours. A 2020 review of 16 studies with 4,237 infants linked tummy time to gross motor development and to rolling and crawling, though the link with sitting, standing and walking was unclear.⁠^12,43 What to do: short and often; put toys at eye level, stay with your baby, and put a sleepy baby on their back to sleep.⁠¹

Why floor time, and less time in seats, walkers and bouncers?

The CDC advises against long stretches in swings, strollers or bouncy seats and says baby walkers are not recommended. Walkers sent an estimated 230,676 children under 15 months to US emergency departments from 1990 to 2014, 90.6% of them with head or neck injuries, and the AAP has called for a ban.⁠^16,24,44 What to do: give a safe floor and space to move, and use seats for getting around rather than for play.

How do you set up play so it asks for movement?

• Toys just out of reach, to encourage rolling at 6 months and crawling, scooting or rolling at 9 months.⁠^26,27
• Something to push, such as a box or push toy, for a baby practicing walking.⁠¹⁶
• Balls to kick, roll and throw, and playground climbing as toddlers grow.⁠^29,30
• Hand play: blocks and playdough build the hand muscles later used for writing and buttoning.⁠^16,19
• W-sitting on its own is not a worry: a systematic review found no evidence against sitting in a W-position and no link with hip dysplasia.⁠⁴⁵

How does physical therapy (PT) help a motor development delay?

Children with delayed rolling, sitting or walking may be referred to a physical therapist, and those with fine motor or self-care difficulties may benefit from an occupational therapist. Under Part C, physical therapy promotes sensorimotor function through motor development, musculoskeletal status and adapting the environment.⁠^13,46

The assessment combines an evaluation instrument, your child’s history, observation and others’ input with the evaluator’s informed clinical opinion, so expect a profile rather than a verdict. Therapy happens, where appropriate, at home or in childcare, with services chosen with you around your family’s priorities.⁠^46,47,48

The evidence depends on the cause: early programs probably improve infant motor outcomes after preterm birth, the 2017 guideline recommends CP-specific early intervention, and guidance for developmental coordination disorder favors activity- and participation-oriented approaches.⁠^10,22,38 Ask for the home program in writing.

Our guides to physical therapy for developmental delays, occupational therapy for developmental delays and speech therapy for developmental delays cover what each discipline does, and our cost and insurance guides cover what is likely to be covered. To find someone directly, search for a physical therapist or browse by state, and weigh early intervention against private therapy.

What should you ask for at childcare or preschool?

The AAP’s model of developmental surveillance includes two-way communication with childcare and preschool staff, and the WHO’s one-hour limit on being strapped in applies there too.⁠^9,12

• Floor time rather than seat time
• A named person who knows this month’s goals
• The home program run there too, if the therapist agrees
• Good positioning in floor play, not long stretches propped up
• Being told what they see, compared with children the same age

From the third birthday, an IEP or IFSP through the school district can carry support into preschool.⁠⁴⁹ Our resources for teachers and questions to ask guide are written to be handed over.

How do you get a motor delay assessed, and what does it cost?

Under three: early intervention. Every state and territory runs a program, and you can refer your own child without a doctor’s referral. Evaluation, assessment and service coordination are free; states may charge sliding fees for some services, but a family that cannot pay receives all Part C services at no cost. Eligibility follows the state’s definition of delay.⁠^5,6,15

Three and over: your school district, which must find and evaluate children who may need special education. Ask in writing.⁠^36,50

Your pediatrician screens at 9, 18 and 30 months, gives special attention at 4 to 5 years, and can rule out medical causes and refer.⁠⁹

What an evaluation involves: an evaluation instrument, your child’s history, their level in each area, and input from people who know them. It is not a test your child can fail.⁠⁴⁷

What happens when early intervention ends at age 3?

If a toddler may qualify for preschool special education, the program must notify the school system and, with your approval, hold a transition conference at least 90 days (and up to 9 months) before the third birthday, by which date an IEP or IFSP must be in effect.⁠^49,51

RelatedPhysical therapy

Sources

1. Centers for Disease Control and Prevention. Milestones by 2 Months. Learn the Signs. Act Early. Page dated May 15, 2026. Checked October 10, 2026.
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   “Developmental milestones are things most children (75% or more) can do by a certain age”; movement milestones: “Holds head up when on tummy,” “Moves both arms and both legs” and “Opens hands briefly”; and the tip “Lay your baby on his tummy when he is awake and put toys at eye level in front of him. This will help him practice lifting his head up. Do not leave your baby alone. If he seems sleepy, place him on his back in a safe sleep area.”
2. 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. PMID 35132439. Checked October 10, 2026.
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   The working group set out to “clarify when most children can be expected to reach a milestone (to discourage a wait-and-see approach)” and used “milestones most children (≥75%) would be expected to achieve by specific health supervision visit ages”; “lists based on median (50th percentile) age milestones might encourage a wait-and-see approach because half of children are not expected to achieve the milestone by that age,” and in CDC focus groups parents of children with disabilities “reported delays in identification because they were told to wait”; “if there was evidence that 50% of children reach a milestone at 11 months and 90% reach it at 16 months, it was placed on the 15-month checklist”; the experts “agreed that a child not meeting a milestone should be considered for screening”; “The CDC checklists should not replace universal developmental screening, provide a risk categorization, or diagnose DDs”; milestones were added “for the 15- and 30-month health supervision visits”; and “less than a quarter of children with DDs receive early intervention services before age 3 years.”
3. Centers for Disease Control and Prevention. CDC’s Developmental Milestones. Learn the Signs. Act Early. Page dated February 17, 2026. Checked October 10, 2026.
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   “Children reach milestones in how they play, learn, speak, act, and move”; “Learn the Signs. Act Early. resources are not a substitute for standardized, validated developmental screening tools”; “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. Talk with your child’s doctor, share your concerns, and ask about developmental screening. 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.”
4. American Academy of Pediatrics. Does My Child Have Physical Developmental Delays? HealthyChildren.org Motor Delay Tool, developed with the CDC. Checked October 10, 2026.
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   “Physical developmental delays are also known as gross motor delays.” Examples are when a child “Is not doing a skill that you think they should be able to do,” “Moves or does not move their body like other children their age,” “Used to be able to do a skill and no longer can do that skill” or “Has difficulty doing a skill that other children their age can do”; “Acting early on motor delays makes a big difference. Do not wait until your child’s next checkup. Motor delays can be a sign of a serious health condition.”
5. U.S. Department of Education. 34 CFR 303.521: System of payments and fees. Electronic Code of Federal Regulations. Checked October 10, 2026.
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   Functions that “must be carried out at public expense, and for which no fees may be charged to parents” include child find, “Evaluation and assessment,” service coordination and the development of IFSPs; a state’s policies may set a “schedule of sliding or cost participation fees that may be charged to the parent for early intervention services,” and “if the parent or family meets the State’s definition of inability to pay, the infant or toddler with a disability must be provided all part C services at no cost.”
6. Centers for Disease Control and Prevention. Early Intervention. Learn the Signs. Act Early. Page dated February 16, 2026. Checked October 10, 2026.
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   Early intervention “May include speech therapy, physical therapy, and other types of services based on the needs of the child and family”; “Programs are available in every state and territory. These publicly funded programs provide services for free or at reduced cost for any child who is eligible”; “If your doctor is not able to connect you, you can reach out yourself. A doctor’s referral is not necessary”; and “If your child is age 3 or older: call any local public elementary school (even if your child does not go to school there).”
7. WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: windows of achievement for six gross motor development milestones. Acta Paediatrica. 2006;95(S450):86–95. PMID 16817682. Checked October 10, 2026.
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   Longitudinal data on “children aged 4 to 24 mo in Ghana, India, Norway, Oman and the USA. Trained fieldworkers assessed 816 children”; windows “bound by the 1st and 99th percentiles”; “About 90% of children achieved five of the milestones following a common sequence, and 4.3% did not exhibit hands-and-knees crawling”; “The estimated 1st and 99th percentiles in months are: 3.8, 9.2 (sitting without support), 4.8, 11.4 (standing with assistance), 5.2, 13.5 (hands-and-knees crawling), 5.9, 13.7 (walking with assistance), 6.9, 16.9 (standing alone) and 8.2, 17.6 (walking alone)”; the windows are recommended “to signal the need for appropriate screening when individual children appear to be late in achieving the milestones.”
8. U.S. Department of Education. 34 CFR 303.310: Post-referral timeline (45 days). Electronic Code of Federal Regulations. Checked October 10, 2026.
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   “the initial evaluation and the initial assessments of the child and family under § 303.321; and the initial IFSP meeting under § 303.342 must be completed within 45 days from the date the lead agency or EIS provider receives the referral of the child.”
9. 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. PMID 31843861. Checked October 10, 2026.
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   “Developmental surveillance is supported at every health supervision visit, as is as the administration of standardized screening tests at the 9-, 18-, and 30-month visits. Developmental concerns elicited on surveillance at any visit should be followed by standardized developmental screening testing or direct referral to intervention and specialty medical care. Special attention to surveillance is recommended at the 4- to 5-year well-child visit, prior to entry into elementary education”; and surveillance “includes bidirectional communication with early childhood professionals in child care, preschools, Head Start, and other programs.”
10. Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatrics. 2017;171(9):897–907. PMID 28715518. Checked October 10, 2026.
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    The diagnosis “has been made between age 12 and 24 months but now can be made before 6 months’ corrected age”; recommendation 5.0: “Any infant with: (a) Inability to sit independently by age 9 mo, or (b) Hand function asymmetry, or (c) Inability to take weight through the plantar surface (heel and forefoot) of the feet should receive standardized investigations for CP” (strong recommendation); motor signs listed include “Asymmetrical hand preference,” “Stuck in floor sitting,” “Weight bears on toes,” “Persistent rounded back in supported sitting,” “Bilateral fisted hands” and “Reduced variation in motor behavior”; “one-third have the mildest form (GMFCS I) and may initially achieve all of their motor milestones on time, offering false reassurance”; “Parent concern is a valid reason to trigger formal diagnostic investigations and referral to early intervention”; and the diagnosis “should always be followed by a referral to CP-specific early intervention.”
11. American Academy of Pediatrics. Your Preemie’s Growth & Developmental Milestones. HealthyChildren.org. Last updated September 24, 2024. Checked October 10, 2026.
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    “by 2 years of age, most children have caught up to the typical milestone range. If your child has not caught up, they may need extra support for a longer period”; “Even with an adjusted age, you will want to see them move forward in their development. For example, your child should progress from pulling themselves up, to standing, and then to walking”; and “Ask your baby’s doctor about early intervention (EI).”
12. World Health Organization. To grow up healthy, children need to sit less and play more. News release on the WHO guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age, April 24, 2019. Checked October 10, 2026.
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    Infants under 1 year should “Be physically active several times a day in a variety of ways, particularly through interactive floor-based play; more is better. For those not yet mobile, this includes at least 30 minutes in prone position (tummy time) spread throughout the day while awake” and “Not be restrained for more than 1 hour at a time (e.g. prams/strollers, high chairs, or strapped on a caregiver’s back)”; the same limit applies to children aged 1 to 4.
13. American Academy of Pediatrics. Is Your Baby’s Physical Development on Track? HealthyChildren.org. Last updated August 2, 2023. Checked October 31, 2026.
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    “Typically, children develop motor skills from the top down. First comes head control and then control over the upper body. While working on these motor milestones, children also develop small, fine motor skills”; signs include “Struggling to roll over, sit or walk,” “Difficulty holding head and neck steady,” “Muscles seem stiff or floppy” and “Has a hard time staying balanced or has unusual gait when walking or running”; “Usually, a child who is not doing certain skills will catch up to other children their age. Sometimes, it is a sign of a health condition”; “Parent observations are an important part of a pediatrician’s evaluation”; and “A child with delayed gross motor skills like rolling over, sitting or walking may be referred to a physical therapist,” while “A child struggling with fine motor skills, visual motor skills or independent skills—feeding themself, picking up small objects or buttoning clothes—may benefit from occupational therapy.”
14. U.S. Department of Education. 34 CFR 303.21: Infant or toddler with a disability. Electronic Code of Federal Regulations. Checked October 10, 2026.
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    An infant or toddler with a disability is “an individual under three years of age who needs early intervention services because the individual” is “experiencing a developmental delay, as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas” (cognitive; “Physical development, including vision and hearing”; communication; social or emotional; adaptive), or “Has a diagnosed physical or mental condition that” “Has a high probability of resulting in developmental delay,” including “genetic or congenital disorders; sensory impairments; inborn errors of metabolism.”
15. U.S. Department of Education. 34 CFR 303.111: State definition of developmental delay. Electronic Code of Federal Regulations. Each state’s system must include its “rigorous definition of developmental delay” and “Specify the level of developmental delay in functioning or other comparable criteria that constitute a developmental delay in one or more of the developmental areas.” Checked October 10, 2026.
16. Centers for Disease Control and Prevention. Milestones by 1 Year. Learn the Signs. Act Early. Page dated May 15, 2026. Checked October 10, 2026.
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    Movement milestones: “Pulls up to stand,” “Walks, holding on to furniture,” “Drinks from a cup without a lid, as you hold it” and “Picks things up between thumb and pointer finger, like small bits of food”; tips: “Play together with blocks and other toys that encourage your baby to use her hands,” “Let your baby push things around, such as empty boxes, a ‘kiddie chair,’ or ‘push toys,’ so he can practice walking” and “Encourage your baby to practice walking on her own. Baby walkers are not recommended. Let her hold your hands or hold onto furniture that is safe.”
17. Centers for Disease Control and Prevention. Milestones by 18 Months. Learn the Signs. Act Early. Page dated May 15, 2026. Checked October 10, 2026.
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    Movement milestones: “Walks without holding on to anyone or anything,” “Scribbles,” “Drinks from a cup without a lid and may spill sometimes,” “Feeds himself with his fingers,” “Tries to use a spoon” and “Climbs on and off a couch or chair without help.”
18. Centers for Disease Control and Prevention. Milestones by 5 Years. Learn the Signs. Act Early. Page dated May 16, 2026. Checked October 31, 2026.
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    Movement milestones: “Buttons some buttons” and “Hops on one foot”; the tip “Let your child do things for himself, even if he doesn’t do it perfectly. For example, let him make his bed, button his shirt, or pour water into a cup. Celebrate when he does it and try not to ‘fix’ anything you don’t have to”; and “Don’t wait. 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.”
19. Centers for Disease Control and Prevention. Milestones by 3 Years. Learn the Signs. Act Early. Page dated May 16, 2026. Checked October 31, 2026.
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    Movement milestones: “Strings items together, like large beads or macaroni,” “Puts on some clothes by himself, like loose pants or a jacket” and “Uses a fork”; the tip “Let your child play with playdough by squishing it, pressing it, pinching it, and making balls in different colors. This builds her hand and finger muscles for writing, buttoning, and cutting.”
20. Centers for Disease Control and Prevention. Milestones by 4 Years. Learn the Signs. Act Early. Page dated May 16, 2026. Movement milestones: “Catches a large ball most of the time,” “Serves herself food or pours water, with adult supervision,” “Unbuttons some buttons” and “Holds crayon or pencil between fingers and thumb (not a fist).” Checked October 31, 2026.
21. Alder Hey Children’s NHS Foundation Trust, Sefton Community Children’s Occupational Therapy. Five Steps to Function: Dressing Skills. Information booklet PIAG 335 (review date July 2024). Checked October 31, 2026.
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    Dressing needs balance (“keep balanced when they change their position”), the hands used “together (bilaterally)” and “in a lead-assist way (one hand leads, the other supports)”, reach “in front, behind and above their head”, and body part awareness, “where they are without looking at them”; “Remember undressing is learned before dressing”; “Do each dressing task the same way each time”; “Make sure your child is comfortable, with support if needed on a chair, bed, floor or standing”; “Easy-fit styles are better when starting to practice dressing skills”; backward chaining: “the adult begins the task, with the child only doing the last step. Gradually the adult does less as the child is able to do more of the task themselves. This way the child always gets the reward of finishing the task”; “Start with the fastener in front of your child NOT on them e.g. laid on the table, or hanging on the back of a chair”; “Always practice with large fastenings first before moving onto smaller ones”; “Undoing fasteners is easier to learn first”; “Vertical button holes are easier than horizontal button holes”; and “it can be helpful if the buttons or zippers are a different colour to the fabric to help them stand out.”
22. Blank R, Barnett AL, Cairney J, Green D, Kirby A, Polatajko H, et al. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine & Child Neurology. 2019;61(3):242–285. PMID 30671947. Checked October 31, 2026.
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    “prevalence estimates of 5% to 6% of children are most frequently quoted in the literature”; “The symptoms of DCD are usually apparent in the early years. However, due to the large variability in normal motor development, we recommend that a formal diagnosis of DCD under the age of 5 years is only made in cases of severe impairment”; population data “suggest that about half of those diagnosed with DCD and half of those diagnosed with ADHD have combined problems”; and the recommendations include active video games “as adjuncts to more traditional activity-oriented and participation-oriented interventions”; the history and examination include “Observation of motor activities (e.g. playing, drawing, dressing, undressing)”; “We recommend that the complete assessment considers ADL (e.g., self-care and self-maintenance)”; and activity-oriented and participation-oriented approaches “focus on ADL (including personal care, play, leisure/sports, arts and crafts, and academic, prevocational, and vocational tasks)” and involve “direct training of the performance skill concerned.”
23. Children’s Hospital of Philadelphia. Helping your child be more self-reliant: backward chaining. April 27, 2015, from the hospital’s occupational therapists. Checked October 31, 2026.
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    “I would suggest completing dressing at times with less time constraint, but still socially appropriate, such as nights and weekends”; “do your best to keep it as consistent as possible; same place, same time, same day of the week, and same general routine”; “Backward chaining is working backward from the goal. For example, the goal is put on a T-shirt”; “you will do the majority of the task except ‘pull shirt down to waist’ and provide positive feedback to your child for completing that task”; and “One of the main reasons we start backward is to provide praise and positive feedback which, in turn, typically improves the child’s interest and success in the task.”
24. Centers for Disease Control and Prevention. Milestones by 4 Months. Learn the Signs. Act Early. Page dated May 15, 2026. Checked October 10, 2026.
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    Movement milestones: “Holds head steady without support when you are holding him,” “Holds a toy when you put it in his hand,” “Uses his arm to swing at toys,” “Brings hands to mouth” and “Pushes up onto elbows/forearms when on tummy”; tips: “Let your baby have time to move and interact with people and objects throughout the day. Try not to keep your baby in swings, strollers, or bouncy seats for too long” and “Playing on the floor or play mat with your baby every day helps him to move, learn, and explore.”
25. Centers for Disease Control and Prevention. About Cerebral Palsy. Page dated June 12, 2026. Checked October 10, 2026.
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    “CP is the most common motor disability in childhood”; “The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking)”; signs in a baby younger than 6 months include “Their head lags when you pick him up while he’s lying on his back,” “They feel stiff” and “They feel floppy”; older than 6 months, “They don’t roll over in either direction” and “They reach out with only one hand while keeping the other fisted”; older than 10 months, “They crawl in a lopsided manner” and “They scoot around on their buttocks or hops on their knees but do not crawl on all fours”; “some children without CP may also show some of these signs”; and “about 2.4 out of every 1,000 U.S. children aged 8 years have cerebral palsy.”
26. Centers for Disease Control and Prevention. Milestones by 6 Months. Learn the Signs. Act Early. Page dated May 15, 2026. Checked October 10, 2026.
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    Movement milestones: “Rolls from tummy to back,” “Pushes up with straight arms when on tummy” and “Leans on hands to support herself when sitting”; the tip “Put your baby on her tummy or back and put toys just out of reach. Encourage her to roll over to reach the toys.”
27. Centers for Disease Control and Prevention. Milestones by 9 Months. Learn the Signs. Act Early. Page dated May 15, 2026. Checked October 10, 2026.
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    Movement milestones: “Gets to a sitting position by herself,” “Moves things from one hand to her other hand,” “Uses fingers to ‘rake’ food towards himself” and “Sits without support”; the tip “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.” Crawling is not among the movement milestones on any of the twelve checklists.
28. Centers for Disease Control and Prevention. Milestones by 15 Months. Learn the Signs. Act Early. Page dated May 15, 2026. Movement milestones: “Takes a few steps on his own” and “Uses fingers to feed herself some food.” Checked October 10, 2026.
29. Centers for Disease Control and Prevention. Milestones by 2 Years. Learn the Signs. Act Early. Page dated May 15, 2026. Movement milestones: “Kicks a ball,” “Runs,” “Walks (not climbs) up a few stairs with or without help” and “Eats with a spoon”; the tip “Give your child balls to kick, roll, and throw.” Checked October 10, 2026.
30. Centers for Disease Control and Prevention. Milestones by 30 Months. Learn the Signs. Act Early. Page dated May 15, 2026. Checked October 10, 2026.
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    Movement milestones: “Uses hands to twist things, like turning doorknobs or unscrewing lids,” “Takes some clothes off by himself,” “Jumps off the ground with both feet” and “Turns book pages, one at a time, when you read to her”; the tip “Play with your child outside. For example, take your child to the park to climb on equipment and run in safe areas.”
31. American Academy of Pediatrics. Corrected Age For Preemies. HealthyChildren.org. Last updated December 10, 2018. Checked October 10, 2026.
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    “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 number of weeks your baby was preterm”; and the example: “If your baby was born at 32 weeks’ gestation, she was 8 weeks (2 months) preterm. If she is now 4 months old (16 weeks since birth), her corrected age is 2 months,” so “It would be unrealistic to expect your baby to be ready to roll from her stomach to her back,” a skill that “often develops in term babies around the age of 4 months.”
32. Bhat AN. Is motor impairment in autism spectrum disorder distinct from developmental coordination disorder? A report from the SPARK study. Physical Therapy. 2020;100(4):633–644. PMID 32154876. Checked October 10, 2026.
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    Parent reports on the DCD questionnaire for children with autism “between 5 and 15 years of age” (final dataset n = 11,814): “The proportion of children with ASD at risk for a motor impairment was very high at 86.9%. Children with ASD did not outgrow their motor impairments and continued to present with a risk for DCD even into adolescence. Yet, only 31.6% of children were receiving physical therapy services”; the analysis “did not involve follow-up clinical assessments”; and “A diagnosis of ASD must trigger motor screening, evaluations, and appropriate interventions by physical and occupational therapists.”
33. Engström P, Tedroff K. Idiopathic toe-walking: prevalence and natural history from birth to ten years of age. Journal of Bone and Joint Surgery (American). 2018;100(8):640–647. PMID 29664850. Checked October 10, 2026.
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    In “a population-based cohort of 1,401 healthy 5.5-year-old Swedish children, we found the prevalence of idiopathic toe-walking to be approximately 5%”; “by the age of 10 years, 50 (79%) of the original 63 patients had spontaneously ceased toe-walking”; “One subgroup of children displayed early contracture of the ankle and should thus not be considered idiopathic toe-walkers”; and “Neurodevelopmental comorbidities are common among those who continue to toe-walk.”
34. Noritz GH, Murphy NA; Neuromotor Screening Expert Panel. Motor delays: early identification and evaluation. Pediatrics. 2013;131(6):e2016–e2027. PMID 23713113. An AAP clinical report (erratum 2017). Checked October 10, 2026.
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    The abstract: “Earlier identification of motor delays allows for timely referral for developmental interventions as well as diagnostic evaluations and treatment planning”; highlights include “suggestions for formal developmental screening at the 9-, 18-, 30-, and 48-month well-child visits; approaches to the neurologic examination, with emphasis on the assessment of muscle tone”; diagnostic tests “including brain MRI for children with high muscle tone, and measuring serum creatine kinase concentration of those with decreased muscle tone”; and “The importance of pursuing diagnostic tests while concurrently referring patients to early intervention programs is emphasized.”
35. U.S. Department of Education. 34 CFR 303.303: Referral procedures. Electronic Code of Federal Regulations. The primary referral sources listed include “Hospitals, including prenatal and postnatal care facilities,” “Physicians,” “Parents, including parents of infants and toddlers” and “Child care programs and early learning programs.” Checked October 10, 2026.
36. U.S. Department of Education. 34 CFR 300.301: Initial evaluations. Electronic Code of Federal Regulations. Checked October 10, 2026.
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    “either a parent of a child or a public agency may initiate a request for an initial evaluation to determine if the child is a child with a disability”; the evaluation “Must be conducted within 60 days of receiving parental consent for the evaluation; or ... If the State establishes a timeframe within which the evaluation must be conducted, within that timeframe.”
37. U.S. Department of Education, Office of Special Education Programs. OSEP Memo 11-07: A Response to Intervention (RTI) Process Cannot Be Used to Delay-Deny an Evaluation for Eligibility under the Individuals with Disabilities Education Act (IDEA). January 21, 2011 (copy published by the Tennessee Department of Education). Checked October 10, 2026.
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    “The regulations at 34 CFR §300.301(b) allow a parent to request an initial evaluation at any time”; if the district agrees it must give notice and obtain consent, and must evaluate “within 60 days of receiving parental consent for the evaluation or, if the State establishes a timeframe within which the evaluation must be conducted, within that timeframe”; and if it denies the request, “the LEA must provide written notice to parents explaining why the public agency refuses to conduct an initial evaluation.”
38. 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(2):CD005495. PMID 38348930. Checked October 10, 2026.
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    “Forty-four studies met the inclusion criteria (5051 randomly assigned participants)”; “At preschool age, the intervention probably did not improve motor outcomes” (moderate-certainty evidence); and the conclusion: programs “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)”, with “Considerable heterogeneity” and further research needed “to determine which types of early developmental interventions are most effective.”
39. Peredo DE, Hannibal MC. The floppy infant: evaluation of hypotonia. Pediatrics in Review. 2009;30(9):e66–e76. PMID 19726697. Checked October 10, 2026.
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    “Hypotonia is characterized by reduced resistance to passive range of motion in joints versus weakness, which is a reduction in the maximum muscle power that can be generated”; “central hypotonia accounts for 60% to 80% of cases of hypotonia, whereas peripheral hypotonia is the cause in about 15% to 30% of cases”; “50% of patients who have hypotonia are diagnosed by history and physical examination alone”; and evaluation “includes a karyotype, DNA-based diagnostic tests, and cranial imaging.”
40. Levtzion-Korach O, Tennenbaum A, Schnitzer R, Ornoy A. Early motor development of blind children. Journal of Paediatrics and Child Health. 2000;36(3):226–229. PMID 10849221. Checked October 10, 2026.
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    The study “compared the developmental data concerning 10 motor skills of 40 blind children to a control group of sighted children”; “The motor development of blind children was delayed, the delay being significant in all 10 motor skills that were examined. This delay emphasizes the major importance of vision as a sensory input modality for the process of sensory- motor development.”
41. Centers for Disease Control and Prevention. Signs and Symptoms of Autism Spectrum Disorder. Page dated May 16, 2024. Checked October 10, 2026.
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    “People with ASD may also have different ways of learning, moving, or paying attention”; “Most people with ASD have other related characteristics,” listed as including “Delayed language skills,” “Delayed movement skills” and “Delayed cognitive or learning skills”; and “some people without ASD might also have some of these symptoms.”
42. Lim YH, Licari M, Spittle AJ, Watkins RE, Zwicker JG, Downs J, Finlay-Jones A. Early motor function of children with autism spectrum disorder: a systematic review. Pediatrics. 2021;147(2):e2020011270. PMID 33510035. Checked October 10, 2026.
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    “Twenty-five studies were included in this review; in most of the studies, the authors examined children with later autism spectrum disorder (ASD). Early motor impairments were detected in children later diagnosed with ASD. The meta-analysis results indicated that differences in fine, gross, and generalized motor functions between the later ASD and typically developing groups increased with age. Motor function across different NDD groups was found to be mixed”; “More research is needed to ascertain the clinical utility of motor impairment detection as an early transdiagnostic marker of NDD risk.”
43. Hewitt L, Kerr E, Stanley RM, Okely AD. Tummy time and infant health outcomes: a systematic review. Pediatrics. 2020;145(6):e20192168. PMID 32371428. Checked October 10, 2026.
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    “Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting”; “Most studies were observational in design.”
44. Sims A, Chounthirath T, Yang J, Hodges NL, Smith GA. Infant walker-related injuries in the United States. Pediatrics. 2018;142(4):e20174332. PMID 30224365. Checked October 10, 2026.
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    “An estimated 230 676 children <15 months old were treated for infant walker-related injuries in US emergency departments from 1990 to 2014. Most of the children sustained head or neck injuries (90.6%) and 74.1% were injured by falling down the stairs in an infant walker”; infant walkers “remain an important and preventable source of injury among young children, which supports the American Academy of Pediatrics’ call for a ban on their manufacture and sale in the United States.”
45. Nordon DG, Passone CGB, da Silva CAA, Grangeiro PM. W-sitting in childhood: a systematic review. Acta Ortopédica Brasileira. 2024;32(6):e279277. PMID 39802577. Checked October 10, 2026.
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    “Despite the lack of science-based evidence, many specialists and non-specialists consider W-sitting detrimental to children”; seven studies were analyzed; “This review found no scientific evidence advise against W-sitting in children and no association with hip dysplasia. Moreover, muscular activation remains the same, regardless of the position chosen for sitting.”
46. U.S. Department of Education. 34 CFR 303.13: Early intervention services. Electronic Code of Federal Regulations. Checked October 10, 2026.
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    Early intervention services “Are selected in collaboration with the parents” and “Are designed to meet the developmental needs of an infant or toddler with a disability and the needs of the family”; “Physical therapy includes services to address the promotion of sensorimotor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation”; and “Occupational therapy includes services to address the functional needs of an infant or toddler with a disability related to adaptive development, adaptive behavior, and play, and sensory, motor, and postural development.”
47. U.S. Department of Education. 34 CFR 303.321: Evaluation of the child and assessment of the child and family. Electronic Code of Federal Regulations. Checked October 10, 2026.
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    “no single procedure may be used as the sole criterion for determining a child’s eligibility,” and procedures must include “Administering an evaluation instrument,” “Taking the child’s history (including interviewing the parent),” “Identifying the child’s level of functioning in each of the developmental areas,” “Gathering information from other sources such as family members, other care-givers, medical providers, social workers, and educators” and “Reviewing medical, educational, or other records”; “Qualified personnel must use informed clinical opinion when conducting an evaluation and assessment of the child”; and a “family-directed assessment” identifies “the family’s resources, priorities, and concerns.”
48. U.S. Department of Education. 34 CFR 303.126: Early intervention services in natural environments. Electronic Code of Federal Regulations. Checked October 10, 2026.
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    Services are provided “(a) To the maximum extent appropriate, in natural environments; and (b) In settings other than the natural environment that are most appropriate, as determined by the parent and the IFSP Team, only when early intervention services cannot be achieved satisfactorily in a natural environment.”
49. U.S. Department of Education. 34 CFR 300.101: Free appropriate public education (FAPE). Electronic Code of Federal Regulations. Checked October 10, 2026.
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    “A free appropriate public education must be available to all children residing in the State between the ages of 3 and 21, inclusive”; the obligation “begins no later than the child’s third birthday,” and “An IEP or an IFSP is in effect for the child by that date.”
50. U.S. Department of Education. 34 CFR 300.111: Child find. Electronic Code of Federal Regulations. States must ensure that “All children with disabilities residing in the State ... regardless of the severity of their disability, and who are in need of special education and related services, are identified, located, and evaluated.” Checked October 10, 2026.
51. U.S. Department of Education. 34 CFR 303.209: Transition to preschool and other programs. Electronic Code of Federal Regulations. Checked October 10, 2026.
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    Not fewer than 90 days before the third birthday of a toddler who may be eligible for preschool services, the lead agency “notifies the SEA and the LEA,” and “with the approval of the family of the toddler, convenes a conference, among the lead agency, the family, and the LEA not fewer than 90 days” and, “at the discretion of all parties, not more than 9 months” before the toddler’s third birthday, “to discuss any services the toddler may receive.”

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. It is not a substitute for evaluation by a qualified clinician who knows your child. If your child has lost skills they previously had, contact their doctor promptly.