Occupational Therapy Developmental Milestones: Ages 12-24 Months

As your once-tiny baby transitions to toddlerhood, you’ll start seeing them reach a whole new set of physical, social, and cognitive milestones. This guide covers the fine motor, visual, social, play, cognitive, and sensory development skills to watch for between the ages of 1 and 2 years old. These are all areas in which occupational therapists (OTs) can support toddlers when needed.

Key takeaways

  • Toddlers ages 12-24 months old typically reach milestones that build on skills they learned in infancy.

  • Occupational therapists can support children’s fine motor and visual skills, social and play skills, regulatory and sensory skills, and cognitive abilities.

  • Fine motor skills for toddlers help them start doing more things with their hands, such as manipulating items and toys better.

  • Cognitive skills include being able to find hidden items (object permanence), understanding cause-and-effect, matching, and sorting.

  • Regulatory and sensory development helps toddlers stay balanced enough to venture out and try new experiences or movements, like walking or running.

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What do occupational therapists assess and treat in children?

Occupational therapy can help with several areas of childhood development:

  • Fine motor and visual motor skills

  • Social and play skills

  • Cognitive development

  • Regulatory and sensory organization

Fine motor and visual development is how toddlers use their hands and eyes together to interact with items and their environment. This might include stacking blocks or putting objects into a container. 

Social and play skills are how kids learn to engage with others, such as through playing simple games like peek-a-boo, or smiling while playing with another person. 

Cognitive growth includes problem-solving skills, attention, and cause-and-effect understanding. Cognitive skills keep your child learning and growing.

Regulatory and sensory organization is how toddlers respond to sensory input like touch, sound, movement, or visual stimuli. It also includes how well they deal with different emotions. Good regulatory skills help kids handle transitions, new experiences, and day-to-day routines more easily.

See our other developmental milestone checklists for toddlers:

Occupational therapy developmental milestones: 12-18 months

Fine motor and visual milestones at 12-18 months

At this age, you’ll start seeing your toddler pick up items and manipulate them more easily. This shows how far their fine motor and visual motor skills are coming. Both their vision and their physical movements have to work together so they can manipulate things like toys or blocks. 

Here are some of the expected fine motor and visual skills for ages 12 to 18 months:

  • Picks up small objects with a pincer grasp, using thumb and pointer finger (by 12 months)

  • Puts objects into a container (for example, puts a block in a cup) 

  • Takes objects out of containers 

  • Stacks two blocks (by around 15 months)

  • Turns pages in a board book, often multiple at a time

  • Uses both hands together to manipulate objects

  • Begins to scribble with items like crayons

At this age range, you’ll also start to see your toddler point with an index finger. So instead of just reaching out their arm toward an item, their finger will actually point.  

Regulatory and sensory milestones at 12-18 months

Your toddler will make lots of gains in regulatory and sensory development at this age. They’ll likely start expressing opinions in how they play or what they do! They probably have preferred toys or activities, like toy cars, coloring, or playing outside.

As your child plays with different toys and items, they’ll try to experience them in a variety of ways. This may include mouthing, touching, or banging the items.

When it comes to eating, they should generally tolerate different textures of food, like smooth purees, soft solids, mixed textures, or crunchy foods. They should also tolerate feeling different textures during play, such as grass, sand, or wet textures like water play or bubbles. Keep in mind, if your child doesn’t enjoy certain textures it doesn’t mean a sensory disorder is present. Sensory responses vary among children, so it's best to simply keep an eye on it.

Toddlers this age should also show that they want to move! They will typically:

  • Push toys like toy walkers or toy cars with handles

  • Cruise along furniture

  • Begin early walking 

Toddlers have many emotions and feelings, and it’s normal for them to get upset at times. It may take some time and practice, but as a whole, toddlers at 12-18 months should be able to calm with support from their caregiver. Lots of hugs and deep breaths help these little ones learn how to do this!

Cognitive milestones at 12-18 months

Cognitive skills are growing rapidly in the 12-18 month range. Take a look at some of the fun things you may see your toddler do!

  • Look for objects that are hidden 

  • Imitate simple actions, like clapping or picking up a toy 

  • Use objects correctly (for example, drink from a cup, brush hair with a brush) 

  • Experiment with cause-and-effect actions like dropping a toy, banging toys together, or pushing an item like a toy train

  • Follow simple routines when familiar (such as brushing teeth, getting dressed, getting ready for bed)

  • Show early problem-solving (for example, trying different ways to reach objects, such as standing on a step stool, or turning items around to fit into something more easily, like a shape sorter)

Social and play milestones at 12-18 months 

It’s rewarding to watch your toddler grow their play and social skills! It’s a chance to see their personality shining through. 

Your toddler will typically do the following at this age:

  • Laugh or smile during playtime with another person

  • Play simple interactive games (pat-a-cake, peek-a-boo)

  • Bring objects to show caregivers 

  • Hand toys to others to start an interaction

  • Enjoy exploring toys on their own, but check back with their caregiver

  • Begin simple functional play (feeding a doll, pushing a car) 

Occupational therapy developmental milestones: 18-24 months

Fine motor and visual milestones at 18-24 months

By the time your child turns 18 months, they’re starting to do more and more activities that require fine motor and visual skills. You should start seeing them:

  • Build a tower of 3 to 4 blocks 

  • Scribble with a crayon; begin using vertical and circular scribbles by around 24 months

  • Use a spoon with better control 

  • Dump objects out of containers intentionally, such as in order to get out what they want to play with

  • Insert shapes or objects into openings (simple puzzles or shape sorters)

  • Help remove simple clothing items when getting undressed 

Regulatory and sensory milestones at 18-24 months

At this age, toddlers learn to explore a little, but they also want familiarity. You may see them want to do things on their own, such as feeding themselves or venturing out on a playground. You should also see them want to move often, like trying to climb or carry things themselves.

Your toddler may get frustrated when something is hard for them. That’s OK! Frustration is normal. They will calm more easily with a parent or caregiver to help them.

As far as familiarity, you will see your toddler enjoy things that are routine to them. Maybe they have a “wind-down” routine at the end of the day that they love, such as bathtime or reading books before bed. Or they may really like being at home or at a favorite family member's house. As much as toddlers need to explore, they also benefit from comfortable routines and environments that they know.

Cognitive milestones at 18-24 months

Your child’s understanding and cognitive skills are growing just as rapidly as their little bodies! Here are some cognitive skills to be on the lookout for:

  • Finds hidden objects easily, such as a toy hidden behind a chair or under a blanket

  • Tries trial-and-error problem solving, such as trying to open an item themselves or make something fit

  • Remembers locations of familiar objects, like their shoes, backpack, or water bottle

  • Understands simple cause-and-effect relationships in play, such as that a tower will fall if you hit it

  • Completes simple shape or object puzzles (by around 24 months)

  • Matches identical objects or pictures (by around 24 months)

  • Sorts objects by simple categories such as shape, color, or type (by around 24 months)

Social and play milestones at 18-24 months 

In the 18-24 month age range, your little one will start to imitate other people when playing. For example, they may imitate household tasks like sweeping or cooking. They’re likely more interested in pretend play activities, like feeding a doll or playing doctor. Their play routines are becoming more story-like, as well.

Kids at this age also start becoming more interested in other kids. They will play next to them, which is called parallel play. They likely won’t share in a play task together—they’re still just a little young for this skill. It will come soon!

What if your toddler isn’t meeting developmental milestones?

If your toddler seems to be missing some of these milestones, talk with your pediatrician or an occupational therapist. Early intervention is key, and starting occupational therapy sooner actually leads to faster progress!

Here at Expressable, we provide personalized, virtual occupational therapy designed to fit your child’s needs. Reach out to us to schedule an OT evaluation and get your questions answered.

Frequently asked questions (FAQs)

How Expressable Can Help

Concerned your child isn't reaching age-expected milestones? Looking for communication support from a professional? Expressable is a national online speech and occupational therapy practice serving children and adults. We treat all major areas of communication, feeding, and developmental skills, offer flexible hours including evenings and weekends, and accept most major health insurance plans. We’re proud to have earned more than 4,500 5-star reviews from our clients (4.83/5 average).

Our therapy model is centered on parent and caregiver involvement. Research proves that empowering caregivers to participate in their loved one’s therapy leads to better outcomes. That’s why we combine live, 1-on-1 speech and occupational therapy with personalized education and home practice activities for faster progress.

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