There are so many factors that influence children’s development as it is interwoven into several different systems that work together. The visual systems input, the motor systems output, emotional and behavioral regulation, proprioception and balance, the brains’ ability to refine movement and create schemes or patterns that improve our efficiency, and the execution of movement. These are all systems that as adults we have developed over time and have become experts at using. We forget how much effort and practice it takes to perfect these systems to use them seamlessly and automatically in our daily tasks.
Why as parents and caregivers do we care about these “milestone” achievements? And do we put too much, or not enough value on them? We try not to compare our kiddos to their peers, but this can be telling of deficits a child may need to work on, or the need to find adaptations to improve their development and quality of life. We put value on early developmental milestones such as rolling and sitting because they are the foundation of what is to come next, and it’s these building blocks of movement that allow for experiences that infants and toddlers can learn from.
Working with kids and their families I have learned that there is fluctuation on when gross motor skills are achieved, and there is very much a significant spectrum regarding the perspective of what parents expect from their children. Every family has different expectations and goals, and that is expected and admirable. It is the job of health providers to educate parents on why something may or may not be needed to improve or maintain their kiddos health and development.
For reference, typical development of gross motor milestones:
- 3-4 Months: Rolling; from their back to side lying
- 5-10 Months: Sitting (average is 6 months); sits alone steadily
- 6-12 Months: Pulls to stand on furniture
- 9-17 Months: Walking (avg. 12.1 months); independent steps, falls easily
Not all kids reach developmental milestones at the same time.
We have established that pediatric motor milestones are not achieved at the exact same time for each child and there are multiple factors of influence. This is why we see ranges when it comes to motor milestone achievement and the acknowledgement that just like adults, kids have areas of strength, and they can only make so many changes at any given time.
What do gross motor skills influence?
When considering typically developing bodies it is often take for granted just how much independent movement influences that development. If I want a glass of water, I get up and pour it, or simply ask someone to bring me one. This is not the case for kiddos trying to develop motor and language skills. When someone can’t get what they want they may exhibit behavioral outputs, also known as fits or tantrums that erupt from one’s inability to independently achieve something they want, or more importantly need. Once again, it is important to note how many systems must work together to establish something as relatively simple as getting a glass of water.
We learn from exploring, and this exploration often involves some degree of gross motor skill. Whether it be independent sitting, standing, squatting, climbing, reaching, or walking, these skills allow for infants and toddlers to explore and therefore learn about the environment they are in. This is why it is so important our kids have these skills and to master them because it provides so much enrichment and opportunity within their lives.
Tips and tricks for helping early movement.
- Get on the floor. This is where you can really inspire, create, and explore different experiences that influence the movement you would like to see your kiddo have. For example, if you are working on crawling and your kiddo is wearing pants and you have hardwoods you might notice they are slipping and need to change the surface they are on to a rug or carpet for better traction. You can see and feel what they are experiencing if you are willing and able to personally replicate the activity you are asking of them.
- Be patient! So often we help too much. Children will take what you give them, the more support and help you give them, the less they are willing to do. For example, when you are trying to improve sitting independence, they are likely to lean on whatever support you give them. Start with your hands under their armpits, if you see and feel less wiggling and more stability from their trunk, slide your hands (supporting them) down their trunk, this will make them have to work harder. Over time you will feel and see less of that torso wiggle. When you are ready, slowly remove your hands giving them a small degree of movement but being right there to assist them as needed to continue that positive experience and progress forward toward independent sitting.
- Progress things at your kiddo’s pace. When we are trying to master a new activity as adults, it takes time and practice. Our kids have so many different systems that they are trying to establish that they need to be given adequate time to practice working on these tasks. For example, if your kiddo has not yet reached independent standing, it is going to be hard for them to be able to walk independently. The need for practice at establishing their postural control in a static stand is essential before they can progress to a dynamic activity such as walking.
- Vary movement and give different and new opportunities.In those early months there is very little capability to change your child’s position beyond being helped to lay on their back. Try changing how you hold your kiddo. Lay them down on your thighs with your knees up, so they are sitting up and looking at you, do tummy time on your chest, practice laying on your side with support at the pelvis. Let kids explore different positions and change those positions frequently. Being in a container (i.e., a car seat, or bouncer) all day is no way to develop the many systems needed for movement. Make an effort toward providing different opportunities for movement.
When to call the experts.
As a parent, or caregiver, if you are concerned about a child’s movement patterns or lack thereof, reach out to a medical provider. This will often be their pediatrician. You may get referred to services such as physical, occupational, and/or speech language therapy where a more formal assessment will be done to determine if impairments are present. What those may be, in addition to age-related norms, and how your child compares for their age will be determined. If you know a pediatric physical therapist, you may be able to initiate care without a referral. Based on direct access, further testing or help will guide faster initiation of care. From there, if the child’s development is found “atypical” further services might be warranted, or treatment will begin to address functional deficits.
There is such a wide spectrum for how kids move, and this is often tied to how their nervous system works. As previously mentioned, there are many systems at play when it comes to movement and the quality of that movement. Physical therapy is not only a great place to screen those variants, but it is also a place to improve the quality and confidence of that movement. Our goal is to establish functional, safe and healthy movement that allows for play, engagement and exploration of the world we live in to maximize the quality of life. Be your kid’s advocate! Reach out to your local pediatric PT if you have questions and or concerns regarding your child’s development.
RESOURCE
Effgen, Susan. Meeting the Physical Therapy Needs of Children 2nd Edition. Philadelphia, Davis Company, 2013.
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