milestones

The muscles of the neck make it possible for baby to turn his or her head in the right direction. Similarly, the ability of baby to lift his hand to suck on his fingers, involves a gross motor movement.

Gross motor development usually happens easily and automatically, following a natural sequence. There are, however, times when this is not the case and the absence of certain skills can affect a child’s life well into adulthood.

Does your baby need a check-up even if they’re healthy?

The American Academy of Paediatrics and Bright Futures provide and update guidelines to paediatricians as to the developmental milestones that should be assessed at each check-up.

I know that parents often feel that a check-up for a well child is unnecessary, however this is the time when a healthcare practitioner can analyse milestones in the context of your child’s general health, growth, language development and emotional development.

The attainment of specific gross motor skills enables your healthcare provider to recognise children who may be at risk for developmental delays and learning difficulties.

What developmental milestones can I expect at the various stages?

For those of you with slightly older children you may recall seeing your healthcare practitioner at specific times. We usually like to see a child at 6 weeks, 3 months, 6 months, 9 months, 1 year, 18 months, 2 years and then annually thereafter.

It seems like a lot of visits but this is because so much development happens early on in life and a delay at an early age will definitely impact later functioning.

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At the 6 week check-up the health care provider will ensure that baby:

• Turns the head to both sides while lying on his or her back
• Kicks both legs and moves both arms equally while lying on his or her back
• Has a head lag when pulled from lying to a sitting position
• Lifts the head and is able to turn to both sides while lying on his or her tummy
• Displays the Moro response, stepping reflex, placing reflex
• Has the ability to grasp

At the 3 month check-up the health care provider will ensure that baby:

• Pushes up on his or her forearms and is able to turn the head from side to side while on his tummy
• Tolerates tummy time well
• Is able to roll from his tummy to his back
• Lifts his head in line with the rest of his body when pulled to a sitting position

At the 6 month check-up the health care provider will ensure that baby can

• Pulls his feet to his mouth while lying on his back
• Sits alone
• Reaches for a toy from the sitting position
• Is able to roll from his back to his belly
• Can push up on his hands with extended arms while lying on his tummy
• Can move in a circle to both sides from a tummy position
• Reaches for a toy using either hand
• Picks up toys and puts them in his mouth

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At the 9 month check-up the health care provider will ensure that baby:

• Is sliding around on his tummy in an attempt to crawl or is in fact crawling
• Stands stiff legged while holding onto a support
• Is able to catch himself when falling over from sitting
• Can change position from crawling to sitting and pivoting to grab a toy.

At the 12 month check-up the health care provider will ensure that baby:

• Begins cruising around the furniture
• Can pull to standing from a sitting position
• Can lie down from the sitting position
• Walks with 2 hands held or may take his first steps
• Is able to crawl over and around objects
• Often enjoys the “casting” game where he constantly throws a toy for Mom or Dad to retrieve.
• May help with dressing by sticking out his arms or legs

At the 18 month check-up the health care provider will ensure that baby:

• Begins to run
• Walks up and down stairs while holding your hand
• Can stand on tiptoe with support
• Is able to jump up and down.
• Squats to play
• Throws a ball
• Kicks a ball forward

At the 2 year check-up the health care provider will ensure that baby:

• Walks and runs fairly well
• Jumps in place with both feet off the ground
• Walks up and down stairs alone
• Kicks a ball with either foot
• Is able to walk backwards
• Can stand briefly on one leg when one hand is being held
• Can ride a tricycle
• Climbs up and down a toddler slide

The skills of the child will become more refined as your child matures. Fine motor skills develop at quite a rate during this time so ensuring that your child is doing loads of physical exercise will develop the gross motor skills and in turn support the fine motor skills.

What kinds of activities should I be doing with my baby to make sure they meet their developmental milestones from birth to 24 months?

Encourage motor skills development – birth to 3 months:

• One cannot stress the importance of tummy time enough. Remember that tummy time does not always mean that baby is lying on his tummy on the floor. You can have baby lie across your knees or hold him in the “leopard in the tree position”. All of these positions encourage baby to move the head from side to side and to strengthen the neck.
• Hold a rattle just above the chest and this will encourage baby to lift his head and reach for the rattle.
• Have baby on his back under a baby gym. This will encourage reaching with both arms. Baby will also be able to kick his legs freely.
• Put your baby in different positions when he is awake. This will encourage your baby to move his arms and legs in different directions.
• Taking a bath with your baby is great fun and your baby will get the opportunity to kick freely and splash the water.
• Gently flex your baby’s legs and make bicycle movements. This will strengthen the leg muscles and provide a different movement.

Encourage motor skills development – 3 to 6 months:

• Rolling activities would include games such as placing a toy on the side of baby, which encourages baby to try and reach for it. If baby doesn’t try to roll you could gently lift the corner of the blanket to give him a little momentum to roll from his tummy to his back.
• Sitting activities would begin with loads of cushions around baby for support. Place baby’s hands open on the floor to support his body. This activity will strengthen baby’s neck and trunk muscles and encourage baby to sit alone.
• Crawling activities encourage your baby to put weight on the knees and hands. One activity could be to place baby in a hand/knee position over your leg so that your leg supports under his tummy. Gently rock baby back and forth in this position so that he gets the sensation of weight bearing, being in a crawling position and has to hold his head up for a longer period.

Encourage motor skills development – 6 to 9 months:

• Babies can usually sit independently at this age. Encourage this by handing baby a toy so that the hands are freed up and the core needs to work to hold baby upright.
• Going from a lying down position to sitting involves the core and the ability to rotate your body. If baby struggles with this movement you can help him by rolling baby onto his side and then placing your hand under his shoulder and the other hand on his opposite hip. Guide him upwards instead of picking him straight up. You can do this if he topples over from sitting or if you are changing a nappy.
• Your baby is going to want to begin crawling. You can encourage this by placing toys just out of his reach. You may also want to pop him into a crawling position while supporting under the tummy.
• Crossing the midline is a very important skill for reading. You can begin to encourage this by handing your child a toy from either side of him so that you encourage him to cross over his body and cross the midline.

Encourage motor skills development – 9 to 12 months:

Activities for this age group really start becoming fun. Encourage baby by doing activities such as:

• Allow baby to turn the pages.
• Drop utensils into a container.
• Allow baby to have his own spoon for eating.
• Wave good-bye or say hello.
• Stack cups.
• Allow lots of play in the bath. Pouring water is such fun and great for gross motor skills.
• Babies love to be in a standing position on your lap while being bounced. This strengthens the leg muscles and encourages balance.
• All sorts of rolling games encourage agility and learning about the position of the body in space.
• If you have a large gym ball you can bounce baby in a sitting position on top of the ball.
• Create an obstacle course for crawling around and under.
• Put sturdy furniture close together to encourage cruising.

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Encourage motor skills development – 12 to 18 months:

• Teach your child to throw and kick a ball. Use all different size balls for this activity.
• Pushing and pulling toys involves different muscles and encourages your baby to do more than one activity at a time. He can pull a toy behind him while walking or have fun pushing a lawnmower along. This will involve his arms, legs and back muscles.
• Ride on toys where children learn to propel themselves with their feet. My children used to love to rush around on those little black motorbikes. Rocking horses and tricycles teach gross motor skills since they require a different physical movement to get the object moving.

Encourage motor skills development – 18 to 24 months:

Now your child is really quite stable on his feet and agile. Remember that all activities should be supervised so as to avoid injury but outdoor games do wonders to encourage gross motor skills. Playing on a jungle gym, balancing on a low wall, rolling around on the grass, kicking a ball, jumping on a jumping castle and basically doing all the fun things that children love to do builds strong muscles and will ultimately provide the child with good fine motor skills as well.

Gross motor activities are not only fun for both you and your child but form the basis of preventative paediatrics.

A child who is given the right amount of freedom and time to run, play, jump and tumble is way more likely to succeed as an adult than a child that is over protected or allowed excessive screen time.

The American Academy of paediatrics recommends that infants and toddlers get 180 minutes of activity spread throughout the day. It may seem a lot to parents who are busy and trying to work but the activities do not need to be big planned events.

Activities which allow children to be naturally active because they are outside or being given the freedom to play, do a wonderful job. I have observed children playing for hours with a large cardboard box. The little ones crawl in and out of the box playing hide and seek while the big ones will turn such a box into a house or hideout.

Allowing your children to build houses out of your cushions again encourages all sorts of skills. They balance cushions, crawl carefully between them so as not to allow them to fall, hide inside the space and make up all sorts of imaginary games.

As simple as this all sounds it requires skills that are obtained through normal child’s play.

You do not need to invest in expensive toys or spend endless money on extra-mural activities, you just need to allow children to play.

When you observe an activity which your child finds difficult or avoids, do not hesitate to speak to your healthcare provider. As we said in the beginning, gross motor skills happen sequentially, so if one is missing or delayed, it will have an impact on later skills.

References:

https://brightfutures.aap.org/materials-and-tools/guidelines-and-pocket-guide/Pages/default.aspx

https://pedsinreview.aappublications.org/content/31/7/267

https://www.researchgate.net/publication/327776864_Assessment_of_Fine_and_Gross_Motor_Skills_in_Children

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321389/

https://www.medschool.lsuhsc.edu/medical_education/undergraduate/spm/SPM_100/documents/MotorDevelopment.pdf