Gross Motor Preschool Milestones 3 years to 5 years

During the preschool years (ages 3 through 5) a child learns various new gross motor skills. These new skills are vital for playing with their peers. Each child learns these at a different rate, however the following is an general outline of the development of gross motor skills during the preschool years:preschooler jumping

Gross Motor Skills of a 3 Year Old:

  • Standing on one foot for 3 seconds
  • Walking up and down stairs without holding onto the railing, reciprocating (one foot on each step)
  • Jumps over a line
  • Jumps forwards 2 feet
  • Jumps off a step with both feet simultaneously
  • Kicking a stationary ball 6 feet forwards
  • Throwing a ball both under and over hand
  • Independently get on/off a tricycle and pedal 20 feet

Gross Motor Skills of a 4 Year Old:

  • Standing on one foot for 5 seconds
  • Standing on tiptoes for 3 seconds without moving feet
  • Jumps forward 3 feet
  • Jumps up onto a step (approximately 8 inches high) with two feet
  • Jumps over a small hurdle
  • While running, is able to alternate direction and stop easily without losing balance
  • Hops on one foot 5 times
  • Walks backwards on a line
  • Gallops 10 feet
  • Throwing ball so it hits a target from 5 feet away

Gross Motor Skills of a 5 Year Old:

  • Standing on one foot for 10 seconds
  • Standing on tiptoes without moving feet for 8 seconds
  • Mimics movements accurately
  • Skips 10 feet
  • Jumping sideways
  • Kicking a stationary ball straight for 10 feet
  • Recommended:
    • Swimming: can “doggy-paddle” 2 feet to the edge of the pool
    • Biking: can independently pedal, steer, and stop a bike with training wheels (may begin to try without training wheels)

If a child has not yet learned these skills by kindergarten, or is having trouble performing these skills, there may be a cause for concern. They may be low tone or weak in their core or extremities. If you feel that your child is delayed in their preschool gross motor skills and would like advice or help, feel free to contact us for a physical therapy evaluation.  For a complete Milestone Guide for 3 Year olds compiled by Speech Pathologists, Occupational Therapists and Physical Therapists, click here!

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How Hearing Affects Your Child’s Speech And Language Development

If you are concerned about your child’s articulation (the way he produces his speech sounds) and are considering a speech and boy hearinglanguage evaluation, a hearing evaluation may be helpful as well!

“But I am concerned with my child’s speech, not his ability to hear” – you say? Consider this: if you weren’t able to hear people speaking, how precisely would you be able to imitate their speech? Not very easily! Continue reading to discover just how important and informative a hearing evaluation can be.

Q: What does an initial hearing evaluation consist of?

A: Typically, an audiologist will conduct the following screening measures:

Pure Tone Audiometry Test: This consists of your child wearing headphones and responding (usually by raising his hand) to tones in each ear at different frequencies (pitch) and intensities (loudness). This test identifies the various pitches and loudness levels your child can hear.

Speech Reception Threshold: The audiologist will read two-syllable words pronounced with equal stress on each part, like “hotdog” and ask your child to repeat them. This test checks your child’s ability to understand speech sounds in each ear.

Speech Discrimination Testing: The audiologist will read single-syllable words, like “ball” and ask your child to repeat them. The purpose of this assessment is to determine the percentage of words your child can hear.

Q: Why is a hearing evaluation so important?

A: A hearing evaluation can help to determine if a hearing loss is present.

A: If a hearing loss is present, the evaluation can be the first step to correcting the hearing loss (hearing aids, cochlear implant, amplifier systems for your child’s classroom, etc).

A: A hearing evaluation may help explain why your child’s speech production skills are lower than what is expected for a child his age. For instance, certain speech sounds are heard at different pitch levels or at different volumes. This means, if your child has a hearing loss in a specific area, he wouldn’t be expected to accurately produce the corresponding sounds!

  • Even with a mild hearing loss, many speech sounds (z, v, p, h, g, ch, sh, k) may be affected!

A: A hearing evaluation can even help identify disorders of the ear. For instance, the evaluation can help identify external otitis (more commonly known as “swimmer’s ear”)!

A: A hearing disorder can affect your child in the classroom. Results from an evaluation may help to adjust your child’s school day to optimize his performance (e.g. changing his desk position in the classroom, using an FM system, giving the teacher a small microphone, etc).

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TOT collar: What is it and When it is Appropriate to Use?

A TOT collar is a device used to correct torticollis, often in addition to physical therapy. Next, you may be asking “what is torticollis?” Torticollis, often referred to “wryneck” is a tightening or shortening of the sternocleidomastoid muscle in the neck. Infants with torticollis will likely present with a head tilt to one side, and chin rotated to the other side. Congenital muscular torticollis is usually recognized in the first 6 to 8 weeks of life. With physical therapy, it is correctible in over 90% of cases. tot collarHowever, if left untreated, can lead to scoliosis, plagiocephaly (head flattening) and asymmetry with gross motor milestones.

If the child has a head tilt of 5 degrees or more and can lift his or her head away from the side of the head tilt, a TOT collar can be used, in addition to physical therapy, to help correct torticollis. The TOT collar is made of soft tubing and nylon tubes. The tubing is then fastened with a connecting strap.

The basis of the TOT collar is to have a stimulus to the side of the head tilt so that the child will be able to move his or her head away from the stimulus toward a midline head position.

Early intervention is key when treating torticollis. If you or your pediatrician see flattening on one side of your infants skull and notice that they are looking to one side, make sure to see a physical therapist for treatment.

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When Should You Take A Pacifier Away | Pediatric Therapy TV

Pediatric Speech and Language Pathologist explains when a parent should take a pacifier away from a baby or toddler.

In this Video You Will Learn:

  • If there is a specific age to take the pacifier away
  • How sucking on a pacifier can cause feeding and speech difficulties
  • What kind of pacifier a child should be using

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide audience, this is Pediatric Therapy TV where we provide experience and innovation to maximize your child’s potential. Now, your host, here’s Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I’m your host, Robyn Ackerman. Today, I’m standing with speech and language pathologist, Allison Raino. Allison, can you tell us at what age a child should stop using a pacifier?

Allison: Sure. Unfortunately, there’s no definitive age but what I can talk about are the limitations that pacifiers have on oral development. The first reason why pacifiers can become problematic is the amount of time the baby has a pacifier in their mouth, and the second being the size and the shape of the pacifier.

As the baby transition into chewing, jaw strength and stability is very important developmental growth, and sucking on a pacifier drastically limits the amount of jaw movements, reducing the strength and stability which could cause future feeding and speech difficulties.

The second being the size and the shape of the pacifier. The pacifiers that are rounded on the top and flat on the bottom, they’re too big for the baby’s mouth. The pacifiers that are rounded on all sides, those are preferred because it puts the tongue in a more natural position.

So, my two suggestions would be to limit the amount of time the pacifier is used as well as using the pacifier that is rounded on all sides.

Robyn: All right. Thank you for those suggestions and thank you to all of our viewers for watching. And remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV where we bring peace of mind to your family with the best in educational programming.

To subscribe to our broadcast, read our blogs or learn more, visit our website at That’s

What is Proprioception and Why is it Important?

What: Proprioception is the concept of knowing where your body is in space (body awareness) and the ability to safely maneuver around your environment. It also includes the use of heavy work activities and the ability to stimulate the joint receptors.

Why: Proprioceptive input is important for a child’s frog jumpsdevelopment because it helps them to feel a sense of self, aides in self-regulation and promotes success in both fine motor and gross motor activities. It is also important as it helps a child to be aware of their “personal space” and how to appropriately engage with their peers without overstepping their boundaries (e.g. hugging without asking) or not engaging enough (e.g. decreased eye contact).

Activities to provide proprioceptive input:

  • Wheelbarrow walks
  • Bear hugs
  • Body pillow “sandwich” (have child lay between two large body pillows and provide them with moderate squishes)
  • Frog jumps
  • Jumping on a trampoline or on a mattress
  • Pushing a heavy basket/cart (e.g. fill a laundry basket and have child push across the house)
  • Pulling a heavy wagon
  • Squeezing or rolling playdough/theraputty
  • Bouncing on a pogo stick or on a hippity hop ball
  • Climbing a rockwall
  • Monkey bars
  • Tug of war (e.g. use a towel to play tug of war with a partner using both hands; place pillows behind each child, so that if they fall or lose their balance, they can crash into the pillows)

New Definition of Autism for DSM

Another firestorm of controversy was unleashed recently as experts continue to argue over proposed changes to the diagnosis of autism and related disorders. The American Psychiatric Association has proposed changes to the Diagnostic and Statistic Manual of Mental Disorders (DSM) for the fifth edition that would effectively consolidate Autism, Asperger’s Disorder and autism ribbonPervasive Developmental Disorder Not Otherwise Specified into a unified diagnosis of Autism Spectrum Disorder. The changes come, in part, because of the APA’s belief that these disorders share common set of behavioral manifestations that are reliably differentiated from non-autistic disorder; but not well differentiated from each other.

Reasons For The Autism Diagnosis Criteria Change:

In the published rational, that APA stated “A single spectrum disorder is a better reflection of the state of knowledge about pathology and clinical presentation; previously, the criteria were equivalent to trying to ‘cleave meatloaf at the joints’.” This belief reflects emerging data that several similar brain regions develop in a pathological fashion in all three conditions and underlie the similarities between the conditions.

Autism Diagnosis Criteria Change Consequences:

However, the change in criteria may have other consequences. Fred Volkmar, MD, director of the Yale Child study Center and a leading expert in the field released results from his upcoming study that posited that changes in criteria could lead to as many as 50% of subjects in previous studies being eliminated from the spectrum and facing an end to needed services. While others have challenged this assumption, there is little doubt that a more narrow definition is being sought in part to limit the expansion of children meeting criteria for one of the pervasive developmental disorders. The CDC indicates that current estimates of autism and related disorders is about 1:150 children. However, studies have reported rates as high as 1:90 depending on the methods used in establishing the diagnosis.

Other experts in favor of the new DSM criteria contend that since some states do not provide the same level of care to children with PDD NOS and Asperger’s Disorder, rolling these conditions into an Autism Spectrum Disorder may actually increase access to care in some states.

How This Changes The DSM:

What seems to be lost in this discussion is the paradigm shift proposed to the structure of the DSM. Historically, most categories of disorders (such as Depressive, Anxiety, Amnestic, Substance Use, etc) are made based on behavioral characteristics as opposed to objective data or lab findings and all have maintained a “Not Otherwise Specified” category to allow for partial symptom presentations or atypical patterns that would still fall under the general heading. This format is consistent for the current range of Pervasive Developmental Disorders including autism. The new spectrum model is a departure from existing diagnostic nomenclature and the rational for this has not been explained. Imagine if spectrums were used for all conditions. Depressive Spectrum Disorders could range from a bad week on one end to inpatient hospitalization and suicidal ideation on the other. Researchers would simply treat them all as a continuum of severity. This does not happen mainly because differences in the onset, treatment and prognosis of each depressive disorder are very different even though the characteristics of dysphoria, loss of interest and behavioral changes may be similar. Clearly differences in diagnoses within categories are possible based on factors other than behavioral characteristics.

Supporters of the new DSM criteria may also be undervaluing the neurological and genetic markers currently under study. Recent evidence has suggested high rates of seizures and EEG abnormalities in autism and PDD NOS not seen in Asperger’s syndrome. Numerous genetic disorders have now been shown to have increased risk for autistic symptoms though none have been shown to have increased risk for Asperger’s Disorder. Accelerated head growth, ventricular abnormalities and pathological development of the language centers are all commonly found in autism and PDD, though not frequently present in Asperger’s Disorder. Conversely, neurological conditions that impact right hemisphere function show marked similarities to the nonverbal learning difficulties found frequently in Asperger’s Disorder. Even birth order, high risk pregnancies and prenatal complications are over-represented in autism and PDD NOS though all these biological markers were not considered in the spectrum model currently proposed.

Ultimately, continued research is needed to evaluate the similarities and differences in these conditions and many of us in the field are concerned that lumping related conditions together will weaken this process and potential our understanding of the root causes of these disorders. However, there is no denying that the ongoing discussions related to changes in the diagnostic nomenclature have brought needed attention to escalating rates of these diagnoses and the need for standardization.

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Making Mealtime Fun

Eating is supposed to be an enjoyable and social experience. For children with feeding disorders, the opposite may be true. In fact, children with sensory-based feeding disorders often find mealtimes to be stressful and anxiety-provoking. This might feel mom and child baking togetherdiscouraging to parents, who feel helpless as they worry about their child’s nutrition, growth and well-being. Not to mention that it’s wearing when mealtimes frequently result in meltdowns.

When working with children with feeding difficulties, an important goal is to foster positive experiences with food. Children with feeding disorders often have strong negative associations towards foods, whether from related pain, discomfort, sensory-aversions, or past negative experiences. To break these associations, mealtimes must be strategically planned to ensure positive experiences and a new relationship with food.

8 fun ways to revamp mealtime:

1. Make a placemat with your child. Help your child decorate a construction-paper placemat. Let them choose favorite movie characters, stickers, or pictures to fill their placemat. Laminate your child’s placemat to use at mealtime.

2. Let your child help with cooking. Give your child special jobs to help prepare meals, weather its helping mix foods, scooping foods onto plates, or adding ingredients.

3. Explore food during non-mealtimes. Plan fun activities to explore foods during non-mealtimes, when there’s no pressure to eat. You might make a craft out of foods (e.g. potato stamps), or finger paint with different sauces.

4. Make fun food shapes. Incorporate cookie-cutters into meal preparations. Have your child choose a fun shape, whether it be a racecar, an animal or a favorite shape. You might make heart-shaped pancakes, star-shaped sandwiches, or triangle potato slices.

5. Forget the manners. Let your child get messy while they explore their food. Touching and playing with food in a fun context will help young children reduce textural sensitivities. If you’re worried about messy eating occurring in public, then set parameters ahead of time. For example, you might make “silly rules” for Friday night dinners at home.

6. Make an edible craft. Plan a fun edible craft to create with your child. Instead of focusing on eating the craft, focus on making it. Enjoy planning the ingredients, grocery shopping, and putting it all together. For fun edible craft ideas, visit this previous blog.

7. Make a food face. Use a round plate, or draw a circle on a big piece of paper. Encourage you child to add different parts to the face. You might make spaghetti hair, grape eyes, and an apple smile. Experiencing food in a playful context will create a positive experience with food.

8. Make it social. Eating is a social experience, so be sure to participate with your child. Children learn by watching, so model positive interactions with food. Enjoy laughing and being silly while you experience new foods with your child.

If you suspect that your child has atypical feeding habits, seek help from a licensed therapist right away. These suggestions are not a replacement for feeding therapy, but are a supplement to recommendations by a trained therapist. A therapist trained in treating feeding disorders will help identify the underlying problem, determine whether your child is able to chew and swallow safely, and develop a specific plan to intervene.

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How To Tie A Shoe Part 2 | Pediatric Therapy Tv


Click here to watch part 1 of the How To Teach Shoe Tying Video

In This Video You Will Learn:

  • The step by step guide of teaching a child How To Tie a Shoe

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide
audience, this is Pediatric Therapy TV, where we provide experience and
innovation to maximize your child’s potential. Now your host, here’s Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I’m your host, Robyn
Ackerman. In today’s segment, Marissa Edwards, pediatric
occupational therapist, will be showing us how to teach tying a
shoe. Marissa?

Marissa: Hi. This is part two of “Teaching Your Child How To Tie Their
Shoes.” The story that I use is “The Pirate Story” and I’m going
to go through that story with you right now. You can also find
this on the ADVANCE for Occupational Therapists website.

We start with the laces separated and we say, ‘X marks the
spot’. Then we have to put the key inside the treasure chest,
and we have to hurry up and lock it tight because the pirates
are coming. Then we find an island because we need to bury our

We find an island, and we have to walk around the island to make
sure there are no pirates on the island. Then we take our shovel
– there are no pirates, by the way – we take our shovel, we dig
into the island, and then we have to bury it really, really
deep. And that’s it.

Robyn: Thank you, Marissa, and thank you to our viewers. And remember,
keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of
mind to your family with the best in educational programming. To
subscribe to our broadcast, read our blogs, or learn more, visit
our website at That’s

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The Importance of Teaching Self-Advocacy Skills to Children with ADHD

Attention Deficit Hyperactivity Disorder is a neurological condition associated with under activation of the frontal lobe. This area of the brain is also associated  boy with ADHDwith the executive functioning skills such as organization, time management; planning, impulse control, cognitive flexibility, and ability to self monitor one’s work. Children with ADHD without a doubt demonstrate poor executive functioning. These children have difficulty initiating action on tasks, organizing materials appropriately, managing time effectively, etc. These are all skills that can be developed and improved; however, they are also areas that need be accommodated in order for the child to perform to his or her ultimate potential. Many articles and blogs (link to my past blogs on EF) have been published regarding teaching executive functioning skills. There is also ample work out that there that provides accommodations that teachers may utilize in the classroom setting. We can teach the child the skills, we can accommodate the child; however, if the child is not a self advocate than it is all for naught.

 Step 1 To Teaching Children To Advocate For Themselves:

The first stage to begin to develop self advocacy skills is for the child to be able to recognize that he or she exhibits weaknesses or deficits with particular skill sets. Explain to the child (in child friendly terms) what it means to lack organization skills, have difficulty planning, and struggle with time management. Use daily examples from the child’s life (e.g. how long did homework take last night? How long should have it taken?). Once the child identifies that there is a problem he or she can then work on solving the problem.

Step 1 To Teaching Children To Advocate For Themselves:

The next step is to target one task at a time. Work with the child to create a list of areas that can be improved (e.g. morning routine, homework, organizing his/her room). Once the list is created, have the child number them in order from the biggest problem to the smallest problem. Self advocacy skills are developed by the child being able to develop the solution to the problems through Socratic dialogue with parent and not by parent simply providing a list of what needs to be done (e.g., what do you have to do first? …., well, that is one step, but is there something that needs to go before that?). This process is time consuming and will create headaches for many parents on a daily basis. However, if you ultimately want the child to develop the skill set, he or she must develop the solutions. After the first problematic behavior is tackled, the parents and child should then target the second one on the list in a similar manner. There are many strategies and devices (use of timers, checklists, etc) that are way too exhaustive to be explained in this blog that are wonderful tools to help with task completion; however, the first step is for the child to identify that he or she needs help.

The ultimate goal of childhood is to develop independence and skills necessary to live in society. One of the most important skills to develop is self-advocacy; to be able to identify that one has a problem and also to know when to seek others out for help and guidance.

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10 Tips to Help your Middle Schooler or Teen Sit Still During a Test.

Test taking in middle school can be stressful for your child and he/she may find it difficult to sit still throughout the duration of the test. There are a number of different strategies that you can teach and provide your child to help organize his/her body for improved focus during a test.

 10 Tips To Help a Child Sit Still During a Test:

1. Eat well and sleep well on the days leaving up to the test: This will ensure the body and brain are well nourished on the day of the test.bored boy taking a test

2. Work out before the test: Getting exercise and activity can help the body and mind to focus and organize for a day’s work, particularly on testing day.

3. Take deep breaths: Prior to test day, review deep breathing techniques with your child so that he/she can exercise the deep breaths during the test. Deep breaths will help calm your child and help him/her focus.

4. Drink from water bottle: Encourage your child to keep a water bottle with a straw on his/her desk during the test. Have him/her take sips from it when he/she begins to feel antsy during the exam.

5. Fidget tools: Small items such as stress balls, rubber bands or bean balloons can be manipulated with the hands while seated at the desk during the test. .

6. ChewEase pencil toppers: An alternative to a fidget tool, the chewy pencil topper can help direct your child’s extra energy during the exam and help with concentration.

7. Wall pushes: Have your child take a break from the test to do wall pushes. Similar to push ups on the floor, place hands shoulder width apart at shoulder level on the wall and keep the back straight. Do 10 wall pushes by bending elbows and bringing the nose to the wall, while keeping the back and hips in line.

8. Use a timer or a stopwatch: This will help your child time him/herself throughout the test and know how to pace him/herself during the exam period.

9. Chair push ups during the test: Place hands on either side of the chair near the hips. Push through the hands and shoulders to lift bottom up off of chair. Do 10 repetitions.

10. Sit on large exercise ball/move-n-sit cushion: Sitting on a therapy ball or move-n-sit cushion will provide your child with controlled movement and vestibular input while seated during the test. This will aide in your child’s focus without him/her needing to get up out of the desk.

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