The walking stage is a huge milestone for every child. It’s an exciting new time when your baby officially becomes a toddler. Most babies learn to walk between 12 and 15 months. A baby is considered delayed in walking once they turn 18 months old. When a child is delayed in a certain gross motor skill, parents are always curious why this delay is happening.
Here are some reasons that your baby may be delayed in walking:
Muscle weakness and/or low muscle tone. This is the most common reason. A child who has weakness or low tone in their core and hip muscles may have difficulty with walking. Sometimes this weakness affects the earlier milestones such as crawling, pulling up to stand, and cruising. If your baby had difficulty learning early milestones, they are more likely to have difficulty with walking. A physical therapist can do exercises with your child to strengthen their muscles and help them learn to walk.
Orthopedic concerns. This involves the bones and joints in a child’s legs and how they are aligned. An example is hip dysplasia. These concerns are diagnosed by an orthopedic surgeon and are treated in a variety of ways.
Neurological concerns. This involves the nerves, muscle fibers, and nervous system of the body. An example is diplegic cerebral palsy. These types of concerns are diagnosed by a neurologist.
Orthopedic and neurologic concerns can be very scary to parents. It is important to understand that a delay in walking does not automatically mean that your child has an orthopedic or neurological disability. If you think your child is delayed in walking, speak to your pediatrician. A pediatric physical therapist can evaluate red flags for causes of delayed walking, as well as help your child to learn this skill.
As babies grow and develop certain milestones are often celebrated, such as rolling, sitting, crawling, and walking. As a pediatric occupational therapist, one of the milestones I always celebrate might not be visible to the untrained eye. Crossing midline, defined as the ability to reach across the body’s invisible midline with your arms or legs to perform tasks on the opposite side of the body, is a required skill for many higher level coordination activities.
This skill typically develops around 18 months of age. Oftentimes when children are referred for occupational therapy due to poor fine motor skills, handwriting, or coordination, they are not crossing midline efficiently.
Some ways to observe whether or not your child is crossing midline efficiently include:
Watching to see if your child switches hands during drawing tasks. Do they switch from left hand to right hand to avoid their arm crossing over when drawing lines across paper?
Evaluating hand dominance: by age 6, children should have developed a hand dominance. Children with poor midline integration may not yet have developed a hand dominance.
Tracking an object across midline: this can be observed during reading, as decreased midline integration can lead to poor ocular motor skill development required for scanning.
Observing ball skills: children who are not yet crossing midline may have a difficult time crossing their dominant leg over their non-dominant leg to kick a ball forward.
Assessing self-care skills: putting on socks, shoes, and belts may be extremely difficult as these are activities that require one hand to cross over to assist the other in the process.
Children who have difficulty crossing midline may not be able to keep up with their peers, which may cause increased frustration during participation at school and in social situations. In addition, crossing midline is a required skill needed in order to complete more challenging bilateral coordination activities, such as cutting with scissors, using a fork and knife to cut food, tying shoe laces, writing out the alphabet, and engaging in sports.
https://nspt4kids.com/wp-content/uploads/2017/01/Blog-Crossing-Midline-FeaturedImage.png186183Mary Kate Mulryhttps://nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngMary Kate Mulry2017-01-27 12:02:512017-01-27 12:02:51Why Crossing Midline is Important for Development
Primitive reflexes are foundational motor responses to sensory input that appear in utero or shortly after birth for the purpose of defense and survival. They are the foundation for higher level motor, cognitive or intellectual processes that develop as a child matures and takes on increasing demands.
Most primitive reflexes integrate within the first year of life meaning that complex, adaptive and purpose-driven actions can over-ride automatic responses. Postural reflexes, which typically begin to develop in the second year or life, are automatic reactions with a higher level response. They develop a child’s equilibrium reactions for balance and coordination as the child begins to sit, stand, walk and run. Their development is heavily influenced by the integration of primitive reflexes.
Each reflex is associated with development of a particular area of the brain and lays the groundwork for control of motor coordination, social and emotional development, intellectual processing, and sensory integration. When primitive reflexes do not adequately integrate, persistence of these patterns may interfere with related milestones. When a reflex is present, it can be viewed as a signal that function in that region of the brain is not optimized. When difficulties in a particular area of functioning exist, research has demonstrated a strong correlation with the persistence of reflexes originating from the area of the brain regulating those functions.
Why might some reflexes not be integrated?
There are many explanations for why a reflex (or several reflexes) may not be integrated. Factors such as genetics, unusual gestational or birth history, limited sensory-motor experiences, or early disease, illness, or trauma may contribute to persistence of reflexes. It is important to note that many children, and even fully functioning adults, do not have all of their reflexes fully integrated. It is when an individual displays a cluster of symptoms impacting sensory, motor, emotional, social or academic functioning that reflex integration becomes an important component to examine.
What happens if reflexes do not integrate?
Since primitive reflexes are major factors in motor development, a child with persistence of one or more primitive reflexes may experience a variety of challenges. Primitive reflexes are what help infants initially learn about their inner and outer environments, and are heavily linked to the sensory system.
If reflexes persist, they interfere with the development of higher level sensory systems (visual, auditory, tactile, taste, vestibular, smell, and proprioceptive). Interference with sensory systems can lead to learning, behavioral, and/or social challenges for children, especially in academic settings. Additionally, postural reflexes, which depend on the integration of primitive reflexes, are unable to fully develop. Underdevelopment of these reflexes causes delays in righting reactions related to balance, movement and gravity. An individual who has not developed efficient postural control will have to compensate for these automatic adjustments by expending extra energy to consciously control basic movements.
Below are just a few red flags of persistent primitive reflexes:
Over/under-responsivity to light, sound, touch, and/or movement
Difficulty with reading, spelling, math, or writing
Difficulty remaining still, completing work while seated, or frequent fidgeting
Poor grasping abilities. May grasp pencil too tight or too loosely
Difficulties with eating (pickiness, excessive drooling, messy eater)
Poor balance and/or coordination
Poor spatial awareness and/or depth perception
Difficulty knowing left from right
Poor bladder control and/or gastrointestinal issues
What do we do if reflexes are not integrated?
Activities and exercises that target specific reflex pathways can be introduced in order to strengthen particular neurological pathways. By developing these pathways, we aim to integrate the reflex and mature related functions.
https://nspt4kids.com/wp-content/uploads/2016/10/Blog-Primitive-Reflexes-FeaturedImage.png186183Shannon Phelanhttps://nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngShannon Phelan2016-11-01 05:30:402016-10-28 13:39:53Primitive Reflexes: What Are They and Why Do They Matter?
Cruising is an important gross motor milestone that occurs when a baby steps sideways while holding on to a safe and stable piece of furniture. Cruising facilitates core, hip and leg muscle development, standing balance, and is a crucial stepping stone (no pun intended!) to independent standing and walking.
This is a milestone that is typically reached around 10 months of age. Before your baby can cruise, he or she needs to be able to stand, accepting weight evenly through both legs, with 1 or 2 hands supported at a safe and stable piece of furniture, such as a couch or ottoman. Many babies are excited once they can start standing on their own at a piece of large furniture, although they often do not know how to move around.
Here are a few useful tips to help your baby learn how to cruise:
Place toys a few steps away in either direction. If your child has the toy she is interested in playing with right in front of her while she is standing at the couch, there will be little motivation to move. However, if you place the toy just a few steps away, your baby will be highly motivated to try and get to the toy. Make sure you don’t place the toy too far away though, as that might encourage your child to crawl to the toy instead, or your child may lose motivation due to feeling that the toy is completely out of reach.
Show your baby how to cruise. Since the cruising motion is most likely different from any other movements your child has performed, he may not know that he can step sideways or how to activate the muscles required to do so. When your baby has both hands supported on the stable piece of furniture, slowly and gently elevate the lead leg off the ground, move it a small distance to the side, and then bring the other leg to meet it.
Practice! Learning new gross motor skills takes lots and lots of practice. Babies learn through trial and error, so the more that they work on a new skill the better at it they will become. Give your child frequent, supervised opportunities to practice cruising.
https://nspt4kids.com/wp-content/uploads/2016/04/Blog-Baby-Cruising-FeaturedImage.jpg186183Colleen McCloskeyhttps://nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngColleen McCloskey2016-04-07 05:30:052016-04-04 13:06:10Get Your Baby to Start Cruising
Developmental check-ups with a Pediatrician throughout your child’s first year of life (at 2, 4, 6, 9, and 12 months) are a perfect place to bring up any concerns you as a parent may have about your child’s development. While pediatricians have their own set of developmental red flags, these only hit the “big-bad-uglys” as we like to call them, including: is your child rolling by 6 months, sitting independently by 8 months, crawling by 12 months, and walking by 18 months.
These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. I have seen many children referred to physical therapy for delayed walking skills, who are not standing independently or didn’t roll consistently until 8 months.
To help these children who are being missed by the pediatrician’s red flags, I have put together a list of gross motor skills to discuss with your pediatrician at your child’s check-ups throughout their first year.
Lifts and maintains head up when on belly
Controls head during pull to sit
Controls head when held at shoulder
Controls head while in supported sitting
Sits independently for 1 minute
Rolls from belly to back
Rolls from back to belly
Lifts chest off ground when on belly, pushing onto extended arms
https://nspt4kids.com/wp-content/uploads/2016/03/BlogFirstYearMilestones-FeaturedImage.png186183Andrea Ragsdale PT, DPThttps://nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAndrea Ragsdale PT, DPT2016-03-10 05:30:202016-03-04 14:45:59Gross Motor Milestones in the First Year
We continue our series on checklists for yearly Pediatrician check-ups (click here to see the checklists for the 1-year visit, the 2-year visit and the 3-year visit). Pediatricians have a set of developmental red flags, but these only hit the “big-bad-uglies” as we like to call them, including the following: Can you understand everything your child says? Does your child fall excessively? Is he feeding himself? These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. To help bridge the gap between Pediatricians’ red flags and children who need therapy services, I have put together a checklist of things to discuss with your Pediatrician at your child’s 4 year check-up.
At 4 Years Your Child Should Be Able to Do the Following:
Gross Motor Skills
Places one foot on each stair, while going up and down stairs without handrail use
We continue our series on checklists for yearly Pediatrician check-ups (click here to see the checklist for the 1-year visit and the 2-year visit). Pediatricians have a set of developmental red flags, but these only hit the “big-bad-uglys” as we like to call them, including: stutter, go up and down stairs by themselves, or answer and ask “yes or no” questions. These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. To help bridge the gap between Pediatricians’ red flags and children who need therapy services, I have put together a checklist of things to discuss with your Pediatrician at your child’s 3 year check-up.
At 3 Years, Your Child Should Be Able to Do the Following:
Gross Motor Skills
Pedals a tricycle
Catches a ball thrown from 5 feet away
Jumps forward at least 24 inches, with both feet leaving the ground at the same time
Stands on 1 foot for 3 seconds
Walks up stairs with 1 foot on each step
Fine Motor Skills
Draws circle, horizontal lines, and cross, with demonstration
Strings small beads
Opens screwed top container
Pulls up pants and puts on coat independently
Increases word production to >300 words
Combines 3 word phrases
Starts to understand differences between opposites
Building off of last month’s 1 year check-list for Pediatrician check-ups, we bring you a check-list to look at prior to your child’s 2 year old check-up. Again Pediatricians have a set of developmental red flags, but these only hit the “big-bad-uglys” as we like to call them, including the following questions: does your child get frustrated when trying to talk, can he or she jump or attempt to jump, did your child walk by 18 months. These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. To help bridge the gap between Pediatricians’ red flags and children who need therapy services, I have put together a checklist of things to discuss with your Pediatrician at your child’s 2 year check-up.
2-Year Check-Up Red Flags:
Gross Motor Skills
Runs forward 10 feet, without a loss of balance
Jumps in place, jumps forward, and jumps down from a step
Walks forward, backwards, and sideways independently and without a loss of balance
Walks up and down a set of stairs, using a handrail
Kicks a ball forward 3 feet
Fine Motor Skills
Turns pages of thick page book, 1 at a time
Stacks 5 cubes
Draws vertical lines given demonstration
Takes off button-less clothing and socks independently
Begins saying 2 word phases and 2 word questions
Increases vocabulary to saying >50 words and understanding >300 words, with new words added every week
Answers “yes or no” questions
Points to objects named
Speech should be understood at least 50-75% of the time by a familiar listener
Developmental check-ups with a Pediatrician throughout your child’s first year of life (at 2, 4, 6, 9, and 12 months) are a perfect place to bring up any concerns you as a parent may have a about your child’s development. While Pediatricians have their own set of developmental red flags, these only hit the “big-bad-uglys” as we like to call them, including the following:
Is your child rolling by 6 months?
Is your child sitting independently by 8 months?
Is your child crawling by 12 months?
Is your child walking by 18 months?
These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. I have seen many children referred to physical therapy for delayed walking skills, who are not standing independently or didn’t roll consistently until 8 months. To help these children who are being missed by the Pediatricians red flags, I have put together a checklist of things to discuss with your Pediatrician at your child’s 12 month check-up.
Checklist for your child’s 12-month doctor visit:
Gross Motor Skills
Independently transitions into and out of sitting
Rolling independently from back to belly, and belly to back, with ease
Crawling on hands and knees with reciprocal form
Pulls to stand at stable surface
Cruises along furniture
Fine Motor Skills
Begins using pincher grasp (thumb and single finger)
Transfers objects from one hand to the other
Places toys into large container, and takes toys out
Begins holding spoon during feeding
At least 1-2 words
Babbling with constant – vowel combination, ie. ba-ba, ma-ma, da-da
Labeling object with consistent sounds, ie. ball is always “ba”
The transition form preschool to Kindergarten is one of the first big steps a young child takes in his academic career.
As a parent, you may be wondering what the main differences are between the preschool and kindergarten setting and how to best equip your child for these changes. Although the change in environment reflects just a chronological year of advancement, the expectations are vastly different.
What to Expect in Preschool:
Children are able to expand their play to incorporate peers and develop the skills necessary to gain a greater sense of self and those around them. This might be the first time children are expected to engage with peers, follow directions, and adhere to structure.
Offers more play-based interventions and structured unstructured time (free play, art time where the child can choose what they want do).
Children learn to focus, share, take turns, and listen while others speak.
Language and cognitive skills emerge and strengthen.
What to Expect in Kindergarten:
The expectation is that the child can endure increased structure and will be able to write, utilize proper pencil grip, and engage in rote counting.
There is an emphasis on increased child independence as the student becomes more responsible over his choices.
Children are expected to implement peer problem-solving to avoid tattling and to enhance conflict resolution strategies.
Implementation of self-help and self-advocacy skills are expected.
In some cases, the length of the school day is longer.
To prepare your child for Kindergarten, utilize these strategies to create a smooth transition:
Explore new activities as a family to help your child adjust to change. This will help him to be okay with experiencing the unknown.
Read to your child for 20 minutes a day to foster listening and focusing skills.
Use consistent routines and disciplinary methods to get the child familiar with the fixed systems in the school setting (i.e. understand expectations and how to modify behavior).
Teach child independence through child-friendly clothing (pick out clothes), toileting independence, and setting the expectation that the child will put away toys and coats regularly.
https://nspt4kids.com/wp-content/uploads/2015/04/kindergarten-FeaturedImage.png186183Ali Swillingerhttps://nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngAli Swillinger2015-04-20 13:21:422015-04-21 11:41:55The Transition from Preschool to Kindergarten: What Every Parent Should Know