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World Health Organization Development Study Results: Gross Motor Milestones In the First Year

 

The line between typical and atypical development can be a hazy one. There are standards that pediatricians, physical therapists, and developmental experts use to monitor growth and deviations from the norm, which allow us to recommend interventions when appropriate.  In 2006, the World Health Organization (WHO) released a whole new set of standards for evaluating and assessing the development of children from birth to 5 years.

What makes this new standard a great tool to monitor the change and growth of infants? This standard is based on data collected from healthy children, over multiple years, in six diverse geographic regions including Southeast and Southwest Asia, Europe, West Africa, North and South America. What is exciting about the new evaluation tool is that now, pediatric specialists have more than just reference curves for physical growth, but curves for motor development as well.

The six gross motor milestones WHO examined in babies were the following:

1.    Sitting without support
2.    Standing with assistance
3.    Hands-and-knees crawling
4.    Walking with assistance
5.    Standing alone
6.    Walking alone

The “windows of milestone achievement” were organized into percentile rankings which pediatricians and physical therapists can use, much like a growth chart.

Without delving too deep into statistics and calculations, the typical age range (in months) for each milestone is listed below:

1.    Sitting without support: 3.8 – 9.2 months
2.    Standing with assistance: 4.8 – 11.4 months
3.    Hands-and-knees crawling: 5.2 – 13.5 months
4.    Walking with assistance: 5.9 – 13.7 months
5.    Standing alone: 6.9 – 16.9 months
6.    Walking alone: 8.2 – 17.6 months

The average (mean) age for healthy children achieving each milestones is as follows:

1.    Sitting without support: 6 months (with 1.1 month standard deviation, SD)
2.    Standing with assistance: 7.6 months (with 1.4 month SD)
3.    Hands-and-knees crawling: 8.5 months (with 1.7 month SD)
4.    Walking with assistance: 9.2 months (with 1.5 month SD)
5.    Standing alone: 11 months (with 1.9 month SD)
6.    Walking alone: 12.1 months (with 1.8 month standard deviation)

(Click here to view this information in chart form from WHO.)

What is most interesting is that about 90% of the children studied met their milestones in a common sequence, and only 4% of the children skipped hands-and-knees crawling.  (Read here about the importance of crawling.)

As you read over these standards and timelines, remember that every baby develops differently from another. If you see your baby fall behind on any of the 6 gross motor milestones above, mention it to his pediatrician, and she will most likely recommend a physical therapist to help him along.



Reference:
WHO Multicentre Growth Reference Study Group.  WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatrica, 2006; Suppl 450: 86-95.

Holiday Toy-Gifting Guide to Promote Gross Motor Skills

It’s the holiday season yet again. In this time of family, friends, foods, and traditions, many little minds are thinking about new toys.   This is the perfect opportunity for parents and family members to stock up on games and toys to facilitate their children’s development.  While some older children might have wish-lists to be fulfilled, there are plenty of toys outside of the latest trend that will help promote growth in children of all ages. As any therapist knows, a toy can be a powerful tool to promote developmental gains, particularly in children who are a little behind their peers.  Below are some toys that help kids strengthen their big muscle groups and attain gross motor skills, without making play seem like work.

Learning Tables

A learning table is a great investment if you have an infant. It will grow alongside your baby and help her attain valuable gross motor skills such as body control in tummy time, cross-body reaching, independent sitting, cruising, standing, and weight-shifting, all while promoting her upper body and cognitive growth.  Early learners can keep busy with the lights, sounds, and activities; the height of the tables adjusts so that babies from 6 to 36 months can play in various positions. Babies will be challenged throughout each step of their development and learn about cause and effect. Read more

3 Tips to Encourage Your Baby to Sit Independently

Sitting independently is a wonderful and fun new milestone for every baby. It is the first time your little one is upright and able to look around.  In the sitting position, babies have both hands free to play with toys.  Although there is a healthy range of ages for a child to achieve the milestone of sitting independently, a good rule of thumb is that a baby should sit independently for longer than a minute at six months of age. If  your baby needs some encouragement to sit on her own, there are strategies you can use to help. Read more

Ways to Encourage a Baby to Sit Up | Pediatric Therapy Tv

In today’s Webisode, a pediatric physical therapist will show us helpful ways to encourage a baby to sit up independently.

Read about useful tips to get your baby to roll

In this video you will learn:

  • How old your baby should be to sit up
  • Strategies to support your baby as they sit up

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, and I’m here today with Leida Van Oss, a
Pediatric Physical Therapist. Leida, can you tell us a
couple tips on how to get a child to start sitting up
independently?

Leida: Sure. So the first stage of sitting should be done by four
months of age, and this is called prop sitting. This is
when they support themselves on their own. So you want to
put a toy down by their feet, and then tilt them forward so
that they put their hands on the ground, and then that
should encourage them to support themselves on their hands.
She’s older than four months, so she doesn’t want to do it.

But then the next stage is this kind of sitting, where they
want to bring up their hands, and sit by themselves
independently. So if they’re not quite wanting to do that
yet, you can take their toy – there we go – and lift it up
in front of them, so that they want to look up and raise
their arms up. This will activate the core and back
muscles, which will help bring up their head and do more of
an independent sitting.

You want to make sure that you keep a hand behind their
body, so that in case they topple backwards, you can catch
them really quickly. Then, the last mature stage of sitting
are things like rotating and reaching out if they need some
support. So, again, you can use toys to have them turn to
the side or reach up, or reach far [inaudible 00:01:37].
Those are all things that are going to help encourage more
mature sitting skills.

Robyn: All right. Well, thank you so much, 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 learnmore.me. That’s
learnmore.me.

10 Signs at School Suggesting a Student May Benefit from Physical Therapy

Children develop and improve their gross motor skills significantly during their early school years, between three and ten years of age. A lot of gross motor development occurs at school while playing at recess or doing activities in gym class. School offers the opportunity to recognize if a child needs extra assistance from a physical therapist in expanding or improving their gross motor skills.

Physical therapist treats child

Here are some tips for teachers that will help determine if a child would benefit from physical therapy:

  1. The child prefers to sit and play instead of run or participate in gross motor activities during recess or gym class.
  2. The child has difficulty jumping, skipping, or galloping when compared to their peers.
  3. The child has an atypical gait pattern (for example, they walk on their toes or they are “knock-kneed”)
  4. The child prefers to w-sit (with their knees bent, feet by their bottom, and bottom on the floor) instead of crossed-legged on the floor.
  5. The child frequently trips, falls, or bumps into objects.
  6. When walking up and down the stairs, the child does not alternate their feet, instead placing both feet on each step.
  7. The child is unable to kick a soccer ball.
  8. The child is unable to catch or throw a playground ball.
  9. The child runs significantly slower than his peers or has difficulty running for more than one minute.
  10. The child complains of pain or tightness in their ankles, knees, hips, or back.

If you see any of these characteristics in children at school, they may benefit from a physical therapy evaluation. Without fully developed gross motor skills, a child is going to have difficulties keeping up with their peers during recess or gym class. It will also affect their ability to participate in gross motor games and sports. Also, it is important to note that many children will exhibit the above behaviors and may or may not require physical therapy (PT) intervention therefore it is important to consult with a PT first.

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10 Activities to Improve Balance

Balance is a great skill to help your child progress with their gross motor skills, leisure activities, and activities of daily living.

The following activities are various ways you can work on improving static and dynamic balance for improved performance in activities such as sports, games, self-care, and many more!

  1. Stand with one foot on the ground while the other foot is resting on a stool in front of the other foot. This is the primary skill in working towards balancing on one foot. If this is too easy, replace the stool with a ball that your child has to rest his or her foot on. Then, progress to just standing on one leg. To make it more challenging play a game (such as catch, zoom ball or balloon tennis) while balancing.
  2. Stand on top of a bosu ball. A bosu ball is an exercise ball cut in half with a flat plastic surface on the bottom. If your child gets really good at standing on top of the bosu ball, turn it upside down so that the ball is underneath and he or she is standing on the flat side. Once this is mastered, play catch while standing on the bosu ball.
  3. Stand on a balance board. A balance board is a flat surface made of wood or hard plastic that has a rounded or curved underside. This can be a very challenging activity just to stay upright!
  4. Simply stand on one foot! Make this into a contest with the whole family and see who can maintain their balance the longest.The person who wins gets to pick a family activity.
  5. Put two lines of tape on the ground and practice walking on a pretend balance beam. The space between the two pieces of tape could start large (6 inches) and progress to 4 inches apart. If your child steps out of bounds, he or she has to start again. By employing a balance beam that is flush with the ground, this will decrease any possible fear of falling. Once this becomes easier, utilize a real balance beam to work on more challenging balance skills.
  6. Sit on an exercise ball while playing a board game at the table. Don’t let your child put his or her feet on the ground while playing unless they need to make sure they don’t fall.
  7. Play hopscotch only while jumping on one foot. No switching feet is allowed! This makes the game slightly more challenging.
  8. Sit, kneel, or stand on a flat platform swing. Once you child can simply balance, play catch, zoomball, or balloon volleyball while sitting, kneeling, or standing.
  9. Stand on a trampoline with just one leg on the surface. To make this even more challenging, invite someone else to walk on the trampoline (or jump) while trying to keep your balance!
  10. Try any of the above activities with your eyes closed. Balancing with your eyes closed is significantly harder than having your eyes open. Therefore, if your child has mastered all of the above activities, make it one step harder to keep them challenged!

The possibilities are endless! Get creative and make these activities easier or harder depending on your child’s progression of skills.  By working on balance, your child will learn to use their muscles properly in order to adjust to changes in movement. This will set them up for success in playing games and sports with their peers! As always, ensuring your child’s safety during these activities is very important. Utilize pillows, mats, and adult supervision when practicing these activities.

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