The CDC put out new milestone guidance for families and crawling was removed as a milestone. This decision led to a lot of uproar in the pediatric physical therapy and occupational therapy world and a lot of confusion for parents! Let’s have a conversation in this blog post about crawling and whether it is still important for us to consider.
First off, let’s consider the guidelines put out to parents and healthcare professionals. The developmental monitoring guidance, which is designed for parents to have a quick way to see if their child’s development is on track, no longer includes crawling as a milestone.
This does NOT change child development, developmental screening, or developmental evaluations. Developmental screenings are recommended to be done at 9, 18, and 30 months of age. Additionally, Autism Screening is recommended at 18 and 24 months of age. Any concerns about a child’s development will lead to a developmental evaluation, which looks more in depth at a child’s development.
Developmental screenings and evaluations will continue to include crawling as a milestone. Given that, we can include that crawling continues to be a milestone and one that is important to address.
Why Is Crawling Important?
In many ways crawling represents freedom. Crawling is usually the first time a baby can actively explore their environment, versus someone having to carry them from point A to point B. Babies also gain a sense of independence from their parent or caregiver, as they move away from them and then move back.
When babies bear weight on their arms, they develop shoulder stability and they develop the arches of the hands, which helps later on with handwriting and fine motor skills. Crawling also helps develop vision skills and gives babies important sensory feedback, from stimulating the vestibular system while moving in space, gives information to the touch receptors on the hands, legs and feet, and gives proprioceptive information from the joints and muscles. This sensory feedback helps babies develop spatial awareness, or the sense of where their body is in space.
Finally, crawling helps develop core stability and coordination, because you’re using your opposite arm and leg at the same time, along with moving in a rhythmic manner.
All of these components work together as the baby learns to control their bodies against gravity at this new level.
Getting Crawling Ready
The most important thing parents that do to support their babies development is to have lots of floor time, without the use of supports, so that baby can explore.
Babies need to move against gravity, and see, by trial and error, when I reach for that toy, what happens? A lot of times they start moving by a happy accident, like they lean one way to get something and they roll over. If they don’t have those opportunities, those happy accidents can’t happen.
When the baby is on the floor, encourage them to move by putting toys slightly out of reach. As parents, having the patience to let them go through that trial and error process and not jump in can be so hard, and sometimes even I have to sit on my own hands.
The transitions babies do over and over again during play, moving from sitting to belly and back to sitting, from sitting to hands and knees to sitting again, is what gets their little bodies truly ready for crawling. They move in and out of positions, getting their core muscles primed to support them on hands and knees.
Crawling Variations
Many babies will crawl in a typical all fours pattern, but there are so many variations too. Some babies will first commando or army crawl before getting up on hands and knees. This is where we often see lots of different variations and asymmetries. Some babies will do lot of pulling with their arms and some will always push off with the same leg. I generally tell parents not to worry about funny looking army crawl patterns. It will work itself out when the babies are on hands and knees crawling and moving in a much more symmetrical and synchronized way.
Some babies will bear crawl, where the legs are kept straight. This often happens when the baby is avoiding hard floors! As long as you’re seeing lots of variety of movement patterns during play, this isn’t concerning.
Crab crawl: Baby moves with either one or both legs tucked under. This is another common variation. Its often due to asymmetries in the pelvis and hips, but it can also just be a normal variation.
Bottom scoot: Baby uses hands to push across the floor while sitting upright on their bottom. Some babies don’t go onto hands and knees at all and will get around on their bottoms. If baby is choosing this method of mobility, keep an eye out for how they are figuring out how to pull up to standing so that they are able to get to the next stages of development on the road to walking. My favorite activity to introduce to bottom scooters is climbing up the stairs- you can’t pull that off with a bottom scoot!
Crawling backwards: many babies will crawl backwards before figuring out how to crawl forwards; if you see your baby crawling backwards, just enjoy the process and watch them problem solve and figure out how to change directions; they’re almost there!
When To Get Help
Babies will learn to crawl on hands and knees between 8-10 months of age. Like every milestone baby works towards, there are many small steps that add up to the big achievement of the milestone. If a baby is able to do all the steps up to crawling, such as moving from sitting to hands and knees and rocking on hands and knees, they’re on their way.
Some signs baby may need some help with their gross motor development:
Happy Sitter: this is the baby that is happy being placed in sitting, but doesn’t move out of the position
Baby has always hated tummy time and hasn’t developed a way to move on their belly to move in circles, forwards, or backwards
Baby is 10 months and not moving in and out of sitting
Baby loves to stand and wants to be placed in standing all the time (not getting there themselves)
At Kid PT we offer developmental screenings to local families who have questions or concerns about their children’s development. I tell parents that at that screening you will either get peace of mind that there aren’t any concerns or they’ll get recommendations as to how to help their child and support their development. Its a win-win!
To schedule a Developmental Screening, call/text us at 908-543-4390 or email info@kidpt.com.
http://jonikidpt.wpengine.com/wp-content/uploads/2015/11/kidpt.png00jonikidpthttp://jonikidpt.wpengine.com/wp-content/uploads/2015/11/kidpt.pngjonikidpt2022-07-23 19:44:552022-07-25 13:54:58Crawling: Does It Still Matter?
Have you ever thought you were going crazy when it came to your kids? Sure, we all get stressed out by the demands parenting requires of us whether they be mundane, daily happenings (“No you can’t have another cookie!”, “Stop teasing your brother!”) or extreme, unlikely circumstances (Hello pandemic-looking at you!)
But, what if there was something wrong with your child, (who also happens to have neurodevelopmental delays or another neurodivergent diagnosis) and no experts had any answers for you? What if you took your kiddo to all the “BEST” doctors out there and they either had no answers, their diagnosis conflicted with one another, or worst of all, they just didn’t believe your child had a problem?
Misdiagnosis happens.
I am here to tell you that it happens. And when it is your child who is struggling and suffering, it is exquisitely painful. You feel like you are living in a nightmare that you simply cannot wake from and that somehow, those around you are seeing a distorted view of reality. A 2019 article* states that, “the mindset that young children are rarely seriously ill is one of the main reasons that they are more likely to be misdiagnosed than adults are. That’s on top of all of the ways that approximately 10 percent of American adults are misdiagnosed every year. When doctors and nurses expect to see a healthy child with a common short-lived illness, they may miss the uncommon ones.”
The article goes on to list the main reasons for children receiving a diagnosis that’s wrong or delayed:
Attitude: Since most children are healthy, and most illnesses resolve on their own, doctors may tend to reassure parents rather than accept concerns are real
Biology: Young children’s bodies and systems are radically different than adults, so they present and respond in unexpected ways
Unequipped: Most children’s emergency room visits are to community or adult hospitals that often don’t have needed kid-sized equipment or pediatric experts. Urgent care centers have similar issues.
Communication: Young children don’t understand or know what is wrong so they’re dependent on parents or caregivers to recognize and then interpret their symptoms
Experts may give you the brush off.
However, there are cases where a parent’s concerns are dismissed, as I was when my daughter presented with a long, puzzling, seemingly unrelated laundry list of symptoms that spanned years, nearly a decade by the time a diagnosis was finally rendered. During that time period, I was given advice from some well-meaning individuals who said things like:
“Just accept her as she is and stop looking for answers that aren’t there.”
“Doctors are the experts and you have to trust them when they tell you something, even when treatments don’t work or something seems to be missing in their answer.”
“You want her to be sick so that you get attention or sympathy”
Did any of this help my daughter get better or me find answers? That would be a resounding no. Oh, and by the way, that last piece of “advice” above was given to me, in front of my child, by a supposedly well-respected doctor. He dismissed all the hundreds of pages of tests, scans, medical records and prior diagnosis, didn’t help my daughter, and charged for it!
So what DO YOU DO? You don’t give up- you trust your gut! Parents know their children best and what their “normal” looks like, even if it doesn’t match the textbook image. Remember to believe in yourself and your ability to help your child. Make a bulleted list of every symptom, even if it does not seem totally related, and the date the symptom started. Research the heck out of your child’s symptoms and any test results you have, using the best and most trusted resources you can find. Become well acquainted with clinical research papers, societies for various branches of disease types ( think brain, stomach, nervous system, etc.) Join an online group for other parents who may be seeking answers for their child or who may have information to share.
The Society to Improve Diagnosis in Medicine says not to get overwhelmed by the risks of misdiagnosis. Rather, recognize there are a few key things to do, to assist in getting an accurate and (hopefully) prompt diagnosis. These tips also help if your child is in the middle of a diagnostic journey today.
Sign up for the doctors’ or hospitals’ patient portal and check the records thoroughly. “Is the information correct? Are the medications and medical history correct? Read it, correct it, and tell the doctor” or the staff.
Important test results can slip through the cracks and that may lead to misdiagnosis and lack of treatment. Keep track of any tests that are done on your child. That includes blood tests, urine tests, x-rays, and any other type of scan. If your child has a test, simply ask when the results are expected and note it in your calendar. If you don’t get called or emailed with results, call and ask about them. Remember, “No News is No News.” Don’t accept being told, “We will call you if there’s a problem.”
Trust your gut. You’re the people who know and care about your child the most. All of the experts encourage parents to speak up if they feel their child’s symptoms aren’t getting enough attention or if there’s any confusion between what the family is saying and the medical professional is hearing.
If your child isn’t showing signs of improvement, get a second opinion. Ask friends and family members in town for a recommendation of a pediatrician in a different practice, or ask your current pediatrician for a specialist to give a second opinion.
Be prepared before you bring your child to the doctor or an emergency room. While your child is healthy, check if there’s a pediatric urgent care or emergency room close to where you live. If you have a planned appointment, there is a valuable tool you can start using today. The SIDM Patient Toolkit is a handy step-by-step workbook with sections to fill out before, during and after your doctor’s appointment.
If you’re using the internet to look for more information, be sure to use reliable and trusted sources. The American Academy of Pediatrics’ (AAP) Healthy Children section is a great place to begin.
In closing, you, as a parent, are the most trusted authority on your child. If you feel that something is wrong with your child and it is not getting resolved, don’t be afraid to speak up. Your child and your family deserve answers and the best possible care. Be brave and know that what your GUT is telling you, may be right. (If you have a question for Melanie (author/Kid PT Marketing) email her at info@kidpt.com)
I have to admit, I’m not the most coordinated person. You may have noticed the same about yourself or your child.
The big question parents often ask me is whether their child is on the clumsy end or is there another explanation for it.
The biggest question to ask yourself is whether your child’s clumsiness is impacting their everyday life. Is it making them a wallflower on the playground? Is it making it difficult to make it through a meal without spilling or dropping something? Is the child tripping frequently or bumping into things?
Partially because clumsiness has been the butt of so many jokes in media, its often not taken seriously. The truth is that clumsiness doesn’t naturally improve and can have a really big impact on a child’s confidence and self-esteem.
Plus, therapy can help! So if there’s a big problem impacting a child’s everyday life that is making them feel bad and we have the power to improve it, we can’t overlook it!
Let’s take a look at 2 different people with Developmental Coordination Disorder (DCD), how it impacts their lives, and then we can talk more about how to know when to seek help.
Meet Jane
Jane is a very warm and friendly seven-year-old girl diagnosed with developmental coordination disorder and dyspraxia. She has never had success with academic, gross motor or fine motor activities, and prefers to talk her way out of challenges. Talking she is good at, but only with adults. She has struggled to make and keep friends.
Jane started a PT program at Kid PT and after two months of participating in a program working on her visual-motor and rhythmic movement skills, her mom reported that not only was she moving better, but she was having so much more success socially.. Mom said, “I can imagine that if you can’t keep up with the kids on the playground, that’s going to affect your confidence playing with the other kids.”
Mom’s observation was so true and impacts so many children everyday. Our innate sense of rhythm runs in the background of everything we do. It affects how we interact with others and how we multitask emptying a backpack at school while saying hello to a friend while smiling and remembering everything you need for the day. The consistent and reliable rhythm of our brain and body supports all of these seemingly mundane tasks that can be overwhelming if you have to think about them every step of the way!
Meet Jimmy
After 17 years of struggling with his body to get through daily life, Jimmy came to Kid PT.
For years, Jimmy’s pediatrician told his mom that he would grow out of his clumsiness and to just keep him active. He played rec soccer and baseball, but he was always lagging behind and by the time he entered middle school he just gave up on sports altogether. He was a talented artist and loved video games, so he kept himself very busy with those activities.
Jimmy’s mental health was suffering though and he was struggling to get enough energy to get through each day. His mom had a friend that said to come to Kid PT and see if we could help.
During his evaluation, I identified many sensory and motor deficits that were greatly impacting all of his movement skills. His vestibular function (inner ear) was impaired, particularly the vestibular ocular reflex, which keeps vision steady as we move through space. His vision was working too hard trying to make up for vestibular impairments, so his balance was decreased at night when vision couldn’t be relied on as much.
He also had postural asymmetries that he was likely relying on for years that were causing musculoskeletal issues, in addition to affecting body awareness. His movement system had never gone on autopilot. He had to focus so much on moving his body to get through his daily routines, that it was zapping up so much of his energy, leaving him fatigued and frustrated.
Understanding the building blocks of development of the movement system for a teen, who has only experienced failure with the practice, practice, practice approach, can change one’s perspective dramatically.
Instead of blaming yourself for not trying harder, you can own your challenges, empower your strengths, and begin to move forward. Awareness of his challenges didn’t change his body immediately, but it did change his perception of himself.
What is Developmental Coordination Disorder?
Children with Developmental Coordination Disorder (DCD) are not simply clumsy. DCD is a motor skills disorder that affects approximately five to six percent of all school-aged children. DCD has been described in many ways over the years, including dyspraxia, minimal brain dysfunction, and clumsy child syndrome. The medical community has chosen to use the term DCD as the preferred diagnostic term. DCD occurs when a delay in the development of motor skills, or difficulty coordinating movements, results in a child being unable to perform common everyday tasks. They often have difficulty keeping up with their peers during gross motor play, have frequent falls, and have a hard time doing daily skills, such as zipping and tying shoe laces.
The biggest challenge is often with learning a new movement-based skill, which is a challenge that is experienced throughout childhood. These children are often labeled as lazy (read more about how NOT lazy these kids are here!). They’re often told that if they would just try harder they could do it. In the past, it was often assumed that children would outgrow these challenges, but research has demonstrated that children with coordination problems do not simply outgrow these problems. In fact, these children are at greater risk for being sedentary and less healthy as adults than their peers. These children are also at greater risk for mental health problems.We cannot risk overlooking the struggles of these children. There is too much at risk for their futures!
Children with DCD are constant victims of imperfect practice. These children blend in with their peers well and are often not even diagnosed. Goal-oriented methods help with the practice component, but this is not enough. Life will constantly present new skills, so this creates a constant challenge, especially throughout childhood. In addition to working towards specific skills, we can work on developing a child’s building blocks of movement in order to also “teach the child how to fish.” Building the foundations of movement, rather than just teaching gross or fine motor splinter skills, improves the child’s learning abilities and decreases their reliance on others.
Children with DCD often have low tone, as well. Due to the low tone, it is generally assumed that these children are flexible everywhere. However, when you look closely at their core, the opposite is often discovered. Children with low tone typically don’t develop sufficient three-dimensional control in their core. Without the development of core control, asymmetries often remain and limit the development of core control. Often parents will tell us their kids will just randomly fall out of their seats in school (learn more about why here!).
Children with coordination disorders can vary in their vestibular responses. The vestibular system can be underactive, limiting the child’s ability to develop a strong sense of where they are in space, or the vestibular system can be oversensitive, leading to fear of movement. Low tone and hypermobility can lead to less information going from the joints and muscles (proprioception) and traveling to the brain to tell us where we are in space. Commonly, the visual system will work hard to make up for less teammates in the balance team.
Many children with coordination disorders will have difficulty getting their bodies stacked up with good alignment in order to turn their power on. These kids will often hold their bodies in an alignment that feeds into chest breathing, with their chest shifted up and their back appearing to be arched. This position and breathing pattern feeds into the child’s fight-or-flight system, or sympathetic nervous system, and gives them less ability to use their calming parasympathetic nervous system.
Children with coordination disorders struggle to put all of the pieces of their movement skills and sensory feedback together to be able to combine it with timing, sequencing, and multitasking. Being able to do this is demanded from a student, even in kindergarten! Because of this, beginning school is often the turning point for parents to seek out extra help for their child.
We move through daily life without consciously thinking about how we are moving our bodies. We can walk while daydreaming without bumping into a street sign, and we can sit in a chair without falling off while reading and writing. This may sound natural for many of us, but children with postural deficits use excessive energy, attention, and focus to fulfill all of the expectations they face each day. When our gears are synchronized, movement is automatic and children can focus on higher level skills, whether it is moving through the classroom without bumping into things or learning algebra. Filling in or strengthening these missing building blocks to develop a child’s sensory-motor system can build automaticity in order to multitask and to free the child up for higher cognitive skills. That’s where we can help!
Children with coordination disorders are often called lazy and told they’re not meeting their potential. People assume things will get better as the child gets older and that these are delays that will “catch up.” In the meantime, the child struggles with their self-worth, self-esteem, and mental health. As we said before, research supports that children do not grow out of these struggles, and that children with coordination challenges are typically more sedentary adults with increased risk of cardiovascular and mental health problems.
Supporting a child’s ability to learn the skills they need in daily life is important, but we cannot fall into the work harder and try harder pit, without also working towards long-lasting change. We can help these children fill in those missing and weakened foundational skills. There are so many ways we can help these children meet their personal potential and protect their mental health, all at the same time. They are working so hard, day in and day out- let’s acknowledge that, support their efforts, and improve their building blocks so that they are building their houses with the strongest foundation as can be.
Top 10 Tips for Parents of Children with DCD
Martial arts and swimming are individual sports that help improve body awareness, sensory processing, and balance. They are sensory rich and can be modified for individual differences.
Explore movement in fun, social, and noncompetitive ways, such as hiking, yoga, and creative movement.
Identify postural imbalances that may be limiting the development of core strength and learn ways to improve postural symmetry..
Provide supports for sitting if the child has difficulty sitting upright, such as a yoga wedge or a towel roll.
Encourage the development of timing using music and movement opportunities.
Adapt the environment for success. Some adaptations include picture schedules, written lists, and typing instead of writing.
Practice listening, looking, and moving at the same time. Play walking and looking games, such as “I spy,” while going for a walk.
Model the use of feedback during play. For example, if you throw a ball and it lands short of the basketball hoop, say “I threw it too soft.” Discuss what you could do differently, try it and discuss whether it was successful. Bring awareness to this process.
Backward chaining is a way to learn how to complete a task by working backwards from completion. The child first does the last step to complete the task. Next, they would try the last two steps. The child can build this until they are independent with the entire task.
Team up with a PT or OT specialist to work on the foundations of movement so that practice is more effective and successful!
Getting Help
If you see your child is working harder than other kids to get through their daily activities, don’t wait to look for help. You also don’t need an official diagnosis to get help. Reach out to us at KidPT and come in for a Discovery Visit. We will listen to your concerns, do a screening of your child and their movement skills, and help you make a plan. We’re here for you!
References
Zwicker JG, Suto M, Harris SR, Vlasakova N, Missiuna C. Developmental coordination disorder is more than a motor problem: children describe the impact of daily struggles on their quality of life. Brit J Occup Ther. 2017:030802261773504. 10.1177/0308022617735046.
Sugden, D A, Chambers, M, & Utley, A. Leeds Consensus Statement 2006.
Cousins M, Smyth MM. Developmental coordination impairments in adulthood. Hum Move Sci. 2003;22(4):433–459. doi: 10.1016/j.humov.2003.09.003.
Wilmut K, Du W, Barnett AL. Navigating through apertures: perceptual judgements and actions of children with developmental coordination disorder. Dev Sci. 2017:20(6). doi: 10.1111/desc.12462.
Missiuna C, Moll S, King G, Stewart D, Macdonald K. Life experiences of young adults who have coordination difficulties. Can J Occup Ther. 2008;75(3):157–166. doi: 10.1177/000841740807500307.
Fitzpatrick DA, Watkinson EJ. The lived experience of physical awkwardness: adults’ retrospective views. Adapt Phys Act Q. 2003;20(3):279–297. doi: 10.1123/apaq.20.3.279.
Lingam R, Jongmans MJ, Ellis M, Hunt LP, Golding J, Emond A. Mental health difficulties in children with developmental coordination disorder. Pediatrics. 2012;129: E882–91.
Hill EL, Brown D. Mood impairments in adults previously diagnosed with developmental coordination disorder. J Ment Health. 2013;22:334–40.
Harrowell I, Hollén L, Lingam R, Emond A. Mental health outcomes of developmental coordination disorder in late adolescence. Dev Med Child Neurol. 2017;59(9):973‐979. doi:10.1111/dmcn.13469.
Cairney J, Hay J, Veldhuizen S, et al. Trajectories of cardiorespiratory fitness in children with and without developmental coordination disorder: a longitudinal analysis. Brit J Sport Med. 2011;45:1196-1201. 406/mojsm.2018.02.00054.
http://jonikidpt.wpengine.com/wp-content/uploads/2015/11/kidpt.png00jonikidpthttp://jonikidpt.wpengine.com/wp-content/uploads/2015/11/kidpt.pngjonikidpt2022-07-02 11:11:112023-09-28 10:07:59Is My Child Clumsy or Could it be Developmental Coordination Disorder?
