Between the Milestones of the 1st Year

As a mom of two girls and a PT for kids I often get asked about milestones and whether a parent should be concerned. There are many clues to whether a parent should be concerned that go beyond looking at a chart that tells you when a child typically will develop a skill.

There are many charts that describe ages and stages so I won’t go into that. I want to discuss the grey that lives between the black and white of those big milestones. These are the things that I look for when I evaluate a baby to see if they need some extra help or whether they just need more time, exploration and play.

Variation
Babies move with lots of variation in their movement patterns. This allows them to practice different angles and amounts of movement in each direction. Look for the baby practicing movement with all different strategies. For example, the baby that is sitting may get down to the floor going to one side, the other side or forwards.

Progression
Rather than looking at what a child is doing at a certain age, look at the changes that occur daily. From week to week you will see a baby change in their movement patterns, starting from down on the floor to higher and higher until the child is walking. Rather than being concerned about a timetable for when a child is crawling, I want to know if they are progressing from being on their tummy propped on elbows, to pushing up on straight arms, to reaching for a toy in this position. This is an example of a progression. If a child is 16 months and not walking, I want to know if the child is cruising and walking with a push toy. As long as the child is showing these prerequisites, walking is likely just a matter of time.

Symmetry
Babies should be rolling to both the left and right, reaching for toys in all directions in sitting, and cruising to both sides. Babies will often have a preferred side to move when learning a new skills, such as rolling. Once the child has learned to roll they should do it to both sides. Symmetry is very important to look at with the increased incidence of torticollis, which often presents with asymmetries throughout the body.

Quality
Parents will often comment that the baby looks stiff or awkward when moving when there are concerns. A physical therapist will be able to break down the components of movement to see where this is coming from, but it is often a lack of trunk rotation or elongation of one side. When it comes to gross motor development, quality is important. Even if a child is developing their skills during the predicted outcome I would recommend having a physical therapy evaluation to identify the source of the decreased quality. Solving the problem in infancy can prevent future problems from developing.

Transitions
Perhaps most importantly to set the stage of the actual milestones of sitting, crawling and walking, are all of the transitions that happen in between. Babies perform these transitions over and over again to master moving through space, using rotation in all different planes, and elongating and shortening their trunks in all different positions. For example, moving between lying down and sitting, pulling to stand, and moving between sitting and hands and knees.

Weight Shifts
Babies shift their weight forward and back and side to side thousands of times a day. These little shifts happen first on their backs while reaching for a toy, progresses to reaching for a toy while on their tummy and later the baby will rock on hands and knees. These shifts that occur over and over again set the stage for each following skill. These shifts are the key for initiating movement.

The first year of life comes with so many changes. It is an incredible process that an infant goes through. While looking at the big gross motor milestones, this is a peek into details that a physical therapist will look at when evaluating a child and can help parents to better understand the journey of motor development.