Important Motor Milestones: What Are They And When Should I Bring Up Concerns To My Pediatrician

Important Motor Milestones: What Are They And When Should I Bring Up Concerns To My Pediatrician

Every child develops on their own timeline. Just like the growth chart that your pediatrician reviews with you at well checks, it is important that your baby or child follows his or her curve, but it is less important the exact timing of milestones. Some babies will walk at 10 months, and some won’t walk until they are 18 months. Both of these are okay, as long as your baby continues to progress and achieve new motor skills.

As a physical therapist, there are a few major milestones that I look for in the first year of a baby’s life. These are all important milestones for overall development. Here are some of the milestones I look for and when you should bring up concerns to your pediatrician. 

Another important thing to note is that if your baby was born at or before 37 weeks, you should adjust for prematurity while tracking their milestones. This means they get those extra few weeks to “catch up”. You will continue to correct for prematurity with all developmental skills until two years of age.

Lifting head in tummy time

Why this is important: This strengthens the muscles in your baby’s neck, back, and shoulders. It sets the foundation for head and trunk control needed to eventually roll, sit up, crawl, and stand. 

When does this happen: Baby should start to attempt to lift their head off the surface within the first two weeks. By one month old, your baby should be turning his or her head and lifting briefly off the surface, even if just for a few seconds. By three months old, your baby should be able to lift his or her head to a 45-90 degree angle with their head in the middle (not tilted to either side). 

How can I help my baby do this: Do a few minutes of tummy time after every diaper change throughout the day. In this 0-3 month period, you can also put your baby on your chest or across your lap. You can also hold your baby on their tummy if this helps them tolerate it better. A firm, flat surface, is the best place to practice this because they have a surface to push against. They will have more difficulty lifting their head if they are on a soft surface.

When to bring up concerns to my pediatrician: If your baby is not attempting to lift their head from the surface in the first 1-2 months, or if they are not able to tolerate it longer than a few minutes at any point in development.

Rolling

Why this is important: Rolling helps to strengthen head and trunk muscles, build core strength, and promote weight shifting, which are all important for developing balance in sitting and standing. 

When does this happen: Baby should start rolling over from tummy to back and back to tummy during the 4-6 month time frame. Some babies roll from tummy to back first, and some babies roll back to tummy first. Both are normal. 

How can I help my baby do this: Continue to practice tummy time - this will help your baby to practice shifting their weight. Encourage your baby to reach for toys on their tummy and out of reach on their back. You can also initiate a roll by placing your hand on one of your baby’s hips and gently bring it across their body.
When to bring up concerns to my pediatrician: If your baby is making no attempts to roll over either side by 6 months.

Sitting 

Why this is important: This is a skill that will give your baby independence in playing with toys and will help to support eating solid food. It will work on the upright postural control required for independent standing and walking.

When does this happen: Your baby should be able to sit with support by 4-6 months. By 6 months old, your baby should be able to sit unassisted, with their hands on the surface. By 7-9 months, your baby should be able to sit upright without their hands on the surface and be able to reach for toys while sitting without falling over.

How can I help my baby do this: Practice supported sitting with your hands. Avoid using products such as a bumbo seat or sit-me-up chair - these devices will encourage your baby to lean into the surface behind them and round their spine, and this will make it harder for them to eventually sit up on their own. Make sure when you are practicing sitting, your baby’s bottom is behind their head, so that their trunk is leaning slightly forward.
When to bring up concerns to my pediatrician: If your baby is not sitting independently by 8 months old, bring this up to your pediatrician at their well check. If you notice that they are unable to hold their head up in sitting and need a lot of assist by 4-6 months, you can also bring up concerns to your pediatrician.

Crawling

Why this is important: Crawling helps to develop the strength, balance, and coordination that it will take to walk independently. It also encourages your baby to use both sides of their body and both sides of their brain. It helps with visual development and fine motor skills, as well. 

When does this happen: Your baby will start crawling around 7-9 months. Some babies will belly crawl first, and some will go right to crawling on hands and knees. Both are normal. 

How can I help my baby do this: Continue to practice tummy time often. Teach your baby to rock on their hands and knees. Position toys out of reach when they are doing tummy time.
When to bring up concerns to my pediatrician: If your baby is not motivated to crawl or having trouble crawling by 10 months of age. 

Walking

Why this is important: Walking is crucial for continued physical development and it gives your child a new way to explore their environment!

When does this happen: Typically by 12-15 months, your baby will start to take their first steps. 

How can I help my baby do this: Encourage your baby to play in a standing position by placing their favorite toys on elevated surfaces like the couch, on top of a diaper box, flipped over laundry basket, or play table. You can hand them toys in standing to see if they will take their hands off of a surface. 

Avoid putting your baby in a walker to practice walking. This will encourage your baby to walk on their tiptoes with their trunk leaned forward. This will likely prolong the development of independent steps because they don’t have to figure out balance while being supported by a device.
When to bring up concerns to my pediatrician: If your baby is not taking any steps by 16 months, discuss this with your pediatrician. 

References/resources:

www.pathways.org

https://www.cdc.gov/ncbddd/actearly/milestones/index.html

https://www.luriechildrens.org/en/specialties-conditions/pediatric-physical-therapy/resources/gross-motor-skill-development-by-age/