How Important Are Infant Gross Motor Milestones?
As a pediatric physical therapist, whenever a friend of mine has a baby, the first question they ask me and one that I'll hear frequently during the first year is, 'Is my baby on track and doing what they're supposed to do?'
When it comes to infant gross motor milestones, this list is a good one for parents to look at:
- 1 month: briefly lifting head when on tummy, coordinating lifting head with pushing into arms
- 2 months: able to lift head to 45 degrees when on tummy and able to look to both sides through 90 degrees when on back
- 3 months: able to prop and hold on tummy with lifting head to 90 degrees with a chin tuck
- 4 months: grabbing knees/thighs while on back, starting to roll belly to back and prop sitting (sitting with weight bearing through the arms)
- 5 months: grabbing feet while on back, pushing up through extended elbows on tummy, starting to roll back to tummy
- 6 months: independent sitting, passing object between hands on back, lots more rolling tummy to back and back to tummy
- 7 months: pivoting in a full circle on tummy, starting to hold all fours position with some rocking back and forth
- 8 months: creeping on hands and knees on all fours, sitting with legs in a variety of positions, going from sitting to all fours and back to sitting
- 9 months: pulling to stand through arms and standing with both arms on a stable surface
- 10 months: laterally cruising along furniture
- 11 months: cruising while facing forward
- 12 months: standing independently
- 12 to 16 months: taking first steps
The first year of life is truly amazing. When a baby is born, they are completely dependent for everything and can barely hold their head up for more than a second. By the end of that first year they can be taking steps, saying their first words and self-feeding.
The early months of life are imperative for tummy time. This offers a plethora of benefits, including giving the infant control of spinal flexion and bringing them out of physiological flexion, the alignment they are born in. This prepares them for sitting, standing, walking and running as they age. Tummy time also gives them weight bearing into their arms and progressively into their hands. This helps to create the arches of the hand that are essential for fine finger manipulation needed to button pants, grip a pen and tie a shoe. It is also imperative during these early months to make sure that the infant is looking in both directions and not forming a preference as this can lead to a misshaping of the head when infants spend more time on their back. This can begin to effect ear position and even jaw alignment, which can affect feeding.
As infants begin to push up more with their arms straight and bring their knees under them they begin to creep on all fours. This movement and the transition in and out of all fours from sitting is important for so many reasons. It continues to stretch out the fingers and muscles of the hand for improved fine motor skills. It is essential for the changing of the shape of the hip joint, creating a much more stable joint that will allow the infant to progress towards independent standing and walking.
Pulling to stand and standing with arm support helps an infant learn to bear weight through an upright position. Cruising allows an infant to learn to shift their weight side to side, preparing the basic building blocks for taking a step. Cruising facing forward allows an infant to practice taking steps controlling their hips, knees and ankles while still having the safety of weight bearing through their arms.
So what do all these milestones mean, and what should you do if your baby doesn't hit them?
No two infants are the same and will not meet these milestones at exactly the same time. Some kids will do it before others and some will move at a slower pace. There can be a wide variety of reasons that a child is not meeting their gross motor milestones. They may not have had as many chances to practice the skills due to a lack of floor time, specifically tummy time. It may be that the infant has abnormal muscle tone due to a wide variety of possible causes, including prematurity, genetic syndrome or a benign cause. This abnormal muscle tone then makes moving against gravity more challenging. When your baby is more than a couple of months behind on these milestones, it is time to raise concerns with your pediatrician. Physical therapy is much more effective with early intervention. It is easier to teach someone an efficient way of moving than it is to correct an inefficient way.
Adam Schlichte, P.T., D.P.T., C.N.D.T., has more than 16 years of experience as a pediatric physical therapist. He has advanced certifications in neurodevelopmental treatment and advanced baby treatment, and has clinical expertise in cardiopulmonary, neuromuscular disorders, genetic syndrome, premature infants, cerebral palsy and plagiocephaly. Adam sees pediatric patients at MyMichigan Health's Pediatric Center for Rehabilitation, located at 32 S. Homer Road in Midland. For more information, visit www.mymichigan.org/rehab.