Ages Birth to 5 yearsTheresa Wallace BMR (PT)

Birth to Age OneConsider the amount a baby accomplishes in

its first yearHead controlFollowing objects with their eyesRollingGrasping toysSittingBanging toys togetherStandingPoking

This is just a small sample of what a baby will do in its first year

Gross Motor Skills One to three months of age

Turns head to side while on back Starts to lift head up while on tummy Turns head to side to clear airway on tummy Kicks and extends legs

Three to six months of age Begins to roll – belly to back first Puts weight through hands while on tummy Lifts head when pulled into sitting Sitting balance improves and should be close to

independentWhat do we need to do

Start tummy time early, to develop neck control and build tolerance to the position

Fine Motor SkillsOne to Three months of age

Moves arms symmetricallyHand to mouth movement may be observedHands starting to spend time open

Three to Six months of ageGrasp reflex inhibited so starts to drop objectsEyes move independent of the headHands open most of the timeUses radial palmar grasp

What do we need to d0Introduce toys for grasp and release Encourage visual tracking

Gross MotorSix to Nine months of age

Sitting independently May crawl – backwards first Pull to stand Stands while holding on

Nine to Twelve months of age Walks with hands held Cruises around furniture Creeps on hands and knees May stand alone momentarily Kneels May begin independently walking

What can we do to help Provide movement exposure – chances to reach for toys

and stand at the couch

Fine Motor SkillsSix to Nine months of age

Will attempt to pick up small objectBangs toy on a tableTransfers toys between handsVoluntary release

Nine to Twelve months of ageTakes toy out of a containerPokes with index fingerImitates a scribbleBangs blocks together

What we can do to helpProvide appropriate toys for hand manipulation and

exposure to hand movement

Barriers to Gross Motor Development – Year One

Limited tummy time – if not exposed early, may have delays in head control, rolling, independent sitting and walking

Children with limited tummy time may not crawl effectively and this over the long run may decrease fine motor skills even at school age

Limited exposure to transitional movements such as rolling and lying to sitting can cause children to get “stuck” in sitting and not progress to further stages of gross motor development

Barriers to Fine Motor Development – Year One

Lack of exposure – tentative about allowing small objects near child, messes at eating time

Overly helpful sibling/parents which do everything for their child (not letting them help to get undressed, feed themselves, and other self care tasks)

Ensure vision assessment has been completed as vision issues can hamper the child’s ability to see and manipulate small objects

RED FLAGSGross Motor

W-sittingDelays in all motor milestones – rolling, sitting,

weight bearingTightness of muscles or jointsFavoring of one side of the body

Fine MotorFavoring one hand/armPlay limited to chewing and mouthing objectsNot using thumb to grasp small objectsUncoordinated or jerky movements when using

hands

Back to sleep – tummy to playThis program was introduced when it was noted that gross

motor developmental milestones were getting later in babies which were not sleeping on their tummies

Babies used to experience tummy time for sleep, were very comfortable with the position, and utilized early reflexes to develop such things as rolling

With the back to sleep program implemented to reduce SIDS, many parents were no longer giving their babies any tummy time

Subsequently, a decrease in head control, decreased babies that crawled, later rolling and sitting and walking skills were noted

Babies should be introduced to tummy time from the day they come home, 30 seconds of tummy time is not enough

Many parents state their child doesn’t like tummy time, but so many valuable skills are developed from this position

The Problems with W-SittingUsually happens due to the position of the child’s hips

and knees (anatomical position)Hips are turned in, so W-sitting is secure and easy to doW-sitting is often seen in children with intoeingW-sitting can interfere with a child’s ability to develop

other types of sitting – ring, long sittingIt can cause tight muscles and loss of joint rangeIt can cause musculoskeletal changes above and beyond

the position of the hips (stress on ligaments and redirection of tendons)

Limit W-sitting by moving the child up to play at a seated surface, or introducing other positions such as ring

Gross Motor SkillsTwelve to Eighteen Months of Age

Walks alone Run is a hurried walkCan walk backwards and sidewaysThrows a ball forwardPulls a toy while walkingWill bend and look through legsGoes up and down stairs on hands and kneesMay progress to walking up and down stairs

holding a rail or hand (both feet on one step)

Gross Motor SkillsEighteen Months to Two Years

Carries toys while walkingWill sit by backing into a child size chairKicks a ball with purposeRun is maturing – legs more together, less

fallingSquats to playWill push or pull toysWalks upstairs with one hand held

Fine Motor SkillsBy age Two

Grasps pencil between thumb and fingerImitates vertical lines and circlesCan grasp a small bead and put onto a stringCan snip paper with scissors (supervised)Builds tower of 6 blocksHolds two objects in one handCan activate more complex cause and effect toysTurning single pagesEffective use of spoon or forkDrinks from a cupHelps with dressing by

Pulling pants off Taking socks off Finding arms of shirt

RED FLAGSGross MotorW-sittingWalk is immature, falling regularlyFavoring of one side of the body or

assymmetrical looking gaitUnable to focus on one area of play, constantly

switching play activityFine MotorGives up easilyAvoids fine motor activitiesAvoids messy activitiesStill mouthing objects

What can we do to help – Age 2Exposure – introduce crayons and scissors,

stairs and ride on toysPersistence – keep reintroducing objects and

tasks even if they are not enjoyedAttention – start to ask for longer periods of

attention instead of always allowing the child to dictate when an activity is done

Independence – encourage help by the child even if it takes a longer time to accomplish the task

Gross Motor SkillsAge Three

Stand on tip toesJumps with two feet Catches a large ball (trapping to chest)Jumps forward (12-36 inches)Jumps over objects (2 inches high)Starting to one foot standMay start to one foot hopWalks forwards and backwards generally along a

lineWalks up/down stairs alone, first with both feet per

step, progressing to alternating feetClimbs jungle gyms and laddersJumps down off small stepMay start to pedal a tricycle

Fine Motor SkillsAge Three

Crayon is held between thumb and fingersCopies horizontal and vertical lines and circles,

may imitate a crossCan cut with scissors along a straight lineManipulates a bead in one handCan match block patterns with 3-4 blocksStarts to pull up a zipperMay start doing large buttonsRemoves pants independentlyPuts on front opening shirt independently

Red FlagsFailure to meet many of the expected milestones

Any one or two milestones may be due to exposure to a specific task. A male child may not like fine motor as much as gross motor so may not be as good at coloring. A female child may like to color a lot but doesn’t like to go outside and play with a ball as much.

Inability to be directed to the task askedAttention issuesDifficulty following directionsTotal focus and desire to do only one type of

activity – lining up carsFixation on inappropriate types of play (spinning

tires instead of making the car move)

What can we do to help – Age 3Recognize areas which are concerns Exposure – practice skills which are difficult,

make games and have funPersistence – keep reintroducing objects and

tasks even if they are not enjoyedAttention – start to ask for longer periods of

attention instead of always allowing the child to dictate when an activity is done

Independence – encourage help by the child even if it takes a longer time to accomplish the task

Gross Motor SkillsAge 4

Gallops forwardJumps at least 36 inchesStarting to skipStands on one leg for 5 secondsCan hop forward with either footThrows underhand and overhand with direction (at

least 6 feet)Starts to catch without trapping to chest (smaller 3

inch ball)May start to ride bike with training wheelsCan jump and change direction repetitivelyMaintains balance on tip toes

Fine Motor SkillsAge 4

Has picked a hand preferenceUsing wrist movement to direct pencilCopies a crossTraces a square and triangleCan use a computer mouseColors within the linesDraws a person with head, body, arms and legsCan cut out a square or triangleBuilds designs with blocksZips and separates shank on jacketAttempts smaller buttonsMay start to lace shoes

Gross MotorAge 5

Skips effectivelyHops forward on one foot 20 inchesIs able to perform a sit up and push upKicks a ball so it raises in the airStands on one foot more then 10 secondsStarts to walk heel to toeStarts to catch a tennis ball without trapping it

to the chestStarts to hop side to side on one foot over a

line

Fine Motor SkillsAge 5

Mature pencil grasp (or tripod)Finger movement directs pencilCopies square and triangleCuts a circle with accuracyIdentifies letters of the alphabetCopies letters of the alphabetTies a knot (tying shoe laces by age 6)Puts on pull on garments correctlyBuilds with construction toys

Most ImportantRecognize signs of delays early – early

intervention gives the best chance of changesProvide a variety of movements, experiences,

toys and exposure to scissors, crayons, blocks and basic learning materials

Early exposure usually provides the best outcome

Be persistent and patient – for those children with delays, these tasks are really hard and it can be really frustrating for them. They will avoid what is difficult for them to do

Make activities fun – turning an activity into a game may help a child forget how difficult it is