Developmental Milestones: Paediatric Physiotherapist Explains
What are Developmental Milestones?
Developmental Milestones are the skills and behaviours that children typically achieve as they grow and develop. This includes a child’s physical development, language and communication, cognitive development (learning, thinking, problem-solving) and their social and emotional development.
As a paediatric physiotherapist we are concerned with all areas of development, but focus in on a child’s physical, or motor, development.
From birth, typical motor development generally follows a specific sequence. Once a baby develops their head control, they will start rolling, progressing to sitting and crawling, then moving more upright until they take their first independent steps.
The important thing to remember is that children develop at their own pace, and the only way to develop is not on one strict timeline.
Developing Head Control
Baby being able to hold their head up themselves is one of the first motor skills to emerge. By around 2 months old, when baby is on their tummy, they should be able to hold their head up. Signs that your little one is developing head control is them lifting their head when being carried and moving their head to look around. Lots of tummy time on you and on the floor are encouraged to help progress this ability. Wearing your baby in a sling is also great to do at this age and stage.
Baby’s favourite thing to look at right now is you. Enjoy interacting in smiles and listen for baby making new noises.
Does your baby prefer to look one way or have you noticed a flat spot on their head?
This could be due to a head turning preference and a sign of plagiocephaly. Plagiocephaly is the term for head flattening which is produced by pressure on the baby’s skull when lying in the same position for prolonged periods of time.
There can be many causes as to why this happens:
- Baby may have a preferred sleep position
- Tight neck muscles which limit them turning their head fully – your baby may need stretches to their neck muscles which will be taught by your physiotherapist
- Position in utero or after a difficult labour
- Lack of tummy time
- Prematurity
The Association of Paediatric Chartered Physiotherapists (APCP) have a information leaflet you can access here.
Tummy Time
The Association of Paediatric Chartered Physiotherapists (APCP) have a useful information leaflet about tummy time.
Tummy Time can start from newborn and is important as it:
- Helps promote a more rounded head shape
- Improves development of head control and strengthens muscles of the head, neck & back
- Assists with attainment of motor milestones
- Enhances vision and hand-eye co-ordination
Rolling
By around 6 months old, babies should typically be able to roll from their back to their belly, and from their belly to their back. The important thing is that you are seeing your baby progress through some ‘mini skills’ prior to rolling – the building blocks of what they need their body to do to be able to roll.
Around 3 months when playing on their tummy baby will come up onto their forearms, then progress to pushing up onto their outstretched hands around 4 to 5 months. These positions are great for strengthening baby’s back muscles.
Another ‘mini skill’ for rolling is baby bringing their body into a side lying position for play. This is a great position for bringing hands together for midline play. You could make a point of doing some play in side lying (alternating each side), so baby gets comfortable in this position. It also helps them see the world from a new perspective!
Another lovely ‘mini skill’ to look for is baby reaching for their feet. Lifting their legs and grabbing their toes works the muscles in their hips and tummy, and is the beginning of rolling from their back to their front.
Sitting
Around the time your little one is learning to sit independently, lots of other lovely skills are emerging. You may notice them banging toys together, clapping their hands, saying ‘mama’ and ‘baba’ and even recognising their own name. Sitting opens up a whole new world to baby and you will see their desire to explore and engage grow with this new motor skill.
Just like with rolling, there are some ‘mini skills’ to look for to show that baby is heading towards sitting up themselves. Pushing up onto outstretched arms when on their tummy is an important pre-sitting skill to help make sure baby’s back muscles are lovely and strong.
In sitting they need to balance their trunk between going forwards and backwards until they are confident sitting upright. This can take time, but with you close by during floor play, you may find them briefly sit with your support, and the support they need becomes less and less.
A lovely skill to see before baby is confident sitting and playing is baby learning to support themselves. You will see your little one putting their arms out to prop on to help keep themselves upright.
Watch our top tips about helping your child move from crawling to standing
Crawling
Around the same time baby is learning to sit, you may also notice your little one start to crawl. This skill is typically seen around 8-10 months, however a little later than this is also fine. It’s important to say that not all babies will crawl, or some for only a very brief amount of time, however this skill is so beneficial for development for lots of reasons!
Crawling requires lots of co-ordination and strength, and gives lots of feedback through baby’s joints in their legs and arms. Putting weight through their arms and legs helps work on shoulder stability and stability around their hips and core.
Here are some things, those ‘mini-skills’, you may see to know that crawling is on its way.
- Pivoting on their belly (often begins around 4-5 months)
- Pushing backwards on their belly
- Inching forward on their belly
- Army crawling
- Rocking on hands and knees
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Your Little Ones Milestones – From Pulling to Stand to Jumping
Milestone – Walking
Walking is a very exciting milestone for your little one to achieve and a camera ready moment. It is important to remember that children reach this milestone on their own timescale. Those early walkers may be taking steps by their first birthday, but it is also entirely typical to see those first steps closer to 18 months old.
There are lots of ‘mini skills’ you will see before those first steps happen, and the important thing is seeing that these mini skills are progressing. Your little mover will first start by pulling to stand. This can start by your little one coming on to their knees at a lower surface, then pulling to stand on furniture or at your legs. When they feel confident they will then start cruising. The next step would be pushing a push-a-long toy, or holding your hands, and before you know it they will be taking their magical first steps!
Top Tip – giving your little one something to hold can encourage those first steps to happen
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Did you know Paediatric Physiotherapists do not recommend the use of baby walkers?
There are two main reasons for this:
❗️Safety – even under supervision, there are high numbers of accidents reported every year including – falling down stairs, head injuries, burns, scalds, and trapped arms / legs.
‼️ Delayed development – some studies have shown that baby-walkers do not encourage development and may actually delay the achievement of standing and walking.
More information can be found in the leaflet below:
⭐️ A baby walker is not to be confused with a push along toy – which are great for your little one.
⭐️ If your little one does spend some supervised time in a baby walker, double the amount of time they spend playing on the floor.
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Milestone – Climbing Stairs
When your little one starts to crawl you can expect that they will want to climbs stairs if given the opportunity! Climbing stairs on all fours is expected around 9 – 12 months and is both a fun activity and good strengthening exercise for your little one. Just make sure they remain supervised and you practice good stair safety out with practicing this skill.
Your little one will progress to walking up stairs one step at a time, i.e. two feet to one step, with help (hand hold or using a rail) from around 18 months of age. It is important to remember that you need a confident walker before progressing to walking up stairs, so bear this in mind if your little one walked closer to 18 months. Walking up stairs with assistance should typically be achieved around their second birthday.
After this, they will progress to walking up stairs one at a time without help, before walking up one foot per step with and without assistance. Stair climbing comes before being able to walk down stairs. This is because the muscles work differently for coming down stairs and can be a trickier skill to master!
Milestone – Jumping
Once your little one is walking confidently there are a few motor skills that are expected to follow. Parents love to know when to expect their little walker to start jumping! This skill can be seen as early as 2 years old, however in my experience I would say this is an emerging skill around 2 1/2 years old and is mastered in most typical 3 year olds.
A ‘jump’ is defined as both feet leaving the floor at the same time.
Here are some things to try at home:
⭐️ Role play jumping – your little one learns a lot from watching you!
⭐️ Break it down – start with practicing bending both knees together, then add in going up on tip toes.
⭐️ Use something bouncy – with supervision you could do some hand held bouncing on a cushion, a small trampoline, or on a bed. Just make sure it’s safety first!
⭐️ Off a small step – with hands held prompt your little one to ‘jump’. They may initially jump their feet separately. Your goal with this one is that both feet are off the ground at the same time, even if a little staggered!
⭐️ Use puddles – puddles offer so much reward for jumping and are a great motivator!
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