July 24, 2021 Dr.Srinivas Gada 0 comment

What are Gross Motor Milestones? And why should you know them?

“There are two gifts we should give to our children, one is roots, and the other is wings”, said Maria Montessori. First, a good base of gross motor (GM) skills is essential, as gross motor skills are the foundation and roots on which fine motor skills, self-care skills, play, and social interaction can take place. Besides, a delay or difficulties in gross motor skills can not only impact a child’s independence, education, inclusion, and fitness, but they also cause low self-regard and affect their confidence.

Acquiring and honing gross motor skills has been vital to humans to be mobile, survive and thrive on this planet. Gross motor skills involve the use of large muscles in our core, our arms, and legs. Hence, they include our ability to sit, stand, walk, run, jump, kick, climb, throw, catch, ride, swim, and undertake exercise, among others. Also, assessing a child’s gross motor skills gives us information about a child’s postural control, muscle tone, strength, agility, flexibility, balance, and visual-motor coordination.

Furthermore, these milestones develop on a well-established trajectory. Consequently, using this knowledge of gross motor milestones can help us identify developmental conditions such as Dyspraxia/DCD (Developmental Coordination Disorder). Also, the knowledge of gross motor skills can help us identify motor difficulties in neurodevelopmental conditions such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and Learning Disabilities (LD). Delay in acquiring these milestones can also occur in various neurodevelopmental disorders such as Myopathies, Neuropathies, Muscular Dystrophies, and various syndromes.

As one can appreciate, there is a wide variation in the achievement of gross motor skills. In this article, I have covered ‘gross motor milestones‘ in a typically developing child. But a note of warning before you read any further. While each milestone listed below is important, missing a single milestone in the absence of anything else may not be significant. Nevertheless, a delay in developing several of these milestones in a child deserves prompt attention and a thorough neurodevelopmental assessment.

0 – 3 months

They can turn their head side to side
A child can bring their hands into the midline
In a prone position, they can lift their chin and even lift their head up momentarily
Also, in a prone position, they can prop themselves on the forearm with their face vertical
They can push their feet against your hands
They can kick actively in bath
Many can roll from side to back
They can hold their head steady momentarily when held

3 – 6 months

Many can roll from front to their back
This is followed by their ability to roll back to front
In a prone position, they can push themselves up on extended arms
They begin to sit with some support to their trunk
Later they can sit alone briefly
They can prop their arms in front for support while seated
Many can turn around when lying on the floor, i.e., they can pivot on their front

6 – 9 months

A child can now get into a sitting position
They have mastered the ability to sit steadily without support
They can put their arms out to sides for balance if required
Initially, they can try energetically to crawl
Followed by their ability to make progress crawling, either moving forward or back
This is then followed by their ability to commando crawl on their elbows and knees
Followed by their capability to crawl on all four limbs, i.e., bear walks
A child can bounce on their feet when held
He/she have the capacity to stand when held up
They can pull themselves to stand up
They can stand holding on to furniture

9 – 12 months

They can pivot while seated
They can climb on a low ledge or a step
Followed by their ability to crawl up some stairs
They can side-step inside of a cot or while holding onto rails
They can cruise around the furniture holding both hands
They can stand with one handheld
He/she can stand for a few seconds on their feet without assistance
They can walk with both their hands held
Many can walk with one handheld

12 – 18 months

They can climb into a low seat
They can climb some stairs, both up and down, on all fours
They can stand up from sitting without support
They can walk with their arms high and out
Followed by their capacity to walk independently
Many can walk while carrying a toy
Many can walk backwards while pulling a toy on a string
They can stoop to pick up a toy or object from the floor
They can run stiff-legged

18 – 24 months

They can seat themselves in a small chair
Many can run, with the ability to start and stop
This is then followed by their ability to run well
He/she can kick a small ball with the demonstration
Followed by their ability to kick a ball on their own
They can walk up and down the stairs, 2 feet to a step
Followed by their capability to walk up one foot to each step with one handheld
Many can jump off a step
Many can throw a ball overarm
They can squat while playing

24 – 36 months

They can kick a ball with some force
He/she can turn around obstacles while running
They can pedal a tricycle
They can walk up with alternating feet but come down 2 feet to a step
They can balance on one leg momentarily
Many can stand and walk on their tiptoes
He/she can catch a large ball with extended arms
They can jump off the bottom step
They can jump in place
He/she can throw overhand
Many can stand with both feet on a balance beam

3 – 4 years

Many can walk or run up and down the stairs with alternating feet
They can balance on one leg for 3–5 seconds
They can hop
They can throw and catch a large ball, bounced from another person
She/he can start using a bat
They can sit cross-legged on the floor
They can walk on a straight line for 4-6 steps
Many can run and kick a medium size ball
Many can jump off the last 2 steps

4 – 5 years

They can now balance on one leg for 8–10 seconds
They can walk downstairs one foot to each step
He/she can walk heel-to-toe along a straight line
They can throw, catch, and bounce a large ball
She/he can hop on each foot for 3+ hops
They can bend and touch their toes, keeping their knees straight
Many can run fast while outdoors

5 – 6 years

He/she can run upstairs
Many can jump off the last 3 steps of a staircase and land on both feet
They now have the ability to balance on each leg for 15–20 seconds
Many can ride a bicycle
With a tennis ball, they can throw, catch, and bounce to self
They can jog at a steady pace in a playground
They can hop-skip
He/she can walk in a march, swinging arms with opposite legs
They can now hop on one foot for 12-15 feet
Many can skip using a rope

6 – 8 years

They can run downstairs
They can walk backwards heel-to-toe
Many have the ability to jump backwards
They now have the capability to balance on one leg for 20+ seconds
They can throw a tennis ball up and catch
They can hop-skip in an open area
Many can jump off the last 4 steps on a staircase
Many can skip with a rope for 3+ skips
Many have the capacity to do somersaults

Some things you could do to help

Children learn best through play. Providing them opportunities to practice and experiment help. Be patient. Praise their efforts. Break down the task into smaller chunks and offer them cues and feedback. Increasing muscle strength in their core, arms and legs through exercise and therapy is hugely beneficial.

Conclusion

As you can see from the above, the agility, strength, balance, control, and motor skills of children gradually increase and refine as they grow. A thorough neurodevelopmental assessment will assist in identifying fundamental difficulties and conditions affecting the acquisition of gross motor skills. Failure to acquire these milestones can occur in various neurodevelopmental disorders such as DCD, ASD, or ADHD. A neurodevelopmental paediatrician would also distinguish the nature and the severity of delay in a child. After a neurodevelopmental assessment, a paediatrician will recommend any investigations that need undertaking where required and or recommend physiotherapy.

A physiotherapist will then be able to see your child and offer you a tailored programme of play and activities that are not only fun but will also improve your child’s day-to-day functioning. Consistent practice of physiotherapy exercises can help improve your child’s muscle strength, balance, coordination and movement.

I regularly see children with gross motor difficulties who are in secondary school but have not met the gross motor milestones for a 6–7-year-old. Recognising and tackling these motor delays can avoid developing several consequences for a given child, such as disengagement from learning, low self-esteem, low mood, anxiety, and poor psychological health. On the other hand, earlier identification and effective interventions can help the child acquire these fundamental skills, build on their learning and gain valuable qualifications and employment. Hence, good knowledge of gross motor milestones is crucial.