Motor Skill Development

When your baby was tiny, you might remember that their movements were very often jerky and asymmetrical (different on each side) as they had not yet developed stability of the head, neck and core. 

By about 3 months your baby will become a little stronger and you will gradually see their body and limbs becoming more symmetrical (the same on both sides). By 4 months they will have their hands together and by 6 months they will be able to reach with both arms, pass toys from hand to hand and push up when lying on their tummy with both hands.

They should not show a hand preference until at least 18 months. Even when this begins to develop, they should always be able to reach and push well with both hands and open, grasp and let go of toys with both hands.

They will also kick both legs well and will begin to take weight on both legs for a short time when held standing. They may start to commando crawl on their tummy or scoot about on their bottom. Sometimes they will use one side more than the other but you should see them use all 4 limbs well at other times.

When to seek help:

Skills such as taking the first step, smiling for the first time, and waving “bye-bye” are called developmental milestones. Children reach milestones in how they play, learn, speak, behave, and move (for example, crawling and walking).

We know that babies develop at their own pace within a fairly wide time scale and that there is a recognised sequence which most babies follow. Your baby should gradually move through this sequence and you will recognise and enjoy their developing skills.

When to seek help:

When your baby is born, labour can cause their head to become misshapen. This is normal and corrects within the first few weeks after birth.

You might notice that your baby is developing a flat spot on the back or side of their head. Plagiocephaly is the medical term for head flattening. It is produced by pressure on the baby’s skull when lying in the same position for prolonged periods of time. This could be due to a head-turning preference. New born babies have very soft skulls which are susceptible to being moulded or flattened. This is cosmetic and does not cause any pressure on the brain or any developmental problems.

Try to make sure that your baby is not in one position for too long. As your baby learns to move and the pressure is taken off the flattened area, the head shape can start to improve. This can take months and might correct fully.

Simple things to try:

• Always place your baby on their back to sleep. Alternate which end of the cot/crib they sleep at each night.
• Place your baby in lots of different positions during awake times. Put them on their tummy, support them lying on their side, carry them in different positions.
• Rearrange the furniture. Babies are attracted to look at the light and might turn their head towards a window.
• Reduce the amount of time your baby spends in one position where there is uneven pressure on their head like in a baby bouncer/swing chair or car seat. Try only to use the car seat when your baby is traveling in the car. A sling can be a good alternative to using a pram or buggy if used safely.
• Tummy time is very important. A small roll or a rolled up towel under their chest might help them to stay in this position for longer. Try a little and often approach. For more information have a look at:

• If you are bottle feeding your baby alternate the arm you hold your baby in. This will encourage them to look a different way.

Physiotherapy and using positions through out the day is the best way to prevent/improve plagiocephaly. There are no recognised benefits to helmet therapy.

For more information and advice look at:

• Head Turning Preference and Plagiocephaly from the Association of Paediatric Chartered Physiotherapist (APCP). You can find this leaflet in some other languages.

When to seek help:

Tummy time helps build muscles that your baby needs for activities like sitting and crawling. It also helps your baby develop a more rounded head shape.

Tummy time should be carried out as often as possible when your baby is awake, alert and happy. Don’t be discouraged if your baby dislikes tummy time to start with. With practice, encouragement and interaction your baby will start to enjoy being on their tummy.

For more information and advice look at:

• Tummy Time from the Association of Paediatric Chartered Physiotherapist (APCP). You can find this leaflet in some other languages.

When to seek help:

Most babies and children follow a similar developmental pathway. There will be individual variations in the time they achieve particular skills. There might also be variations in the types of movements they use; some children will crawl, some may bottom shuffle. Some children are quick to develop in certain areas, while others are a little later in developing a particular skill. In most instances provided the child is well and the environment is appropriate, the child will reach their motor skill potential.

Most children learn to sit between 4 to 9 months. Sitting can be delayed if children aren’t given the opportunity to practice this position. Children who prefer playing on their backs for increased periods of time may be later to sit. Also, if the child has a dislike of tummy time (see above) this can directly affect how strong the back and neck muscles are. Continue to practice tummy time in a variety of ways. The videos below will give you some suggestions to try with your baby.

Some children W-sit. This is when they sit on the ground, with their bottom, knees, and feet all touching the ground. Their feet will be resting outside their knees. When looking at the seated position from above, it resembles the letter ‘W’.

There are a number of reasons why children ‘W’ sit. This position should be discouraged as it can cause problems like:

• reduced stability in the trunk and pelvis
• increased flexibility in hips, knees, ankles and feet joints
• in turning of legs and in-toeing walking pattern.

For more information and advice look at:

• Promoting Physical Development Lying to Sitting from the Association of Paediatric Chartered Physiotherapists (APCP). You can find this leaflet in some other languages.

When to seek help:

Most babies and children follow a similar developmental pathway. There will be individual variations in the time they achieve particular skills. There might also be variations in the types of movements they use; some children will crawl, some may bottom shuffle. Some children are quick to develop in certain areas, while others are a little later in developing a particular skill. In most instances provided the child is well and the environment is appropriate, the child will reach their motor skill potential.

Most children begin to crawl from between 5 to 13.5 months. Some children don’t crawl up on their hands and knees. Some may:

• Roll from back to front to back.
• Commando crawl (move along the floor on their belly by pulling with their arms/pushing with their legs).
• Move along on their backs by pushing with their legs.
• Bottom shuffle (can be with one leg tucked under, side propping on one hand or pulling with both legs in a frog-legged position).

Crawling up on hands and knees allows the child to develop their shoulder and hip muscles’ strength and stability. This is important in preparation for more upright activities such as kneeling play and eventually independent walking. We would always encourage hands and knees crawling whenever possible.

Bottom shuffling is a common way for children to move. It can delay walking until 24-30 months. This can lead to worry for parents and carers. Once a child becomes fast and efficient in bottom shuffling it can be very hard to break this pattern of movement. It can make the progression from crawling through kneeling to pulling to stand more difficult. Try not to worry they will get there in the end.

For more information and advice look at:

When to seek help:

Most babies and children follow a similar developmental pathway. There will be individual variations in the time they achieve particular skills. There might also be variations in the types of movements they use; some children will crawl, some may bottom shuffle. Some children are quick to develop in certain areas, while others are a little later in developing a particular skill. In most instances provided the child is well and the environment is appropriate, the child will reach their motor skill potential.

At around 6 months, most babies may stand when held and begin to bounce. They can do this as their core, pelvis and legs muscles strengthen. Many babies will begin pulling up to stand about 9 months and most will stand at the sofa or with hands held by 12 months. Some babies dislike standing especially if they enjoy bottom shuffling. Some babies don't like the feel of the flooring on their feet e.g carpet, sand, lino, grass, wood, stone.

For more information and advice look at:

Most children learn to walk between 8.5 to 17.5 months. This may be delayed if they preferred to bear walk, inchworm, bottom shuffle or commando crawl. These are normal ways for children to move but can delay walking to 18-24 months. A baby walker will not help and is not recommended as it encourages toe walking.

The use of baby walkers/bouncers/jumpers/static entertainers/door bouncers is not recommended.

Physiotherapists and other Health Professionals do not recommend the use of baby walkers or jumpers for these two main reasons:

• Safety: even under supervision there are high numbers of accidents reported every year including falling downstairs, head injuries, burns, scalds, and trapped arms/legs.
• Delayed development: studies have shown that baby walkers and jumpers delay the achievement of standing and walking. They do not teach a child to walk. They encourage children to bounce and walk on their toes which can continue when they learn to walk independently. The more time your child is in one of these devices, the less time they have to practice moving on the floor. In turn, this will delay them getting up onto their feet.

For more information and advice look at:

• Baby Walkers from the Association of Paediatric Chartered Physiotherapists (APCP). You can find this leaflet in some other languages.

When to seek help:

Most babies and children follow a similar developmental pathway. There will be individual variations in the time they achieve particular skills. There might also be variations in the types of movements they use; some children will crawl, some may bottom shuffle. Some children are quick to develop in certain areas, while others are a little later in developing a particular skill. In most instances provided the child is well and the environment is appropriate, the child will reach their motor skill potential.

Parents often ask whether or not their child is walking “normally”. In most cases, their gait (walking pattern) will be normal with no reason for concern. There are a huge variety of toddler gait patterns. What you may consider abnormal may be a ‘typical’ gait pattern for your child's age and/or stage.

Although parents often worry about the following, these are considered normal variations in a child’s gait.

Bow Legs/Knock Knees

Bow Legs is normal in children up to the age of 4. It can be associated with obese/overweight babies/toddlers and early walkers. In this age group, in standing, the distance between the knees of 8-10cm is normal.

Knock Knees is normal in children from 2-4 years. In this age group standing, a distance between the ankles of 8-10cm is normal. It should self-correct by 6-7 years of age.

For more information and advice look at:

• Bow legs and knock knees in children and young people from NHS Inform

When to seek help:

Curly/Crossed Toes

Congenital curly/crossed toes can occur on one or both feet and affect the 3rd, 4th and 5th toes. The toes tend to be flexible and don’t interfere with walking.

Flat Feet

We know that the majority of children between 1-6 years of age have flat feet. All children before the age of 3, have flat feet, as the arch on the inside of the foot does not begin to develop until after this age. This is part of the normal development of their feet. Over 95% of children grow out of their flat feet and develop a normal arch. The other 5% continue to have flat feet, but only a small number will ever have a problem. Most children with persistent flat feet participate in physical activities, including competitive sports, and experience no pain or other symptoms. It is less important how your foot looks as to how it functions. Most children with painless flexible flat feet do not need any treatment.

For more information and advice look at:

• Flat Feet in Young Children leaflet from the Association of Paediatric Chartered Physiotherapists (APCP). You can find this leaflet in some other languages.
• Choosing Footwear for Children leaflet from the Association of Paediatric Chartered Physiotherapists (APCP)
• Flat feet in children - information for parents and carers by Royal Hospital for Children Glasgow
• Flat feet in children and young people from NHS Inform

When to seek help:

Frequent Falls

Falls are part of every baby and toddler’s daily life. Falls help children learn how to get back up, problem solve, strengthen their core muscles, and also work on their balance. One study has found that on average, a group of normally developing one year old children fell 17 times an hour. The number of falls should reduce as children get more practice walking independently. They should be given as much opportunity to do this as possible. Choosing the correct footwear will help provide stability around the ankle, thus helping to reduce falls. 

For more information and advice look at:

• Choosing Footwear for Children from the Association of Paediatric Chartered Physiotherapists (APCP).

When to seek help:

Intoeing

Some children’s feet turn in when they walk. This is called intoeing or ‘pigeon toe’ and is very common in young children. It is one of the most common normal variants in children and is usually seen in both feet but may be just one. It is normal for toddlers and young children to walk with their feet facing in the way. It is more common than out-toeing. Your child may appear to trip more often but this will get less in time.

Intoeing is more common in children who 'W' sit. Encourage your child to sit with their legs in a basket, out in front of them or tucked to the side. Intoeing tends to happen on both sides. It usually resolves by 8-10 years of age.

For more information and advice look at:

• Intoeing Gait leaflet from the Association of Paediatric Chartered Physiotherapists (APCP). You can find this leaflet in some other languages.
• Intoeing in children and young people from NHS Inform

When to seek help:

Toe Walking

Toe walking is walking on tip toes or when the heel doesn't touch the ground. It can happen some, most or all of the time. Toe walking is a normal part of development and lots of children grow out of this. In some cases toe walking can continue into adulthood. Toe walking can sometimes be due to other conditions like cerebral palsy, muscular dystrophy or neurodevelopmental differences like autism.

For more information and advice look at:

• Toe walking leaflet from NHSGGC
• Toe walking in children and young people from NHS Inform

When to seek help: