Twenty-month-old Sadee, a first-time pediatric patient, wobbled unsteadily as she attempted to make her way to a stuffed rabbit that her Mom held out to her on the other side of the examining room. "She's behind the other kids, I think," her mom said. And she was right. Sadee (not her real name) rolled over at 7 months of age, had difficulty sitting up, and now teetered like a buoy as she reached over to hug her stuffed animal.
Like Sadee's mom, parents are often on the ball when instincts kick in and signal that something isn't quite right in their child's motor developmental pattern. In Sadee's case, the problem was a gross motor delay. She was hitting most of her other milestones, developing communication skills and interacting with her family members and peers in day care, but she looked almost as if she were on a balance beam when attempting to walk. According to Sadee's mom, her first pediatrician suggested intervention. "With us moving to a new area, we never got around to it. We really thought she'd catch up."
Parents are usually first to notice trouble with gross motor milestones. A 9-month-old may have trouble rolling over, staying upright when in a sitting position, or transferring a block from hand to hand.
Gross motor development normally follows a predictable sequence. In medical school, there is a throwback to preschool days when we're taught the head-to-toe maturation of the nervous system: "Head, shoulders, knees, toes" is how parents can also think of the progression of motor development, beginning with the head and neck when infants are able to hold their head steady, and ending with the legs, resulting in a child's ability to eventually walk. Motor-development progression is more important than timing. Put simply, with each month, an infant should be able to get more body parts off the ground.
There are many exercises to help develop your baby's motor skills. "If your child is not using arms or hands when sitting or lying on his own, it's helpful to support him on your lap and bring him to the table to play with an object," says Penny Glass, Ph.D., a developmental psychologist and director of the Child Development Program in the Division of Behavioral Medicine, Department of Psychiatry & Behavioral Sciences at Children's National Medical Center in Washington, D.C. The hard surface of the table provides stability to manipulate the object, and Mom's arms ensure security.
During tummy time, an infant is placed on his stomach on a mat to help prepare him for later crawling activities. According to Dr. Glass, infants with less advanced muscle control can be easily discouraged when they fail: "If a baby is just beginning to raise his head when placed on his tummy, he may still have more difficulty lowering his head back down with control and may 'face-plant.'" Dr. Glass suggests using your lap and legs as the training wheels for tummy time. "If you're concerned about head control, you can place your baby tummy-side down across your lap with her arms forward and hands under her chin," she explains. Your other leg should be underneath her hips. Make her comfortable. When she's ready, she'll begin to lift her head and move her shoulders just a bit. Keep the practice time short and pleasant, but do it often throughout the day. Raise slightly your leg that is under her shoulders. Tell her what a good job she's doing.
Gradually your child will get stronger and stronger, and then be ready for tummy time on a mat. (Cover the mat with a plain blanket; a pattern may distract your child so that she looks down instead of up.) Position her arms with her hands under her chin and place one toy about two feet away in front of her face so she has something to look at. Rest your hand lightly on her bottom and tell her again what a good job she's doing. When she's ready, she'll raise her head.
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