Encouraging milestones in your baby

This blog details the different physical developmental milestones your baby should achieve in their first year and easy ways to encourage their development from a physiotherapist's point of view.

Watching Misaki reach the different milestones has been an absolute wonder. Seeing the textbook knowledge play out in my very own baby is a joy to witness. It is just amazing how she has basically reached these milestones herself but when she was struggling to roll I assisted her with some physio guidance. I am doing the same now for her commando crawling. I am not a paediatric specialist physiotherapist but have worked in the area enough in my career to have retained some of the important knowledge. I am a musculoskeletal physiotherapist so most of my paediatric treatment has been on torticollis (which I treated on Misaki successfully- see my blog on "My baby is making my boobs lop sided"). 

The reason I am writing this blog is just to summarise the different stages of motor development in the first year or so with a few practical applications from a physiotherapist point of view. The different stages happen at different ages in different babies so it is important to not stress too much if it is not happening when your friend’s babies are ticking off the skills.

The stages do happen sequentially though and each stage needs to happen to allow the baby to gain strength for the next stage. One thing I really remember from Uni about paediatrics is to not use the toys that hold a baby suspended upright in a pelvic harness so that they can jump before they can stand or even sit.

This is bad for the babies’ spine as they don’t have the muscle control to be able to hold themselves in that position and they are not being placed in a position where they can be practicing all the stages of motor development. Babies need to be able to hold their torso independently before they can sit, crawl, stand and walk. Likewise, they will find it hard to concentrate on eating when they don’t have the independent lateral trunk support so therefore they need to be well supported when starting to eat solids from 4-6 months of age (or when they can sit independently).

“Don’t use jolley jumpers as this is bad for the babies spine and legs... and they are not being placed in a position where they can be practicing all the stages of motor development...”

Kicking

Misaki was genius at this. Glad she hasn’t kicked so much that she hasn’t lost those edible chunky thighs though! Kicking is obviously a great leg strengthener for standing and walking in the future. You can encourage kicking by having them on their backs and bending their legs to their chest and then straightening them against your hands. Get them to push against your hands when their knees are half bent. This is incidentally a good stretch- the straightening of their legs. They have been couped up in your womb for 9 months in the flexed position to stretching their legs out and raising their arms above their head and lying them on their stomachs gives their body and limbs a good stretch. Look to the blog of GymbaROO/ Kindergym.

Getting them to push against your hands when they are doing tummy time is also a good leg strengthener and a precursor to commando crawling. You could also get them to kick a balloon whilst lying on their backs. Make sure you do all of these activities described in the blog with bare feet. Bare feet increases the stimulation of the nerves in the feet which allows for increased feedback for inhibition of primitive foot reflex (Babinski), body awareness, balance and learning.

“Tummy time is also important for overriding primitive reflexes...”

 Head lifting

Misaki got to develop this skill well too due to her being in a hip splint for the first 6 weeks of her life I needed to put her on her tummy to change her nappy. Tummy time is the best way to develop neck strength which she will need for sitting, crawling, standing and walking. I mention in another blog Baby Bonding Mums and Bubs Exericse Routine that I lift her up in to the air in a ‘super girl’ pose supporting her torso and pelvis (which is an incidental arm strengthening exercise for me).

Although this is great for her neck and back strength, I was reading today this could initiate the startle (Moro) reflex which occurs with sudden forward or backward head movement before they are 12 weeks old. The startle reflex causes them to quickly extend their limbs and then quickly flex them and cry. It also releases adrenalin which is not good for the body- released in times of fight or flight stress levels. Misaki demonstrated none of this and I was doing it slowly and gently once she had good head control. She was enjoying it thoroughly. I am sure if done slowly and when she has good head control is not going to do any harm but paediatric experts please correct me if I am wrong.

Another nice way to do tummy time whilst cuddling your baby is holding them on their tummy on your forearm (when they are small enough to fit there). Your baby will tell you when she has had enough. Make sure you support your babies’ head when holding and transferring them, especially lifting them up and lowering them down until they have enough head control. Tummy time is also important for overriding primitive reflexes.

Grasping and reaching

I won’t talk about the fine motor skills of grasping but they get more refined with time and practice. The reaching (and grasping to hold the object) is best practiced first on their back and later on their stomach and then when sitting encouraging sitting balance and later to encourage crawling. First giving them their toys to hold, eventually passing from one hand to another, encouraging vision with tracking the toy you are moving, crossing the midline of their bodies and then placing the toys just out of reach but within their sight so they want to move their body to reach for them.

Rolling

This is meant to happen from 5 months. She is now totally all over it at 8 months and got it eventually mostly through trial and error. I did help her along with some repetitive physio moves though. When she is lying on her back I would bend one leg and then raise the opposite arm above her head (so that it was out the way when we rolled in that direction) and then I would slowly roll her bent leg and pelvis over on to her side and then on to her tummy (singing the “10 men in the bed roll over” song in a fun, relaxed, you are not failing at rolling voice). Breaking the movement down in to stages and performing them slowly allows her to learn the process better. She got it eventually.

Sitting

Misaki was sitting at 6 months so was on track for this skill. She still needed some supportive padding around her in case she lost her balance, especially if looking around. She can still not get herself to a sitting position independently but I practice this with her. When she is lying on her stomach or back I roll her on her side and then push through her hips as she assists me with her hands pushing her up from the sides. I do it slowly so that she can learn the movements and do as much of it for herself as possible. She has good protective (parachute) reflexes if she is losing her balance sitting by reaching her arm out to the side. This is good for arm muscle tone and strength too. She also demonstrates good core control to control her sitting balance too. You can encourage this sitting balance when she can sit assisted on your lap by bouncing her up/ down, rocking side to side etc. This is also excellent for vestibular development. See the blog on Vestibular exercises. Sitting and reaching for toys promotes good hand eye coordination too.

“Sitting on your lap and bouncing and rocking.. is excellent for vestibular development...”

It is important to not sit your baby too early as they need lots of tummy time to develop back, arm and leg muscle strength for further milestones. Many, including myself get them in to sitting positions too early because our babies are getting frustrated that they can’t get to the sitting position themselves. You can practice sitting: See my blog on Techniques to encourage a good sitting posture for life but make sure there is plenty of tummy time and practice at transitioning to various positions so they can develop those necessary muscles and brain pathways.

Commando crawling

Misaki has had a massive couple of weeks in that she is getting from sitting to all fours and then rocking forward and backwards, sometimes reaching for toys and occasionally reaching one arm or one leg forward initiating the crawling action. Some children skip commando crawling or crawling all together. Some say it is because they don’t see us adults doing it but it is very helpful to perform this skill to gradually develop more back and neck strength and for the coordination of moving the arms and the legs in that cross pattern that is then transferred to walking. It starts as one limb moving and then becomes two limbs together; the opposite arm together with the opposite leg. To encourage commando crawling have them on their tummy and then have a toy just out of reach, then bend one leg up and then push your hand in to their foot encouraging them to push back in to your hand to propel themselves forward.

Crawling

Crawling starts from about 9 months. If they are not naturally getting themselves into the all four position around this age, then from sitting with the legs out in front of them take one foot out to the side (1 sided W sit) and then bring the other foot in to their midline. Then slowly transfer them forward so that they take the weight on to their hands and move their shins so that they are underneath their hips. If the baby looks like they are supporting their weight well slowly rock them forward and backwards. As with all of these suggestions do them several times a day when your baby is enjoying the activity, performing the transitions slowly so that she can learn the process.  I found having padding under Misaki’s chest when she is in all fours has helped her with her arm and leg crawling movements. She has also started going in to a ‘downward’ dog as she is experimenting with how to propel herself forward. It is so cute. I really do feel for her when she gets frustrated that she can’t work it out though.

Pull to stand

Pull to stand happens from about 8 months to a year. Misaki is already pulling herself in to high kneeling to reach in to the toy box so it will only be a matter of time when she wants to get to something that bit higher and will place a foot rather than a knee on the ground and pull with her arms and push with her leg to stand. If they are struggling to do this after 1 year of age, you can encourage the individual stages of progression I have just described and use toys to encourage them to stand and reach for the toy.

Standing

Standing happens from about 9 months to a year. They will first need to have that head, trunk, pelvis and leg strength developed from the other stages to stand. They will first need to hold on with their hands to a stable support and slowly take away the supports. You can hold your baby around their trunk before they can stand for short periods but make sure they have adequate head, trunk or leg control for the amount of support you are giving them.

“need to crawl for about 5 months before they walk and doing so beforehand can lead to learning difficulties...”

Walking

Walking happens anywhere from 9 months to 15 months plus. They say that they need to crawl for about 5 months before they walk and doing so beforehand can lead to learning difficulties down the track. Don’t encourage those baby walkers or holding their hands to walk before they are ready to walk so they are not going to hurt themselves by falling or not hurt their developing muscles, ligaments and bones because they are not strong/ old/ developed enough to be walking. They will start by cruising, which is ‘walking’ around while holding on to furniture for support. They will then take away this support when they are ready, walk very shakily and gradually get stronger and more confident to walk safely unassisted. Don’t be worried if they are still not walking by 15 months, it can happen in around the 16th or 17th month. Encourage leg strengthening with their pull to stand and standing by placing toys on a sturdy table for cruising and then when ready toys or yourself further and further away from them.

So my little Misaki lagged behind a lot on the standard time frame for rolling but has caught up fast to be back on track at 8 months to rocking forward and backward on all fours about to start crawling any day now. Moral: don’t stress about the ‘normal’ time frames but encourage your babies learning by giving them lots of floor time and helping encourage the moves if required with gentle handling at the age appropriate time. Do not try and get them to perform activities their bodies are not ready for as this will only cause potential harm rather than accelerate their learning. Be patient and enjoy the amazing power of nature before your very eyes!

Summary

Milestones develop in a certain order but can happen at different ages so don't worry if they take longer to develop than other babies.

Don't encourage milestones before they have the muscle or mental facilities to do so as this can harm their spine and delay rather than progress their development.

There are many activities that you can do with your baby to help them practice and develop the milestones. Physiotherapists can help guide you if you need and assess whether your child has developmental delays.

Melli Tilbrook is a Women's Health Physiotherapist based in Adelaide South Australia.

Melli Tilbrook is a Physiotherapist based at Adelaide Physiotherapy and Pilates Studio, Beulah Park.