Childhood development

Gross motor skills

Babies

Before babies are born, they spend their final few months in a very tight space, in a curled up position. When they are born, they then need to spend time adjusting to the freedom of being able to move, and the effect of gravity. As they move their arms and legs the movement will look uncontrolled and jerky to begin with.

Most of a baby’s day should be spent where they can explore and play on their tummy and their back. This way they will strengthen their muscles, discover their bodies, develop their response to sensations and reactions, and learn to move by themselves with your support for their safety. Long periods in buggies and car seats should be avoided.

Tummy time (Prone)

On their tummies, babies will develop their ability to hold their head up, and strengthen the muscles needed for sitting, rolling and crawling. Often babies don’t like this position as it is hard for them to lift their head initially, and they often can’t see you when flat on the floor.

If your baby can’t lift their head up when lying on their tummy by 4 months old speak to your Health Visitor and look at our self help resources

NB: Tummy time may be unfamiliar to babies at first, but can be increased gradually, starting from a minute or two at a time, as the baby becomes used to it. Babies should not sleep on their tummies.

Rolling

Being able to roll over is often a baby’s first experience of being able to move towards a toy by themselves. Babies usually learn to roll from their front to their back before they learn to roll from their back to their front. By giving your baby plenty of time throughout the day on their back and their tummy with toys around them they will start to try to move to get them…but put the toys too close to them and they wont need to move at all!

  • To help your baby learn to roll over

If by 6 months your baby is not showing any signs of trying to roll and you have been trying these ideas, please contact your Health visitor and look at our self help resources

Sitting

Babies enjoy sitting up to play with toys, and look at their world from a different view instead of being flat on the floor. Babies are often held sitting on parents and carers laps, and as they get older and stronger giving them less and less support when you are holding them will help them to develop their ability to do this by themselves.

But be careful! Babies don’t develop their ability to save themselves with their hands, when falling to the side when sitting (saving reactions) until after they have learnt to sit independently

Bumbo style seats don’t allow babies to sit by themselves or use their muscles to encourage independent sitting, or then develop their ability to move in and out of sitting they can only do this through practice with you. So limit the amount of time your baby is in a bumbo or high chair and instead let them practice to sit on the floor.

To help your baby learn to sit by themselves

If your baby is not showing signs of being able to sit by 6 months and you have been trying these ideas, please contact your Health visitor

Moving from lying to sitting

You move your baby frequently throughout the day from lying to a sitting position every time you change their nappy, or pick them up from the floor. When a baby is able to move from lying to sitting by themselves, they will develop good muscle strength in their tummy, back and shoulder muscles, which they need to crawl and walk. As a baby develops their head control and sitting ability, they should start to join in with you, for example every nappy change you can practice.

Babies learn to sit up in 2 different ways

On their tummies (usually first) by pushing up through their arms and moving their legs to the side to sit on their bottom

On their backs by using mostly one arm to push through, and their tummy muscles to sit forwards.

To help your baby learn to sit up from lying down 

Crawling

A baby needs to be happy on their tummy and pushing themselves up on their hands and knees before they can start to crawl. Sometimes babies commando crawl on their elbows with their legs on the floor, before crawling.

Crawling is excellent for developing muscles and sometimes older children who never learnt to crawl continue to have some weakness in their muscles. Babies need a surface with grip to learn to crawl, such as carpet or a large rug, so they can push themselves without slipping. Sometimes babies who have laminate and wooden flooring at home tend to bottom shuffle instead of crawl which can delay walking. Once a baby has learnt to crawl, crawling up stairs is a good way of helping babies learn to push up on their feet to get into standing and walking (but always need close supervision for their safety)

To help your baby learn to crawl

If your baby isn’t showing signs of crawling by 10 months and you have been trying to help them, please contact your health visitor and see our self help resources. Remember they need to be strong enough to push up with their arms and legs when lying on their tummy to be able to crawl, so you may need to help them achieve this first

Moving into standing

Moving into standing requires babies to be able to sit, move into kneeling, and then pulling up into standing. Being able to complete this movement by themselves first is important for babies to be able to then walk. Allowing your baby to pull up on your fingers when sitting (without moving through kneeling) won’t help your baby to be able to complete the movement for themselves. Babies will need appropriate height tables / chairs to pull themselves up on, but be careful of those hard corners and edges on coffee tables.

Parents often feel the need to buy lots of equipment for a baby, however door bouncers and standing/ jumping baby gyms should be avoided or their use kept to very short periods as they do not help a baby to develop physically. Instead they actually encourage babies to stand on tip toe and arch their backs. Your baby may then find it difficult to learn to stand and be still and stand and walk with flat feet.

To help your baby learn to move from sitting into standing please see

Floor to stand

Standing

If your baby is not showing signs of trying to stand or take weight through their feet by 12 months, and you have been practising these ideas please contact your Health Visitor

Walking

Is the last of the big milestones a baby will achieve, usually within their first 12-18 months, and a much anticipated day by parents. Babies will first learn to stand with support from furniture, cruise around the furniture, walk with push a long walkers, or hands held before taking their first steps. All of these stages are important for babies to master before they move to the next, and some babies take longer than others. There are other factors which influence a babies ability to walk too, like having laminate floor at home, or furniture which is far apart so a baby crawls between it instead of taking a step. Baby walkers allow babies to walk abnormally (often on tip toes), and do not strengthen the muscles needed for sitting, crawling or independent walking.

It is much more important to give a baby a safe space on the floor to roll, crawl and pull themselves up into standing.

To help your baby learn to walk independently

Information about baby walkers

If your baby is not showing signs of walking by 15 months please contact your health visitor

Shoes

Babies feet are soft and pliable and if the wrong footwear is worn for prolonged periods of time it may cause damage and lead to problems later in life. Young children who are not yet walking do not usually need shoes, but you may wish to buy them soft shoes which help to protect the feet when crawling and keep your baby warm when you are outside.

For further advice, click this link.

Toddlers

From taking those first steps to learning to run, toddlers will perfect their walking, getting quicker and steadier as they fall less. They will start to try to learn to run and master steps and stairs, but have no awareness of danger so need you close by to keep them safe.

By the age of 2 years toddlers will be able to run and avoid obstacles in their way. They will climb on your sofa or chairs and be able to get down again, and walk up and down stairs with you or holding on to the rails. They will be starting to try to scoot themselves on a sit on toy without pedals. If your toddler didn’t start walking until between 18months to 2 years then it is likely these skills will be a little delayed too, don’t worry they will catch up!

At the age of 3, toddlers will be able to run at speed, jump, climb slides in the park, pedal a tricycle, kick and throw a ball and balance for a few seconds on either leg! Phew hope you can keep up!

For toddlers to be able to achieve all these amazing skills, they have to have opportunities to practice them regularly. Just like adults if we try to learn to do something new, we couldn’t do it without the practice either.

Your toddler will need space, and different places to explore and help them develop their physical skills such as running and jumping in the garden and park playing chasing games with you.

Other physical activities such as soft play, swimming pools and play equipment in the park provide great opportunities for toddlers to be active and to challenge and develop new skills.

Watching TV promotes a sedentary lifestyle and should be restricted to short periods.

Prolonged periods in car seats and push chairs should be avoided.

Non-urgent advice: To help your toddler's physical development

Wheels

Starting with a toddlers scoot a long toy, ride on toys, progressing to trikes, scooters and bikes are all excellent for developing balance, strength.

Bounce

Children love trampolines, bouncy castles and space hoppers, which are all great for developing strength, jumping, balance, and getting fit.

Balance

Kicking a ball by standing on one leg, walking along a balance beam in the park and playing stepping stones are all great ways to develop balance.

Friends and family

Children learn by watching and playing with others who are often older than them. Families taking part in activities together are really important in promoting a child’s development. Good opportunities for this include playing games with children in the garden or park.

Practice

Children often need to do something again and again to help them get it right. They might need encouragement if they are getting stuck or reassurance to come back and try again later. It is very tempting to take over and do something for them as it’s quicker, but this won’t help them to learn how to do it next time.

School age

Your child has been busy mastering running, jumping, climbing and pedalling. You’ve given them space and opportunity to develop their skills but now they are ready for their next adventure- school!

By the age of 4 your child is confident on the stairs and can walk up and down using alternate feet, they are an expert on their tricycle, they can walk and run on tip toes, jump, hop and climb well and are able to throw and kick a ball reliably (well most of the time, we would still recommend you mind your valuables)!

By the age of 5 your child is an expert at moving around and keeping you on the go! They can walk the tight rope easily, run lightly on their toes, they are skilful at climbing, sliding, swinging, digging and skipping. They can balance on one foot for 8-10 seconds but they will have a preferred side, they can hop 2-3 metres forward and move rhythmically to music- how do they fit it all in one day!

You may think that with all the moving that your child does throughout the day that they are getting enough exercise but it’s important that the activities they do are varied to work on different muscle groups and continue to keep them strong. If we keep repeating the same activity, eventually we get too good at it and our muscles find it easy and aren’t working very hard anymore. School is a great place for them to work on new skills and practise old ones, but also different sports, clubs and groups ensure that we are working all our muscles.

Non-urgent advice: To help your child's physical development

Our favourites include swimming, rock climbing, martial arts, gymnastics and dance. A few ideas of new skills that would be great to try at home could be learning to ride a bike, practising throwing and kicking with a smaller ball, throwing and kicking a ball at a target or through a hoop, trying the balance bar at the park and standing on one leg whilst throwing and catching a ball.

Watching TV promotes a sedentary lifestyle and should be limited to short periods.

Visit Active Oxfordshire for more ideas.

Common Concerns

Young children often present with bowing of legs, knock knees, intoeing or pigeon toes, curly toes and flat feet. These are normal variations and will resolve naturally as the child grows.

Children with these conditions need to develop their movement skills through outdoor play activities. Physiotherapy or leg splints/insoles will not alter their leg appearance.  

A child can be referred to us if the condition has an impact on their development, functional skills or causes pain. 

Curly Toes

This is common condition that is present from birth and tends to affect third and fourth toe. Its more noticeable when baby starts walking. Its caused by tight tendons that runs towards the end of toes, causing pulling the toe under the next toe, curling it towards the underside of the foot and often to one side. In majority of cases curly toes are asymptomatic, should improve with age and do not require intervention. Physiotherapy or orthotics (insoles) will not help to correct this. Parents can stretch the curly toes regularly. Stretching will not cure it, but it will help to maintain flexibility.

Referral

If these cause blisters, rubs, pain, or muscle/tendon tightness please refer them to the Nuffield Orthopaedic Centre in Oxford.

Flat feet

What is it?

It is common for children to have flat feet. The inner arch in feet may not develop until five to six years.

Frequent falls due to flat feet is common in children under four years and physiotherapy is not required.

What you can do

Walking on uneven surfaces (sand, wood chippings, grass, slopes), walking along balance beams and stepping stones help develop foot and ankle muscles needed for balance.

Children should also wear shoes which offer support rather than those which are not width fitted and may slip off more readily such as wellies and crocs.

Referrals

A referral from your GP to podiatry may be appropriate for assessment of foot posture if the flat foot is severe and causing pain

Non-urgent advice: Learn more

Fore further information, see:

Bow Legs (Genu Varum)

What is it?

A small gap between the child’s knees when standing with their feet together is common under two years old and will gradually improve over time.

Referrals

If it is severe your child can be referred to the Nuffield Orthopaedic Centre.

Knock Knees (Genu Valgum)

What is it?

Knock knees (genu valgum) is a condition when in standing with your knees together gap between ankles are more than 7-8 cm. Knock knees is typical part of development in children between the age of 2 and 6 years old. This usually correct naturally, and no treatment is necessary. In some cases, slight knock knees continue into adulthood, but this isn’t usually anything to worry about unless it causes other problems. Special shoes, braces or exercises are not recommended.

Referral

Please measure the gap prior to making a referral to the Nuffield Orthopaedic Centre. 

In-toeing

What is it?

If your child walks or stands with feet pointing in it is called intoeing or ‘pigeon toed’. This is a common normal presentation. Children may have intoeing either in one or both legs. It is more noticeable between four and seven years. This will be corrected naturally when a child grows older. This may take up to 11 years. Physiotherapy will not help or speed up the natural correction.

Intoeing related tripping is common and physiotherapy treatment will not prevent it.

‘W’ sitting (bottom between your heels) can make intoeing worse, and should be avoided, using cross legged sitting instead.

Non-urgent advice: Learn more

Fore further information, see:

Out-toeing

Out-toeing is when your foot turns out in relation to the direction of walking. Out-toeing is normal part of development. We naturally walk with our feet pointing out and typical range is from neutral to up to around 30 degrees out- toeing. Out-toeing resolves spontaneously and physiotherapy treatment will not change this. Your GP can rule out the following medical conditions: Perthes disease, slipped upper femoral epiphysis (SUFE) and developmental dysplasia (dislocation) of the hip (DDH).

Toe-walking

What is it?

Children under three years tend to walk on their toes to gain stability. If your child can squat down fully to the floor with their heels on the floor, and return to standing, indicates they have full calf muscle length.

Referral

If your child can’t do this, they may benefit from a referral.

Non-urgent advice: Learn more

Fore further information, see:

 

Page last reviewed: 1 October, 2021