A few years later, when his little sister, Hannah, was still crawling at 15 months, I figured she was on her brother’s timetable. But when the nine-month-old in your Mother Goose class is handily navigating the room on two feet and your 15-month-old is still on all fours, a parent can start to worry.
“The quality of movement is sometimes more important than the child’s ability to stand on two feet,” he says. For example, parents should pay attention to their baby’s strength, muscle tone and whether she can use both sides of her body equally well.
“Babies with a laid back temperament, though not entirely proven by literature, tend to be late in crawling and walking. If you are worried at any point, there is nothing wrong with contacting your doctor or a physiotherapist,” he says.
Anne-Marie Hamilton, a partner and pediatric physiotherapist at Pediatric Physiotherapy Associates in Toronto, says many babies simply lack the opportunity to start walking. Anne-Marie says that bicycling your baby’s legs or putting them on their feet and trotting them around doesn’t help develop motor skills.
She suggests helping your baby walk while holding their hips, so they are controlling their trunk themselves. “If your baby won’t stand without holding on to the couch, get a toy with two parts.
“When your baby goes into a squat and returns to standing, that is giving them the muscle work to be able to manage walking.” But be careful not to join the neighborhood race to see whose baby walks first.
In This Articles developmental screening is done by health visitors but, if they suspect a problem, they will bring it to the attention of the GP. Hence, even doctors who are not directly involved in developmental assessment must have knowledge of normal development.
If a child has failed to reach a milestone at a given time but appears to be on the threshold of achieving it then a safe option is to review the child a month or so later to ascertain the progress made. If the child is nowhere near achievement of the milestone or there are other causes for concern then referral is required.
This is an approximate guide to some gross motor development of a child in the first three years of life, but variation is common : 6 weeks: sits with curved back, needs support.
In ventral suspension (when held above couch with examiner's hand supporting the abdomen) can hold head at level of body briefly. 3 months: can hold head at 90° in ventral suspension.
Most children are able to walk alone by 11-15 months but the rate of development is very variable. Some children will fall outside the expected range and yet still walk normally in the end.
Delayed motor maturation (often familial): this is the term to describe a late walker who is normal in other respects. Severe learning disabilities: there is a delay in all developmental areas, but gross motor development is often less affected than fine motor skills, language and social skills.
Either by affecting brain development or directly causing delay in walking : In the extreme form, institutionalized babies kept in cots show delay in gross motor skills but this is rare.
However, a similar process can be seen in children who have been ill and bed-bound for long periods of time. Emotional deprivation doesn't tend to affect these skills as much as others.
Rickets has been reported to delay walking ; this is reversible if the disease is not too advanced . It is worth noting that obesity and developmental dysplasia of the hip have not been proven to be causes of delayed walking .
The issue surrounding baby walkers is not entirely clear, but research suggests that they have little effect . There are a number of essential questions to ask about any child suspected of developmental delay.
Most of the answers should be in the 'red book', the personal health record of the child. Prematurity and problems suggesting possible intrapartum asphyxia should be noted.
Relatively few cases of cerebral palsy are due to intrapartum asphyxia . As babies of earlier gestation are surviving they may be contributing to the cases of cerebral palsy.
A family history of muscular dystrophy or some other neurological disorder may be significant. The National Institute for Health and Care Excellence (NICE) recommends using the General Movement Assessment (GMA) during routine neonatal followup assessments for children between 0 and 3 months who are at increased risk of developing cerebral palsy .
Poor head control or floppiness at 6 months. Observation: put the child on the floor with some toys within easy reach whilst obtaining the history.
Neglect and emotional deprivation can cause developmental delay. Tales or inversion of the foot can suggest imbalance of muscle tone and neurological abnormality.
Look for strength, asymmetry of movement and the presence of primitive reflexes. Passively flex and extend the limbs and pick up the child to assess muscle tone and control.
Do tone and muscle control feel normal for a baby of this age? Cerebral palsy is associated with spasticity eventually but at an early stage flaccidity is present .
Put the child down on his or her feet, at first keeping some control over the body. Hold the child standing, facing towards the mother and encourage him or her to walk a few steps to her.
The plantar response is extensor at birth but, by the time the child is ready to walk, the neural pathways should have become mediated and the response should be flexor. A GP should be able to do a few basic tests and should learn the 'feel' of a normal or abnormal baby, but full assessment is best left to those with the skills, the training and the time.
If the delay in walking is isolated, with no other developmental delays noted, the only investigation required is a creatinine hospholipase (CPU), also known as creatinine kinase (CK), level to exclude muscular dystrophy. Children who are at increased risk of developing cerebral palsy and have abnormal features should be referred to a child development service for an urgent assessment .
The most common delayed motor milestones in children with cerebral palsy are: Not walking by 18 months (corrected for gestational age).
If walking seems to be the only significant delay : referral to a community pediatrician may be in order for more detailed assessment but a pediatric physiotherapist or occupational therapist may be able to take a direct referral and offer appropriate management. If this seems to be part of global delay, refer to a community or general pediatrician to establish the cause.
Delay due to neglect or poor parenting can usually be reversed provided children are given an opportunity to develop their skills. Management will involve the health visitor and child protection team to monitor and support.
A multidisciplinary approach may be required for more complex cases: Children with severe learning disabilities may need physiotherapy to address gross motor development problems and any hypo tony. In cerebral palsy, community physiotherapy or occupational therapy staff may help parents maximize potential.
DMD's patients also need physiotherapy as well as support for school. If a diagnosis such as Down's syndrome or cerebral palsy has already been made then an explanation should be given that delayed milestones are to be expected.
Kotlarsky P, Haber R, Bali V, et al. ; Developmental dysplasia of the hip: What has changed in the last 20 years? Dushanbe AV, Caldwell PH, Rajeshkumar P ; Drugs for nocturnal enuresis in children (other than decompression and tricyclics).