Gross and Fine Motor Milestones Ages Birth to 5 years Theresa Wallace BMR (PT)

Consider the amount a baby accomplishes in its first year Birth to Age One Consider the amount a baby accomplishes in its first year Head control Following objects with their eyes Rolling Grasping toys Sitting Banging toys together Standing Poking This is just a small sample of what a baby will do in its first year

Gross Motor Skills What do we need to do One to three months of age Turns head to side while on back Starts to lift head up while on tummy Turns head to side to clear airway on tummy Kicks and extends legs Three to six months of age Begins to roll – belly to back first Puts weight through hands while on tummy Lifts head when pulled into sitting Sitting balance improves and should be close to independent What do we need to do Start tummy time early, to develop neck control and build tolerance to the position

One to Three months of age Fine Motor Skills One to Three months of age Moves arms symmetrically Hand to mouth movement may be observed Hands starting to spend time open Three to Six months of age Grasp reflex inhibited so starts to drop objects Eyes move independent of the head Hands open most of the time Uses radial palmar grasp What do we need to d0 Introduce toys for grasp and release Encourage visual tracking Notes for Terri: -perhaps take away the eye tracking and eyes move independent of head because this is more of a sensory skill rather then fine motor. Could add: for 1-3: Hand to mouth movement may be observed. For 3-6-demonstrates increasing degrees of eye hand coordination-instead of eyes move independent of head.

Six to Nine months of age Gross Motor Six to Nine months of age Sitting independently May crawl – backwards first Pull to stand Stands while holding on Nine to Twelve months of age Walks with hands held Cruises around furniture Creeps on hands and knees May stand alone momentarily Kneels May begin independently walking What can we do to help Provide movement exposure – chances to reach for toys and stand at the couch

Six to Nine months of age Fine Motor Skills Six to Nine months of age Will attempt to pick up small object Bangs toy on a table Transfers toys between hands Voluntary release Nine to Twelve months of age Takes toy out of a container Pokes with index finger Imitates a scribble Bangs blocks together What we can do to help Provide appropriate toys for hand manipulation and exposure to hand movement

Barriers to Gross Motor Development – Year One Limited tummy time – if not exposed early, may have delays in head control, rolling, independent sitting and walking Children with limited tummy time may not crawl effectively and this over the long run may decrease fine motor skills even at school age Limited exposure to transitional movements such as rolling and lying to sitting can cause children to get “stuck” in sitting and not progress to further stages of gross motor development

Barriers to Fine Motor Development – Year One Lack of exposure – tentative about allowing small objects near child, messes at eating time Overly helpful sibling/parents which do everything for their child (not letting them help to get undressed, feed themselves, and other self care tasks) Ensure vision assessment has been completed as vision issues can hamper the child’s ability to see and manipulate small objects

RED FLAGS Gross Motor Fine Motor W-sitting Delays in all motor milestones – rolling, sitting, weight bearing Tightness of muscles or joints Favoring of one side of the body Fine Motor Favoring one hand/arm Play limited to chewing and mouthing objects Not using thumb to grasp small objects Uncoordinated or jerky movements when using hands

Back to sleep – tummy to play This program was introduced when it was noted that gross motor developmental milestones were getting later in babies which were not sleeping on their tummies Babies used to experience tummy time for sleep, were very comfortable with the position, and utilized early reflexes to develop such things as rolling With the back to sleep program implemented to reduce SIDS, many parents were no longer giving their babies any tummy time Subsequently, a decrease in head control, decreased babies that crawled, later rolling and sitting and walking skills were noted Babies should be introduced to tummy time from the day they come home, 30 seconds of tummy time is not enough Many parents state their child doesn’t like tummy time, but so many valuable skills are developed from this position

The Problems with W-Sitting Usually happens due to the position of the child’s hips and knees (anatomical position) Hips are turned in, so W-sitting is secure and easy to do W-sitting is often seen in children with intoeing W-sitting can interfere with a child’s ability to develop other types of sitting – ring, long sitting It can cause tight muscles and loss of joint range It can cause musculoskeletal changes above and beyond the position of the hips (stress on ligaments and redirection of tendons) Limit W-sitting by moving the child up to play at a seated surface, or introducing other positions such as ring

Twelve to Eighteen Months of Age Gross Motor Skills Twelve to Eighteen Months of Age Walks alone Run is a hurried walk Can walk backwards and sideways Throws a ball forward Pulls a toy while walking Will bend and look through legs Goes up and down stairs on hands and knees May progress to walking up and down stairs holding a rail or hand (both feet on one step)

Eighteen Months to Two Years Gross Motor Skills Eighteen Months to Two Years Carries toys while walking Will sit by backing into a child size chair Kicks a ball with purpose Run is maturing – legs more together, less falling Squats to play Will push or pull toys Walks upstairs with one hand held

Fine Motor Skills By age Two Grasps pencil between thumb and finger Imitates vertical lines and circles Can grasp a small bead and put onto a string Can snip paper with scissors (supervised) Builds tower of 6 blocks Holds two objects in one hand Can activate more complex cause and effect toys Turning single pages Effective use of spoon or fork Drinks from a cup Helps with dressing by Pulling pants off Taking socks off Finding arms of shirt

RED FLAGS Gross Motor W-sitting Walk is immature, falling regularly Favoring of one side of the body or assymmetrical looking gait Unable to focus on one area of play, constantly switching play activity Fine Motor Gives up easily Avoids fine motor activities Avoids messy activities Still mouthing objects

What can we do to help – Age 2 Exposure – introduce crayons and scissors, stairs and ride on toys Persistence – keep reintroducing objects and tasks even if they are not enjoyed Attention – start to ask for longer periods of attention instead of always allowing the child to dictate when an activity is done Independence – encourage help by the child even if it takes a longer time to accomplish the task

Gross Motor Skills Age Three Stand on tip toes Jumps with two feet Catches a large ball (trapping to chest) Jumps forward (12-36 inches) Jumps over objects (2 inches high) Starting to one foot stand May start to one foot hop Walks forwards and backwards generally along a line Walks up/down stairs alone, first with both feet per step, progressing to alternating feet Climbs jungle gyms and ladders Jumps down off small step May start to pedal a tricycle

Fine Motor Skills Age Three Crayon is held between thumb and fingers Copies horizontal and vertical lines and circles, may imitate a cross Can cut with scissors along a straight line Manipulates a bead in one hand Can match block patterns with 3-4 blocks Starts to pull up a zipper May start doing large buttons Removes pants independently Puts on front opening shirt independently -added age 3 and moved over bullets-just editing

Failure to meet many of the expected milestones Red Flags Failure to meet many of the expected milestones Any one or two milestones may be due to exposure to a specific task. A male child may not like fine motor as much as gross motor so may not be as good at coloring. A female child may like to color a lot but doesn’t like to go outside and play with a ball as much. Inability to be directed to the task asked Attention issues Difficulty following directions Total focus and desire to do only one type of activity – lining up cars Fixation on inappropriate types of play (spinning tires instead of making the car move)

What can we do to help – Age 3 Recognize areas which are concerns Exposure – practice skills which are difficult, make games and have fun Persistence – keep reintroducing objects and tasks even if they are not enjoyed Attention – start to ask for longer periods of attention instead of always allowing the child to dictate when an activity is done Independence – encourage help by the child even if it takes a longer time to accomplish the task

Gross Motor Skills Age 4 Gallops forward Jumps at least 36 inches Starting to skip Stands on one leg for 5 seconds Can hop forward with either foot Throws underhand and overhand with direction (at least 6 feet) Starts to catch without trapping to chest (smaller 3 inch ball) May start to ride bike with training wheels Can jump and change direction repetitively Maintains balance on tip toes

Fine Motor Skills Age 4 Has picked a hand preference Using wrist movement to direct pencil Copies a cross Traces a square and triangle Can use a computer mouse Colors within the lines Draws a person with head, body, arms and legs Can cut out a square or triangle Builds designs with blocks Zips and separates shank on jacket Attempts smaller buttons May start to lace shoes

Gross Motor Age 5 Skips effectively Hops forward on one foot 20 inches Is able to perform a sit up and push up Kicks a ball so it raises in the air Stands on one foot more then 10 seconds Starts to walk heel to toe Starts to catch a tennis ball without trapping it to the chest Starts to hop side to side on one foot over a line

Fine Motor Skills Age 5 Mature pencil grasp (or tripod) Finger movement directs pencil Copies square and triangle Cuts a circle with accuracy Identifies letters of the alphabet Copies letters of the alphabet Ties a knot (tying shoe laces by age 6) Puts on pull on garments correctly Builds with construction toys

Most Important Recognize signs of delays early – early intervention gives the best chance of changes Provide a variety of movements, experiences, toys and exposure to scissors, crayons, blocks and basic learning materials Early exposure usually provides the best outcome Be persistent and patient – for those children with delays, these tasks are really hard and it can be really frustrating for them. They will avoid what is difficult for them to do Make activities fun – turning an activity into a game may help a child forget how difficult it is