FITMOM Classes are very unique, not only do we have ongoing discussions regarding conception, pregnancy, healthy eating and exercise, but we spend lots of time learning about how our babies are developing.  Recently I met with a local Physical Therapist who specializes in infant and child development.  Today she shares her best practices for incorporating tummy time & the importance of gross motor skill development.

Baby on the move
Winnie Wong at kiddiemoves@gmail.com.

Ever wonder about your baby's rolling, sitting, crawling, and walking skills? Is it okay to wait it out if these skills are not showing up yet? All of these skills are part of gross motor skills, because they are movements of the arms, legs and body. Parents can help or hinder the development of these skills early on. Imagine if someone cooked and cleaned for you every day ever since you were a child, would you learn those skills without practice?

Babies need to move to develop their muscles and coordination. With the Back to Sleep recommendation, babies are spending a lot of time on their back from the day they are born. With the vast availability of exersaucers, bouncy chairs, Bumbo seats, jolly jumpers, car seats and strollers, babies can be "contained" too much. They are essential when parents need to shower, cook in the kitchen, do an errand, but they should be used in minimally. Very often, babies are not getting enough time exploring the world on their tummy. As a result, there has been an increase in babies developing flat spot on their heads from spending too much time with the back of their heads against firm surfaces. Some babies are learning to sit, roll, or crawl later simply from lack of exploration time outside of baby equipment. One of the key component early on is supervised tummy time while baby is awake. It helps develop neck and arm strength which will build towards pushing up and crawling and later on walking.

All babies develop at their own pace. Does it matter if mine is later than yours?

Most certainly babies develop their moving skills at different rate, just as some people are natural born athletes. However babies who are behind in developing their moving skills may warrant further check up with a doctor or health care professional. Perhaps the reason is due to insufficient floor time. Or maybe there is a medical reason. Walking is a huge milestone but not the end. Gross motor skills become more challenging as a child gets older, such as riding a bike, skipping, climbing stairs without hand support, and hopping. If a child is walking later than expected, he/she may also then develop the more advanced gross motor skills later.

What can parents do?

Some simple playmats on the floor and interesting toys can be the start to exploration. Tummy time can be built in from day 1 with baby being awake and laying on mommy and daddy's chest. When tummy time is incorporated daily from day 1, baby will gradually learn to tolerate it more and more.

When baby is learning to sit on the floor, parents can be a gentle support around baby's waist or back. Give the baby a chance to totter a bit to learn what movement means. If baby is always leaning against parent for support, the baby will not learn to use their own muscles to maintain sitting. Put toys in front and to the side of baby to encourage them to reach for them. Give them a chance to reach instead of just putting the toy in front or right into baby's hands.

When baby is learning to crawl, it is also a good time to teach him/her to crawl up the stairs (even if 1-2 steps) with supervision. It will build towards coordinating the arms and legs to move in different motions, and also for getting up to standing.

When should parents be concerned?

There is a large range of typical development, but if baby is developing outside of the general range, then parents should bring their concerns to their health care provider.

Here are typical physical development guidelines provided by pathways.org:

• By 3 months, while lying on tummy, baby is lifting and holding head up
• By 6 months, baby is using hands to support self in sitting, rolls from back to tummy, and accepts entire weight when standing with support.
• By 9 months, baby is sitting and reaching for toys without falling, moves from tummy/back to sitting, crawling on hands and knees with alternate arm and leg movement.
• By 12 months, baby is pulling to stand and cruising along furniture. Baby is standing alone and takes several independent steps.
• By 15 months, baby is walking independently and squats to pick up toys.

Signs to watch for as provided by pathways.org:

• At 3 months, while lying on tummy, baby has difficulty lifting head. Legs are stiff with little or no movement.
• At 6 months, baby is unable to hold head upright when sitting with support, arches back and stiffens legs when sitting with support.
• At 9 months, baby is using one hand predominantly, showing poor use of arms in sitting, difficulty crawling, inability to straighten back when in sitting or standing with support, cannot take weight on legs in standing.
• At 12 months, baby has difficulty getting to stand because of stiff legs and pointed toes, only uses arms to pull up to standing, sits with weight to one side, strongly flexed or stiffly extended arms, needs to use hands to maintain sitting.
• At 15 months, baby is unable to take steps independently, poor standing balance and falls frequently, or walk on toes.

If baby shows some of these signs above, then share your concerns with your child's doctor or health care provider.

Parents are often on the lookout for the sitting, crawling and standing milestones. One of the crucial one that gets missed is the ability to transition between sitting and tummy/hands and knees/back position by 9 months. Often babies are learning to sit by 6-9 months and may inadvertently be left in sitting for long periods of time on the floor. Some will figure out how to transition into hands and knees position, and some will continue sitting and eventually use bum scooting as a method to move. Crawling was once thought to be an optional phase of development. However its importance in hand and arm development is now being recognized, ranging from developing handwriting skills to hauling oneself out of the pool.

Where can parents get help? 
Parents can share their concerns with the baby's doctor or health care provider. Parents can also find Pediatric Physiotherapists who are licensed with the College of Physiotherapists of Ontario and has unique knowledge of child development. A Paediatric Physiotherapist will assess the baby to see how his/her development is compared to the typical range of skills. If a baby's skills is considered to be behind, the Physiotherapist can work with the baby and family to progress those skills.

For further information, please contact Winnie Wong at kiddiemoves@gmail.com.