Motor Skills & Movement Difficulties

early intervention and motor skills-movementDoes your child seem to struggle to move?

Physical movement takes a great deal of coordination for a young child!  A child must figure out how to alternate the movement of their arms and legs to crawl.  Pulling themselves up for the first time is a great deal of work as they build strength in their small muscles!   While at first, movement may seem awkward, over time the large muscle movements ( gross motor) to small muscle movement ( fine motor skills)  enable toddlers learn as they explore their environment.

At teli our Pediatric Physical Therapists have extensive experience with motor skills and movement concerns and are excellent resources for help.  Parents are worried and want answers.  To support  worried parents and families, our staff has identified some of the most common questions that parents ask and provides answers.

Q:  Should I worry that my child isn’t bearing weight on her legs?

A: The ability to stand, like all motor skills, involves a progression of abilities for a child from sitting, to crawling, to pulling themselves up to stand and eventually walking. Children develop these skills at different rates and while there are typical age ranges for developing motor milestones, the journey may be unique for each child.

We typically look for children to support some weight on their legs when held around their chest as early as 2 months, and gradually take more and more of their own weight between 4-6 months. At 6-7 months most babies will support their full body weight and may begin to bounce up and down when given support around their chest. If your child is not sustaining their own body weight for 10-15 seconds by 6 months of age it may be wise to discuss this with your pediatrician.

There can be many reasons a child does not support weight on his feet.  After consultation with your pediatrician, their recommendation may be to have a developmental assessment through Early Intervention Services. There can be neurological, sensory or orthopedic reasons why your child is experiencing challenges. Through Early Intervention, a Physical Therapist will address your concern and if needed, make referrals to other medical specialists.

Another possibility why your child won’t stand may just be that his body is not developmentally ready yet. This is often the case if your child seems to be gaining all developmental milestones at a slower rate. Using “equipment” like jumpers and exercise saucers does not improve your child’s ability to stand or walk as these “containers” may be putting your child in positions that they are not developmentally ready to use. Again, all developmental concerns should be addressed by Early Intervention therapists, the “experts” in movement and motor skills.

Resource:   Patty Ross – teli Physical Therapist

Q:  When I hold my child they almost slip through my arms. Should I be concerned?

A: If your child feels like they are slipping through your arms when you hold them this could be referred to as “hypotonia” or low muscle tone.  Muscle tone is the amount of tone a muscle exhibits when moving through space.  There are three main categories of muscles tone; hypotonic or low; typical; and hypertonic or high. A child who “slips” through your hands may be experiencing lower muscle tone than is typical.

Although the causes of mild to moderate hypotonia are often unknown, we can still treat the symptoms of low muscle tone. If left untreated hypotonia, it can adversely impact a child’s movement and their achievement of developmental milestones. A child with low tone may not crawl which is important for hand eye coordination and strengthening core muscles which can impact a child’s building skills as a walker and learner.  Kids who don’t crawl may have a difficult time with coordination for sports, climbing, and agility skills.

Importantly, with the help of a well-trained Early Intervention Physical Therapist and evaluation can be performed to identify your child’s needs for services. Some of the potentials ways to help build muscle tone in your child are:

  • In Babies:
    • Steps to help them pull to sit
      1. Support with a pillow so they have a gravity advantage
      2. Hands behind the shoulders with fingertip support for the head
      3. From the ground pulling by hands
      4. Child pulls up when given an opportunity
    • In Toddlers:
      • Steps to help them strengthen their core muscles
        1. Using a Therapy Ball, roll on belly, side, and sitting for balance with support
        2. Wheel Barrow crawl – hold their legs while they advance using their arms
        3. Knee walking
        4. Heavy work- push, pull, or carry a heavy (2#) object across the room then over an obstacle course

Through Early Intervention support, families can make simple alterations to daily routines to improve movement and control.  Early Intervention is a wonderful way to set your child up for their best future!

Resource: Callie Lodico, Physical Therapist

Q:  Why does my child feel so stiff when I hold them or change their diaper?

A: If your child feels stiff when you hold them or change their diaper, they may be experiencing hypertonia, or an atypical increase in their muscle tone. Muscle tone is the amount of tone a muscle exhibits when moving through space.  There are three main categories of muscles tone; hypotonic or low; typical; and hypertonic or high.

While you may think your child is being difficult during diaper changes and resisting you, it is not the case. Their muscle tone will increase when their legs are being moved away from their body. A parent may get frustrated because they think their child is being difficult and resisting having their diaper changed. However, moving slowing through the process may help both you and your child.

Some of the potentials ways to help to address tenseness in your child’s muscles are:

  1. Gentle massage in stroking movements
  2. Using Kinesio taping (often used by athletes)
  3. Range of motion exercises

As a first step you should discuss this with your pediatrician who will most likely recommend an Early Intervention evaluation with a trained Early Intervention Physical therapist.  Together you can decide what works best for your child.  Early Intervention Physical Therapists have lots of strategies and ideas to share about how to embed therapeutic practices into your child’s daily routines!  Early Intervention therapists help coach you to lay the groundwork for a thriving child.

Resource:  Callie Lodico, Physical Therapist

Q:  Why does my child appear to only turn their head to one side?

A:  When a baby has a strong preference to keep their head turned to one side, we suspect torticollis.  Torticollis is caused by a tightness in the child’s neck muscles.  These muscles are attached at the base of the skull just behind the ear and the collar bone, close to the sternum.  These attachment sites cause a diagonal pull when the muscle contracts (shortens).  The back of the ear is being pulled toward the inner end of the collar bone.  This causes two actions – the head tilts toward the shoulder and the face turns away which is the turning to one side you child might be experiencing.

Treatment for a child with torticollis involves stretching of the tight muscles.  It typically takes stretching numerous times every day for several months to remedy this condition. If you suspect your child is experiencing torticollis, you should speak with your pediatrician who will most likely recommend Early Intervention services with a Physical Therapist.   The Physical Therapist will assess the severity of the condition and develop a customized stretching program which usually includes a tilting stretch and a turning stretch that you can incorporate into your child’s daily routine.

We have been seeing a rise in the number of cases of torticollis and plagiocephaly (misshapen head).  In some cases, these conditions are due to a tilt in the position of the head in the womb or trauma during birth.  However, it is also believed that these conditions are increasing partly because infants are spending more time in a reclined sitting position in car seats, bouncy chairs, swings, high chairs, and strollers. In these positions there is pressure on the back of the baby’s head and the baby’s head may lean to the side often.   We can try our best to prevent the causes we have control over, by giving babies time off the back of their head. Find ways to make tummy time more enjoyable – this is one of the best activities you can have your baby do!

Resource:  Jeannine Moyer, Physical Therapist

Q:  My baby seems to try to move but can’t seem to figure out how. What can I do?

A: Babies typically develop skills in a certain order, achieving milestones sequentially.   The key to building their skill base is developing the strength and coordination in one area to be able to move on to the next skill.  However, they often practice the next higher skill while still mastering the lower one. If you have concerns about your child’s development and ability to move, you should discuss this with your pediatrician. An Early Intervention evaluation by a physical therapist can assess what skills the baby currently has and identify the appropriate plan to help them literally move forward.

Your child might be able to play with their feet when laying on their back, propping on their hands or forearms when on their belly, or leaning their body weight to one side while reaching with the other hand.  These skills are the foundation for your child to develop higher level skills.  Playing with their feet causes a baby to strengthen the abdominal muscles which are needed to roll and crawl, in addition to developing body awareness.  Pushing up onto their hands when on their belly strengthens the shoulder complex and arms.  Shifting their body weight to reach with the other hand develops balance and coordination.

Once a baby has mastered these basic skills they may be ready to army crawl then crawl on hands and knees.  Often times, we see a baby scoot backward on their belly as they are developing the skill of moving forward.  A tip to encouraging them to move forward is to position a toy just out of reach so that they can barely touch it with their fingertips but cannot grab it.  If you place the toy too far away, many babies just give up, but if it is close enough where they think they can reach it, they will try harder.  To advance from army crawling to hands and knees, start by helping them rock forward and back on their hands and knees.

Through Early Intervention, a physical therapist can help address your child specific challenges and support you and your child as they develop their motor skills.

Resource:  Jeannine Moyer, Physical Therapist

If you are seeing some of the following signals in your child’s behavior, you should talk to your health care provider.  Importantly Early Intervention Services are available at no cost to you!   Call us today 412-922-8322!

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teli provides therapeutic Early Intervention for children birth to 3. We're here to help every child reach their potential! Early Intervention