Expert Q&A: Gross motor skill development in babies

<i></i>
 Photo: Getty Images

Dr Katie Heathershaw is a Melbourne-based paediatrician and the Fisher-Price paediatric specialist who has been providing expert care to infants and children with different health needs for over 23 years. Here, she answers questions about babies' gross motor skill development, including crawling, tummy time, reaching, using a jumper chair, and neck movement. 

1. My nearly-six-month-old hates tummy time. He still can't sit on his own or crawl, and he rarely rolls over either. Should I be worried?

Developmental progress can vary quite a lot from one baby to the next, and other factors like sickness or prematurity can also influence your baby's development.

Tummy time reluctance can become a bit of a self-perpetuating issue because as he spends less time on his belly he doesn't become accustomed to it, build his upper body/shoulder and neck strength, or learn to roll as quickly (though he will learn it eventually so don't worry!).

Try to encourage your son to gradually spend a little more time each play time on his belly. Mix it up with time outside on a rug under the trees or try some time on his tummy on your chest. If he is still struggling to lift his chest and upper body up, try placing a small folded towel underneath your son to help prop him up a little. Unsupported sitting is also a variable milestone, and it's not uncommon for this to not be achieved until seven months or later. Until then make sure you prop him up with plenty of cushions or by sitting behind him.

Fisher-Price's Play IQ website (www.fisherprice.com.au/playiq) is a great resource for checking where your baby's development is at and for getting some ideas for activities and toys to encourage him to get to the next milestones. For example, the Fisher-Price Kick & Play Piano Gym may help with your tummy time problem.

But if you are ever concerned about your baby's development, check with your health nurse or doctor.

2. My almost-one-year-old has been commando crawling for months, but doesn't get up on all fours. She pulls herself up and is cruising around furniture and can get herself in and out of a sitting position, but there are no signs of cross-patterned crawling. Is this normal?

Advertisement

Crawling is actually the most inconsistent gross motor milestone. Some babies never crawl, some crawl commando style then move on to more traditional 'up on all fours' crawling, some crawl 'bear' style, and yet others bottom-shuffle. All are effective ways to move and are considered normal variations.

However if you are worried about your baby's development, please make an appointment to discuss with your health nurse or doctor.

3. I have identical triplet boys who are six months old tomorrow (born 11 weeks early). One of my boys isn't really reaching out much for his toys under the play gym like his brothers do, and I'm wondering whether there's anything I can do to help him?

Your triplets' corrected age is a little over three months, so when we are thinking about developmental milestones that is the age we should be using.

It's always tricky with multiples because you can't help but compare, but the reality is that at this age we would only really expect babies to be just starting to discover their hands and to start to 'bat' at toys. If your son has also had to face some medical issues with his prematurity, or perhaps he has a different temperament, then that could easily explain the difference you are seeing.

A couple of points to note: it is important to be sure that his vision is ok. Is he fixing and following your face and toys? Is he moving his limbs well and equally? If all is well on those points, continue to spend time in play with all three boys under the play gym and in talking, singing and reading face-to-face; the rest will follow.

If you do have any concerns please ensure you check with your health nurse or doctor.

4. When is it appropriate for my baby to use an exersaucer or jumper chair?

These items should only be used when your baby has very good head control and is able to sit with support as well (which indicates good truncal tone). This is usually at about four to six months but does very much depend on the individual baby.

I would also suggest using these when your baby is well rested, as of course your child is going to be better able to maintain head control etc. when they are not tired.

Make sure you are using a product with excellent safety standards like the Fisher-Price Rainforest Jumperoo, always under adult supervision. Check with your health nurse or doctor for further guidance.

5. My five-month-old daughter tends to look in one direction more than the other. I can't tell if her head is being pulled that way or if she just favours that direction. Should I be worried?

It's not uncommon for babies to have a preference to turn their head to one side or the other due to their position in the uterus. Another cause for this issue can be a tightening or stiffness of the neck muscle (sternomastoid muscle) which is called a torticollis.

In the first instance, even though your baby's head will naturally come to rest on the preferred side, there is no stiffness or limitation to movement. You can check this by gently placing your hands on your baby's head and moving it from side to side (passive range of movement) or by moving your face or interesting toys to your baby's non preferred side and seeing if your baby is able to turn her head to look that way (active range of movement).

If your daughter does have a torticollis her chin will point to one shoulder and her head will point to the other shoulder. The muscle will be tight on the side that the head is tilting to, more commonly the right. Torticollis can be associated with a difficult birth and also can be associated with an increased chance of congenital hip dysplasia.

In both cases an associated problem can be positional plagiocephaly or misshapen head, where the baby can develop a flattened area on the back of the head on the side she always turns to. The best way to check for this is to get a 'bird's eye view' of her head (when wet if she has a lot of hair) to check the symmetry.

It's not unusual to have breastfeeding difficulties due to the head preference, but sometimes using the 'football' hold will be helpful.

Medical assessment, initially with your health nurse, is probably a good idea as torticollis does need management by skilled paediatric physiotherapist. Other head turns and plagiocephaly need increased tummy time and positional management.

6. My very big baby (90+ percentile for height and weight since birth) surprised us by walking unaided at nine months, after we'd read that big babies walked later. I've been told we need to "make him" crawl more because "that part of his brain will be underdeveloped". Can you shed some scientific light on this please?

This is a question I'm often asked. Crawling is said to be important to build strength in the shoulders, upper body, hands and wrists, as well as involving bilateral coordination, motor planning and cross body patterning. But there is no scientific evidence that shows that children who skip this milestone by moving straight to walking, bottom shuffling or commando crawling would be better off if forced to crawl instead. I'm sure that as a parent of a nine month old who is now on the move you know that would be a pretty unrealistic idea anyway!

You can still give him those experiences by setting up a crawl tunnel using old cardboard boxes joined together like a tube, or let him crawl his way over a doona or cushions piled on the floor. When he gets a little older he can pretend, on all fours, to be all sorts of four-legged creatures in fun imaginative games.