What is the sequence for gross motor skills?

 

 

A baby’s first year is a time of amazing transition. At birth, your baby can do little more than look around, nurse and move hands and feet. Near their first birthday, expect them to be an active crawler—maybe even starting to take steps—playing with rattles and toys, and transitioning toward drinking from a cup. Here’s what you might expect:

0–3 Months

• Focus eyes on objects about 12 inches away
  
• Raise head when lying on their stomach
  
• Jump at loud noises
  
• Smile back when you smile at them 
  
• Watch their own hands move
  
• Hold a rattle for a few minutes

3–6 Months

• Kick their feet and wave arms when they see or hear someone they know
  
• Reach for toys or people
  
• Roll over
  
• Turn toward a familiar voice
  
• Hold head steady
  
• Notice small objects
  
• Push up with arms while on their stomach
  
• Sit up straight with help
  
• Begin to focus on patterns in black and white

6–9 Months

• Sit up without help
  
• Stand up while holding onto your hands
  
• Stand up on your lap and bounce
  
• Recognize a familiar voice
  
• Start to crawl around and may pull up on furniture
  
• Eat a cracker by themselves 
  
• Play pat-a-cake
  
• Play with their hands and feet
  
• Pick up cereal (such as Cheerios) and try to put in mouth

9–12 Months

• Crawl, climb, cruise (moving about while holding on to supporting objects, furniture, etc.)
  
• Begin steps toward walking alone
  
• Explore and handle objects: wave, shake, twist, turn, squeeze, poke and even put them in their mouth
  
• Crawl while holding a toy
  
• Pick up small objects between thumb and one or two fingers (although not with ease)
  
• Take steps alone; walk like a robot
  
• Pull string to get the toy at the other end
  
• Move a toy from one hand to the other
  
• Hold two toys at the same time; maybe hit them together
  
• Crawl up stairs
  
• Walk if one or both hands are held
  
• Pull self up to stand and move while holding on to furniture (cruising)
  
• Start drinking from a plastic drinking cup instead of a bottle

0-3 Months

• Raises head & chest when on stomach
• Stretches & kicks on back
• Opens and shuts hands
• Brings hand to mouth

3-6 months

• Rolls both ways
• Plays with feet and brings feet to mouth when on back
• Sits with support
• Reaches with either hand
• Transfers object from hand to hand
• Supports whole weight on legs
• Begins to pivot to left and right while on belly

6-9 Months

• Sits and plays with toys
• Assumes hands-and-knees position
• Gets from sitting to crawling position
• Crawls forward on belly

9-12 Months

• Gets to sitting position without help
• Pulls self-up to stand
• Take steps holding on to furniture
• May Stand without support
• May take some steps without support

Working on your child’s gross motor skills at an early stage helps to set the foundation for developing more complex skills as they grow. SPD’s physiotherapists, Natalia Szukalska and La Min Maung, share some activities that you can do with your child to help develop or improve their gross motor skills.

 

Gross Motor Skills

Gross motor skills refer to the movements of the large muscles in the body, such as muscles in the shoulders, arms, trunk, hips or legs.

Infants typically develop gross motor skills following a sequence, starting from their head to their feet. This means that they will develop control of their neck muscles, followed by their shoulders, arms, trunk, hips and then legs.

 

1)  Holding Head Up

Head control helps in the development of movements including crawling, sitting and walking. Newborns typically have little head control as their neck muscles are still fairly weak. Tummy time is one of the common ways to help build up muscles in the neck and shoulders. You can make tummy time more comfortable for your child by laying them tummy-down on items, such as pillows, water mats or therapy balls.

Tummy time by placing your child tummy-down on a therapy ball is one way to help build up neck and shoulder muscles

However, children who have tight or rigid (high muscle tone) or floppy (low muscle tone) muscles like children with Down syndrome or cerebral palsy, may struggle when they lay flat on their tummy. For these children, you can try placing them in slightly vertical positions so as to make it easier for them to hold up their head. You can do this by sitting in a reclined position on a sofa or a bed and placing your baby on your chest, supporting the baby’s underarms, if needed.

Placing your child in more vertical positions can help them hold their head up more easily

You can gradually increase the number of tummy time sessions per day, with each session lasting one minute or less. Tummy time can also be incorporated into your child’s daily routines, for instance, after changing a diaper or before feeding. For older children, you can do it during storytelling time or when watching television.

 

2)  Rolling

Typically, children first start to roll from their tummy to their back, then from their back to their tummy. Rolling enables them to experience the movement of the entire body, strengthening their neck, trunk, arms and legs muscles, as well as their coordination. It is also their way of moving around until they learn to crawl.

Encouraging your baby to roll:

• Practise with your child on a soft surface, for example, on a mat.
• Place your child’s favourite toy in the direction where you want them to roll towards or use a musical toy to encourage them to move towards the sound.
• To help your child roll from the side onto their tummy, bend one of their knees and press it gently to guide the movement.

To encourage rolling, place your child’s favourite toy in the direction where you want them to roll towardsTo help your child roll from the side onto their tummy, bend one of their knees and press it gently to guide the movement

 

3)  Sitting

Sitting helps to develop a child’s back and core muscles. It also gives your child a new way of seeing and interacting with the environment, playing with toys and socialising with others.

Encourage your child to sit by:

• Reducing the support given gradually while ensuring your child’s safety.
• Practising supported sitting, for instance, using a big plush toy that the child could lean onto for support when needed.
• Using your child’s favorite toys, songs or videos during practice.
• Coaxing your child to reach for toys when sitting unsupported.

Encourage your child to reach for toys when sitting unsupported

 

4)  Crawling

Crawling is a good exercise to help a child build strong trunk, arms and legs. The alternating movements of using an arm on one side and a knee on the other while crawling helps the child to work on their coordination, which is needed for walking.

If your child struggles with it, start by placing your child on their hands and knees for a few seconds and increasing the duration gradually. You can place a bolster under the tummy or place them across your thigh. When your child builds up enough strength, you can place your child’s favorite toys at a short distance from them and encourage your child to crawl and get them.

Crawling is a good exercise to help a child build strong trunk, arms and legs

 

5)  Walking

Before children start to walk, they will first need to learn how to stand properly. To help your child learn to stand, you can get them to play with toys in a supported kneeling position before gradually progressing to standing. When your child is playing or watching television, encourage them to stand, but ensure that there is a steady object nearby that they can grab for support.

When your child is confident in standing, you can start to train them to walk. Cruising is one method, where you place a favorite toy on one end of the sofa to encourage them to walk towards it, while being able to hold on to the sofa for support. You can also introduce walking by getting your child to push a baby chair with their favorite toy on it or by getting them to play with a push toy.

Cruising, where the child moves along steady furniture and using it as a support, is a way to train your child to walkYou can also encourage your child to walk by getting them to play with a push toy

 

6)  Jumping

You can teach your child to jump by getting them to practise squatting first. Place small toys that they can easily grab, like a small ball, on the floor and encourage them to pick it up. When they master squatting, you can introduce jumping down from a small step while holding their hands. Keep encouraging and praising your child for their effort. Next, you can demonstrate jumping up or jump over a line. Do remind them to bend both knees prior to jumping.

L-R: Encourage your child to jump by first getting them to squat, then introduce jumping by holding their hands and later by jumping over a line

 

7)  Ball Skills

Ball skills are great for improving strength, balance, hand-eye coordination and timing. Children can also enhance their play and social skills by playing together with their peers and family members.

• Children learn to roll a ball, followed by throwing underhand and finally throwing overhand.
• Catching is the most challenging. It requires focus, good hand-eye coordination and timing. Start with throwing a small beach ball 1-2 m away from your child.
• Kicking a ball is a fun way for children to learn weight transfer from one side of the body to another, which is a necessary skill for walking. They will also learn how to balance on one leg.

L-R: Throwing a ball, catching a ball and kicking a ball are fun ways to improve the child’s strength, balance, hand-eye coordination and timing

 

The above activities are some suggestions for you to help your child develop gross motor skills while having fun at the same time. If you have any questions on how to implement these activities for your child, please speak to your child’s physiotherapist.

 

References:

1. Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders: A Guide for Parents and Professionals, second edition (2007), Sieglinde Martin
2. Gross Motor Skills for Children with Down Syndrome: A Guide for Parents and Professionals, second Edition (2013), Patricia C. Winders
3. Parents’ Guide to Fine Versus Gross Motor Skills, Pathways – Accessed on 23 July 2019
4. Normal Development, Physiopedia – Accessed on 25 July 2019

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