One of the biggest concerns parents face surrounds development and if their child is “on-track” or delayed, and what this might mean. Before determining if a child is delayed in their development, we must first consider what development means and what it encompasses.
Motor development is not a strict/rigid timetable. In fact, it is influenced by many factors from birth. These can include: their physical attributes (i.e. size), environment, genetics and their personality. Furthermore, physical development is only one part of development. A child’s development is multi-faceted and includes: social/emotional, sensory, cognitive, language, and physical development. These 5 facets of development all influence each other, and some children attain skills in one area of development quicker than other areas.
Some studies suggest we consider development timelines more loosely, and instead they should be considered more as optimal vs critical milestone guides. These studies have shown that when we focus more on connecting with our bubs/children through meaningful play and provide opportunities in our environment for sensory stimulation and movement in various ways, this enhances our child’s neural connections for development.
Most brain cells are developed before birth, but connections are strengthened during early infancy and childhood. This is due to plasticity of the brain. Plasticity of the brain is its ability to adapt and change to stimuli it’s exposed to, with it being optimal between 0-12yrs of age. This in turn affects a child’s development, and ultimately their physical development. Given the fact that development is multi-faceted, we can further enhance physical development by incorporating the other areas of development (i.e. sensory, cognitive, language and social/emotional areas).
When we speak about optimal vs critical milestones, these are to alert us if certain movement patterns are existing beyond that point where they are no longer helpful, and in fact hindering development (such as certain reflexes), or if they are showing signs of severe delay in their physical development. As physios, we can address your concerns of delayed milestones or abnormal movement patterns and will assess whether your child needs some extra assistance with exercises or activities to enhance their physical development. If there appear to be any further concerns, or concerns outside our scope of practice, we will discuss with you about referring on to specialists in our field to address this further.
Delays in motor skills (such as rolling, sitting, walking)
Delays in gross motor skills, such as rolling, sitting, and walking can occur due to various reasons as mentioned under the Development tab. Factors such as: the environment, a child’s motivation to move, their genetics and physical attributes, previous illness/medical conditions, retained early reflexes, their clothing and footwear, if they have high/low tone and hypermobility all influence the way a child moves, and how they do it. As physios, we can address these areas to provide optimal opportunities for children to move, improve coordination and strength and engage in the world around them. We can provide inspiration to modify a child’s environment to encourage movement, provide advice with regards to clothes, shoes and play equipment to enhance movement patterns, and can suggest games and activities to assist children with improving gross and fine motor skills. Ultimately, we want to empower children and parents through positively engaging activities, making movement fun, nurturing their interests and passions, and focusing on the whole child, not just their motor skills.
Development Coordination Disorder (DCD)
Development Coordination Disorder (DCD) is also known as the ‘clumsy’ disorder. It basically means that a child has problems with coordinating movement and can appear awkward or clumsy. Many parents raise concerns over their ‘clumsy’ child, especially between the ages of 2yrs-5yrs old. Parents or child-care workers tend to notice a child falling over more than usual, or not being able to catch themselves if they trip and tend to end up with more head knocks. Additionally, it can extend to fine motor skills such as messy handwriting, or difficulty with zips/buttons, or troubles using cutlery. Gross and fine motor skills tend to be delayed and require more time and energy to complete tasks. DCD is a lifelong condition, so educating children and parents on the condition and ways to manage it may help with their confidence and self-efficacy. As paediatric physios, we can assist with education and awareness about DCD, and give you the tools to help your child manage it. This could be in the way of exercises, or movement and sensory classes, and a management plan to empower you and your child to maximise participation at school, with sports and with their friends.
Toe walking is a common complaint facing many parents. There are a number of reasons why it may occur, such as: anatomical (shortened/tight calf muscles or Achilles tendon), sensory aversions underfoot, habitual, overuse of various play equipment (such as jolly jumpers, or pushing a walker that’s too tall or light), developmental conditions, neurological reasons. The most common reason is known as idiopathic toe walking, which means that your child does it for an unknown reason, and eventually grows out of it. There are certain factors that we, as physios, look for when assessing your child and their toe walking. Things that you can look out for as parents include: do they do it all the time? Is it only over certain surfaces? Do they do it in bare feet as well as with shoes on? Do you notice it more when they’re tired at the end of the day? After a thorough assessment, we can provide some strategies to assist with your child’s toe-walking such as a strengthening program, soft tissue management and advice with regards to footwear and play-equipment.