Sunday, January 16, 2022

Watching your children develop can be the most rewarding experience a parent can have.  You develop expectations for your children and hope they will achieve them.  When children are young, these expectations are small.  You await their first smiles, the first time they sit, roll over, crawl or take their first steps.  These milestones are expected to occur during specific time frames of development.

The development of motor milestones in infancy is crucial to the attainment of higher level skills that enable us to function in the environment.  If your child is not reaching his/her developmental milestones during the appropriate age range, this will delay the achievement of subsequent milestones, and potentially cause the child to compensate for the lack of development.  For example, Sydney is 3 ½ years old and ascends and descends stairs leading with one leg one step at a time instead of using both her legs to reciprocate (right-left-right) stairs.  Because her right leg always leads upstairs, her right side has become stronger than the left and there is an asymmetry.  When she runs, she tends to lead with her right side and therefore does not run appropriately and cannot keep up with her friends on the playground.  Since Sydney has now developed this asymmetrical weakness, she compensates when trying to achieve age appropriate gross motor skills.

There are many reasons why a child would have delayed motor development.  It might be that he/she has not been exposed to many of the developmental positions for prolonged periods of time, like tummy time, being on all fours, and kneeling. Perhaps they are spending most of their time in a “container” such as a bouncy seat, swing, or car seat and, therefore, haven’t had the opportunity to develop muscle strength.  Another reason may be an underlying condition that affects muscle strength or muscle tone. It is also possible that some reflexes that were present at birth and in infancy still have not been integrated and are inhibiting development.  In order to discern what the cause may be, it is advisable to seek the help of trained professionals, including physical therapists, occupational therapists, and medical professionals.

Physical therapists primarily target gross motor skills which involve large muscle groups. Occupational therapists primarily work with fine motor skills which involve small muscle groups. If you notice your child is not progressing towards achieving some of their fine motor milestones, it is necessary to look at whether they have mastered some of their gross motor skills.  Once the larger movements have been mastered, the smaller movements can then be refined.  For example, a baby will first grossly swipe at a toy in order to get the toy.  Once the baby has more control of his/her shoulder movement (gross motor), he/she can then concentrate on his/her hand movement (fine motor) and eventually grasp the toy.

Motor development occurs throughout early childhood, not just during infancy.  When a child is having difficulty sitting in class and writing at his/her desk, handwriting might stand out as being that child’s area of difficulty, but really that might be just one component of the problem.  Mikey, who is 7 years old, has poor handwriting and cannot sit for the duration of his lesson.  Because it is difficult for Mikey to sustain an upright posture as a result of weakness in his core and proximal muscle groups, he is unable to concentrate on refining his handwriting skills. Mikey would, therefore, benefit most from PT to fix his underlying problem.

If you have concerns that your child is delayed or demonstrating difficulty with age-appropriate skills as a baby or in early childhood, it is advisable to seek professional evaluation.  The sooner any issues are addressed, the sooner your child can progress without compensatory adaptations.  If you are unsure if your child may benefit from PT or OT, The Therapy Gym in Teaneck is offering screenings to advise you if your child may need a PT evaluation, an OT evaluation, or if no therapy is recommended at this time.

Elisheva Fuchs is the owner of Teaneck-based Therapy Gym. She can be reached at: ellie_thetherapygym.com  or  201-357-0417 and her website is: www.thetherapygym.com

by Elisheva Fuchs, PT, DPT

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