Gross and Fine Motor Milestones

1. Gross and Fine Motor Milestones Ages Birth to 5 years Theresa Wallace BMR (PT)

2. Birth to Age One • Consider the amount a baby accomplishes in its first year • Head control • Following objects with their eyes • Rolling • Grasping toys • Sitting • Banging toys together • Standing • Poking • This is just a small sample of what a baby will do in its first year

3. Gross Motor Skills • One to three months of age • Turns head to side while on back • Starts to lift head up while on tummy • Turns head to side to clear airway on tummy • Kicks and extends legs • Three to six months of age • Begins to roll – belly to back first • Puts weight through hands while on tummy • Lifts head when pulled into sitting • Sitting balance improves and should be close to independent What do we need to do • Start tummy time early, to develop neck control and build tolerance to the position

4. Fine Motor Skills • One to Three months of age • Moves arms symmetrically • Hand to mouth movement may be observed • Hands starting to spend time open • Three to Six months of age • Grasp reflex inhibited so starts to drop objects • Eyes move independent of the head • Hands open most of the time • Uses radial palmar grasp What do we need to d0 • Introduce toys for grasp and release • Encourage visual tracking

5. Gross Motor • Six to Nine months of age • Sitting independently • May crawl – backwards first • Pull to stand • Stands while holding on • Nine to Twelve months of age • Walks with hands held • Cruises around furniture • Creeps on hands and knees • May stand alone momentarily • Kneels • May begin independently walking What can we do to help • Provide movement exposure – chances to reach for toys and stand at the couch

6. Fine Motor Skills • Six to Nine months of age • Will attempt to pick up small object • Bangs toy on a table • Transfers toys between hands • Voluntary release • Nine to Twelve months of age • Takes toy out of a container • Pokes with index finger • Imitates a scribble • Bangs blocks together What we can do to help • Provide appropriate toys for hand manipulation and exposure to hand movement

7. Barriers to Gross Motor Development – Year One • Limited tummy time – if not exposed early, may have delays in head control, rolling, independent sitting and walking • Children with limited tummy time may not crawl effectively and this over the long run may decrease fine motor skills even at school age • Limited exposure to transitional movements such as rolling and lying to sitting can cause children to get “stuck” in sitting and not progress to further stages of gross motor development

8. Barriers to Fine Motor Development – Year One • Lack of exposure – tentative about allowing small objects near child, messes at eating time • Overly helpful sibling/parents which do everything for their child (not letting them help to get undressed, feed themselves, and other self care tasks) • Ensure vision assessment has been completed as vision issues can hamper the child’s ability to see and manipulate small objects

9. RED FLAGS • Gross Motor • W-sitting • Delays in all motor milestones – rolling, sitting, weight bearing • Tightness of muscles or joints • Favoring of one side of the body • Fine Motor • Favoring one hand/arm • Play limited to chewing and mouthing objects • Not using thumb to grasp small objects • Uncoordinated or jerky movements when using hands

10. Back to sleep – tummy to play • This programwas introduced when it was noted that gross motor developmental milestones were getting later in babies which were not sleeping on their tummies • Babies used to experience tummy time for sleep, were very comfortable with the position, and utilized early reflexes to develop such things as rolling • With the back to sleep program implemented to reduce SIDS, many parents were no longer giving their babies any tummy time • Subsequently, a decrease in head control, decreased babies that crawled, later rolling and sitting and walking skills were noted • Babies should be introduced to tummy time from the day they come home, 30 seconds of tummy time is not enough • Many parents state their child doesn’t like tummy time, but so manyvaluable skills are developed from this position

11. The Problems with W-Sitting • Usually happens due to the position of the child’s hips and knees (anatomical position) • Hips are turned in, so W-sitting is secure and easy to do • W-sitting is often seen in children with intoeing • W-sitting can interfere with a child’s ability to develop other types of sitting – ring, long sitting • It can cause tight muscles and loss of joint range • It can cause musculoskeletal changes above and beyond the position of the hips (stress on ligaments and redirection of tendons) • Limit W-sitting by moving the child up to play at a seated surface, or introducing other positions such as ring

12. Gross Motor Skills • Twelve to Eighteen Months of Age • Walks alone • Run is a hurried walk • Can walk backwards and sideways • Throws a ball forward • Pulls a toy while walking • Will bend and look through legs • Goes up and down stairs on hands and knees • May progress to walking up and down stairs holding a rail or hand (both feet on one step)

13. Gross Motor Skills • Eighteen Months to Two Years • Carries toys while walking • Will sit by backing into a child size chair • Kicks a ball with purpose • Run is maturing – legs more together, less falling • Squats to play • Will push or pull toys • Walks upstairs with one hand held

14. Fine Motor Skills • By age Two • Grasps pencil between thumb and finger • Imitates vertical lines and circles • Can grasp a small bead and put onto a string • Can snip paper with scissors (supervised) • Builds tower of 6 blocks • Holds two objects in one hand • Can activate more complex cause and effect toys • Turning single pages • Effective use of spoon or fork • Drinks from a cup • Helps with dressing by • Pulling pants off • Taking socks off • Finding arms of shirt

15. RED FLAGS Gross Motor • W-sitting • Walk is immature, falling regularly • Favoring of one side of the body or assymmetrical looking gait • Unable to focus on one area of play, constantly switching play activity Fine Motor • Gives up easily • Avoids fine motor activities • Avoids messy activities • Still mouthing objects

16. What can we do to help – Age 2 • Exposure – introduce crayons and scissors, stairs and ride on toys • Persistence – keep reintroducing objects and tasks even if they are not enjoyed • Attention – start to ask for longer periods of attention instead of always allowing the child to dictate when an activity is done • Independence – encourage help by the child even if it takes a longer time to accomplish the task

17. Gross Motor Skills • Age Three • Stand on tip toes • Jumps with two feet • Catches a large ball (trapping to chest) • Jumps forward (12-36 inches) • Jumps over objects (2 inches high) • Starting to one foot stand • May start to one foot hop • Walks forwards and backwards generally along a line • Walks up/down stairs alone, first with both feet per step, progressing to alternating feet • Climbs jungle gyms and ladders • Jumps down off small step • May start to pedal a tricycle

18. Fine Motor Skills • Age Three • Crayon is held between thumb and fingers • Copies horizontal and vertical lines and circles, may imitate a cross • Can cut with scissors along a straight line • Manipulates a bead in one hand • Can match block patterns with 3-4 blocks • Starts to pull up a zipper • May start doing large buttons • Removes pants independently • Puts on front opening shirt independently

19. Red Flags • Failure to meet many of the expected milestones • Any one or two milestones may be due to exposure to a specific task. A male child may not like fine motor as much as gross motor so may not be as good at coloring. A female child may like to color a lot but doesn’t like to go outside and play with a ball as much. • Inability to be directed to the task asked • Attention issues • Difficulty following directions • Total focus and desire to do only one type of activity – lining up cars • Fixation on inappropriate types of play (spinning tires instead of making the car move)

20. What can we do to help – Age 3 • Recognize areas which are concerns • Exposure – practice skills which are difficult, make games and have fun • Persistence – keep reintroducing objects and tasks even if they are not enjoyed • Attention – start to ask for longer periods of attention instead of always allowing the child to dictate when an activity is done • Independence – encourage help by the child even if it takes a longer time to accomplish the task

21. Gross Motor Skills • Age 4 • Gallops forward • Jumps at least 36 inches • Starting to skip • Stands on one leg for 5 seconds • Can hop forward with either foot • Throws underhand and overhand with direction (at least 6 feet) • Starts to catch without trapping to chest (smaller 3 inch ball) • May start to ride bike with training wheels • Can jump and change direction repetitively • Maintains balance on tip toes

22. Fine Motor Skills • Age 4 • Has picked a hand preference • Using wrist movement to direct pencil • Copies a cross • Traces a square and triangle • Can use a computer mouse • Colors within the lines • Draws a person with head, body, arms and legs • Can cut out a square or triangle • Builds designs with blocks • Zips and separates shank on jacket • Attempts smaller buttons • May start to lace shoes

23. Gross Motor • Age 5 • Skips effectively • Hops forward on one foot 20 inches • Is able to perform a sit up and push up • Kicks a ball so it raises in the air • Stands on one foot more then 10 seconds • Starts to walk heel to toe • Starts to catch a tennis ball without trapping it to the chest • Starts to hop side to side on one foot over a line

24. Fine Motor Skills • Age 5 • Mature pencil grasp (or tripod) • Finger movement directs pencil • Copies square and triangle • Cuts a circle with accuracy • Identifies letters of the alphabet • Copies letters of the alphabet • Ties a knot (tying shoe laces by age 6) • Puts on pull on garments correctly • Builds with construction toys

25. Most Important • Recognize signs of delays early – early intervention gives the best chance of changes • Provide a variety of movements, experiences, toys and exposure to scissors, crayons, blocks and basic learning materials • Early exposure usually provides the best outcome • Be persistent and patient – for those children with delays, these tasks are really hard and it can be really frustrating for them. They will avoid what is difficult for them to do • Make activities fun – turning an activity into a game may help a child forget how difficult it is