Motor Development (Birth-12 months)
The first year of life is one of the most critical stages in childhood development. From the moment a newborn opens their eyes, they undergo dramatic physical and mental changes.
Let’s take a look at typical motor development from 0-12 months and possible red flags to look out for:
The Neonate Stage (0-10 days old):
At this stage, the most important things to look for are reflexes: Moro startle reflex, ATNR, palmar and plantar grasp. When awake, babies usually have uncontrolled & random arm and leg movements. The majority of their time is spent sleeping.
Babies that are born before 37 weeks of gestation
Babies born with the following diagnoses: Brachial plexus injury, stiffness, floppy, feeding problems
1 Month Old:
At this age, babies are still in physiological flexion and their primitive reflexes are still present. Lateral vision is better than midline vision. They now start kicking their legs more.
Same as neonate
Torticollis can be identified at this time (head tilts in the direction of tightness and rotates to the opposite direction)
2 Months Old:
Babies have more range of motion and movement in their arms/legs. They start tracking toys or favorite faces. When lying on their belly, their knees are still bent and most of their weight is on their shoulders. Their elbows are behind their shoulders. When placed in supported sitting, babies will flex over with their head to the floor.
High muscle tone (extreme stiffness)
Low muscle tone (extremely floppy)
3 Months Old:
Symmetry is important at this age. Baby's head should be in midline and they should be able to lift their head when placed on their belly. They start to hold toys and their legs are more in line with the body instead of the frog position (knees bent as shown in the 1 month old picture above). Their elbows are in line with their shoulders.
Strong asymmetries: inability to maintain a midline alignment
Difficulty lifting head when placed on belly
Poor visual control and difficulty tracking
Cries when placed on belly and arms are not in line with shoulders
4 Months Old:
At this age, a baby begins to have controlled and purposeful movements. The baby is able to keep their head in midline with good control. They will begin to bring their hands together or hands to mouth. On average, babies will start rolling from belly to back and back to side around this month. Babies also begin to push up onto elbows while holding their head up high and they begin to reach for toys while on their belly. Their elbows are in front of their shoulders.
Lack of symmetry
Excessive low tone: Increased frog posturing when on belly (very floppy)
Excessive high tone: Arching and pushing into extension (very stiff)
Difficulty bringing hands to midline when lying on back
5 Months Old:
At this age, a baby continues to develop coordination between both sides of the body. They begin to push up onto extended arms when placed on their belly. They begin to bring their feet to their mouth. They can roll from belly to back and back to belly. They begin to pivot when lying on their belly. Babies begin to sit with propped arms. They also begin to bang or shake toys.
Don’t bring their feet to mouth
Poor trunk control and increased arching
Not reaching with both hands
Cannot roll to the side
Does not like tummy time
6 Months Old:
At this age, babies are more active when placed on their belly or back. They have good head control in all positions. They begin to have trunk rotation when placed on their belly, back, or in sitting. Babies can pivot all the way when placed on their belly and sit independently. Rolling is consistent at this age and they can stand when given support at their hands.
Not rolling independently
Does not reach for feet with hands for play
Does not tolerate being on belly
Back is rounded or slumped
Poor head control
Doesn’t weight bear on arms when lying on belly
Unable to lie on one side
Doesn’t kick legs
7 Months Old:
At this age, babies are more social and are moving so much more in all positions. They begin to rock on hands/knees and some will begin to crawl. They begin to move from sitting to hands/knees. They sit with a more upright posture and their forward and side protective responses come into play. When placed in supported standing, they begin to bounce.
Significant crying when placed on belly
Makes no attempt to push up onto extended arms when lying on belly
Not sitting independently
Does not bear weight through their legs when placed in supported standing
8 Months Old:
At this age, babies are busy moving around. They don’t like to stay in one position for a long time. They are crawling by now. They transition from crawling to a sitting position. They also begin to crawl up onto stairs.
Propped sitting only
Can’t transition to sitting from crawling position
Can’t get up into a crawling position
9-10 Months Old:
At this age, babies are moving into many different positions at all times. They are climbing onto stairs/furniture. They begin to pull up to standing at furniture. They begin to get down from a standing position.
All previous red flags
Prefer to “W” sit or a wide based ring sit
Tight hips and knees
Difficulty getting on hands and knees
Not pulling up to standing
Not taking weight on legs in standing
Prefers to use one hand
11-12 Months Old:
At this age, babies have mastered crawling, pulling up to standing, and cruising along furniture. Babies can stand independently for short periods of time. Their legs are stronger and can walk with hands held. Some babies are walking independently. Babies have up to 16-18 months to learn how to walk on their own. If your baby is not walking by 16 months, you may want to get a physical therapy evaluation to make sure your baby is on the right track.
All previous red flags
Delayed if not sitting and crawling
Not pulling up to standing
Not weight bearing through legs
Not standing while holding onto furniture
Sits with all weight on one side
Not attempting to walk with support
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