Advanced Gross Motor Skills in Children
Top Contributors - Robin Tacchetti and Jess Bell
Introduction[edit | edit source]
Childhood milestones are specific behaviours that reflect stages of growth and development. Gross motor milestones involve the large muscles and typically occur within defined timeframes. But while there are general timeframes for motor development, it is important to note that skill acquisition does vary and every child develops at their own pace. Moreover, differences in how children are raised can cause variation in motor skill development - expectations, cultural beliefs and practices all affect childrearing, and provide children with different experiences and opportunities to practise skills.
The progression of gross motor milestones occurs in a predictable pattern. Children develop from top to bottom, improving upper body control before lower body control. Each new skill builds on a previous skill - e.g. standing comes before walking. Upright advanced gross motor skills can only occur once a child is independent in sitting and is able to transition in and out of the sitting position.
Dependent Standing[edit | edit source]
At around 4 to 5 months, children may start to stand with anterior support or upper extremity support (i.e. dependent standing). They are not independent with any of their mobility in an upright position at this point, but they are able to start exploring this pattern in that movement. External support is essential due to their underdeveloped balance responses and poor anterior-posterior weightbearing alignment.
During hand-held walking at around 7 months, infants have a wide base of support with moderate abduction, hip external rotation and pronated feet. The amount of pronation correlates to the amount of abduction and external rotation of the hips. At this stage, a child's hips and knees will be flexed when practising hand-held walking.
High Kneeling[edit | edit source]
At around 7 to 9 months, infants start to kneel with anterior support. They are able to push from a quadruped position into a high-kneeling position using a support surface.
Pull-to Stand[edit | edit source]
From 8 to 10 months, infants start to pull themselves up into standing with hand support. This movement is initiated by the upper extremities. In an upright position, the child will hold onto a support (e.g. cot rails) and bounce as they interact with their environment. During these early pull to stand experiences, an infant has difficulty sitting back down - they have not yet developed the eccentric hip and knee control required to lower themselves to the ground. Once tired, they will simply let go and drop down into sitting.
By 10 months old, infants rely mainly on their lower extremities to facilitate the pull-to-stand motion with very little effort from the upper extremities. The upper extremities are used mainly for balance. They move into standing by moving from high-kneeling (i.e. knee standing) to half-kneeling postures (i.e. kneeling on one knee). They use these same postures to get back down to the floor.
To transition from high-kneeling to half-kneeling to standing the child moves through the following steps:
- wide base of support
- shifts weight to one side
- elongates trunk on the weight shifted side
- unweighted leg moves forward and foot is placed flat on the floor in a half-kneeling position
- uses hip and knee extensors to facilitate moving against gravity to a standing position
The video below by Pediatric Physical Therapy Exercises demonstrates high-kneeling to half-kneeling to stand:
With practice, these movements become quick and very controlled. Once the child is able to pull-to-stand, they will squat and play for long periods of time, moving back and forth between furniture and the floor. As the child moves from squat-stand-squat, co-contraction of the ankle musculature occurs, which enhances stability.
Cruising[edit | edit source]
At around 10 months old, infants begin to step sideways holding furniture for support. This supported lateral movement is called cruising. Infants are able to move along furniture such as couches or tables and eventually start to move between pieces of furniture, thus navigating around the room. A cruising gait has less hip and knee flexion and improved anterior-posterior alignment. Balance improves as the infant starts to lift a hand and rotate their body. They may even take 1-2 steps without upper extremity support. The child will eventually stand independently letting go of their support surface.
Cruising facilitates a child's lower extremity strength, specifically the hip abductors/adductors and ankle evertors/invertors. During this stage, the plantar grasp reflex may still be present although considerably diminished. Complete resolution of the reflex is necessary for independent, unsupported walking to develop.
This video by Kids on the Move provides tips to encourage cruising:
Independent Ambulation[edit | edit source]
Children begin to walk independently between 10 and 15 months old. Their gait progresses with time as they gain more experience. Features you may observe as walking progresses are listed below.
Initial Gait[edit | edit source]
- Hips and knees flexed
- Abduction and external rotation of the hips
- Wide base of support
- Pronated feet
- No heel strike
- Upper extremities often in a high guard position
- Abducted shoulders away from the body (head height)
- Elbows flexed
- Hands up high
- Circumduction of leg
- May see high stepping gait and flat foot stepping
Gait Progression 1[edit | edit source]
- Upper extremities in mid guard position
- Shoulders abducted out to side (close to shoulder height)
- Elbows flexed
- Hands just above the waist and stabilised against the body
- Fingers pointing upwards
Gait Progression 2[edit | edit source]
- Upper extremities able to relax into shoulder extension and hang at the child's side
- Reciprocal arm swing during gait then develops
- Increasing hip and knee extension
- Decreased hip abduction
- Decreased external rotation of the hip
- Narrowing of the base of support
- Neutral pronation/supination of the feet
- Heel strike, push off (at around 2 years old)
** A child's gait continues to mature until the age of 7-9 years old. At this stage, their gait resembles that of an adult.
**Children activate more motor units than adults, which suggests they have less control and weaker muscles.
Gait Parameters[edit | edit source]
Gait parameters such as step and stride length, velocity and cadence will change as the child grows and matures.
- Step length: The measurement from heel strike on one foot to heel strike on the opposite foot.
- Stride length: Measured from heel strike on one lower extremity to heel strike on the same extremity. Stride length is roughly twice the step length.
- Velocity: the distance covered over a specified amount of time. Velocity is correlated to the length of one's stride or step. Between the ages of 1 and 3 years, a child's velocity increases as their stride and step length increase.
- Cadence: The number of steps per minute. During initial independent walking, the child spends very little time in single limb stance due to a lack of strength and stability in their hips. This decreased stance time results in a high cadence. As their strength and balance increase over time, the amount of time in single limb stance increases with a subsequent decrease in cadence.
Stairs[edit | edit source]
Many factors play a role in the ability of a toddler to negotiate stairs. One key factor is opportunity. Some children do not have stairs in the home and, therefore, may not have the chance to practise this milestone. Those who do have stairs are more likely to ascend stairs at a younger age.
Initially, during stair climbing an infant will place both feet on each step. Alternating feet with stair climbing does not generally occur until the age of 3. Upper extremity support changes as stair climbing progresses. Initially, the child will be dependent on upper extremity support from a handrail or adult. As they progress, no upper extremity support will be required.
Milestones in 3-6 Year Old[edit | edit source]
- once able to clear the floor with both feet simultaneously
- occurs around 3 years old
- Pedalling a tricycle
- have to coordinate both legs doing different activities
- have to maintain trunk stability and control
- occurs around 3 years old
- occurs around 4 years old
- occurs around 4 years old
- occurs around 5-6 years old
Resources[edit | edit source]
References[edit | edit source]
- Karasik LB, Robinson SR. Milestones or millstones: How standard assessments mask cultural variation and misinform policies aimed at early childhood development. Policy Insights from the Behavioral and Brain Sciences. 2022 Mar;9(1):57-64.
- Newell KM. What are fundamental motor skills and what is fundamental about them?. Journal of Motor Learning and Development. 2020 Jul 25;8(2):280-314.
- Eskay K. Advanced Gross Motor Skills Course. Plus, 2023.
- Tecklin JS, editor. Pediatric physical therapy. Lippincott Williams & Wilkins; 2008.
- Thurman SL, Corbetta D. Changes in posture and interactive behaviors as infants progress from sitting to walking: A longitudinal study. Frontiers in psychology. 2019 Apr 12;10:822.
- Versfeld P. Learning To Stand - Development and Training Course. Plus, 2023.
- Price C, Morrison S. What happens to babies’ feet when they are learning to walk?. Frontiers for Young Minds. 2023 Jan 6.
- Dewolf AH, Sylos Labini F, Ivanenko Y, Lacquaniti F. Development of locomotor-related movements in early infancy. Frontiers in Cellular Neuroscience. 2021 Jan 21;14:623759.
- Berger SE, Theuring C, Adolph KE. How and when infants learn to climb stairs. Infant Behavior and Development. 2007 Feb 1;30(1):36-49