Normal Physical Development Sequences
One way to encourage baby to raise their head is to lay them on your chest and talk/sing to them or, while baby is laying on his/her stomach, shake a rattle above their head to get them to look up. Alternating holding the baby on one shoulder and then the other shoulder will help them learn to turn their necks in different directions to accept visual and auditory stimulation.
As baby develops, it is important for them to begin to place weight on their forearms while lying on their stomach. To help with this, place a rolled towel under his/her arms when he/she is lying on the floor (on his/her stomach). Also, a soft wedge can be used in the same manner with a toy in front of the baby.
You can assist baby with learning to roll from their back to their side or stomach by holding a toy to one side and taking one leg and placing it across the body with the foot flat and the hip and knee bent. Gently rock baby back and forth to help develop the feeling of rolling.
To help baby develop the trunk muscles necessary for sitting, offer them many opportunities to sit up. This can be done in a highchair with toys on the tray. If baby is not able to support herself enough, rolled towels can be placed on either side to make her feel more secure. If holding baby in your lap in a sit-up position, encourage him to look up and around by shaking a toy above his head or to the side.
You can help baby keep her back straight by tapping or rubbing her spine, bouncing her up and down in the sitting position or stroking the center of her back gently and rapidly. As baby becomes stronger and is able to sit-up independently, help him learn how to go from sitting to laying by positioning their body correctly.
As baby starts to creep and experiment with crawling, encourage him to assume the hand-knee position by placing a rolled blanket below his abdomen when lying on his stomach. Once he is comfortable with this position and is able to maintain it himself, help him to rock back and forth. This encourages him to shift his weight from one arm to the other. You can also accomplish this by placing a toy in front of him so he will pick up one hand to get the toy.
When baby starts to pull to stand on furniture or with assistance from parents, make sure her feet are flat on the floor and that her knees are apart and slightly bent. Also, always stay close to baby as they experiment with standing on their own, even if they are holding on to something. The child cannot sit down from this position without assistance. Spend some time with baby standing in your lap, holding on to her hands and bouncing her up and down.
Once baby is standing and holding on to furniture, encourage them to start cruising along the furniture. This helps them develop the rhythm of walking and the muscles necessary for success. Also, by placing two chairs next to each other and asking baby to walk between them, she begins to gain confidence in her abilities. Soon you can move the chairs further apart and she will let go of one, take a step and grab hold of the next one.
At this age, baby can be encouraged to throw balls overhand, which assists her with developing balance while standing. As baby becomes more comfortable with standing on her own and possibly taking steps, let her stand/walk on different textures such as grass, gravel, sand, etc. Baby will walk between two adults when they begin to take steps and can be encouraged to walk longer and longer distances in this way. As she progresses, help her to walk up and down small inclines or hills.
To develop muscles, the child can be given the opportunity to push or pull large toys or boxes around the house. They can also be given ride-on toys to pedal and things to climb on, including stairs. Dancing is a good activity for children to learn balance, coordination and develop muscles. It is also a good medium to introduce skills such as standing on tiptoe, standing on one foot, skipping and jumping.
When Should a Parent Refer a child to Physical Therapy?
There are certain sequences that are used to gauge whether a child is developing on schedule. The issues below are signals that a parent may need to bring the child to a physical therapy professional.
Birth to 2 months:
- Doesn’t lift head in prone position (while lying on their stomach)
- Does not turn head to one side in prone position
- Does not turn head to both sides in supine position (lying on back)
- Does not hold head up 90 degrees in prone (lying on stomach)
- Does not extend both legs or kick reciprocally
- Does not roll to back when placed on their side
- Does not place weight on forearms in prone position
- Does not rotate or extend head
- Is unable to grasp a rattle
- Cannot bring both hands together
- Does not roll over one way
- Does not hold head up when pulled to sitting
- Is unable to hold head steady in supported sitting position
- Does not bear weight on legs
- Is unable to keep head level with body when pulled to a sitting position
- Does not demonstrate balance reactions
- Cannot bear weight on hands in prone position
- Does not move head actively in supported sitting position
- Does not roll over either way
- Does not bear weight on legs
- Cannot lift head or assist when pulled to sitting position
- Demonstrates little balance reactions or protective extension of arms
- Does not roll over both ways
- Cannot sit with little or no support
- Does not hold weight on one hand while in the prone position
- Cannot bear weight on legs and bounce
- Cannot get to sitting position without assistance
- Does not assume crawling position (hand-knee position)
- Does not show interest/motivation to crawl
- Cannot sit on own without hand support
- Does not pull to stand using furniture
- Cannot switch positions from sitting to prone
- Does not creep on hands and knees
- Cannot pivot while in sit position to retrieve toy
- Cannot pass an object from one hand to the other
- Cannot stand holding on to someone or something
- Cannot pick up small object
- Does not walk with one hand held
- Cannot stand alone well
- Does not demonstrate balance reaction while in the kneeling position
- Does not walk alone one to two steps
- Does not demonstrate motor planning by climbing on furniture
- Has a hard time picking up small objects
- Does not attempt to creep upstairs
- Does not walk without support
- Cannot throw ball
- Does not bend down to retrieve objects
- Does not demonstrate balance reaction in standing
- Does not run
- Cannot walk upstairs with one hand held
- Cannot carry large toy while walking
- Does not squat in play
- Cannot retrieve toy off of floor from standing position
- Does not climb onto furniture, turn and sit
- Cannot build tower of 6 blocks
- Does not use utensils well
- Does not jump in place with both feet
- Does not stand from sitting by rolling on side
- Cannot catch large ball
- Has difficulty with gait and balance
- Does not walk downstairs using rail for support
- Does not have wide range of movement
- Does not run and stop without holding
- Does not avoid objects when running
- Cannot kick stationary ball
- Is not able to stand on one foot for 2 seconds
- Cannot build tower of 9 blocks
- Cannot complete 5-6 piece puzzle
- Is not using utensils properly
- Does not attempt to ride tricycle
- Does not demonstrate grasp of crayon
HCEI dba Karen A. Fay Physical Therapy Services
We provide physical therapy services to individuals from infant to adult. If you think you know of an individual may qualify for our services, or if you’re just not sure, see How to Obtain Services. Alternatively, you may visit our Physical Therapy Services page for more information.
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