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Children demonstrate strength, coordination, and controlled use of large muscles.

Gross motor development includes the control and movement of large muscle groups such as the torso, head, legs, and arms. Children begin working on their gross motor skills as soon as they are born. These skills develop from top to bottom.

Children who do not have any developmental or health challenges first gain control of their head. Next, children gain control of their torso and begin to learn balance, evidenced by their ability to roll over and sit up. Eventually, a child can use the lower half of his or her body when beginning to crawl, cruise, and walk.

Children need time and space to work on these very important skills. Even when they are newborns, children can be placed on their tummies to gain strength in their necks, which is essential for head control. Tummy time also helps develop children’s torsos and eventually will contribute to their ability to roll over and push up. Once children can sit up, they have a whole new way of observing and exploring their world. This new position supports children in scooting, crawling, climbing, and, eventually, walking.

Physical development is one area that is greatly impacted by physical disabilities or health issues. Children with disabilities may not master all gross motor skills. Instead, individual growth will vary and depend on children’s own unique abilities. For example, a developmental milestone for a child with a physical disability may be learning to walk with a walker by the age of three.

Birth to 9 months

Children are beginning to develop and coordinate the large muscles needed to purposefully move their bodies.

Indicators for children include:

  • Lifts head while on tummy
  • Brings feet to mouth while lying on back
  • Rolls from back to stomach and from stomach to back
  • Brings both hands to midline, i.e., center of the body
  • Begins to gain balance, e.g., sits with and without support
  • Scoots body to attempt to move from one point to another

Strategies for interaction

  • Provide plenty of tummy time when the child is awake and alert
  • Provide a dedicated area on the floor where the child can safely explore, roll, and work on additional skills
  • Support the child when mastering a new skill, e.g., keeping arms out to the side for a child who is working on keeping balance while sitting
  • Place objects so that they are visible but out of reach for the child, to encourage movement; watch the child’s cues carefully to prevent frustration

7 months to 18 months

Children develop mobility, as they purposefully move from one place to another with limited control and coordination.

Indicators for children include:

  • Moves from hands and knees to a sitting position
  • Rocks back and forth on knees
  • Crawls from one point to another
  • Pulls to a stand using help from furniture or caregiver
  • Moves objects with large muscles, e.g., pushes a toy car with legs, rolls a ball
  • Cruises while holding on to furniture, e.g., walks around crib, holding on to railing
  • Briefly maintains balance when placed in a non-supported standing position
  • Takes steps independently
  • Gets into a standing position without support

Strategies for interaction

  • Create a safe environment for the child to move around in
  • Encourage the child to move by placing novel objects out of reach
  • Introduce objects that the child can crawl or walk through
  • Encourage new skills by demonstrating enthusiasm and pride as the child begins to attempt the skill
  • Play interactive games with the child, e.g., roll a ball back and forth
  • Support the child as he or she masters new skills, e.g., provide physical support by lightly holding child who is attempting to take his or her first steps

16 months to 24 months

Children now have gained more control over their movements and begin to explore different ways they can move their bodies.

Indicators for children include:

  • Attempts to climb objects, e.g., furniture, steps, simple climbing structures
  • Holds objects or toys while walking, e.g., pulls a car by a string while walking around the room
  • Kicks and attempts to catch a ball
  • Rides a toy by using his or her hands or feet

Strategies for interaction

  • Provide opportunities for the child to run, climb, and jump outside
  • Create safe places for the child to climb; remain with the child in order to prevent falling and injury
  • Use movement games to promote balance, jumping, and hopping, e.g., “follow the leader”
  • Engage in games with the child that encourage the use of large muscles, e.g., roll a ball with the child, create simple obstacle courses to maneuver

21 months to 36 months

Children begin to master more complex movements as coordination of different types of muscles continues to develop.

Indicators for children include:

  • Stands on one foot with support and maintains balance for a brief period of time
  • Jumps forward a few inches; jumps from slightly elevated surface onto the ground
  • Walks up and down the stairs by placing both feet on each step
  • Throws a ball
  • Walks on tiptoes, walks backward, and runs
  • Pedals a tricycle with both feet

Strategies for interaction

  • Incorporate outdoor games where the child has to jump and run
  • Provide safe climbing structures and other materials such as tricycles and low balance beams
  • Use dance and movement activities to encourage the child to move his/her body in different ways
  • Engage in activities that promote throwing a ball

Real World Story

Jacob is 18 months old and was born with Agenesis of the Corpus Callosum (ACC). ACC refers to the absence of the corpus callosum, the band that connects the two sides of the brain. Because of this impairment, the right and left sides of Jacob’s brain do not communicate properly. Jacob has vision impairment, low muscle tone, and poor motor coordination.

He is enrolled in Early Intervention, and a physical therapist, speech pathologist, child-development specialist, and occupational therapist all work with him in developing his skills.

Jacob recently met his goal of crawling. While crawling is often accomplished by age seven to 10 months, Jacob is developing this skill later than what is typical because of his disability. For the next six months, Jacob’s physical therapist will work with him on reaching the following milestones: climbing, taking steps with a walker, and standing unassisted for three seconds. A major goal for Jacob is to take two to three steps unassisted by age two.

Discover how this Real World Story is related to:

Jacob’s disability has also impacted his fine motor development. Currently, skills he is working on include feeding himself finger foods and stacking one block on top of another. He is also focusing on engaging with different types of sensory materials such as play dough, water, and sand. These activities help with his sensory input and help him build tolerance for different types of textures. Again, these are all developmental skills that are often mastered and experienced earlier, but Jacob is developing at his own unique pace.

THIS EXAMPLE HIGHLIGHTS how a disability can impact all areas of development and how it changes the developmental trajectory for children. Jacob may not ever be able to do all the things that typically developing children can, but he is nevertheless working to reach his milestones at his own pace and in his own way. Jacob may not walk unassisted for years, but he is achieving milestones that will support him to eventually reach that skill when he is ready. Since Jacob has global delays, he is receiving therapy for all areas of development. This approach is important because all areas of development impact each other. Early intervention in the first three years is so important for children with developmental delays; it is a critical period for learning and can provide children and families with a much-needed support system.

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About this resource

Age Levels (the age of the children to whom the article applies):
Reviewed: 2012