What If My Baby Is Not Hitting Milestones in Development?

Concerned about your baby not being developmentally where they should be? Join me as I talk with Pediatric PT, Dr Kristine Godsil about what defines “being delayed” and most importantly what thing you can work on at home.

Episode Transcript:

Hi, and welcome back. This is Bev Garrison from first breaths to first steps I have today joining me, Dr. Krisitne Godsil. She’s a physical therapist, does a lot of work with kids and we thought today we talk about some milestones. What if we don’t hit milestones? Rolling. Sitting, crawling, walking at certain timeframes. Welcome Kristine. It’s nice to have. Yeah, it’s great to be here. Christine is the director of the cherry Creek office in Denver, Colorado for active core physical therapy, and does a lot of great work in the space of moms, pregnancy, and kids. So it’s a nice continuum of physical therapy in that aspect.

I thought we’d get started with why milestones are important. It gives your healthcare provider. Cues about their developmental health, reaching certain things at certain specific age ranges tells us that they’re on track or possibly there’s some type of delay or maybe they’re a little behind or actually dis playing a problem.

What sort of milestones do you feel like you see commonly with the pediatric population. That they’re having delays or parents are coming to you or the pediatric healthcare professionals are reaching out to you for help. Yeah, I think the big ones are definitely crawling and walking. As a population or as new parents, those are glaringly obvious of , it feels like my kids should be moving at this point, but they’re not really interested or don’t know how. Those are the ones I usually get the most of and then what you pointed out to earlier, the ones that kind of fly under the radar, maybe a little bit too long are rolling and sitting.

I like to remind new parents, especially my clients that I’m working with, that milestones are in a range. It’s not like, oh my gosh, you hit 12 months when you were not walking in. That’s a problem. There’s this range of where you can achieve those milestones and that can still be okay. They can really help you to tell, is your child a little bit behind which can be okay, but then you can get with. Like yourself, a physical therapist that works with pediatrics or little kids and get an idea of maybe there’s some things I can work on or help to strengthen certain muscle groups and whatnot to get them moving and going. It does show that, like I said before, there is a spectrum, of normal. So if you’re not rolling exactly by four months, That’s okay. It might be a four to six months phenomenon. I tell parents, “man, you got a bigger baby. “There’s there’s a lot more to move there. It’s going to be harder. We have to take a little bit of context at the moment. Okay. Certain environment for that child, for sure. Knowing things, can happen and identifying problems early, helps us to get earlier intervention. I’m sure as you would notice that those kids that you see a little bit earlier on that spectrum, they might get help sooner obviously, but also get to where they need to be a little bit faster.

You got it. And like you were saying too, with the spectrum of it- it’s usually about two, three months for any of those milestones that we give a nice window. What also is important in that realm is interest. Like if your kid is actually interested or looks like they’re trying to do something or not, that’s also very indicative. If we’re falling behind. If there’s something else going on whether that’s in the home or whether that’s, with the child and how they’re observing their environment. I’ve had kids that are, you know, the third child and they’re getting carried everywhere. Right. They don’t have any interests because they don’t meet to. It’s not necessarily a bad thing, but it’s coaching your parents of they’re not seeking it out because they don’t want to. And they don’t need to, you’re taking them everywhere. Right? Right. Exactly. So thinking of those realm, cause it’s not always necessarily, it’s something developmental or always something that’s happening in the body.

Thinking about those environmental factors as well, right. It’s funny that you bring that up. I have three boys and the third is. Took a hot minute for us to start walking, scooping him up, including his older brothers. Yeah. So Maclain was just like, pick me up. I, I I’m ready. I’m ready to rock. You guys are ready to go. I’m ready to go. Let’s get it going. Birth order plays an important role, even as well with things like speech. Because the older siblings are talking for that little person and they don’t have a need for words, or maybe that child isn’t in daycare and doesn’t have that need to go,” hey, I want my toy back.” yes. Yep. That from me, you know, there’s just no need because everyone’s like the baby goes, eh, and you’re like, oh, milk, give him some milk. Exactly. Those physical attributes that we’re kind of looking at the rolling, the crawling, especially walking. I find that. Yeah. The ladder children in earth order the lower on the totem pole.

For sure, I did want to mention each state usually does have early intervention sort of services in Colorado, which is the system that I’m most familiar with. It’s called child find. And the set of providers will have PT, OT, speech, all of them, able to assess kids Development across the board and not just the physical things that you and I are talking about or motor development, gross motor development, but also, other things that we should be seeing at certain ages like speech.

The thing that I rely on the most, my coaching field and whatnot is using a screening tool. I don’t know. There’s you guys, as the physical therapist on the other end get a lot of feedback from your pediatric providers about those tools. Yeah, and I feel like everybody likes their own. But it’s nice to have knowledge, like a broad knowledge on all of them. What are we looking at? Is it, a nice inclusive one where it’s looking at fine and gross motor skills? Are they looking at speech as well. For my realm, when I’m doing an assessment and I usually use my assessment, not in a formal way, but more so as a guiding tool. I use the Peabody because it’s more encompassing for those gross motor skills, like crawling, sitting, walking. But it is nice to see and know what’s coming in the door, so you know what to do with that information. And then how to go about your evaluation with the kids.

It’s good for parents to know the names of those tools, because like, I don’t know, she ran some whatever on his Johnny and I had no idea what she was. It seems like the Peabody is probably a little bit more specific, whereas things that we use in general primary care practice, there’s two, the older one, which was the one, back in the day when I started umpteenth years ago, we won’t talk about that called a Denver II with a developmental screen. And what a grid you saw the time across the top as far as in months. And then it had. Areas of speech and gross motor fine motor things like that. And you would draw a line and see where you’re falling with. All of those at one time looked more commonly used is called the ages and stages questionnaire. And it’s the third edition. Called an ASQ or an ASQ3. In your general pediatric office, is that typically what parents are talking about? It’s used kind of systematically at every well visit. Somebody should be asking you some questions about what your baby is doing, and basically that for us doesn’t diagnose necessarily a problem. It just gives us trends of, Hmm. We’re maybe not moving along in our gross motor skills. Or even a refined motor skills. So it allows you to look at yes, different types of development, but it also allows you to look at a trend. Like, have you been noticing this since two months, four months, six months, are you passing any of those?

There is a lot of questions on there and I will tell you, it’s kind of nice if you go to a provider where you get it earlier, because as moms. It kind of takes a long time to fill out. And it’s pretty specific of what we’re asking you, does your child do, right? Yeah, I think it’s an interesting tool, but I think take it with a grain of salt because some of it is , if you’re not putting your child in that situation, they’re probably not going to do it.

Right. Just like you said, cause there’s one, if I remember correctly and it might be a different version of it, but it’s what does the child do with a baby doll and for our kiddos that aren’t growing up with a baby doll in the household or for whatever reason some will have reactions that they’re playing, they’ll throw it not everyone’s going to hold it and feed it.

Right. So to take it with a grain of salt of looking at being like, okay, well, but then I would look at too, how has their throwing, is it overhead? Is it under those kinds of things I’m not necessarily looking at? Oh my gosh, he’s so destructive. And he’s trying to kill the baby. Not as important sometimes in those, because not everybody has those toys, not everybody has all of that. Looking at the child for where they’re at, what is their environment and then making the assessment from there. It’s all about, is there a trend. Cause I’m sure you’ve seen it too, one symptom doesn’t always mean something. Right. One symptom could just be one symptom.

And unless there’s a grouping or something, that’s that’s trending in a direction. Then that’s where we call for services or that we’re calling to be like okay, maybe. You’ll look into here. But yeah, cause sometimes kids just do random stuff. It always it’s funny with the boys. I mean their, their gross motor skills were on it. Right. But, you know, I was like, “oh my gosh, these kids are like so crazy.” And they’re so full of movement. We’ve got to get outside and run and play in jump. I’m like, Can we thread yarn through macaroni, right. But he’s got a wicked left-handed knuckleball. We’re looking good at 18 months, you know? It’s all relative to where you’re at, right? Yes. So pretty interesting.

Well, today I thought we’d specifically kind of focus on four stages that parents commonly hear about. So rolling. Sitting crawling and walking. First of all, do you think it’s important that these things are achieved in a certain order? But then we’re going to go through and talk about. Sitting, when do we usually see that? And what can you do with maybe you’re not sitting independently or you’re not rolling, what are some things that you can offer from the PT side that could really get these kids kind of moving?

Do you think it’s important that they’re achieved in a certain order or range?

Yes and no. I mean, we have these motor milestones because of how they start to express it and child. But because there’s so many ranges, it’s sometimes it gets convoluted and overlaps. So I wouldn’t say that your child has to roll from back to belly before they sit before that, it’s just cause every child’s a little bit different. What I, what I’m looking at through my assessment. Is, what is happening with these motor milestones as we’re coming across or integrating reflexes? Our babies are all born with primitive reflexes or things that are there to protect them. And as these motor milestones start to express, those reflexes start to go away. We want to make sure that we’re having that nice, delicate dance or balance of those things happening when those don’t work together is when I have more concern. Is that when a reflex is staying around and it’s limiting them from rolling, you’re crawling, not necessarily that they have to roll, sit, crawl, walk,

yeah, I get that a lot. Parents will ask me, “well, we roll front to back, but we don’t roll back to front. They are rolling. Yes. Have that core control and they are doing it. And you very content maybe roll from their back to their belly. They may like it on their belly. Yeah, yeah. Happens a lot in the sleep realm. Once they get to belly, they’re super comfortable. They tend to stay. Yeah. So I always put that in perspective for parents.

Let’s talk about rolling first. Typically I see babies starting to roll over as early as four months old. They’ll rock side to side you know, kind of a motion that’s foundational for them to getting all the way over. They may roll from tummy to back at six months. Is typically were rollover. Both directions is what I see. If say I’m sending you a baby and I’m like this, baby’s just not rolling. It’s, you know, seven months. And we’re not seeing that. What sort of things or exercises or activities would you encourage parents to do in participate with.

Yeah, I think first off is trying to figure out what is their go-to activities. What are their toys that they like? Is it a mirror? Is it a something that shakes? Is it some push toy, those kinds of things. Trying to find something that the child’s always going to come back to is a big one. Because using toys throughout our sessions is pivotal. With any sort of rolling, it’s almost trying to trick those systems of again, playing around with what is the child going to do and how is that body going to respond? Generally I’m taking the toy and I’m having them just watch as I go from side to side.

So are they tracking the toilet the way that they should? And then also can they track the toy over their opposite shoulder? Because once the. Starts going around that time for the child and reflexes and development. Once the head starts going a direction, the body generally follows. So that’s usually where I’ll start with parents is trying to get that head and body connection to get that rolling to start whether it’s just a sideline, whether it’s, you know, from back to belly or belly to back, depending on the preference, because.

Like you said, some kids don’t like tummy time, so they’re going to learn really quickly to go from belly to back and never go back. Yeah. So it’s trying to find those kinds of tools of what that work looks like. But I think that’s the biggest, first step is trying with that glance of trying to figure out can the child track and will they go over that opposite shoulder?

Right? Because once the head goes, the rest of the body tends to follow. You got. Okay. I’m sitting, I would say for me is kind of the next milestone that I feel like I get a lot of questions about at four months, typically babies are holding their, their head a little bit more steady without support. And it’s six months babies usually begin to sit with a little help.

And I would say at nine months they’re sitting. Fairly well without support gets in and out of sitting positions but may require some help at 12 months, definitely getting to sitting kind of by themselves. What do you think can kind of encourage them to be able to kinda balance or tripod, you know, to, to kind of learn how to keep it up right before they topple over?

What sort of things or exercises do you recommend in that? Yeah. So usually around that like five month age well, you’ll be able to have them into that sitting position, but you need to be close by. So because as they’re learning that core balance, they’re also trying to figure out how do they catch themselves.

And that’s where I’ll educate parents on too. Is that. That chance to catch themselves going forward, always happens. First side to side is second and going backwards is last. And usually backwards is around 12 months. So don’t worry if that one doesn’t come to come quickly. But thinking about.

What, when we’re in that sitting position to challenge the core system is thinking about like, can you do hip circles with them? Or if they’re sitting on top of you while you’re laying down, are you guys moving side to side? Cause that’s going to add that reactivity of how they can kind of counterbalance themselves.

Because we already know like babies are a little top heavy for a while. Their heads are really pretty big and that’s why the body follows it. So trying to keep that in mind. So usually I’ll have them work in, play in front since that’s the first thing that’s going to help them catch. So again, finding a toy, something that they’ll want to reach for something that you can bring up to them.

Cause like you’re saying six months is about, they can sit on their own between like eight to 60 seconds. Before they need to catch themselves or before something happens, nine months is where we see them sitting pretty regularly. They’re playing with toys, no issue. You can kind of like, not worry about them toppling over.

So thinking about those kinds of situations of making sure that you’re setting them up for success, because if you’re putting toys all around them in their favorite toys to the right, but they’re only six. I’m probably going to fall over a couple of times. So keeping those in front and center until they get more balanced and more reactivity of sticking that arm out so that they don’t fall.

Yeah. More ability to kind of rebound out of that. You got it. Okay. So crawling, I always have a question with the parents. Like, do they have to crawl before they walk? What do you say to that? I usually say no. I’m like, yeah, we like them too, because it is kind of a precursor for some different activity, but some kids.

Yeah, I think, I don’t think it’s as important as long as we see that those gross motor skills are translating as they’re walking. Because for crawling, we get a lot of this cross body connection that’s happening. And if we think about it, that’s good for walking, running, jumping, like thinking, jumping jacks, those kinds of things.

Right? So as long as we can see those arms, your hips, your body move, and kind of disassociate from each other. No, if you, if your kid doesn’t crawl and you know, they’re running a spine. It’s pretty, it’s pretty certain that you’re going to be okay. It’s it’s those times that they didn’t crawl and they’re like walking, but they’re not running or jumping or like that kind of connection isn’t happening then.

Yeah, maybe it let’s see what happens if we put them in a crawling position, but I wouldn’t say it’s like end all be all for. Right. I would say most babies. This, this seems to be a wide range for me. We’ll crawl between six to 12 months. And there’s a wide differential there of what we consider normal when it comes to reaching that milestone at six months, old, babies will roll back and forth on hands and knees and kind of rock a little bit.

And that I find is a precursor to kind of getting that cross body coordination to crawl, you know, kind of adds their. They’re rocking like that. Sometimes you’ll tend to see them go backwards, which parents are like, come on. Like that normal, that will come first before the forward motion. But by nine months I find they’re creeping, crawling some babies doing some type of commando crawl, which is still cross-body right.

Cause you’re doing opposite even if you’re not involving your legs as much. Yeah. So I think with that, what I always tell parents, like get down in front of them, you know, when they’re walking or when they’re rocking, because you’re kind of motivational and they want to get to you. What other suggestions do you have as far as, as crawling.

Yeah. If you can have two people working together for it, cause then that way, you know, the child can go back and forth or, you know, sometimes in session, like they’ll get stuck on something. Right. And so then we’ll just use that object. And it looks mean, but you’re just slightly pushing away because.

Getting that motivation and that moment, and to move forward is going to find how to move, to get it. And like you’re saying what that more army crawling or what would be typically crawling is whether it’s, you know, their arms that are propelling them or their legs. And so usually in those times too, if it doesn’t look like they’re getting a new.

For us with their arms. I usually give it back board for their feet. So if your baby is that, that army crawler, you can always put like your shin against them. If you’re sitting with them on the floor, you can put a hand on one of the foot one of the feet so that they have something to push off of.

Cause sometimes it’s just that one little push that they’re like, oh, I can do that. That’s cool. And then, like you were saying too Getting them into that hands and knees, if we’re starting to work on that, like creeping motion is, is pretty important. So if they can get up into hands and knees and bras, that’s awesome.

They’re really close to crawling probably. If they need a little bit of help that they’re just like, just rolling or just doing that army crawl. Most of the times I’ll take like the front of hips and just kind of help guide them back. And then that way too, it kind of winds them up and sometimes they just kind of propel forward.

And so it came exactly. So it could almost look like an inch warm at first until they kind of make that connection. But generally those are the, those are the first kind of tips that I help with parents a little bit of, you know, if we’re all on the ground than babies and wouldn’t be on the ground too.

And so making sure that they have that time and, you know, put that effort in. Getting to something. Cause most of the time too, it’s it’s again, are we putting everything at their, at ease for them? Or are we adding a little bit of challenge? So they want to move to kind of looking at those kinds of environmental.

Right. I was just thinking, you know, I also tell parents do things in the morning when baby’s a little bit more fresh. You know, by 3 30, 4, o’clock we’re all kind of done, right. Very hard to teach new tricks in the afternoon. We’re tired. Right? We’re kind of overstimulated. We’ve had. A lot of movement during the day.

So if it’s possible, I encourage parents to try and do some of those things in the morning when they have a good nap and they’re refreshed and they’re happy. Just because when you’re frustrated, it’s really hard to learn new tricks or. To achieve and, you know, act in the moment. Right. So I do try to remind parents as that too.

Okay. So walking the big ones, I usually say that you’ll see prison first, where they’re kind of pulling up and scooting along. Something happens. Anywhere between nine and 12 months with that cruising. But it’s a great way of baby being able to test walking waters and being able to kind of feel that balance of being a bipedal up on too.

But usually to me, that’s a sign that they’re going to be walking soon. You’ll also see them transfer like maybe from the couch to the Ottoman, things like that. But between it’s a wide range as well. 1820 months, maybe kind of a time for walking with average being around 12 months. But again, what sort of things do you recommend if babies aren’t.

Really propelling that way. Like I will tell you probably the most common scenario that I see is you’re trying to get that baby up to bear weight. And they’re just like flipping those legs up. Like they don’t want to bear weight at all. What things do you recommend doing in those sorts of situations?

Yeah. And usually it’s trying to find. Yeah. How, how do they react to those different pressures and then how can you counter it? And so until we find that nice balance, but an easy one is like, if you’re sitting, whether it’s butterfly or whatnot in front of the couch, and Dave is in between you and the couch, if they’re sitting on your lap, then there’s only one place to go, right?

So you can help kind of propel that forward of having them reach up to the couch. And then usually. Either, like have one hand on the belly and one hand on the bottom to kind of help get them upright into that position. And that is that motion kind of over and over again, and kind of congratulating or, you know, have something there that they want up on the couch to make that a little bit easier, especially if your kid is just kind of.

You know, whether it’s going back into that extension of kind of flinging backwards, whether it’s like feeder up and there’s like, no, I’m not putting weight down. But happy little guys, like just, I am not putting my feet down. Huh? Yeah. And those are the times too, like you’re saying there’s multiple things of looking at, are they going to be walking soon?

And I would say cruising it’s going, it is transferring those surfaces. The other one that I think is pretty crucial is like the standing on their own or trying to get up. So it’s almost going into that, like, Type or downward dog position. And sometimes they’ll just like fling up and then they plopped down because they’re like, oh, I don’t know what to do up here yet.

There’s no balance in here. Exactly. Exactly. So those are the three that you’re like, oh, okay. Like things are happening. So that tapping around that 12 to 15 months. Those weren’t, wouldn’t be the times to be like, oh my gosh, he’s not walking. You know, she’s not walking yet. We should probably talk to somebody it’s good to have it on somebody’s radar.

But knowing that we’re going in the right direction for the kids that just stick to cruising. Cause I feel like sometimes that can be something that they’ll just stick to. Cause they’re like, Hey, there’s enough around here. I can hold onto something. Right. Usually I’ll get them into that cruise position.

So whether it’s around the couch or not, we’ll read a book, we’ll play a toy on the couch and then we’ll kind of shift. 90 degrees. So we’re on the edge of the couch now. And we’re looking until we’re fully turned around that their back is against the couch. And, and then we’re, you know, facing outwards with the book, with the toy we’re reading.

And then maybe I’ll scoot a little bit like an inch or two forward, because more often than not that kid’s gonna want to have hands on it. They’re going to want to point to something they’re gonna want to touch, whatever that we’re doing. So it’s those little baby steps. That’s that is the same for a reason.

Cause it takes a little bit until it kind of clicks for the body. So those would be the first ones that I would try if, if kiddos not wanting to put any weight or if they’re not wanting to transition from those surfaces, so. Okay. How do you feel about walkers? Like as far as like push toys?

I’m okay with that. As long as it doesn’t come out from under them all the time, because it’s like are too fast. You know, as far as walkers that you put the baby in with wheels, I don’t ever recommend those just because I don’t want kids going over surfaces downstairs, whatever. It’s more of a safety aspect, but what do you think about like the disks sort of excess saucers where you sit the child in and sometimes their feet aren’t touching or they’re not able to push back?

Like, do you have recommendations with use of those or. I think for the, yeah, for the saucers or the activity tables that move for those, what I see most is that they’re not fitted properly for them or they’re put into soon, cause they’re not big enough for it. So making sure that he can stay flat on that surface and that includes some of the saucers, that’s just like a bounce table, right.

That they’re not moving. I’ll have kids that will be plopped in it and their toes are just pointed and you’re like, oh no, like let’s not start there. Right. Right. So making sure if he can stay flat or that they can move and kick those feet underneath them. And then also that they can be upright. Cause that’s the other thing is like, if kids leaning way too forward and they’re hovering over their activity, but they can’t come back out of it.

That’s an issue too. So oftentimes if we’re. If we’re able to have our feet flat, but we’re not able to have that like stability of our abdominals or the core working for us. I’ll usually use like a towel roll in front of them just to give a little bit of support, to be more upright so that we’re working in a better in a better place so that they can play that.

They’re not limited to that motion of being just over something. Right. But again too, with the saucers that move, I’m kind of on your side of it too, it’s more safety than anything and you just don’t. You don’t want that kid to be there in that law. That’s more of that container theory, right? If your kid’s always in something then that’s an issue.

We want them to be on the floor. We want them to have that play time. So making sure that there’s some sort of environment that they can crawl, walk, be on their belly and all sorts of ways is better than any container. Because that’s, what’s going to get them Xen is having that availability or that range.

So simple maths with maybe like a playpen or something. I would choose that over any sort of container. Yeah, but, oh, and then the standup walkers. I, yeah, I think as long as they have the locking mechanism on them, that’s not going to like, you know, propel them totally forward all the time. And then again, most of the time it’s fitting, so sometimes it can be too tall for a kid.

And so we’re not really getting the benefit out of it because of how they’re trying to push it. It’s not gonna move. Since it’s more on those back wheels instead of the front, or if they could Sue tall and we can’t move it up high enough. So making sure that they’re in again, the most optimal position, because if they’re learning how to walk of having that motivation or that

Momentum. If there was learning how to walk with that momentum forward all the time, because it’s too short, then that’s going to translate of how they’re walking to without it. And that’s not really optimal for the child either. So we don’t want them to always be pushed forward or always feel like they’re running or having to catch their balance.

So just making sure that we’re setting them up for success for whatever device you have. Right. Sometimes with those toys, it’s a little bit difficult because they have to be somewhat easy to move for a child to understand, but you’re right. I feel like it gets them a little bit off balance and they tend to be always planing in this forward.

Motion is not balanced, right? It’s ergonomically, not the position that they’re going to do best as far as being able to. Propel forward and stay upright at the same time. You got it. All right. Well, I think our information today was super helpful. I mean, it covered a lot of ground of what parents are concerned about and what they ask questions about.

So in summary, I always like people to remember developments on a spectrum, right? It’s not going to happen. Week 24. We are not exactly going to see something. And so also it depends on the environment as well as what you put your kids into explore and to learn also depends on your body habitus of your baby.

Right? You’ve got a bigger baby. You might. Be a little bit slower to have some milestones to move around. And so that can be difficult. But I think the thing to remember is early intervention is key. If you and your pediatric healthcare provider are noticing that yeah, we are seeing them lag, you know, Earlier in this situation tends to always be better.

The more time, the more influence we can give, usually we can get them kind of caught up or identify what is the best thing to do for them. To get them moving in the right direction. Yep. Absolutely. All right. Well, if you guys found the information that Christine and I talked about today, helpful, you can press the link below to look at the transcript notes.

You can also, if you’re interested in working with me in coaching you and your new baby from first breaths to first steps, you can contact me@bevgarrison.com until next time be well.

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