Greater Glasgow and Clyde
- 1Plagiocephaly/Head-Turning Preference
- 2Dislike of Tummy Time
- 3Delayed Milestones
- 4Delayed Sitting
- 5Delayed Crawling
- 6Bottom Shuffling
- 8Delayed Walking
- 9Normal Variations in Children’s Gait
- 10Recommended Activity Levels for the Under 5's
Most children develop in a similar pattern. Sometimes as a parent or carer, we can worry about whether our children are "normal". We might worry that our child is not following the typical, expected pathway or that their movement looks different.
Most of the time, our concerns reduce as our child develops and we see our issues resolved. If you are concerned about any aspect of your child’s development, please have a chat with your health visitor or GP.
When your baby is born, labour can cause their head to become misshapen. This is normal and corrects within the first few weeks after birth.
If you have noticed that your baby is developing a flat spot on the back or side of their head, it could be due to a head-turning preference. Plagiocephaly is the medical term for head flattening which is produced by pressure on the baby’s skull when lying in the same position for prolonged periods of time. Newborn babies have very soft skulls which are susceptible to being moulded or flattened.
It should be noted that this is cosmetic and does not cause any pressure on the brain or any developmental problems.
Dislike of Tummy Time
Tummy time helps build muscles that your baby needs for activities like sitting and crawling. It also helps your baby develop a more rounded head shape.
Tummy time should be carried out as often as possible when your baby is awake, alert and happy. Don’t be discouraged if your baby dislikes tummy time to start with. With practice, encouragement and interaction your baby will start to enjoy being on their tummy.
Click here for further information on Tummy Timefrom the Association of Paediatric Chartered Physiotherapist (APCP).
Children develop at their own pace, so it’s impossible to tell exactly when a child will learn a given skill. However, the developmental milestones give a general idea of the changes to expect as a child gets older.
As you can see from the following graph, there is a huge range of variations in when a child achieve certain milestones.
Most children learn to sit between 4 to 9 months. Sitting can be delayed if children aren’t given the opportunity to practice this position. Children who prefer playing on their backs for increased periods of time may be later to sit. Also, if the child has a dislike of tummy time (see above) this can directly affect how strong the back and neck muscles are. Continue to practice tummy time in a variety of ways. The videos below will give you some suggestions to try with your baby.
Click here for further information on Promoting Physical Development Lying to Sittingfrom the Association of Paediatric Chartered Physiotherapists (APCP).
- Tummy Time
- Hands to Feet
- Pull to Sit
- Supported Sitting
Most children begin to crawl from between 5 to 13.5 months. Some children don’t crawl up on their hands and knees. Some may:
- Roll from back to front to back.
- Commando crawl (move along the floor on their belly by pulling with their arms/pushing with their legs).
- Move along on their backs by pushing with their legs.
- Bottom shuffle (can be with one leg tucked under, side propping on one hand or pulling with both legs in a frog-legged position).
Crawling up on hands and knees allows the child to develop their shoulder and hip muscles’ strength and stability. This is important in preparation for more upright activities such as kneeling play and eventually independent walking. We would always encourage hands and knees crawling whenever possible.
Bottom shuffling is a common way for children to move. It can delay walking until 24-30 months. This can lead to worry for parents and carers. Once a child becomes fast and efficient in bottom shuffling it can be very hard to break this pattern of movement. It can make the progression from crawling through kneeling to pulling to stand more difficult. Try not to worry they will get there in the end.
- Starting to Crawl
- Sit to Stand
- Bottom Shuffling
Some children W-sit. This is when they sit on the ground, with their bottom, knees, and feet all touching the ground. Their feet will be resting outside their knees. When looking at the seated position from above, it resembles the letter ‘W’.
There are a number of reasons why children ‘W’ sit. This position should be discouraged as it can cause problems such as:
- Decreased core muscle activation.
- Poor posture.
- In-toeing walking pattern.
- Decreased trunk rotation.
- Delayed or impaired gross/fine motor development.
- Stress on joints.
- Back or hip pain as an adult.
Most children learn to walk between 8.5 to 17.5 months. This may be delayed if they preferred to bear walk, inchworm, bottom shuffle or commando crawl. These are normal ways for children to move but can delay walking to 18-24 months. A baby walker will not help and is not recommended as it encourages toe walking.
Physiotherapists and other Health Professionals DO NOT recommend the use of baby walkers or jumperoos for these two main reasons:
- Safety- even under supervision there are high numbers of accidents reported every year including falling downstairs, head injuries, burns, scalds, and trapped arms/legs.
- Delayed development- studies have shown that baby walkers and jumperoos delay the achievement of standing and walking. Contrary to popular belief, they DO NOT teach a child to walk. They encourage children to bounce and walk on their toes which may continue when they learn to walk independently. The more time your child is in one of these devices, the less time they have to practice moving on the floor. In turn, this will delay them getting up onto their feet.
The use of baby walkers/ bouncers/ static entertainers/door bouncers isNOTrecommended.
Normal Variations in Children’s Gait
Parents often ask whether or not their child is walking “normally”. In most cases, their gait pattern will be normal with no reason for concern. There are a huge variety of toddler gait patterns. What you may consider abnormal may be a ‘typical’ gait pattern for your child's age and/or stage.
Although parents often worry about the following, these are considered normal variations in a child’s gait.
The following are considered normal variants in a child’s gait, although parents will often consult for advice:
- In-Toeing Gait
- Flat Feet
- Curly/Crossed Toes
- Knock Knees/Bow Legs
- Tip-toe Walking
- Frequent Falls
Some children’s feet turn in when they walk. This is called in-toeing or ‘pigeon toe’ and is very common in young children. It is one of the most common normal variants in children and is usually seen in both feet but may be just one.
We know that the majority of children between 1-6 years of age have flat feet. All children before the age of 3, have flat feet, as the arch on the inside of the foot does not begin to develop until after this age. This is part of the normal development of their feet. Over 95% of children grow out of their flat feet and develop a normal arch. The other 5% continue to have flat feet, but only a small number will ever have a problem. Most children with persistent flat feet participate in physical activities, including competitive sports, and experience no pain or other symptoms. It is less important how your foot looks as to how it functions. Most children with painless flexible flat feet do not need any treatment.
Click below for further information onflat feet
- Flat Feet in Children Leafletby Association of Paediatric Chartered Physiotherapists (APCP)
- Flat feet in children - information for parents and carersby Royal Hospital for Children Glasgow
Congenital curly/crossed toes can occur on one or both feet and affect the 3rd, 4th and 5th toes. The toes tend to be flexible and don’t interfere with walking. A referral is not required, as Physiotherapy will have no impact on this condition.
Knock Knees/Bow Legs
Knock Knees is normal in children from 2-4 years. In this age group standing, a distance between the ankles of 8-10cm is normal. It should self-correct by 6-7 years of age.
Bow Legs is normal in children up to the age of 4. It can be associated with obese/overweight babies/toddlers and early walkers. In this age group, in standing, the distance between the knees of 8-10cm is normal.
These conditions do not require a referral to Physiotherapy.
Toe walking is only normal as a transient phase in the early stages of walking independently.
Long-term toe walking can cause the forefoot to broaden, and the heel bone to be under-developed, which leads to issues with finding footwear to fit.
Click here for further information ontip-toe walking
Falls are part of every baby and toddler’s daily life. Falls help children learn how to get back up, problem solve, strengthen their core muscles, and also work on their balance. One study has found that on average, a group of normally developing one year old children fell 17 times an hour. The number of falls should reduce as children get more practice walking independently. They should be given as much opportunity to do this as possible. Choosing the correct footwear will help provide stability around the ankle, thus helping to reduce falls.
Click here for information on our KIDS Developmental Timelinefor learning to stand
- Different Journeys of Development
- Common Areas of Concern
- When to Seek Help