Physical development Facebook Q&A

Should I correct my child's toe-walking? When is it ok to use an exersaucer? Do babies have to crawl before they learn to walk? Paediatrician and Fisher-Price Play IQ™ Expert Dr. Katie Heathershaw answers your questions about kids' physical development.

Q) My four- year-old toe-walks a lot, and has on and off since she was little. She has no other sensory symptoms (been suggested many times by lay people as sign of autism etc. but all Dr/health professionals and we don't think it's related to anything like that). We don't know whether we should get her to stop or not? If we correct her she walks properly but if she gets distracted she goes back to it. Is it going to have any long term effects?

A) Toe-walking is quite common when children first start walking but most grow out of it by about two years of age. As you have alluded to, if it persists beyond this age it can be a sign of other problems such as autism, cerebral palsy or muscular problems. In these cases there would be other symptoms. Children with an autism spectrum disorder would also have delayed social communication, repetitive behaviours, restricted interests and delayed imaginative play. If there are no other symptoms, no tightness at the ankles or Achilles tendon and your daughter is able to walk with flat feet when reminded then the other conditions are unlikely and the diagnosis is likely to be ‘idiopathic toe-walking’ which is not serious. Walking up on toes is not as stable as regular walking so can result in more falls. It is a good idea to have a check with your doctor to screen for underlying problems and see if any treatment such as stretches, physiotherapy or orthotics may be needed.

Q) My nearly six month old hates tummy time. He still can’t sit on his own or crawl. He rarely rolls over either. Should I be worried?

A) Developmental progress can vary quite a lot from one baby to the next and other factors like sickness or prematurity can also influence your baby’s development. Fisher-Price’s Play IQ website is a great resource for checking where your baby’s development is at and for getting some ideas for activities and toys to encourage him to get to the next milestones. For example, the Fisher-Price Rainforest Deluxe Gym may help with your tummy time problem!

Tummy time reluctance can become a bit of a self-perpetuating issue because as he spends less time on his belly he doesn’t become accustomed to it, build that upper body/shoulder and neck strength or learn to roll as quickly (though he will learn it eventually so don’t worry!)

Try to encourage your son to gradually spend a little more time each play time on his belly. Mix it up with time outside on a rug under the trees or try some time on his tummy on your chest. If he is still struggling to lift his chest and upper body up, try placing a small folded towel underneath your son to help prop him up a little. Unsupported sitting is also a variable milestone and it’s not uncommon for this to not be achieved until seven months or later. Until then make sure you prop him up with plenty of cushions or by sitting behind him. If you are concerned about your baby’s development check with your health nurse or doctor.

Q) My almost one year old has been commando crawling for months but doesn’t get up on all fours. She pulls herself up and is cruising around furniture and can get herself in and out of a sit position. But no signs of cross patterned crawling. Should I be worried?

A) Crawling is actually the most inconsistent gross motor milestone. Some babies never crawl, some crawl commando style then move on to more traditional ‘up on all fours’ crawling, some crawl ‘bear’ style and others bottom-shuffle. All are effective ways to move and are considered normal variations. However if you are worried about your baby’s development please make an appointment to discuss with your health nurse or doctor.

Q) I have identical triplet boys who are six months old tomorrow (born 11 weeks early). One of my boys isn’t really reaching out much for his toys under the play gym like his brothers do and I’m wondering whether there is anything I can do to help him?

A) Your triplets corrected age is a little over three months so when we are thinking about developmental milestones that is the age we should be using. It is always tricky with multiples because you can’t help but compare but the reality is that at this age we would only really expect babies to be just starting to discover their hands and to start to ‘bat’ at toys. If your son has also had to face some medical issues with his prematurity or perhaps he has a different temperament, or this is just normal variation, then that could easily explain the difference you are seeing. A couple of points to note: it is important to be sure that his vision is ok. Is he fixing and following your face and toys? Is he moving his limbs well and equally? If all is well on those points then continue to spend time in play with all three boys under the play gym and face to face with talking, singing, reading and the rest will follow. If you do have any concerns please ensure you check with your health nurse or doctor.

Q) When is it appropriate for my baby to use an exersaucer or jumper chair?

A) These items should only be used when your baby has very good head control and is able to sit with support as well (which indicates good truncal tone). This is usually at about four to six months but does very much depend on the individual baby. I would also suggest using these when your baby is well rested as of course your child is going to be better able to maintain head control etc. when they are not tired. Make sure you are using a product with excellent safety standards like the Fisher-Price Rainforest Jumperoo and check with your health nurse or Doctor for further guidance.

Q) My daughter is almost 28 months old and finds it hard to jump. She tries so hard it’s like a one-legged hop, quite cute but share really wants to jump both legs up. Anything I can do to help her?

A) Jumping from a standing start is usually achieved between two and a half to three years of age and is more difficult than hopping off a small step so practice this simpler skill with your daughter first. When you’re out walking look for very low walls or safe curbs; stand on it together holding hands or stand in front of her holding both her hands and encourage her to jump on ‘3’! Bouncing together on a trampoline may be another way to give her the idea or pretending to be frogs and leap frogging around (show her how to squat then leap). Your daughter will eventually learn this fun skill but if you have concerns about more persistent delays in motor development then a paediatric physiotherapist or occupational therapist may be able to help.

Q) My five-month-old daughter tends to look in one direction more than the other. I can’t tell if her head is being pulled that way or if she just favours that direction. Should I be worried?

A) It is not uncommon for babies to have a preference to turn their head to one side or the other due to their position in the uterus. Another cause for this issue can be a tightening or stiffness of the neck muscle (sternomastoid muscle) which is called a torticollis. In the first instance even though your baby’s head will naturally come to rest on the preferred side, there is no stiffness or limitation to movement. You can check this by gently placing your hands on your baby’s head and moving it from side to side (passive range of movement) or by moving your face or interesting toys to your baby’s non preferred side and seeing if your baby is able to turn her head to look that way (active range of movement). In both cases an associated problem can be positional plagiocephaly or misshapen head, where baby can develop a flattened area on the back of the head on the side she always turns to. The best way to check for this is to get a ‘bird’s eye view’ of her head (when wet if she has a lot of hair) to check the symmetry. If your daughter does have a torticollis her chin will point to one shoulder and her head will point to the other shoulder. The muscle will be tight on the side that the head is tilting to, more commonly the right. Torticollis can be associated with a difficult birth and also can be associated with an increased chance of congenital hip dysplasia. It is not unusual for there to be breast feeding difficulties due to the head preference but sometimes using the ‘football’ hold will be helpful. Medical assessment, initially with your health nurse, is probably a good idea for this problem to set you in the right direction as torticollis does need management by skilled paediatric physiotherapist, whilst other head turns and plagiocephaly need increased tummy time and positional management.

Q) My very big baby (90+ percentile for height and weight since birth) surprised us by walking unaided at nine months. We had always read that big babies walked later. I don’t necessarily believe this but I’ve been told we need to “make him” crawl more because “that part of his brain will be underdeveloped”. Can you shed some scientific light on this please?

A) This is a good issue to have raised and often a question that I get asked. Crawling is said to be important to build strength in the shoulders, upper body, hands and wrists, as well as involving bilateral coordination, motor planning and cross body patterning. However there is no scientific evidence that shows that children who skip this milestone by moving straight to walking, or bottom shuffling, or commando crawling would be better off if ‘made to’ crawl instead. I’m sure that as a parent of a nine month old who is now on the move you know that would be a pretty unrealistic idea anyway! You can still give him those experiences by setting up a crawl tunnel using old cardboard boxes joined together like a tube, or let him crawl his way over a doona or cushions piled on the floor and when he gets a little older he can pretend on all fours to be all sorts of four legged creatures in fun imaginative games. If you are concerned about your baby’s development please make an appointment to discuss with your health nurse or doctor.

Q) My four-year-old daughter can’t learn to ride a bike as she physically can’t push the pedals. Should I be worried?

A) Learning to ride a bike is quite a feat of bilateral coordination, motor planning, balance, direction and bravery! Most preschoolers will first learn the skill of pedaling on a tricycle where they don’t have to deal with the balance issue but even then it can be quite a knack to get the hang of alternating the pressure on first one pedal, then the other. Some children get the idea easily whilst others take longer or are not even particularly interested in this activity. It is a very variable milestone and not one you should worry about. If your daughter is frustrated and really wants to learn you could help her by first of all demonstrating the cycling (pedaling) action off the trike. Get her to sit on a stool and take a hold of her feet in your hands to demonstrate the movement. Next, let your hand be the pedals and ‘cup’ each of her feet (with her still sitting on the stool/pretend trike seat) and get her to cycle by alternating and pushing down first one, then the other. You can give a little squeeze to the foot that should be pushing down. When you move to the real trike, you may start alongside her so you can tap her knee to remind her which foot should be pushing on the pedal. Eventually it will just ‘click’ and she will be away. Just like riding a bike…! But if you have any concerns about your baby’s development make sure you check with your health nurse or doctor.

Q) My two-year-old grandson is very pigeon toed. How do we stop it? I heard years ago an old wives tale to put their shoes on the wrong feet. Does this work?

A) Pigeon-toed or an in-toed gait is very common in toddlers and usually completely benign if there are no other medical or developmental issues. The most common cause is tibial torsion, where the tibia tilts inwards, or metatarsus adducts or curvature of the foot. Both of these conditions do not require any treatment and will usually improve as children get older and won’t cause any long term problems. Putting the shoes on the wrong feet will certainly not help! Make sure you also visit your health nurse or doctor to discuss further should you have any concerns about your child’s development.

This article was published in association with Fisher Price.


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