Gross motor development involves learning the motor skills that allow an infant to move and explore their environment. This includes developing motor skills such as reaching for toys, rolling, sitting, crawling and walking. Young children will then add to these skills by improving their balance, learning how to run, jump, climb and participate in many aspects of life.
--What is gross motor delay?
Development is delayed when an infant or toddler does not develop skills within the expected age range. While there is much individual variation in the ages at which a skill may be achieved, there is still a range outside of which development would be called ‘delayed’. These age ranges are based on statistics from large populations of children, which are used for assessment tools.
--What causes gross motor delay?
Gross motor delay may occur for many reasons and may be expected if a child has a diagnosis such as cerebral palsy or Downs syndrome. It is also more likely if a child is born very premature where mild to severe delay can occur in up to 50 per cent of these infants. Sometimes there seems to be no reason why a child’s motor skills are delayed. Assessment, close monitoring and targeted interventions are important.
Some examples of delayed development include:
- unable to roll by 6–7 months of age
- on tummy cannot lift head and hold it up at four months
- not reaching for toys at six months
- poor sitting balance at eight months
- not walking by 18 months
- tripping and falling a lot at two years.
- not running in a coordinated way by three years of age.
--How do I know if my child has gross motor delay?
Physiotherapists have a selection of assessments they can use to assess gross motor delay. These can also give information about what the infant or child is able to do. Early motor interventions should ideally begin as soon as a motor delay is suspected. A diagnosis may not be available immediately but early diagnosis is becoming easier with the good-quality assessment tools that are available.
--How can physiotherapy help with gross motor delay?
Assessment by the physiotherapist can help identify specific areas of delay and reasons why this may be the case. This helps with deciding on the best interventions.
The physiotherapist and parent will develop some goals for the infant or child. Motor learning involves teaching different motor skills to infants by positioning and encouraging certain movements that strengthen muscles and develop posture and balance needed. Activities are repeated or practised which can strengthen pathways in the brain.
Education of parents is an important part of intervention, so they can practice at home and incorporate the activities into their daily routines. As children improve, the therapist will increase the difficulty of tasks in simple ways. New goals may also be developed with the parent.
In many cases, an activity or exercise will achieve many things. For example, in a small child who is unable to sit without assistance, using a supported sitting position and providing toys to encourage wider reach in different directions will help develop trunk strength and stability, postural reactions of body and head to the changes in position, dynamic balance in sitting, and also protective reactions (putting hand out to prop) when they reach too far.
--How effective is physiotherapy for gross motor delay?
The first two years of life is a critical period for neuroplasticity of the brain. This is the ability to develop pathways and learn and change depending on experiences. Therefore, it is important that interventions for children with motor delay or suspected cerebral palsy occur early to have the greatest impact on development.
Goals activity and motor enrichment program (GAME) has shown benefits for children with motor delay and those at risk of cerebral palsy. This is a program that uses motor learning principles, goal-orientated, activity based therapy, parent education and environmental enrichment strategies.
Children who are born early are at higher risk of motor delay and cerebral palsy, and a review of interventions for these in the first year of life has shown that interventions can improve the motor outcomes in the early years of life (up to five years).
A review of articles on early interventions for preterm infants found that intervention programs commencing in the first year of life have a positive influence on both cognitive and motor outcomes during infancy.
--What can I do with my child at home?
Providing an enriched environment at home is important for all aspects of early development. This is an environment that offers variety and opportunities for sensory, intellectual and motor stimulation.
For more specific activities in the case of gross motor delay, be guided by your physiotherapist—they will assist you with activities that target problems and are aimed at specific motor goals.
--Can I access funding with the National Disability Insurance Scheme (NDIS)?
The NDIS is now being rolled out in different regions, details of which can be found on the NDIS website. Your child may be eligible for this type of insurance if they have a delay or disability. There are different pathways for infants and children (0–6 years) who have delays that may not be permanent and those who have a diagnosed disability that will result in some ongoing impairment.
The NDIA has developed the Early Childhood Early Intervention (ECEI) approach, which will help identify the type and level of early intervention support each child needs to achieve their best outcomes.
