There is some evidence that "The Back to Sleep Campaign" to decrease the incidence of Sudden Infant Death Syndrome, may slow emergence of some early motor milestones. The research indicates that typically developing children tend to catch up and achieve walking within the same time frame as babies positioned on their bellies. The question remains how the minor delays affect children with motor challenges.

Beyond infancy, when it comes to skills like running, jumping, and throwing, similar cultural and contextual factors can determine the rate of achievement. For instance, one study showed that Portuguese children tend to outperform American children on locomotor (running and jumping) skills and cardiorespiratory fitness. But American children have better grip strength and throwing speed. These discrepancies were ascribed to differences in the emphasis of physical education classes and culturally favored sports. Portuguese boys, (not girls as much) tend to play more soccer. American children perfect throwing for sports like baseball, softball, American football, and basketball.

Now that people migrate globally, it is important for parents and health practitioners to recognize that variations in development may be a result of cultural background, and that tests standardized in western countries may not apply to all children.

CONSIDER HOW THE INDIVIDUAL CHILD IS DEVELOPING

Caregivers and professionals also need to look at a child's overall development. Children tend to have spurts of development in particular domains. For instance, little Joey may be standing at 8 months, but barely says more than "Mama" and "Dada." His mom remembers that his sister crawled at 8 months and imitated other words. Neither child is delayed. For a variety of reasons, their developmental focus is not the same. In due time, Joey should go through a spurt where learning language becomes predominant and gross motor skills may plateau.

PARENTS, CAREGIVERS, AND TEACHERS : RESOURCES

CDC

Learn the Signs. Act Early. www.cdc.gov/ncbddd/actearly/index.html

WORLD HEALTH ORGANIZATION

https://cdn.who.int/media/docs/default-source/child-growth/child-growth-standards/indicators/motor-development-milestones/who-motor-development-study-windows-of-achievement-for-six-gross-motor-development-milestones.pdf

AMERICAN ACADEMY OF PEDIATRICS

Evidence-Informed Milestones for Developmental Surveillance Tools publications.aap.org/pediatrics/article/149/3/e2021052138/184748

CHECKLISTS ARE NOT THE SAME AS FORMAL SCREENING OR ASSESSMENT

Lists of milestones help parents observe their children. They can be used to start a conversation with a health practitioner, but they do not determine whether there is a problem. Instead, pediatricians or other health professionals may use a screening test. These instruments clearly define what is meant by each test item, and give specific instructions on how to assess each of them. The test items have undergone rigorous research on large numbers of children.

The screening tools may pick up a significant delay. But it should be recognized that they are not diagnostic. One could say that they are like getting an ultrasound or MRI for a condition that can only be definitively determined with surgery.

A referral to a specialist is warranted if a screening is not conclusive, or when a health practitioner or parent still has concerns. In the case of gross motor issues, the referral would be to a pediatric physical or occupational therapist, a pediatric neurologist, a neurodevelopmental pediatrician, a pediatric orthopedist, or a pediatric physiatrist. These practitioners have even more specific, standardized assessments. They also do clinical testing. A therapist will look at strength, range of motion, postural control, motor planning, sensory status, reflexes, achievement in other domains, and more. Physicians may order additional tests like x-rays, MRI, nerve conduction velocities, blood work, and more. A significant deficit is determined based on the interrelationship of a child's abilities and these other findings. •

ABOUT THE AUTHOR:

Aviva Gans, PT MS is a NJ based Pediatric Physical Therapist. Aviva worked as a school-based physical therapist for 29 years and has taught at the university level. She serves as the Chair of the Pediatrics Special Interest Group of the American Physical Therapy Association of New Jersey. She is also involved with the APTA's Academy of Pediatric Physical Therapy. Her primary interests are teaching motor skills to children with learning disabilities, gross motor development, motor learning, and advocating for children, especially children with disabilities. Aviva mentors early career physical therapists, and is available to consult, or speak, with teachers, parents, and parent groups.

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