First time parents don’t quite know what to look forward to when visiting their pediatricians during their child’s first year. Other than immunizations, growth measurements, and nutritional concerns, what else is there to discuss? Each well-child visit is a brief meet-up to assess the child’s growth and development. A red flag is an early warning sign that something is not developing typically and need to be addressed by a specialist.
Below are some physical development related red flags to discuss with your doctor on each of your child’s well-visits. Any one of them could warrant a follow-up visit to a physical therapist to ensure appropriate gross motor development. Early detection and early intervention is important and many red flags should not be dismissed.
1 month
- If your baby prefers to sleep with his or her head turned to one side, be mindful of a flat spot that might start to develop. Switch the side she lies on in her crib and alternate the direction of stimuli.
- Babies at this age should hold their limbs and trunk in some flexion, with random movements here and there. If your baby prefers to lie limply on his back with every limb spread out, pushes into extension with trunk and limbs that seem to stiffen up with every movement, or show difficulties with moving his or her head side to side, bring it up with your pediatrician.
2 months
- If you continue to notice a flat spot or a head turn preference when your baby sleeps on her back at month two, it might be good to bring it up with your doctor.
- At this time, babies are gaining more and more strength in their neck muscles. In sitting, their heads are more upright though continues to bob. If you don’t see your baby using his or her neck muscles at all, it may be a sign of slow development.
4 months
- This is the month of increased symmetry. If your baby continues to prefer to sleep, sit, and play with head only to one side, try to encourage him or her to play with their head in midline.
- A baby on his tummy at 4 month should be able to push up onto his arms and hold his head up. Red flag behaviors to ask your doctor about include: difficulty lifting head up, stiffening in his legs with little or no movement, pushing back with his head as opposed to lifting it forward when trying to roll, and fisted or lack of arm movements.
6 months
- At 6 months, a babies are sitting up and holding themselves up in sitting. They can also roll without help.
- Red flags at this stage are signs that point to difficulties with these tasks, such as: no trunk or head control in supported sitting, increasingly stiff back and legs, or inability to bring arms forward to reach for toys.
9 months
- A 9-month-old can sit and reach for toys without falling. He can move easily from lying down on his back or his tummy to sitting on his bottom.
- If your 9-month-old sits with his trunk leaning forward, doesn’t reach out to play with toys, uses one side more than the other, seems to drag one side to move, doesn’t crawl, and cannot take any weight on his feet when you prop him up, please bring it up with your pediatrician at his 9 months well-visit.
12 month
- Of course every baby develops differently. But by 12 months, a typically developing baby should be able to pull to stand and cruise along furniture. She might be able to stand alone and take independent steps.
- What we as physical developmental experts look for is fluidity of movement. If a child has difficulty getting to standing because of stiff legs, extended trunk, weakness on one side, or pointed toes, that is cause for a more in-depth look. If your baby only pulls up to stand with his arms instead of using his legs, it is definitely good to make your pediatrician aware.
- If your child sits with weight mostly to one side, needs her hands to maintain sitting, holds any part of her limbs stiffly in extension or flexion, or has difficulty moving between positions by her 12 month visit to her pediatrician, please ask about a physical therapy follow-up.
18 months
- A big indicator of need for physical therapy is if a child still cannot stand or take steps independently by 15 months.
- Red flags at the 18 months well-visit include: inability to stand and step independently, frequent falls while standing, poor standing balance, difficulty squatting, or walking predominantly on toes.
The warning signs and red flags mentioned above are meant as a guide to parents. If your child is showing these signs and is not achieving his or her gross motor milestones on time, do not focus so much on a medical diagnosis. What is important during the first year is that your pediatrician is aware of differences in your child’s development and recommend specialist follow-up as needed.
To see what your child should be doing at later stages in life, download our Gross Motor Milestone Checklist here.
