Gross Motor Milestones in the First Year

Developmental check-ups with a Pediatrician throughout your child’s first year of life (at 2, 4, 6, 9, and 12 months) are a perfect place to bring up any concerns you as a parent may have about your child’s development. While pediatricians have their own set of developmental red flags, these only hit the “big-bad-uglys” as we like to call them, including: is your child rolling by 6 months, sitting independently by 8 months, crawling by 12 months, and walking by 18 months.

These red flags are very specific, meaning a child who exhibits these red flags would be identified for services, but not very sensitive, meaning many children who would benefit from therapy services are missed. I have seen many children referred to physical therapy for delayed walking skills, who are not standing independently or didn’t roll consistently until 8 months.

To help these children who are being missed by the pediatrician’s red flags, I have put together a list of gross motor skills to discuss with your pediatrician at your child’s check-ups throughout their first year.

A gif of a toddler taking a couple of steps while using a chair to stand up.2 Months:

  • Lifts and maintains head up when on belly

4 Months:

  • Controls head during pull to sit
  • Controls head when held at shoulder
  • Controls head while in supported sitting

6 Months:

  • Sits independently for 1 minute
  • Rolls from belly to back
  • Rolls from back to belly
  • Lifts chest off ground when on belly, pushing onto extended arms
  • Grabs feet or knees when on back
  • Bears weight through legs in supported standing

9 Months:

  • Gets into and out of sitting independently
  • Army crawls or crawls on hands and knees

12 Months:

  • Pulls to stand at stable surface
  • Cruises along furniture
  • Stands independently for 5 seconds
  • Walks forward with hands held

NSPT offers services in the Chicagoland Area. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!


When Should My Child Be Able To Go Up and Down Stairs?

The thought of your child going up and down a flight of stairs independently may be quite a very alarming thought, especially for kid on stairs
parents of new walkers; however, learning to negotiate the stairs is an important part in your child’s strength and motor development.

Below is a guideline of ages at which your child should be developing stair skills:

  • 10-15 months-Around the time your child starts to walk, he/she should be able to completely climb up at least 2 stairs on hands and knees.
  • 15-18 months-Shortly after learning to climb up the stairs on hands and knees, your child should be able to go down the stairs in the same manner. At this age, your child should also be able to begin walking up the stairs using a railing or your hand for additional support. He/she will likely be using a step-to pattern in which he/she places both feet on each step.
  • 18-20 months-By the time your child is this age, he/she should be able to walk down the stairs as well, placing both feet on each step and using a railing for support.
  • 2 years-At this age, it is typical for a child to walk up the stairs without any support from the parent or a wall/railing, but still putting both feet on each step before proceeding to the next step.
  • 3 years-When your child is around 3 years of age, he/she should now be able to walk up the stairs using a reciprocal pattern, placing only one foot on each step, without requiring the use of a railing for support.
  • 4 years-Your child should now be able to go both up and down stairs using a reciprocal pattern and no rail.
As with all new and challenging gross motor skills, it is vital to make sure that your child is supervised and safe while completing the task. If you have concerns with your child’s ability to negotiate stairs at home or in the community, be sure to schedule an appointment with a physical therapist at NSPT.

How Does Play Help Meet a Child’s Therapy Goals?

Occupational therapists often use play as a means of helping achieve our clients’ goals. Many times, it may not look like our sessions are working on your child’s areas of need; however, when we are working with children, we often try to adapt play activities in order to help your child meet his goals. Play is a very motivating activity for a child to engage in with the therapist and work on some of his goals. Play may also mask the fact that children are working on a difficult skill by introducing fun into the activity. For example, if one of the child’s goals is to improve his handwriting skills, you could play a game that involves writing, such as Boggle, Scattergories, or crossword puzzles.

Therapist and child at Gym

Here are some play activities that OT’s use to help your child meet his goals:

  1. If your child needs to work on balance and coordination, we may play basketball while standing on top of a bosu ball (imagine standing on the rounded part of a ball cut in half).
  2. A child who needs to work on core and upper extremity strength could meet these goals by playing a game while lying on his stomach over a therapy ball, while balancing with his arms on the ground.
  3. In order to improve self-regulation for a child who has sensory concerns, we may start our session by playing on the gym equipment in order to help regulate his nervous system.
  4. To work on bilateral coordination and fine motor skills with a child who does not like drawing, we often use play-doh and have him trace shapes and cut them out with scissors.
  5. Another way to work on gross motor coordination is to practice climbing a rock wall, climbing a ladder, or swinging on the monkey bars.

Sometimes, however, it may be difficult to adapt the activity and make it fun for the child. In this case, the therapist may have the child participate in an activity to work on the skills he needs to improve, but use a play activity as a reward.  From the first example in which the child’s goal is to improve handwriting, the child may still not want to play the games that involve handwriting. Then, the therapist may tell the child that after handwriting, he can do an activity of his choice.

Hopefully, this blog provides a bit more insight into the therapist’s mindset while working with your child. The therapist is constantly thinking and problem solving about how to make an activity therapeutic and how to make it easier or harder based on the child’s ability to succeed at the tasks. If the therapist is successful, the child will not even realize the activities are working on their areas of need and will want to come to therapy every session!

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Activity Analysis of Cookie Baking

While on winter vacation, there are so many wonderful activities that your children are already participating in that benefit their fine kids baking cookiesmotor and gross motor skills; however,you are not always aware of it. This is why it is important to take a look at the activity analysis,in order to break down the skills and components that your child is gaining from a particular activity, such as cookie baking.

The fine and gross motor skills used for cookie baking:

Purpose: To bake something yummy for your friends and family.

Supplies needed: Recipe card, ingredients, cookware (e.g. bowls, spatulas, measuring cups) and oven.

Skills involved:

  • Bilateral skills (e.g. to hold the measuring cup in one hand and pour the milk with the other hand, to stabilize the bowl with one hand and stir the spoon with the other hand)
  • Visual motor skills (e.g. to read the recipe card)
  • Upper body strength (e.g. to stir the ingredients together to form ball of dough)
  • Following directions
  •  Safety awareness (e.g. wearing oven mitts to put the cookie sheet in the oven)
  • Body awareness (e.g. to be mindful of ingredients around you- so that you don’t spill or bump into someone)
  • Fine motor skills (e.g. rolling dough into small balls and/or manipulating cookie cutters, tying a bow on an apron such as shoe tying)
  • Problem solving (e.g. if you forgot an ingredient or complete a step in the wrong order)
  • Taking turns (e.g. if it is a family activity- who is going to go first? Who gets to pour which ingredients into the bowl?)

As you see above, fun and simple everyday activities can help to address a wide variety of skills without having to think twice about it. When you’re doing these activities at home with your child, try to be attentive to tasks/skills that are the easiest for your child and those that are more difficult for your child. By categorizing these tasks, you will be able to work on these skills in a variety of contexts. As always, please feel free to contact your child’s occupational therapist if you have any questions on activity analysis or breaking down an age-appropriate task. Let the baking begin!


Holiday Shopping: How to Choose Developmentally Appropriate Toys for Your Child

The holidays are approaching rather quickly and most parents are hoping to not only get their children gifts that will make them happyholiday gifts for kids and excited, but gifts that will help them to learn and grow as well. It can definitely be challenging to not only find a toy or game that you feel your child will like, but that you as a parent will approve of as well due to the skills it addresses. Fortunately, certain stores have created special catalogs and websites to help sort toys by categories and skills. For example, Toys R Us has featured categories on the ‘Differently-Abled Kids’ portion of their website, such as Auditory, Fine Motor, Gross Motor, Social Skills and Tactile. It is important to use these resources to your advantage. Such resources are not only for children with skill deficits, but they also help you, as a parent, to look at games in a functional and educational manner. Below are some examples to give you an idea. It should also be noted that many of the games that are listed below are specific games that we use as occupational therapists, speech language pathologists and social workers within our daily treatment sessions to work on a variety of goals.

Fine Motor Skills Toys:

  • Easel (e.g. Crayola Magnetic Double-Sided Easel)
  • LEGOs
  • Angry Birds Knock on Wood Game
  • Connect 4 Launchers
  • Hungry Hungry Hippos
  • Mega Bloks Build ‘n Create

Gross Motor Skills Toys:

  • Scooter (e.g. Radio Flyer My First Sport Scooter)
  • Mini Trampoline (e.g. JumpSmart Trampoline)
  • Wagon
  • I Can Do That! Games- The Cat in the Hat

Auditory Skills Toys:

  • Bop It! Reaction Game
  • Melissa & Doug Sound Puzzles
  • Musical Instruments (e.g. Casio Key Light Up Keyboard)
  • Barbie Voice Change Boombox

Thinking Skills Toys:

  • Headbanz
  • Scrabble Flash Game
  • Train set (e.g. Chuggington Wood Beginners Set)
  • FAO Schwarz Big World Map

Overall, it is crucial for parents to keep in mind that while new technology is impressive, traditional board games as well as hands-on toys continue to be an ideal way for children to work on a variety of skills and allow them to explore their environment and pursue their own interests. It is exciting to think that your child will gain so many new skills just from playing one of the games listed above with friends and family. Stay tuned for my next blog on a more detailed breakdown of many of these toys. Happy shopping!


How To Teach Your Child Pre-Writing Skills | Pediatric Therapy Tv

In today’s Webisode, a pediatric occupational therapist explains strategies she uses to teach pre-writing skills.

Click here to check out our previous Webisode, suggesting games for fine motor practice to develop handwriting skills.

In this video you will learn:

  • How an occupational therapist uses shapes to teach a child beginning to advanced handwriting
  • At what age a child should master all shapes for writing

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics, to a worldwide audience, this is Pediatric Therapy TV, where we provide experience and innovation to maximize your child’s potential. Now your host, here’s Robyn.

Robyn: Hello, and welcome to Pediatric Therapy TV. I’m your host, Robyn Ackerman. I’m standing here with Lindsay Miller, a Pediatric Occupational Therapist. Lindsay, can you explain to us, what are some exercises you can do with a child to help with pre-writing skills?

Lindsay: Sure. With some children who are too young to begin writing their letters, we work on practicing making particular shapes. These shapes include horizontal lines, vertical lines, circles, diagonal lines, crosses, Xs, squares, and triangles. So with younger kids, we would probably start off working with the simpler shapes, such as the horizontal and vertical lines, and also the circles.

Once they’ve mastered those, then we would move on to the more complex shapes, like the diagonal lines, the crosses, the Xs, the squares, and the triangles. We work on these shapes in particular, because these are the shapes that you generally use when you’re writing. So if children learn how to write their horizontal and vertical lines and their circles, then it helps them once they’ve begin to start writing their letters, because these are the shapes that we use for upper and lowercase letters. So generally, by age five a child should be able to make all of these shapes.

Robyn: Wow. That’s really great tips. Thank you so much, and thank you to our viewers. Remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of mind to your family with the best in educational programming. To subscribe to our broadcast, read our blogs, or learn more, visit our website at That’s

10 Signs at Camp A Child May Need Occupational Therapy

Camp counselors have their work cut out for them- they have to plan daily activities, monitor the safety of the campers, be a cheerleader to encourage the campers throughout the day, and be a referee to teach the campers sportsmanship, turn taking, and following the rules. However, they are also the best advocates for the campers, as they can observe the strengths and weaknesses of each child, and can talk with the campers’ parents about what they notice throughout the day. Below is a list of some of the many signs indicating a child may benefit from working with an occupational therapist:

10 signs at camp that a child can benefit from occupational therapy:

  1. The child has difficulty following directions, either auditory and/or written, in order to engage in an activity. For boys playing tug-a-warexample, first get the soccer ball, and then sit in the grass.
  2. The child shows aversion to different textures (e.g. grass; sunscreen; finger paint; tags in clothing).
  3. The child demonstrates decreased sportsmanship with peers, such as having a hard time losing, or a hard time with turn-taking.
  4. The child demonstrates decreased body awareness, such as being unaware of having personal space with peers (e.g. sitting/standing too closely to others), or moves too quickly or unsafely around his environment (e.g. trips often, bumps into things).
  5. The child demonstrates decreased hand-eye coordination and motor planning compared to same aged peers, such as difficulty with simple ball skills or basic swimming skills.
  6. The child has difficulty transitioning, such as a hard time with drop-off in the morning or with leaving at the end of the day. Similarly, the child may demonstrate difficulty transitioning between activities throughout the day.
  7. The child has decreased postural control, which might be noted by having a hard time maintaining an erect posture during tabletop tasks (e.g. leaning/propping/fidgeting) or has a hard time lying in prone on his belly.
  8. The child demonstrates picky eating during snack time or mealtime (e.g. only eats hot or cold foods; will only eat a few select food choices; only likes salty/sweet).
  9. The child has decreased attention compared to same aged peers, noted by jumping from one activity to the next without spending much time at each activity; or noted by distractibility and looking around to notice others in the room.
  10. The child has difficulty with handwriting/drawing/crafts compared to same aged peers (e.g. does not know how to hold writing utensil correctly; cannot draw a person with correct parts).

If any of the signs above apply to your child, he would definitely benefit from an occupational therapy evaluation and most likely ongoing occupational therapy (OT) sessions. OT sessions can help your child to gain more confidence for his fine motor and gross motor skills, body awareness, and other age appropriate activities. The goal is to help your child to keep up with same aged peers and expectations he is required to meet at home, at school, and within the community, so that he can have the greatest success.

Fine Motor and Gross Motor Activities to do with Sidewalk Chalk this Summer

Summer is the perfect time to get outside with your child to enjoy the sunshine and fresh air. Summer also offers the chance for your child to unwind a bit, and take a break from all the demands placed on him at school. However, it is still important to keep your child active and engaged throughout the summer months, so that he stays in somewhat of a consistent routine and keeps his mind fresh and in tip-top-shape for the upcoming school year. Here are some fun and simple ways to incorporate fine motor and gross motor activities into your everyday summer routine using an already preferred activity, sidewalk chalk,

Here are a variety of options to explore with chalk:

  • Hopscotch: Create a hopscotch board out of chalk (typically alternating 1 square, 2 squares). This activity addresses fine motor and visual motor skills to draw the squares and write numbers inside of the squares. It also addresses trunk control, balance, and motor planning to complete single-leg hops and two-footed hops into each of the squares. You could also challenge your child to complete animal walks inside the hopscotch board instead (e.g. crab walks, bunny hops, frog jumps).
  • Tic tac toe: Have your child draw a tic tac toe gameboard on the sidewalk or driveway. Little girl playing sidewalk chalk gameThis activity addresses fine motor and visual motor skills to draw horizontal and vertical lines, turn-taking, problem solving and sportsmanship.
  • Hangman: Take turns coming up with a “secret” word for the other player to guess, and create a hangman board. This activity addresses fine motor and visual motor skills needed for handwriting, as your child has to write out the letters which appear either in the “secret” word, or get placed into the word bank. It also addresses executive functioning skills as your child has to memorize which “secret” word he chose, and has to remember how to spell the word correctly, and which order the letters go in.
  • Road: Help your child to draw a pretend road which he can then either ride his bike through or drive his toy cars through. This activity addresses fine motor and visual motor skills required for drawing (e.g. have your child create road signs as well). And if using the road for bike riding, this activity addresses motor planning to get through the road without crashing into the chalk lines, and balance and trunk control to navigate the bike. If using toy cars, this activity can focus more on imagination and possibly social skills, if your child is playing with peers.
  • Baseball diamond: Create a baseball field out of chalk (e.g. home plate, pitcher’s mound, and the bases). This activity addresses fine motor and visual motor skills to draw the diamond and circles or diamonds for the bases, and potentially letters/numbers for a team name and scoreboard. It also addresses ball skills, bilateral skills, and hand-eye coordination to play the actual game of baseball, along with sportsmanship and turn taking.
  • Four square: Draw a four square game board, which includes one large square divided into four equal squares (one for each player). This activity addresses fine motor and visual motor skills to draw the squares, and write the letters inside the boxes. It also includes ball skills, such as dribbling and bounce passing, in order to keep the ball out of your own square. Similarly, this game addresses sportsmanship and turn taking.

Note: Try making your own sidewalk chalk using 2 tablespoons of temper paint, ½ cup of water, and 3 tablespoons plaster of Paris. Directions: In a five-ounce paper cup, mix 2 tablespoons temper paint with one-half cup water. Add three tablespoons of plaster of Paris and stir until you have a creamy consistency. Once hardened (several hours), peel off the paper cup to produce a giant piece of sidewalk chalk.

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In-Hand Manipulation Skills: What are they?

In-hand Manipulation refers to the ability to move and position one or more objects within one hand without using the other hand to assist. Below, are explanations of the terminology often used for In-Hand Manipulation Skills.

In-Hand Manipulation Examples:

Translation: Refers to the linear movement of the object or objects from the palm to the fingers or the fingers to the palm.piggy bank

  • Picking up marbles with the fingers and thumb and moving them into the palm.
  • Moving coins from the palm of the hand to the finger tips to insert into a piggy bank.

Shift: Refers to linear movement of an object on the finger surface to allow repositioning of the object on the pads of the fingers.

  • Adjusting the pencil grip so that the fingers are on the tip of the pencil.
  • Dressing skills including snaps, lacing, and buttoning.

Complex Rotation: Refers to the turning or rolling of an object with finger pads between180-360 degrees.

  • Turning a pencil to use the eraser

Simple Rotation:  Refers to the turning or rolling of an object with finger pads no more than approximately 90 degrees.

  • Unscrewing a bottle cap
  • Puzzles

Why are In-Hand Manipulation skills important?

In-hand manipulation skills are important in the efficiency of every day tasks such as:

  • Drawing
  • Handwriting
  • Cutting with Scissors
  • Eating with a fork, knife, and spoon
  • Dressing skills such as buttons, zippers, and snaps
  • Manipulating small objects for crafts and games

Children who are experiencing difficulties with in-hand manipulation, may be observed using both hands for skills that should only take one hand, changing or transferring objects to the other hand for repositioning, and/or may hold an object against their body during activities.

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How does decreased trunk control affect my child’s schoolwork?

Our trunk muscles (“core”) greatly influence how we move through our environment and how we engage in gross motor and fine motor activities throughout the day. Trunk muscles affect our ability to sit and stand, to carry a backpack or briefcase, to carry books and materials throughout the day, and the ability to participate in extracurricular poor trunk controlactivities and hobbies. We rely on our trunk muscles more than we know. Therefore, if decreased trunk strength or trunk control is noted, many side effects or resulting behaviors may occur, particularly for a school-age child, such as the following:

Affects Of Poor Trunk Control In School Aged Children:

  • May cause distractibility, as your child is focused more on keeping his body in an upright, erect posture, rather than focusing on the task at hand (e.g. teacher’s directions; homework task)
  • May result in decreased body awareness, as your child may not respect their personal space due to propping on others for support to compensate for decreased endurance in a seated position (e.g. lying on floor or propping on elbows during circle time)
  • May be observed as increased fidgeting, as your child is frequently trying to reposition themselves due to the inability to sustain a position for an increased length of time (e.g. mealtime, table time, homework assignment)
  • May produce illegible or sloppy work, as your child may not be maintaining a posture that is suitable for writing (e.g. slouching, falling off of chair, propping head onto hand, sitting on feet rather than keeping feet flat on floor)
  • May result in decreased participation in gym class or recess activities due to decreased endurance and strength for sports-like activities
  • May cause decreased safety, as the trunk is a major “power house” which correlates with upper body and lower body strength as well (e.g. falling off of chair during tabletop activity; falling down the stairs)

If you feel that your child may have decreased trunk control, stay tuned for my next blog on strategies to promote increased trunk control at home and at school! If you have immediate concerns, contact an occupational therapist or your child’s primary care physician.

Click here to read part 2 of this blog: “Strategies to Promote Increased Trunk Control at Home and School”

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