Tag Archive for: milestones

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!


Primitive Reflexes: What Are They and Why Do They Matter?

What are primitive reflexes?

Primitive reflexes are foundational motor responses to sensory input that appear in utero or shortly after birth for the purpose of defense and survival. They are the foundation for higher level motor, cognitive or intellectual processes that develop as a child matures and takes on increasing demands. blog-primitive-reflexes-main-landscape

Most primitive reflexes integrate within the first year of life meaning that complex, adaptive and purpose-driven actions can over-ride automatic responses. Postural reflexes, which typically begin to develop in the second year or life, are automatic reactions with a higher level response. They develop a child’s equilibrium reactions for balance and coordination as the child begins to sit, stand, walk and run. Their development is heavily influenced by the integration of primitive reflexes.

Each reflex is associated with development of a particular area of the brain and lays the groundwork for control of motor coordination, social and emotional development, intellectual processing, and sensory integration. When primitive reflexes do not adequately integrate, persistence of these patterns may interfere with related milestones. When a reflex is present, it can be viewed as a signal that function in that region of the brain is not optimized. When difficulties in a particular area of functioning exist, research has demonstrated a strong correlation with the persistence of reflexes originating from the area of the brain regulating those functions.

Why might some reflexes not be integrated?

There are many explanations for why a reflex (or several reflexes) may not be integrated. Factors such as genetics, unusual gestational or birth history, limited sensory-motor experiences, or early disease, illness, or trauma may contribute to persistence of reflexes. It is important to note that many children, and even fully functioning adults, do not have all of their reflexes fully integrated. It is when an individual displays a cluster of symptoms impacting sensory, motor, emotional, social or academic functioning that reflex integration becomes an important component to examine.

What happens if reflexes do not integrate?

Since primitive reflexes are major factors in motor development, a child with persistence of one or more primitive reflexes may experience a variety of challenges. Primitive reflexes are what help infants initially learn about their inner and outer environments, and are heavily linked to the sensory system.

If reflexes persist, they interfere with the development of higher level sensory systems (visual, auditory, tactile, taste, vestibular, smell, and proprioceptive). Interference with sensory systems can lead to learning, behavioral, and/or social challenges for children, especially in academic settings. Additionally, postural reflexes, which depend on the integration of primitive reflexes, are unable to fully develop. Underdevelopment of these reflexes causes delays in righting reactions related to balance, movement and gravity. An individual who has not developed efficient postural control will have to compensate for these automatic adjustments by expending extra energy to consciously control basic movements.

Below are just a few red flags of persistent primitive reflexes:

  • Emotional lability
  • Over/under-responsivity to light, sound, touch, and/or movement
  • Anxiety
  • Distractibility
  • Inflexibility
  • Difficulty with reading, spelling, math, or writing
  • Difficulty remaining still, completing work while seated, or frequent fidgeting
  • Poor posture
  • Poor grasping abilities. May grasp pencil too tight or too loosely
  • Difficulties with eating (pickiness, excessive drooling, messy eater)
  • Poor balance and/or coordination
  • Poor spatial awareness and/or depth perception
  • Difficulty knowing left from right
  • Poor bladder control and/or gastrointestinal issues

What do we do if reflexes are not integrated?

Activities and exercises that target specific reflex pathways can be introduced in order to strengthen particular neurological pathways. By developing these pathways, we aim to integrate the reflex and mature related functions.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! 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!


Speech-Language Therapy

5 Tips to Make Speech-Language Therapy Successful

With what little time there is, it is important to maximize the efficiency of speech-language therapy, thereby increasing the chance of success. Life is busy, and children are involved in numerous after-school activities. Whether karate, dance, violin, or speech-language therapy, time after school is precious.

5 Tips to Make Speech-Language Therapy Successfulspeech-language therapy

Frequency: After completing an initial evaluation, speech-language pathologists will make recommendations for ongoing therapy services. In many instances, a child attending therapy more than once per week may progress faster toward goals than children who do not attend sessions as frequently. Increased exposure to direct (or even indirect) intervention can result in greater therapy success.

Carryover: Carryover, or the idea that skills learned in the clinic will be transferred or generalized out of the clinic, is an important aspect in a variety of therapies. In order to make therapy a success, children who receive increased practice, and more time spent focusing on a given skill, will improve in abilities and rate of mastery.

Prioritizing Therapy: While after school activities are important, parents also need to make time for speech-language therapy. In order to make therapy a success it needs to become a priority. Consistently attending sessions, whether weekly or more often, is crucial to ongoing progress. Breaks in therapy can result in a regression of newly acquired skills and may prolong the therapy progress.

Positive experience: When therapists create a positive environment for therapy, children are more likely to participate, leading to greater gains and progress. When children are enjoying their time, they are more motivated to work hard. Conversely, when children are struggling to participate, both parents and clinicians can help children see the “what’s in it for me” factor. This may be a compromise of children and clinicians taking turns picking activities, children being “rewarded” with free time at the end of a session, or even a special treat upon conclusion of the session.

Parent Education: Providing information to parents about why speech-language therapy is important can help to justify the reason for ongoing therapy services. When parents are incorporated into the therapy progress, they are more likely to work on therapy goals outside of the clinic environment. Educating and including parents into the therapeutic progress can help to make therapy a success.

The therapeutic process may be difficult for children and families, however following these tips for success can help children to reach their potential, keep families engaged, as well improve speech-language skills!

New Call-to-action

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. 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!

Is Your Baby’s Drooling Normal or Excessive?

Parents often wonder if it’s normal for their child to drool. You might notice your child’s toys are covered with saliva after playing, or you may notice a soaked shirt-collar throughout the day. The short answer to the question “is drooling normal?” is “sometimes.” At certain points in your child’s development, drooling is completely typical. At other points in his development, it is atypical and may require further intervention.

Developmental stages of drooling:

According to Morris & Klein in Pre-Feeding Skills, Second Edition, the following stages of drooling can be expected as your child develops:

  • One – three months: From one to three months of age, drooling is rare when your child is in a supine or reclining position (lying face-up), although some drooling may be noted when he is in a prone or a supported sitting position.
  • Six months: By six months of age, drooling is more controlled when your child is in supine, prone or seated. You may notice drooling as your child babbles or uses his hands to play, point or reach for objects. Drooling may also be noted as your child is teething or in response to eating particular foods.
  • Nine months: By nine months of age, drooling rarely occurs during gross motor activities, such as crawling or rolling. You may still notice drool in response to teething.
  • Fifteen months: By fifteen months of age, drooling rarely occurs during gross motor activities, such as walking and running, although you may notice some drooling during fine motor tasks, such as stacking blocks or manipulating objects. It may also continue in response to teething.
  • Eighteen months: By eighteen months of age, your child no longer drools when attempting fine motor tasks. Drooling may occur during feeding, dressing, play, or teething.
  • Twenty-four months: By twenty-four months of age, noted drooling is minimal.

Why children drool:

Saliva serves many necessary functions. It helps bind food together as we eat, which is important for safe swallowing. Saliva also aids in the digestion of food and helps keeps our oral cavity clean.  For the average child, unnecessary loss of saliva stops around age 4. For other children, however, it can be excessive.

According to Morris & Klein in Pre-Feeding Skills, Second Edition, the following possible causes of excess drooling might include:

  • Teething, which results in more saliva production.
  • Poor oral sensory awareness, resulting in decreased triggering of swallowing. If a child’s face is constantly wet, he may be less responsive to sensory cues that signal a need to swallow.
  • A constant open-mouth posture, which prevents saliva from building up and triggering swallowing as needed.
  • Difficulty swallowing efficiently, which may be due to poor head and trunk control, poor jaw stability, or increased or decreased muscle tone in the lips.
  • A response to certain foods.
  • A response to motor activities that require balance.
  • A possible side effect from specific medications.

How to help your child if he is drooling excessively:

If you feel concerned about the frequency and amount of drool, seek help from a licensed speech-language pathologist, feeding therapist, or occupational therapist. Your child’s therapist will help you determine the underlying cause of your child’s drooling and specific interventions.

Therapeutic interventions might include the following:

  • Increasing oral-sensory awareness to help your child better assess when his face or mouth is wet.
  • Improving head and trunk control to achieve better control of efficient swallowing.
  • Improving oral-motor control (i.e. lips, cheeks, jaw) to better manage saliva and efficient swallowing.
  • Helping your child achieve a closed mouth posture.
  • Improving your child’s ability to swallow.
  • Teaching your child about concepts such as “wet” and “dry.”

By working with a licensed professional, you can eliminate the uncertainty you might be feeling and find answers to your questions.  Most importantly, your child will receive the help he needs to better manage how much he drools.


Morris & Klein. (2000). Pre-Feeding Skills, Second Edition.  Austin, Texas: Pro-Ed.

NSPT offers services in BucktownEvanstonDeerfieldLincolnwoodGlenviewLake BluffDes PlainesHinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!


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.

Infant Reflexes: What They Are and When They Are Normal

There are a number of reflexes that your infant will exhibit. Some children develop reflexes during gestation and they go away shortly baby foot reflexafter birth. Other children may not develop until later in their life and the reflexes may remain forever. Reflexes that do not develop on time or reflexes that do not integrate (go away) at the appropriate age may impact your child’s development. In addition, it can also be a sign of neurological problems, therefore, it is a good idea to know what they are and when they are considered normal. Below is a list of important early infant reflexes and the time-frame in which you can expect to see them.

Early Reflexes:

  • Sucking-swallowing reflex: When a finger is placed in the child’s mouth, the infant will reflexively begin to suck in a rhythmical pattern:
    • Starts: 28 weeks gestation
    • Integrates: 3 months Read more

What are Metalinguistic Skills and What Do They Look Like in My Child?

Metalinguistic skills involve the awareness and control of linguistic components of language. Simply put, it implies the ability to thinktoddler clapping and discuss language. These skills require an awareness of others as listeners and an ability to recognize significant details that indicate changes in speech. For example, you do not usually speak to a teacher in the same way you would speak to a friend. In addition, you do not typically speak in a restaurant the same way in which you speak in a museum. Noticing what kind of speech is appropriate in various environments with various speakers is also reflective of metalinguistic skills.

These metalinguistic skills start to develop as early as one year as your child learns to monitor their own utterances and begin to repair their breakdowns in communication when they are misheard. Before the age of two, children typically learn how to adjust their speaking to different listeners: louder vs. softer, simpler vs. complex, demanding vs. requesting and peer vs. adult. Before the age of four, children should know how to recognize signals indicating that their listener understood the message spoken (i.e., such as a nod for assent and a frown signifying confusion). Children also learn to correct their own speech as well as their conversation partners’ speech. At this age, children spend a significant amount of time exploring new sounds, new words and new speech styles. As they reach their academic years, metalinguistic development continues to improve as children gain an understanding of the specific meaningful units that are associated with language (i.e., sounds, syllables, words, sentences). As a child’s mastery of language components grows, they learn to play with humor by telling jokes, riddles and puns (e.g., “What’s black and white and red (read) all over? A newspaper!”). This indicates a desire to control the use of language that was not present in the early language of children. This manipulation of language is significantly correlated to the development of pragmatic skills or the use of language.

Development of these metalinguistic skills are essential to a child’s ability to be successful in creating enlightening conversations that will serve as foundations for further learning in their lives.

Language Milestones for Preschool-Aged Children

Language encompasses the way in which we produce ideas (expression), understand concepts (comprehension) and use the social 3 year old boyrules for communication (pragmatics). Preschool years are a critical time for a child’s speech and language development. Children are rapidly acquiring new skills, therefore, parents may start to wonder if their child is meeting developmental milestones. Difficulties in language skills and concepts can have long-term implications of a child’s ability to succeed during school-age years. The milestones listed below are intended as a general trajectory that many children tend to follow; however, many will find that there is some variability between stages.

Language Milestones

Two to Three Years Old:

  • Opposites: children will begin to understand differences between words such as “go/stop”, “big/little” and “up/down”
  • Directions: children will begin to follow simple two-step requests (e.g., “get your shoes and put them on”)
  • Stories: children will want to hear more stories and may make ask parents to read books to them
  • Requests: children may begin to name objects when requesting (e.g., “I want juice”)

Three to Four Years Old:

  • Story-telling: children will start to tell more stories, often explaining what happened at school
  • Questions: children will begin to answer simple “wh” questions, including: “who”, “what” and “where”
  • Sentences: children may start to string 4 or more words together, creating more complex sentences

Four to Five Years Old:

  • Understanding: children can be expected to understand most requests made by
    parents (e.g., “clean your room”)
  • Reading: children may answer questions posed by parents during book reading (e.g., “what did the caterpillar eat on Monday?”)
  • Identification: children may start to recognize letters and numbers
  • Grammar: children will start to use age-appropriate grammar (e.g., plurals, past tense, pronouns)
  • Describes: children will begin to use more descriptive words when speaking (e.g., “the smaller shoes are mine”)

Preschool years are such an exciting time for children’s development. Children begin to blossom academically, socially and emotionally. If you have questions, concerns or suspect that your child may not meet all of these milestones, a licensed speech-language pathologist may be able to help!

Click here to download a free copy of the 3 Year Old Milestone Guide covering Speech, Fine and gross Motor, Behavior, Social/emotional and more!

What is a Late-Talking Toddler?

Many parents may wonder, is my child normal? When it comes to speech and language development, there are certain milestones Toddlers Playing A Gamebetween birth to 1 year and 1 to 2 years that we would hope all children achieve. Some children may progress through these milestones faster or slower than others, but there is usually a typical pattern of development.

When a child’s speech and language developmental pattern is not following that of typical peers, he or she may be referred to as a “late-talking toddler.”

Warning signs that your child may be a late-talking toddler include:

By 2 years old, if a child is not yet:

  • using 50 words to communicate
  • understanding about 300 words
  • combining 2-word phrases (e.g., “more milk”)

Such children may also appear to be frustrated when unable to communicate, including having tantrums and/or hitting oneself or others.

Some parents may be familiar with the “wait and see” approach. The idea behind this is that parents will wait to see if their child becomes a late-talking toddler; however, doing this allows the gap between potentially delayed children and typical peers to grow. It is better to seek intervention when they first notice a delay.

Studies have shown that early intervention can be most beneficial for these children. When started early, speech-language pathologists can help these late-talking toddlers to “catch-up” to their peers. Research has revealed that, if untreated, these children may develop difficulties when they become of age to attend school, both academically and socially.

If any of these warning signs describe your child, a licensed speech-language pathologist can help! An SLP can conduct an evaluation to determine if there is a delay.

This evaluation would include:

  • observation: watching your child play and interact
  • elicitation: prompting your child to respond via pointing, gesturing or speech production
  • parent-reporting: learning what skills your child may be demonstrating at home, but not during their time together with a speech-language pathologist

There is so much that can be done to help these children; please contact us if you have questions!

Why It’s Important NOT to Skip Crawling

Crawling is an important gross motor milestone for babies that are 8-10 months of age. It is at this time that your child is figuring out baby crawlinghow to get from one place to another independently. For some children, crawling is more difficult to learn and is, at times, delayed. This can often lead to a child skipping the crawling milestone and going straight into cruising and walking; however, this means that he or she may be missing out on some important benefits of the crawling stage.

Below are some of the reasons why a baby should NOT skip crawling:

  • Crawling helps strengthen the shoulders, back and core muscles, which are necessary for further gross motor development.
  • Crawling helps strengthen the tiny intrinsic muscles in the hand, facilitating development of the arches in the hands. These muscles are also important for emerging fine motor skills.
  • Crawling assists the child in learning bilateral coordination of his or her arms and legs.
  • Crawling also has a role in development of the visual-motor system as it requires scanning the environment with the eyes and moving the body in accordance.

A baby should be showing signs of emerging crawling skills by 8 months of age. This includes belly crawling (sometimes called “army crawling”) and pushing up onto their hands and knees and rocking. By 9 to 10 months of age, a baby should be crawling independently and using his or her arms and legs symmetrically. If you think your baby requires additional help in learning how to crawl, contact a Family Child Advocate to schedule an evaluation with a physical therapist.