Motor Delay In Children: Early Identification And Intervention
As part of our series on early intervention, we look at Motor Developmental Delay, also referred to as delay in a child’s movement and muscle coordination. Find out how you can detect this...
By Dr Arpan Kumar and Dr Pooja Sharma
In our series on developmental delays, we have previously looked at cognitive delay or delay in thinking and understanding. Here, we examine movement and muscle coordination in children. If you’ve been following our series, you’d know that a developmental delay is indicated when a child has not reached particular milestones within the expected time period. At the same time, we also need to consider that children don’t develop skills on a strict timetable.
For example, some babies start walking when they are just nine months old while others don’t take their first steps until 15 months. In both cases, the babies are still within the range of typical development. Plus, minor differences related to a child performing a skill aren't usually a cause for concern. A developmental delay is only when it is more than just being ‘slower to develop’ or ‘a little behind’. Such a delay is shown by a child who is lagging beyond the developmental range or is continually behind his peers.
What is motor development?
In simple terms, motor development is the development of movement. The ability to move is essential to human development. Motor skills are necessary for everyday activities like sitting, walking, running, climbing stairs, picking up objects, using cups, knives and forks, pouring drinks, dressing, holding and using pencils, pens, scissors and using keyboards. Motor development is the evolution of motor changes across the lifespan.
Motor development can be divided into two parts:
Gross motor development: This involves the development of the large muscles in the child’s body. These muscles allow your child to roll, sit, crawl, stand, walk and run, and perform day-to-day activities.
Fine motor development: This involves the small muscles of the body, especially in the hand. These muscles allow your child to hold bottles, toothbrushes, crayons and pencils. They also help your child to manipulate toys, button shirts, eat food, etc.
More on movement
Motor development also involves:
- Understanding how well your child's muscles work. This is referred to as muscle tone. Your child needs a balanced muscle tone in order to develop his muscles and use them with ease.
- Understanding your child’s vestibular and proprioceptive systems. Both are part of the child’s sensory system.
- The vestibular system is located in the inner ear and allows the body to maintain its balance.
- The proprioceptive system involves the muscles, joints and tendons. It allows the body to understand where it’s located. Maintaining balance and posture, and having coordinated movements, is possible only when the proprioceptive system is functioning well.
Did you know?
The typical development of a child’s motor skills usually follows a predictable order or sequence.
- Development occurs from the inner body to the outer body: This means that children usually develop or gain control over their arms before they develop or gain control over their fingers.
- Development also starts from top to bottom: Children need to control their head first, then they will gain control over their legs and feet.
Motor developmental delays
Take note when your child is continually behind in motor skills when compared to other children her age. For example, a baby who isn’t rolling over by four months may be just a little behind in that one skill. But if she is also not able to hold her head up and push up when lying on her tummy, she’s behind in more than one motor skill. That’s a sign of a developmental delay.
We cannot tell why exactly a developmental delay occurs. It could be due to:
- Chromosomal abnormalities
- Structural brain abnormalities
- Inborn errors of metabolism (IEM)
- Infectious diseases
- Accidents, birth trauma
- Birth asphyxia
- Environmental factors
A developmental delay can also be a symptom of other underlying medical conditions, including:
- Cerebral palsy
- Foetal alcohol spectrum disorders
- Autism spectrum disorder (ASD)
- Muscular dystrophy
- Genetic disorders, such as Down Syndrome and Fragile X Syndrome
In each of these conditions, the severity of the problem may vary from one child to another.
Motor skills – know the early warning signs and act!
All children develop at different rates and in slightly different ways. Differences in development may be related to personality, temperament, experiences or even, cultural aspects. Some children are born with special needs that can impact their health, growth and development. Other children may not show developmental deficits, delays, or differences, until later in their childhood.
It is important for a parent to know the early warning signs regarding motor skills so a child can get the necessary support and help early. Early intervention also helps parents understand the types of services and support that will meet the child’s needs. The sooner a concern is identified, the better. The child and the family can then receive individualised developmental support and guidance, specifically around building up the child’s motor skills.
How to spot
- Has stiff arms or legs
- Has poor coordination or moves in a disorganised, awkward manner compared to other children his age, or displays difficulty planning out his movements
- Has fearful reactions to ordinary movements or an excessive need to seek out sensory inputs such as spinning, rocking or hand flapping
- Pushes away from you or ‘arches’ backwards when held close or cuddled
- Has a floppy or limp body posture
- Uses one side of the body more often than the other
- Displays extreme reactions to touch, textures or pain
Symptoms by age:
- By 3 months, still has difficulty holding her head up
- By 4-6 months, is not reaching for, grasping or holding objects, or bringing objects to her mouth
- By 6 months, does not roll over or cannot sit up without help
- By 12 months, is not pulling up to a standing position, not standing up when supported, not creeping using hands and knees, is dragging one side of her body while crawling, or not yet picking up small items using thumb and index finger
- By 18 months, has difficulty walking independently and without your help, is not scribbling with crayons
- By age 2, is walking only on toes, cannot kick a large ball, is not building a tower using 3-4 blocks
- By age 3, is not walking up or down stairs independently while alternating her feet, shows poor coordination and falls or stumbles a lot when running, is not able to jump by lifting both feet off the ground. Is also not able to catch a large ball, or has difficulty turning pages in a book
- By age 4, has difficulty standing on one foot for 5 seconds, pedalling tricycle 10 feet forward, hopping on 1 foot, or drawing simple shapes
- By age 5, has difficulty skipping using alternating feet, propelling himself on a swing, or trouble cutting in a straight line with a pair of scissors
Who can help your child work through the delay?
If there are concerns regarding your child's development, talk to your paediatrician to direct you to an appropriate therapist, who will first make an assessment. This is done to understand the child’s issues after which, you will be suggested appropriate therapy. In case of fine and gross motor development, a child will usually benefit from an assessment made by an occupational therapist (OT) and/or a physiotherapist (PT) specialising in paediatrics. Ideally, a child should start therapy as early as possible. This therapy will help a baby develop from a very early age, by placing her in beneficial positions and helping her to move.
For children with motor delay, both physiotherapists and occupational therapists have important roles to play. Together, they can help a child reach his potential. While there is some overlap in what these two fields offer, a coordinated programme that uses the knowledge and training of each professional, can help children with motor skill development and life skills. Both physiotherapists (PT) and occupational therapists (OT) have important roles to play
The first meeting with a therapist
The first session with a therapist will be an assessment session. The general components of evaluation will include:
- Interview with parents or caregivers: History-taking and understanding the chief complaints, developmental information
- Assessment and observations directly with the child
- A comprehensive report that summarises information gathered
- Goal-setting for therapy, based on the report
Role of a physiotherapist
- To help the child reach developmental milestones that require gross motor skills, such as sitting, crawling, standing, walking, kicking a ball and jumping
- To assess if the child needs aids such as standers, wheelchairs, or orthotics; and to help the child and family become familiar with such equipment
Note: Physiotherapists often work with children who have difficulty with mobility and stability from birth to age 3, but services can extend beyond this point, if needed.
Role of an occupational therapist
- Helps improve gross and fine motor skills and visual perception, sensory processing, visual skills, and self-care
- Plans typical activities during sessions. This involves grasping and releasing toys, improving hand-eye coordination, handwriting skills, and learning how to bathe, dress and feed oneself
- Teaches social skills, anger management, and tips to improve focus
- Works on strengthening the hands, wrists and fingers, developing appropriate pincer and pencil grasps, comes up with tactics to help improve body awareness and hand control through playing games and activities that are graded in difficulty. Skills are mastered through practice, motivation and confidence
- Looks at modifications and adaptive devices if required (e.g. pencil grasps, use of splints to promote hand function, modified cutlery, so on). Based on this, the therapist hands out recommendations to parents for particular games used to achieve certain skills
What parents can do
Whilst all children develop skills at their own pace, you can assist your child’s development. It is important to understand from your child’s therapist how you can support your child at home. Here are some ways to do so:
- Talking and reading
- Providing opportunity for suitable and sufficient gross motor and fine motor activities
- Letting your child play with toys/objects that will help improve his grasping, gripping skills
- Depending on your child’s age, encourage her to participate in all activities of daily living such as dressing and attending to personal hygiene (to the best of her abilities)
Note: There is no need for expensive toys. The most interesting objects for a baby or toddler to play with are often just furniture and boxes to pull up on and stand, cushions to fall on, containers and a spoon to bang and make sounds. Give older children time outside where they can run and jump.
Government-run centres to help children with motor delay in India
- Swami Vivekanand National Institute of Rehabilitation Training and Research (SVNIRTAR), Olatpur, PO Bairoi, Cuttack
- National Institute for the Orthopedically Handicapped, BT Road, Bonhooghly, Kolkata
- All India Institute of Physical Medicine and Rehabilitation (AIIPMR), Mahalaxmi, Mumbai
- Pt. Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, 4, Vishnu Digamber Marg, New Delhi
- GB Pant Hospital, 1, Jawaharlal Nehru Marg, New Delhi
- Post Graduate institute of Medical Education and Research, Chandigarh
- Christian Medical College, Vellore
- NIMHANS, Bangalore
- National Institute for the Mentally Handicapped, Secunderabad
Always keep track of your child’s developmental milestones
Your child’s development can be effectively improved with timely intervention and a supportive home environment. The key is to act early. Always keep track of your child’s developmental milestones and talk to your doctor about them during your routine visits.
We hope you found this article useful. You can look forward to more informative articles, as we plan to cover other areas of child developmental delays.
Dr Arpan Kumar is Director and Senior OT while Dr Pooja Sharma is an OT at OT4Kids, NEW DELHI
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