1. Gross and Fine Motor Milestones
Ages Birth to 5 years
Theresa Wallace BMR (PT)

2. Consider the amount a baby accomplishes in its first year
Birth to Age One
Consider the amount a baby accomplishes in its first year
Head control
Following objects with their eyes
Rolling
Grasping toys
Sitting
Banging toys together
Standing
Poking
This is just a small sample of what a baby will do in its first year

3. Gross Motor Skills What do we need to do
One to three months of age
Turns head to side while on back
Starts to lift head up while on tummy
Turns head to side to clear airway on tummy
Kicks and extends legs
Three to six months of age
Begins to roll – belly to back first
Puts weight through hands while on tummy
Lifts head when pulled into sitting
Sitting balance improves and should be close to independent
What do we need to do
Start tummy time early, to develop neck control and build tolerance to the position

4. One to Three months of age
Fine Motor Skills
One to Three months of age
Moves arms symmetrically
Hand to mouth movement may be observed
Hands starting to spend time open
Three to Six months of age
Grasp reflex inhibited so starts to drop objects
Eyes move independent of the head
Hands open most of the time
Uses radial palmar grasp
What do we need to d0
Introduce toys for grasp and release
Encourage visual tracking
Notes for Terri:
-perhaps take away the eye tracking and eyes move independent of head because this is more of a sensory skill rather then fine motor.
Could add: for 1-3: Hand to mouth movement may be observed.
For 3-6-demonstrates increasing degrees of eye hand coordination-instead of eyes move independent of head.

5. Six to Nine months of age
Gross Motor
Six to Nine months of age
Sitting independently
May crawl – backwards first
Pull to stand
Stands while holding on
Nine to Twelve months of age
Walks with hands held
Cruises around furniture
Creeps on hands and knees
May stand alone momentarily
Kneels
May begin independently walking
What can we do to help
Provide movement exposure – chances to reach for toys and stand at the couch

6. Six to Nine months of age
Fine Motor Skills
Six to Nine months of age
Will attempt to pick up small object
Bangs toy on a table
Transfers toys between hands
Voluntary release
Nine to Twelve months of age
Takes toy out of a container
Pokes with index finger
Imitates a scribble
Bangs blocks together
What we can do to help
Provide appropriate toys for hand manipulation and exposure to hand movement

7. Barriers to Gross Motor Development – Year One
Limited tummy time – if not exposed early, may have delays in head control, rolling, independent sitting and walking
Children with limited tummy time may not crawl effectively and this over the long run may decrease fine motor skills even at school age
Limited exposure to transitional movements such as rolling and lying to sitting can cause children to get “stuck” in sitting and not progress to further stages of gross motor development

8. Barriers to Fine Motor Development – Year One
Lack of exposure – tentative about allowing small objects near child, messes at eating time
Overly helpful sibling/parents which do everything for their child (not letting them help to get undressed, feed themselves, and other self care tasks)
Ensure vision assessment has been completed as vision issues can hamper the child’s ability to see and manipulate small objects

9. RED FLAGS Gross Motor Fine Motor W-sitting
Delays in all motor milestones – rolling, sitting, weight bearing
Tightness of muscles or joints
Favoring of one side of the body
Fine Motor
Favoring one hand/arm
Play limited to chewing and mouthing objects
Not using thumb to grasp small objects
Uncoordinated or jerky movements when using hands

10. Back to sleep – tummy to play
This program was introduced when it was noted that gross motor developmental milestones were getting later in babies which were not sleeping on their tummies
Babies used to experience tummy time for sleep, were very comfortable with the position, and utilized early reflexes to develop such things as rolling
With the back to sleep program implemented to reduce SIDS, many parents were no longer giving their babies any tummy time
Subsequently, a decrease in head control, decreased babies that crawled, later rolling and sitting and walking skills were noted
Babies should be introduced to tummy time from the day they come home, 30 seconds of tummy time is not enough
Many parents state their child doesn’t like tummy time, but so many valuable skills are developed from this position

11. The Problems with W-Sitting
Usually happens due to the position of the child’s hips and knees (anatomical position)
Hips are turned in, so W-sitting is secure and easy to do
W-sitting is often seen in children with intoeing
W-sitting can interfere with a child’s ability to develop other types of sitting – ring, long sitting
It can cause tight muscles and loss of joint range
It can cause musculoskeletal changes above and beyond the position of the hips (stress on ligaments and redirection of tendons)
Limit W-sitting by moving the child up to play at a seated surface, or introducing other positions such as ring

12. Twelve to Eighteen Months of Age
Gross Motor Skills
Twelve to Eighteen Months of Age
Walks alone
Run is a hurried walk
Can walk backwards and sideways
Throws a ball forward
Pulls a toy while walking
Will bend and look through legs
Goes up and down stairs on hands and knees
May progress to walking up and down stairs holding a rail or hand (both feet on one step)

13. Eighteen Months to Two Years
Gross Motor Skills
Eighteen Months to Two Years
Carries toys while walking
Will sit by backing into a child size chair
Kicks a ball with purpose
Run is maturing – legs more together, less falling
Squats to play
Will push or pull toys
Walks upstairs with one hand held

14. Fine Motor Skills By age Two Grasps pencil between thumb and finger
Imitates vertical lines and circles
Can grasp a small bead and put onto a string
Can snip paper with scissors (supervised)
Builds tower of 6 blocks
Holds two objects in one hand
Can activate more complex cause and effect toys
Turning single pages
Effective use of spoon or fork
Drinks from a cup
Helps with dressing by
Pulling pants off
Taking socks off
Finding arms of shirt

15. RED FLAGS
Gross Motor
W-sitting
Walk is immature, falling regularly
Favoring of one side of the body or assymmetrical looking gait
Unable to focus on one area of play, constantly switching play activity
Fine Motor
Gives up easily
Avoids fine motor activities
Avoids messy activities
Still mouthing objects

16. What can we do to help – Age 2
Exposure – introduce crayons and scissors, stairs and ride on toys
Persistence – keep reintroducing objects and tasks even if they are not enjoyed
Attention – start to ask for longer periods of attention instead of always allowing the child to dictate when an activity is done
Independence – encourage help by the child even if it takes a longer time to accomplish the task

17. Gross Motor Skills Age Three Stand on tip toes Jumps with two feet
Catches a large ball (trapping to chest)
Jumps forward (12-36 inches)
Jumps over objects (2 inches high)
Starting to one foot stand
May start to one foot hop
Walks forwards and backwards generally along a line
Walks up/down stairs alone, first with both feet per step, progressing to alternating feet
Climbs jungle gyms and ladders
Jumps down off small step
May start to pedal a tricycle

18. Fine Motor Skills Age Three Crayon is held between thumb and fingers
Copies horizontal and vertical lines and circles, may imitate a cross
Can cut with scissors along a straight line
Manipulates a bead in one hand
Can match block patterns with 3-4 blocks
Starts to pull up a zipper
May start doing large buttons
Removes pants independently
Puts on front opening shirt independently
-added age 3 and moved over bullets-just editing

19. Failure to meet many of the expected milestones
Red Flags
Failure to meet many of the expected milestones
Any one or two milestones may be due to exposure to a specific task. A male child may not like fine motor as much as gross motor so may not be as good at coloring. A female child may like to color a lot but doesn’t like to go outside and play with a ball as much.
Inability to be directed to the task asked
Attention issues
Difficulty following directions
Total focus and desire to do only one type of activity – lining up cars
Fixation on inappropriate types of play (spinning tires instead of making the car move)

20. What can we do to help – Age 3
Recognize areas which are concerns
Exposure – practice skills which are difficult, make games and have fun
Persistence – keep reintroducing objects and tasks even if they are not enjoyed
Attention – start to ask for longer periods of attention instead of always allowing the child to dictate when an activity is done
Independence – encourage help by the child even if it takes a longer time to accomplish the task

21. Gross Motor Skills Age 4 Gallops forward Jumps at least 36 inches
Starting to skip
Stands on one leg for 5 seconds
Can hop forward with either foot
Throws underhand and overhand with direction (at least 6 feet)
Starts to catch without trapping to chest (smaller 3 inch ball)
May start to ride bike with training wheels
Can jump and change direction repetitively
Maintains balance on tip toes

22. Fine Motor Skills Age 4 Has picked a hand preference
Using wrist movement to direct pencil
Copies a cross
Traces a square and triangle
Can use a computer mouse
Colors within the lines
Draws a person with head, body, arms and legs
Can cut out a square or triangle
Builds designs with blocks
Zips and separates shank on jacket
Attempts smaller buttons
May start to lace shoes

23. Gross Motor Age 5 Skips effectively Hops forward on one foot 20 inches
Is able to perform a sit up and push up
Kicks a ball so it raises in the air
Stands on one foot more then 10 seconds
Starts to walk heel to toe
Starts to catch a tennis ball without trapping it to the chest
Starts to hop side to side on one foot over a line

24. Fine Motor Skills Age 5 Mature pencil grasp (or tripod)
Finger movement directs pencil
Copies square and triangle
Cuts a circle with accuracy
Identifies letters of the alphabet
Copies letters of the alphabet
Ties a knot (tying shoe laces by age 6)
Puts on pull on garments correctly
Builds with construction toys

25. Most Important
Recognize signs of delays early – early intervention gives the best chance of changes
Provide a variety of movements, experiences, toys and exposure to scissors, crayons, blocks and basic learning materials
Early exposure usually provides the best outcome
Be persistent and patient – for those children with delays, these tasks are really hard and it can be really frustrating for them. They will avoid what is difficult for them to do
Make activities fun – turning an activity into a game may help a child forget how difficult it is