Is My Child Doing What They Should? Milestones from 1 to 5 years

 

Do you ever find yourself comparing your child to their peers at the park or playground? Or maybe even comparing them to their older sibling? Do you feel like they are behind with their motor skills? What truly is “age appropriate”? In this post, we will cover age-appropriate milestones from age 1 to 5 years and what to do if your child isn’t hitting their milestones on time. 

What are developmental milestones?

Developmental milestones are physical signs of development that provide information with regards to your child’s development. There are milestones for each age range that will slowly emerge over time. Each child will develop on their own individual timeline, so keep in mind that some children may skip over milestones, while others may need a little bit more time to get where they should be. 

1 year

At 1 year, children are crawling well and begin to pull up into standing and walk while holding onto furniture (“cruising”). They may stand alone and take a few steps without holding on. At this age, it is best to provide many safe places for your child to explore. Using furniture such as a couch, coffee table, or ottoman is great for working on standing and cruising. 

18 months

At 18 months, children are walking quickly on their own. They are able to pull toys while walking and climb up into chairs without help. At this age, you can encourage development by continuing to provide safe areas for your child to walk and move around. Provide toys that your child can push or pull and balls to kick, roll, or throw. Bubbles, blocks, puzzles, and books are great toys to use at this age. 

2 years

Around 2 years of age, children begin to stand up on their tip toes to reach for objects placed up high. They are filled with energy—running, jumping, and climbing. They are now able to go up and down stairs while holding onto the railing or wall and stepping with both feet on each step. At this age you can work on walking backwards and ball skills such as rolling and kicking a large ball back and forth. Take your child to your local park or playground and encourage climbing and walking on different surfaces. 

3 years

By 3, most children are able to ride a tricycle (3-wheel bike). They are climbing well,running easily, and jumping off of surfaces. They are also able to walk up and down stairs on their own, with one foot on each step. To encourage development at this age, actively play and exercise with your child rather than having them passively watch a screen or TV. Allow your child to help with chores and carrying things. Get outside and have your child interact and play with other children. 

4 years

At 4 years, your little preschooler is able to hop on one foot and stand on one foot for more than 3  seconds. Most of the time, they are also able to catch a playground ball that is bounced or tossed to them and are showing improved accuracy in throwing4 year olds love to try new things and participate in make-believe play. You can work on these skills while playing pretend and building imagination with your little one. 

5 years

Around 5 years, you should expect your child to run fast to a target and turn around quickly to change directions. They can catch and throw a small ball, walk on a balance beam forwards and backwards, and stand on one foot for approximately 10 seconds. They may be able to skip or this skill might still be emerging. In order to work on their motor skills, arrange play dates and trips to the park with peers. You can also explore your child’s interests in your community whether it be trips to the zoo if they’re interested in animals or joining a gymnastics program at your local gym if they love to monkey around at the playground.

What if my child is behind?

If you are reading through the above milestones and have concerns about your child, it would be beneficial to first schedule an appointment with your pediatrician for a developmental screening. If the child presents with suspected delay, your doctor can then refer your child to a Physical Therapist (PT) for an evaluation. A physical therapist can use a standardized assessment tool in order to compare your child to their same-age peers. If a delay is indeed present, physical therapy services may be recommended in order to work on motor development, strength, balance, etc. 

Questions or Concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9493. 

Elle Faerber, PT, DPT

Physical Therapist 

 

References: Important Milestones: The Children’s Hospital of Philadelphia. (2014, May 05). Developmental Milestones. Retrieved from https://www.chop.edu/primary-care/developmental-milestones 

Your Baby By Five Years. (2021, May 17). Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-5yr.html 

Photo Credit: Photo by Joshua Choate from Pixabay

Congenital Muscular Torticollis: What is it and how can I help my child?

Infant smiling while laying on back

You may have heard the strange medical term “torticollis” from your pediatrician, neighbor, or friend. Frankly, it can be overwhelming and quite confusing to understand. In this post, we will review what torticollis is, reasons why babies may develop a torticollis, what parents can look for if they have concerns, associated impairments if left untreated, and tips on ways to prevent torticollis. 

What is torticollis?

The term torticollis is Latin for “twisted neck”. Congenital muscular torticollis (CMT) describes the posture of the head and neck caused by shortening or tightness of the sternocleidomastoid (SCM) muscle. This rope-like SCM muscle starts at the collarbone and sternum and inserts into the skull behind the ear. When this muscle contracts or is tight, it will cause the head to tilt towards the side of the muscle and rotate away from the involved SCM muscle. With this tightness, weakness on the opposite side of the neck may result. A torticollis is named for the side of the involved SCM muscle, either right or left.

What causes torticollis?

There is little agreement on what causes CMT. The most widely accepted theories include a difficult delivery requiring use of a vacuum or forceps and unusual positioning inside the uterus. Other risk factors for CMT include large birth weight, male gender, breech position, multiple birth, a primiparous (pregnant for the first time) mother, difficult labor and delivery, nuchal cord, and maternal uterine abnormalities.

What will a torticollis look like?

A baby with torticollis may present with the following: 

  • Tilt their head in one direction
  • Prefer looking at you over one shoulder rather than turning to follow you with his or her eyes
  • If breastfed, he or she may have trouble breastfeeding on one side or prefer one breast only
  • Have difficulty turning his or her head in one direction 
  • Some babies with torticollis will develop a flat spot on their head (plagiocephaly) caused by lying with their head consistently turned to one side
  • A small lump or “ropey” knot may also be felt in the neck due to a tight and tensed muscle. 

What can happen if a torticollis is left untreated?

An infant with CMT will be unable to have symmetrical movement of their head due to range of motion (ROM) and strength imbalances. If left untreated, associated impairments include jaw asymmetries, ear displacement, facial asymmetries, plagiocephaly, scoliosis (a curved spine), pelvic deformities and movement patterns that may affect normal development. 

What can you do?

If you have concerns that your child has torticollis or plagiocephaly, schedule an appointment with your pediatrician. Your doctor may teach you stretches and strengthening exercises to practice at home. They may also suggest taking your baby to a physical therapist (PT) for treatment. The skull is most malleable and with rapid brain growth during the first 3 months of life. This brain growth slows around 5-6 months. The sooner you address torticollis and plagiocephaly (especially before 6 months), the better and faster the outcomes!

While it is best for your baby to sleep on their back, incorporating various positions during supervised and awake playtime is great for strengthening his or her neck muscles. This includes tummy time, side-lying, and supported sitting. If your baby has a flat spot on their head, these positions can also help by relieving pressure off this area. You can do tummy time on the floor, on your chest, or even across your lap! Encourage your child to use their neck muscles to follow you or a toy with their eyes and head, especially turning their head to the side they least prefer. Start by working on this for 10-15 minutes total each day, gradually increasing as your child tolerates more. 

Another good way to encourage your baby to turn their head to their least preferred side would be to modify their room environment. This may include positioning their crib next to a wall rather than in the middle of their room. This will encourage your baby to use their weaker neck muscles to turn their head away from that non-exciting wall in order to look at whatever is interesting in their room. 

Questions or concerns?

If you have questions or concerns about your child potentially having torticollis or plagiocephaly, please contact us at info@playworkschicago.com or 773-332-9493. 

 

Elle Faerber, PT, DPT

Physical Therapist 

 

References: Campbell, S. K., Palisano, R. J., & Orlin, M. (2012). Physical therapy for children. Saunders. 

“Infant Torticollis.” Home – Johns Hopkins All Children’s Hospital, www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Infant-Torticollis. 

Photo Credit: Photo by Pexels at pixabay.com

Early Intervention Initial Evaluation: What to Expect

Making the call to Early Intervention (EI) can be the daunting first step in addressing developmental concerns for your child. What comes next? PlayWorks Therapy’s Director of Developmental Therapy, Kim Shlaes, explains what to expect during an Illinois Early Intervention initial evaluation.

Service Coordinator
After a referral is made for your child, a service coordinator is assigned to your case. The service coordinator:

  • Is the point of contact for you and your family to help guide you through the EI process.
  • Is responsible for conducting an intake meeting to collect all the needed information and paperwork to set up an initial evaluation.
  • Coordinates the evaluation and ongoing services, should your child qualify.
  • Is responsible for writing and updating the Individualized Family Service Plan (IFSP) based on recommendations made by providers during their initial evaluation, goals you and your family have for your child, and assessments while in EI.
  • Is responsible for informing a family of their rights while in EI.
  • Helps facilitate the transition from EI as the child ages out of the program at three years old.

Initial Evaluation
Next, your service coordinator organizes a team of at least two credentialed evaluators. The evaluation team is selected based on developmental concerns you have for your child. An evaluation team typically has a combination of the following: developmental therapist, occupational therapist, physical therapist, and/or speech and language pathologist. Other providers, such as social workers, nutritionists, interpreters, and others are added to an evaluation team as needed.

The initial evaluation typically takes about one hour to complete. A parent/guardian is required to attend the evaluation. A typical evaluation follows the following routine:

  • Review reasons for the referral to EI, including parental and pediatrician concerns.
  • Review the child’s birth and medical history. The evaluators will also ask questions about your child’s milestones, their social history (including who your child lives with, who cares for your child during the day, any languages your child is exposed to), and your child’s opportunities to socialize with other children.
  • The evaluators take turns playing with your child.
  • The evaluators ask you several questions about your child’s development (i.e. how your child completes “self-help” skills such as eating and dressing, how they socialize with other children, how they communicate with you, how they process sensory information, etc.).
  • Evaluators then score their assessments and make recommendations for ongoing therapy or additional evaluations. If your child qualifies for services, you and the evaluators write discipline specific goals for your child, based on what your family wants to target while in EI. This part of the evaluation is the “IFSP meeting”.

What comes next?
Should you decide to move forward with Early Intervention services, your service coordinator organizes a team of credentialed therapists to provide service to your child. These therapists contact you directly to schedule your child’s therapy sessions, which are held in a natural environment for your child, most commonly your home or their school/daycare. Services typically begin within a few weeks of the initial evaluation.

Questions or concerns?
If you have questions or concerns about your child’s development or the Early Intervention process, please contact us at info@playworkschicago.com or 773-332-9439.

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Photo Credit: willingness.com.mt/types-of-play-therapy/