Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine.

I'm Melanie Cole, and joining me today to discuss motor skills in children is Dr. Michelle Mikhnos. She's an assistant attending pediatrician at New York Presbyterian Hospital Weill Cornell Medical Center, and she's an instructor in pediatrics at Weill Cornell Medical College Cornell University. Dr. Mikhnos, it's such a pleasure to have you join us. I love talking about the babies and talking about development and as kids grow, because that's my favorite age. So, I'd like you to start by telling the listeners what is meant by motor or physical development in early childhood. What are we talking about here?

Michelle Mikhnos, MD: Sure. Well, first off, thank you so much for having me. I'm excited to talk about childhood motor development as well. When we talk about motor or physical development, we're referring to the progression of a child's ability to use and control their body. Children gradually develop both gross and fine motor skills.

Gross motor skills refer to the use of larger muscle groups, like the core and extremities, which can manifest as a child holding their head up, sitting, or walking. Then, fine motor skills refer to more precise movements, such as using the pincer grasp or clapping. And milestones in general are skills most children can do by a certain age. Many of the early milestones are necessary for achievement of the next set of abilities, which is why we ask about development at well visits.

Melanie Cole, MS: So, let's talk about some of those milestones. And I understand, and we're going to talk about what if they don't hit them, because children do grow at different levels, they don't always hit the ones you're going to talk about on time. And we'll talk about what happens if that happens, but what are some of those milestones for development of motor skills?

Michelle Mikhnos, MD: Absolutely. So first of all, it's so much fun to watch children rapidly develop new skills and abilities that allow them to explore the world around them. I'll touch on a few of the major milestones, but if our listeners would like a comprehensive list of motor, social, language, and cognitive milestones, I do recommend going to the CDC website to look for those.

At first, when babies are born, they do not have the strength to hold their head up. However, you can start promoting neck and core strength by starting tummy time soon after birth. By two months, many babies can hold their head up for periods of time while they're on their stomachs. And then, at four months of age, infants start to push up onto their forearms during tummy time. They can also hold their head without support when held upright and they can hold a toy placed in their hand. Then, by six months, children can usually roll from their tummy to their back. They can reach toward toys that they want and they can also sit while supporting themselves with their hands placed out in front. Then, around nine months, most infants are able to rake food towards themselves and sit without support. By 12 months of age, kids become proficient at picking things up between their thumb and pointer finger, as well as walking while holding on to furniture. Then, between 12 and 15 months, we see many kids standing and taking a few steps on their own. And at two years, most children are able to run, kick a ball, and eat with a spoon. Then, by three years of age, kids are often able to put on a pair of loose-fitting pants and are more apt at using forks. And then, soon after that, between three and four, kids will start holding a crayon between their finger and thumb, and then they can even start pouring themselves a glass of water messily and with adult supervision. And then finally, after five years of age, most kids can button a few buttons on their own and also hop on one foot.

The important thing I want to stress is that these milestones are skills about 75% of children can do by a certain age. So, there are some children who may develop certain skills slightly later and your pediatrician can assess if they require closer monitoring or specialist intervention. And of course, many children start exhibiting motor abilities even earlier than the ages that I mentioned previously, so just make sure you're on the lookout for increased mobility even earlier on.

Melanie Cole, MS: Well, thank you for that comprehensive list, Dr. Mikhnos, I'd like you to reassure and reiterate for parents that not all children grow at the same rate. And these milestones that are set out and are generally recognized, not every kid is going to hit them by every single age. And as parents, we freak out all the time. Can you just give us a little bit of a reassurance that some kids just develop these things at different ages?

Michelle Mikhnos, MD: Absolutely, I do absolutely want to echo that every child is unique. We even have twins who may not necessarily be the milestones at similar rates or when you're comparing siblings as well, kids might be a little bit different. Some children might even completely skip over a certain milestone and maybe go from crawling to walking instead of having a full out crawl around the age of between 9 and 12 months as well. Anytime a parent or caregiver or even a teacher has a concern that a child is not meeting one or more of the milestones, I do encourage that they reach out to their pediatrician who can either help with a full evaluation to reassure you or to offer specialty services at that point.

Melanie Cole, MS: Are there some red flags, things that specifically say, "Okay, this is definitely something you want to bring up to your pediatrician"?

Michelle Mikhnos, MD: Some red flags to look out for are asymmetry in movements. Also at around nine months, if a baby is having an ability to roll to both sides, sit with support or transfer objects, that can be a red flag. And then, by 18 months, if babies are unable to do sit, stand, and walk independently and manipulate small objects like food or they're not able to use a spoon, that's also something I would definitely bring up to the pediatrician. But again, I do want to encourage parents to come to their pediatrician with any concerns that they have about development so that we can perform a more thorough evaluation. Another thing to look out for is that if a child is losing previously honed skills, it can be concerning for developmental regression, and those concerns should certainly be addressed promptly.

Melanie Cole, MS: Tell us about early intervention, why this is so important, and what a great thing it is. My daughter wasn't speaking. Of course, now at 21, you know, who can stop her from speaking? But when she was little, there weren't those words and we did that early intervention and she loved it. Can you speak about the types of therapy that are available for kids with motor delays and why it's so important that parents take advantage in their states of those early intervention services?

Michelle Mikhnos, MD: So when a child initially screens positive for a motor delay, we initially recommend a comprehensive evaluation, which may include an assessment by physical therapist and/or an occupational therapist, as well as other child developmental specialists. Children who are less than three years old with suspected developmental delays should be referred to early intervention or EI, which provide different services depending on a child's needs. So, I know we're specifically talking about motor delays, but they also address speech, cognitive, or behavioral delays as well.

Families can also call 311 or visit nyc.gov to learn more about EI if they're living in the New York City area. Early intervention is incredibly helpful. It can get families set up with specific therapies and help them set specific goals and create service plans to help meet those goals. When the delays are identified, families receive sessions with physical and occupational therapists, tools or equipment that might be helpful, and resources to learn how to best help and support their child so they can develop new skills. The therapist can also introduce caregivers to exercises that are more easily incorporated to daily routines, and practicing skills with familiar and trusted people is key to childhood learning and the response to the intervention is greater the earlier they are introduced.

Melanie Cole, MS: In your experience, and I know how my experience was, how well do the kids like and tolerate these therapies? And how long, if you were telling parents, and I know again, every kid is different, but how long does it take to see some results from these?

Michelle Mikhnos, MD: So, the therapies which are run by licensed professionals are designed to be engaging and age appropriate. So, many children have tons of fun during these sessions. They're also meant to be educational for caregivers so that these exercises can be continued on a daily basis at home, in the park, or in daycare even. And really, it varies significantly depending on the delay and the child's needs how long a child will be going through early intervention or services even beyond early intervention. Some children might graduate once they're achieving age-appropriate milestones within just a few months. For those who continue to benefit from services by their third birthday, the early intervention team, along with your pediatrician, can help create a transition plan that include therapies that are most beneficial for their child. They can then graduate into services provided by the Committee on Preschool Special Education, or the CPSE, when our kids are graduating into preschools. And then even after that, after the fifth birthday, you can establish an IEP or an Individualized Education Program once kids are school-aged.

Melanie Cole, MS: This is really so important, this type of information for parents, especially newer parents, because it's not something that we know about when we're new parents. As we wrap up, Dr. Mikhnos, I'd like you to give us some strategies and tips. Now, I understand that those generally come from the OT or the physical therapist that's doing this early intervention, but you see this every single day. And if you want parents to start to recognize those red flags and to get their children involved in those milestones, what are some things we as parents can do to kind of help this along and make sure that we're at least helping our children to follow that.

Michelle Mikhnos, MD: There are so many different activities that parents can try at home. Truly, most importantly is to talk, play, and engage with your baby and child during regular everyday tasks, such as changing, bathing, and feeding as well. And specifically for our babies, you can encourage the development of neck, core, shoulder, and back strength by starting tummy time shortly after birth. When babies get older and closer to four months, you can start giving them safe toys to play with that are easily held like rattles or colorful cloth books. And then, you can also allow your baby to safely interact with their environment and you should refrain from keeping babies in swings or strollers for too long. At around six months, we encourage caregivers to play safe toys just outside of their reach to encourage them to roll and reach for those toys. And in general, I could go on and on about these different recommendations. You can always ask your pediatrician about them or even go on to the CDC, which has helpful tips for parents.

 Overall, the goal is to encourage age-appropriate milestones in a safe environment. So if you have any concerns about milestones, infant toys, or equipment, please do not hesitate to reach out to your pediatrician about that.

Melanie Cole, MS: Great advice, great tips and information. Thank you so much, Dr. Mikhnos, for joining us today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts, Spotify, iHeart, and Pandora. For more health tips, please visit weillcornell. org and search podcasts. We have so many great podcasts on there, and don't forget to check out Back to Health. Lots of great ones there as well. I'm Melanie Cole. Thanks so much for joining us today.

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