Kids Health

A Pediatric PT Answers the Most Common Questions She Hears About Baby Development

baby standing"
baby standing
Source: @thiswildheart
Source: @thiswildheart

When hearing about my job as a pediatric physical therapist, people are frequently blown away by the idea that babies and children need physical therapy (PT). The reason babies may need PT vary. 

So why do some babies need physical therapy? Some babies are born prematurely or with genetic or neurological diagnoses, and they may have a more difficult time achieving motor milestones. Other times babies are born with asymmetries, such as a head turn preference. Or babies can simply be behind in meeting gross motor milestones for no particular cause. For all of these reasons, and many more, pediatric PT can benefit baby. Of course, if you have questions or concerns about how your baby is developing, talk to your pediatrician. 

Each child has individualized PT needs, and it’s incredibly rewarding to be involved in the care of children. To help parents seeking more answers about their baby’s development, here are answers to some of the most common questions I hear as a pediatric physical therapist.


1. Is tummy time that important?

If you’ve ever spent time with a pediatric physical therapist, you are probably aware that tummy time is one of our favorite things! Tummy time is one of the BEST ways to promote gross motor development for your child. It’s important for core strength, posture, development of crawling, and general promotion of future gross motor skill acquisition. Additionally, it’s extremely important to prevent “flat head syndrome.” 


2. How can I make tummy time easier?

Now, we know tummy time is NOT easy. But there are ways to make it easier. Start from day one. Introduce your baby to supervised tummy time, as soon as possible. This will help your baby learn to enjoy tummy time, instead of hate it. Until the mid-1990s, most babies were tummy sleepers, so babies typically preferred being on their bellies. The sooner you start, the sooner your baby will learn to love it. Try doing tummy time over your lap or on your chest as well. A flat, firm surface is also much easier than a squishy, soft surface for tummy time. 


3. What equipment should I buy for my baby?

I’ll let you in on a little secret. Your baby doesn’t need any particular piece of equipment to progress gross motor milestones! Your baby will develop best by being allowed time on the floor in order to learn how his or her body moves and explores. When you need a piece of equipment for containment, use something for short periods of time, and aim for something that still allows your baby to move. For example, pack ‘n plays or playpens still allow your baby to explore how his or her body moves while being contained for safety. 


baby doing tummy time

Source: @shapinup


4. What if my baby isn’t reaching gross motor milestones on time?

This is a VERY common question that we frequently receive as pediatric physical therapists. Every child develops at his or her own pace. Some babies walk at 8 months, while others walk at 18 months. Neither is necessarily right or wrong. As long as your baby is progressing and achieving new skills, there is typically nothing to worry about. If you find that your baby isn’t quite on par with other similarly aged babies, try giving your baby more time on the floor. Babies need opportunities to gain new skills, and this involves playing on the floor instead of being held or being contained in equipment. 


5. My baby only likes to look to one direction—is this normal?

Turn preferences are very common. Babies typically find one side first and then find it easier to look to that direction, and thus, the preference can be further enforced causing a directional preference. If you notice this, encourage your baby to start looking to the other direction by setting up his or her environment to the opposite side. Hold toys and keep yourself in the other direction. Lie your baby in the crib so that they have to look in their non-preferred direction when you walk into the room. Hold your baby so they look out into the world toward the non-preferred side. 


8. My baby’s head is getting flat on one side—what should I do?

When babies have a turn preference, it’s also common for one side of the head to become flat. Babies have very soft heads, as their little skulls need to move through the birth canal. If you start to notice one side of the head becoming flat, it’s time to work on our favorite recommendation—tummy time! Tummy time works threefold for flat heads:

  • Gets the baby off the back of his or her head.
  • Helps the baby strengthen the muscles that will pull on the skull to round it out.
  • Allows the baby to more easily rotate to the opposite side of the flat spot. 


9. How can I help my baby start to sit up?

If you’re trying to help your baby sit up, it’s best to actually avoid positioning devices that advertise the development of sitting (like Bumbos, exersaucers, or bouncy seats). I know this sounds counter-intuitive, but sitting in these devices teaches your baby to rely on a piece of equipment to sit up.

Instead, work on developing the necessary strength that the baby needs to sit up independently. This involves a lot of—you guessed it—tummy time. Tummy time will strengthen the necessary muscles so the baby learns to sit independently. You can also work on sitting with your baby leaning all the way forward. This will encourage your baby to place his or her hands on the floor, and this is called prop sitting. Once the baby gets comfortable and strong enough in prop sitting, he or she will remove the hands and sit up independently. 


10. How can I help my baby start to crawl?

Some babies do skip crawling, but there are many benefits to crawling. Once again, tummy time is important for crawling development. By being allowed time on the floor, your baby will learn how to use his or her body to get into a crawling position.

Once your baby learns how to scoot on the floor, you can toss your leg in front of your baby so he or she has to navigate over it. By crawling over your leg, your baby will feel what it’s like to get his or her knees under the body. You can also place toys just slightly out of reach so the baby is motivated to creep toward them.  


baby standing

Source: @akinasway


11. How can I help my baby start to stand?

Begin by setting up short surfaces where your baby will be motivated to stand—think foot stools, couches, small chairs, etc. When they start to show interest in standing, use your hands at the baby’s hips while his or her hands are supporting the body on the surface of the couch, chair, etc. Pull the hips back over the heels so that baby is standing in a little bit of squat—the knees and hips should be bent with the chest leaned a little bit pitched forward.

This position helps your baby engage all the right muscles to learn how to stand independently. If your baby is leaning his or her chest into the surface, pull the hips back or move the surface closer to promote standing in a better posture. 


12. How can I help my baby start to walk?

Once your baby is standing independently, he or she will start to show interest in walking. Spread out surfaces so that they are a little out of reach and your little one will have to let go of one surface to reach another. Place toys a little out of reach in either direction or down low so that your baby needs to move side to side or down low to reach the toys. Babies need thousands of hours of practice to achieve independent walking, and they will fall A LOT, but they will get there eventually! Try to avoid infant walkers or pulling your baby up onto his or her toes to walk, as these encourage poor walking patterns and could delay independent walking. 


Babies need thousands of hours of practice to achieve independent walking, and they will fall A LOT, but they will get there eventually!


The above are by no means a comprehensive list of all the questions related to pediatric gross motor development. Again, if you have questions or concerns about how your baby is developing, discuss them with your pediatrician. Additionally, if you’re worried and would like an expert opinion about how your baby is developing, ask for a PT referral. Your initial evaluation will assess how your baby is developing, and if necessary, further treatment may be recommended.

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