“What Should My Baby Be Doing and When?”
An exploration of the importance of learning your baby’s milestones
I’ve been stealing babies (with the permission of their parents) since I was a young child myself. My neighbors adopted a baby when I was 8 years old, and I quickly elected myself as their mother’s helper. I’d consider myself pretty experienced in feeding, diapering, entertaining, soothing, and playing with children of any age. Then I became a Doctor of Physical Therapy who specializes in pediatrics and learned some things.
I realize that even if people (ahem, myself) have experience with taking care of babies, they do not necessarily know what their baby SHOULD be doing from a developmental perspective. Things like when babies are supposed to be doing certain milestones, what skills they should have when being introduced to foods, or with self-soothing to sleep. Even if people have one, two, or three children, each of those children will develop at a different rate and likely with different strengths.
One child may excel at a gross motor milestone expert and be a motor marvel. Think of those kids who are lightyears past the others out on the peewee soccer field. The next child may be really great at speech and cognitive skills, understanding everything their parents tell them from 6 months old, picking up sign language from YouTube, and having full conversations before two. Another may really rock their fine motor tasks and be a pro at doing puzzles or coloring/ crawling. Parents say things to me all the time like, “My first was walking by this age, and so my second must be behind.” Spoiler alert, the first walked at 9 months old, which is crazy EARLY, and the second has exceptional emotional intelligence and is more content to sit and interact with his caregivers than to explore his home.
I have been a practicing physical therapist for the past 14 years, and here are some of the questions I get asked on repeat.
“Is my baby doing what they’re supposed to be doing at this age?”
“Is my baby developing in a normal time frame?”
“Why is my baby not doing this when my friend’s baby is doing it?”
“How do I play with my baby?”
“How can I help my baby to reach their milestones as fast as they should?”
Every baby develops at a different level. Just like every human has different strengths, every child has different areas where they shine. I ran track and cross country for years, not because I was a motor marvel, but when it came to sheer stubbornness and physical endurance, I had what was needed. There are certain benchmarks in different areas such as vision, reflexes, speech, fine motor, and gross motor skills that children should reach in a certain age frame. They are windows, usually spanning about 3 months. They are not meant to bring you anything but reassurance. Think about how much can change in a week, a month, and a trimester of pregnancy! The same is true for your baby.
I created a class called “Baby’s Practically Perfect First Year” to help parents with a few things. The first is to learn what these normal ranges for development in these areas are. I also wanted to give parents the skill set to see if there are any real issues. The additional goal is to help parents play with and position their child in ways that help make progress with their movement and play skills, whether there is an issue or not.
I always joke that I have an “evil queen” parenting style. I’m of the mindset that a little boredom goes a long way in learning some self-sufficiency and teaching the ability to self entertain. No one should have to play with their baby or child all day, everyday. I strongly encourage independent play (supervised as appropriate) so that your child can learn how to explore their environment. BUT, we must set children up to access these successful play skills. I cannot just lay a newborn on the floor and expect them to do anything other than watch the shadows and lights. Even evil queens like to have fun, so during those times of purposeful play with your child, there are ways to make it the most beneficial to their development.
I recently started offering “Tummy Time with Miss Mora” which is a class to help parents and babies ENJOY tummy time. I was worried that I was giving the most basic of basic tips because tummy time is something that is second nature to me due to my child experience and my profession. What I found is that what feels natural and normal for me can feel scary or difficult for other people. People asked “can I do Tummy Time class more than once?” My answer was “heck yeah” because tummy time is different every day of your child’s life. As humans, we’re dynamic, and ALWAYS changing. Because your child learns new skills daily, what works one day may be completely different the next day.
For example, most tummy-to-back rolling happens initially as a reflexive accident. Baby activates their ATNR and STNR reflex (take my class to have me break these down) and suddenly they’re on their back. On that day, they have no real control of this skill aside from reactivating the reflex and experiencing the same roll. Some kids will do this on repeat until they learn to control it and do it on their own. Here is where individual children’s personalities come in. One baby may LOVE the feeling of rolling over. These are who I suspect are the future roller coaster lovers. This child will perfect the skill to try to access that fun sensation they realized they liked. Another baby may feel really insecure or even terrified by the experience of falling backwards into a roll. These are the little muffins who anchor themselves to the floor whenever they feel themselves rolling. These are the parents who say, “They rolled early on, and then they have never done it again.” Your little one learned a skill, decided they didn’t like it, and learned to CONTROL not doing it. How amazing is that little human!!!??
A baby may hate tummy time one day. Babies come prepackaged and stay in the fetal position that we call “physiological flexion” in the therapy world. They literally cannot stretch out certain areas in their bodies comfortably for the first few weeks. This has protective evolutionary elements like helping with feeding, breathing, bonding and maintaining body heat, etc, but it makes tummy time hard AF. If you want to know what I mean, try this activity. Lay down. Curl into a fetal position. Get onto your tummy and try to do “tummy time” in the fetal position. Do not untuck your knees or arms. Try to lift your head to look at something to your right, left, and front. How did that go??? Want to cry? So does your baby!
But as babies unwind from the womb, they may realize tummy time is a place for fun. A place of bonding, a place of new sensory experiences, a place where the pressure on their stomach helps them expel burps, poop, or gas better! And then tummy time goes from being miserable, to being enjoyable.
A pediatrician’s job is to help you keep your baby alive. A visit is typically to make sure that your child is growing, healthy, and getting the nutrition and sleep that they need so they can continue to grow and thrive. I find that sometimes the visits do not get to focus on your child’s movement patterns and other areas of development as much. Not the pediatrician’s fault, it’s totally our healthcare system and insurance reimbursement rates, etc.(an area that could be a whole other rant and blog). If they do address things, they probably do not have the 45+ minutes to go over specific ways to stretch, position, and play with your baby for optimal function.
With the rise of sleeping on the back since 1997, which I fully support, there is an increase in positional plagiocephaly, or “flat head syndrome.” Babies are born with soft skulls. That is how they get out of their birthing parent’s body. If they had a solid rock of a head, I do not want to think of what would happen to all the pelvic floors and cores! These soft, malleable little noggins are at risk for becoming misshapen if too much pressure is put on one spot all the time. We like to put our babies in containers, and these containers can be our undoing when it comes to things like head shape and gross motor skills.
With the increased awareness with diagnoses autism, ADD and ADHD, I find a lot of parents are secretly worried that their child might have some of these things. Parents perceive a delay in a skill as a sure sign there is something wrong with their baby. They unnecessarily worry that their child is on the spectrum or has an attention issue because they’re not really sure what their child should be doing in the first place.
“They’re six months old and not talking. That means they have autism, right?”
“They are 9 months old and can’t walk. That means they are delayed, doesn’t it?”
“They gag and make faces when I introduce new foods. That must mean they’ll be a picky eater.”
We can definitely screen for certain things during development, but knowing what range and in what order things should be happening with your child can be reassuring. Another soap box for me to climb up onto is this…If your baby was born prior to 40 weeks, please give them that time back. A baby is technically not considered premature after 37 weeks, but preemies are given that time back with a calculation called “age adjustment.” An example of this would be a baby born at 36 weeks, who is currently 8 weeks old but only expected to have the skills of a 4 week old. But if a baby is born at 37 weeks, we expect them to be doing 8 week things at 8 weeks old, even though they may be more at a 5 week old level. It’s bizarre to me, but it’s one of the most reassuring things I can explain to parents. Give them their time back!
Here are some examples of where it can be valuable to be playing with your baby in certain areas to detect issues early.
*Early work on visual tracking play and attention to reading a book can be valuable in helping your child’s vision and attention/receptive language skills. This can help your child with learning skills later on. It also might help you to identify a vision problem earlier rather than later. Some children do need glasses, so if a child seems to be having an uncoordinated eye or trouble focusing after a certain point, seeing a pediatric eye doctor can be necessary.
*Another area that helps with early intervention is with the proper introduction to solids. There is so much murkiness here and some parents are so confused on the “right way.” Spoiler alert, there is no perfect way to introduce solids, but I am working on a course called “Practically Perfect Introduction to Solids” that offers practical advice from an evidence-based perspective for feeding your baby. Just know that there are ways to introduce your baby to solid foods that can help them be successful with eating.
*Gravitational insecurity can be a key issue for babies who don’t like certain sensory input. These are the children who might not like rocking or being in the car. They may be jarred by aggressive movement or bouncing. It can be helpful for these children to have some of that movement incorporated slowly into life so they get used to this input and have less stress moving on in their gross motor movement. On planet earth, gravity will always be a thing, so helping them get used to that early is important!
*My final example would be toe walking. Tip toe walking can be a result of many things. Ankle tightness, joint stability, muscle tone, sensory seeking, positioning, etc. Because this is something that usually starts when a baby first starts standing, its easy to see and easy to treat early on. If we address it very early, the bad habit of toe walking is nipped in the bud. It’s very simple for a baby to learn flat foot stance and proper body mechanics as a new stander and walker so that we don’t have this problem in our preschool and middle school years.
There are so many ways to play with your child to help them develop all the skills they need to be functional toddlers and beyond. The wonderful part is that there are many medical professionals out there, including physical therapy, occupational therapy, speech therapy, behavioral therapy, sleep specialists, and mental health professionals, that are there to help you help your child maximize their happiness and accessibility to every environment of their life.
“Baby’s Practically Perfect First Year” launches this week. It is a self-paced, learn as you go format. You can access it online, and registration gives you access for one year. The class includes about 1.5 hours of down to earth discussion of different areas of development, with suggestions for promoting these skills with your child. There are videos of babies in different ages doing different skills for your learning. The course also includes a handy dandy cheat sheet of skills for parents to quickly reference.
If you have any questions about your child’s development, please ask! I am not a fan of “wait and see.” As Mary Poppins says, “Today or never, that’s my motto.”
Perfectly Yours,
Dr. Mora
