Crawling is a milestone often overlooked, despite it being one of the most important. It usually develops after independent sitting has been established, and before standing and walking occurs. Most children crawl from month 8/9, until walking at around month 11/12, on average. This gives a baby a solid foundation of 2-3 months on their hands and knees. So, why is this important, if we almost never have to crawl again in life? Why is walking not the main focus of development instead? The answer is this – crawling makes use of all of our limbs, in a coordinated manner, incorporating the use of the trunk, and requires much control and strength. Not only this, crawling demands great levels of accuracy when it comes to our physical movement, and the planning thereof. We need to judge and perceive distance in order to accurately get where we want to, working on our visual perception too. We use these skills in walking too, but the physical demands are actually less (aside for the balance aspect, that is) since all four limbs are required to move in a sequential manner that coordinates arms with legs as well as left with right. Due to the nature of crawling, and the position the body is in – called four-point kneeling, and the incorporation of our arms, we are able to develop greatly in terms of proximal stability, which is the strength and stability of the shoulder and pelvic girdles, in order to assist in the maintenance of postures. As adults, we still find long periods of time in four-point kneeling challenging, and the weaker you feel your core strength may be, the chances are, the more you’ll struggle maintaining a weight bearing position through your arms, like ‘planking’ or doing push-ups. So, why do we need strong arms and shoulders? Most of us are not planning to be heavy-weight champions, right? So we think upper limb strength shouldn’t be too important. But this is so wrong! We take our shoulder strength for granted, and those of us who have dislocated a shoulder or broken a clavicle may understand just how difficult things are without that strength. A task like cutting requires the use of both hands, and in doing so, both arms generally need to be lifted off of the table to cut properly. For a child, this means a few minutes of elevated arms, which, for their small bodies is really no easy task, considering their core is working hard to hold their seated posture correctly at the same time. Add a weak core to this mix, and we have so many more problems. I can think of so many bilateral activities requiring both arms elevated – mixing something in a bowl, pouring a glass of juice, carrying a heavy object, reading a book whilst sitting/lying, throwing and catching a ball, lacing and threading beads – all tasks we expect our school-going children to be able to do. For this very reason, a weak core and weak shoulders is something most often picked up when children start school and these tasks are expected of them. Tasks requiring fine motor skill like writing and colouring become really messy because children with weak shoulders fatigue easily. In OT we have a golden rule called ‘proximal stability before distal dexterity’ – which means a strong core is essential for adequate and effective function of the limbs and hands. So when a child has a weak core, it’s often most evident in poor fine motor skills or even gross motor skills, depending on how weak the core really is. A child with a weak core – often termed low muscle tone, also slouches and fatigues very easily. This is a child rocking on his chair in class, hooking his feet around the legs of the chair, resting on his hands, slumped over the desk, fidgeting and shifting positions frequently. He might even compensate by getting up and walking around. It’s an effort to sit up straight and they are exhausted by the end of the day. Paying attention in class is difficult when they are so busy trying to sit properly. A tired body makes for a distractible mind! It is quite common for these children to be misdiagnosed with ADD/ADHD because of this. So yes, whilst we are not all training to be weight lifters or professional swimmers, a strong set of shoulders is really a big deal to a young child. A well developed core allows them to develop in many other ways, and when these muscle groups are not well-developed, some serious issues can arise. Another question I get asked is why children do not crawl. In my eyes, a child bum shuffling across the floor is considered as ‘not crawling’, as is a child who leopard crawls (moves on their tummy). These do not have any components of crawling – no four-point kneeling, no weight bearing through the arms or hips and no use of tummy muscles. So essentially, there is no advantage or development in those kinds of movement. These happen when a child has a weak core and is reluctant to get into the correct position because it may be simply too difficult for him to achieve it, and he comes up with his own means of mobility. We then get the parent who claims “my child was so advanced he just skipped crawling and went straight into walking” – however, your child was probably too weak to crawl, and his fine motor abilities will really be affected, making him struggle through first and second grade. That is definitely not considered advanced and having a child unwilling to crawl is cause for concern. It is an indicator of weakness from an early age – please do not ignore it, address the problem there and then! A common link has been found between non-crawlers and the use of exersaucers, walkers and jumpers. These prevent core strengthening due to the support they provide. They also remove most motivation for mobility, 1) because my toys are always right here in front of me, and 2) I can move around while I am in the walker, and bounce or rock in other devices, which is much easier and way more fun – that crawling thing is hard! As humans we are naturally taking the easy way out – and babies are very much the same. Why learn to crawl if you can get what you want through other means? So yes, these devices are so much fun, our babies do love them for that reason. But they also cause laziness, delayed (or even skipped) milestones and problems later on with other areas of development. Other areas in which crawling has advanced development – are in our visual perceptual abilities. We use these skills everyday in all our movement patterns, and fine motor skills, as well as accuracy in tasks. We need visual perception to build puzzles (visual closure), find something in a cluttered draw (figure ground perception), copy off the blackboard in class (visual motor integration), organize things in rows, columns, left and right (spatial relations) and pay attention to detail in order to find the differences in things (visual discrimination). When we crawl we use depth perception in order to identify where objects are in our environment – so that we can judge, plan and adapt our movement patterns using this visual feedback. Crawling babies are seen to develop mostly in their spatial relations skills and visual motor integration abilities, as well as motor planning skills. Children need these skills in writing, cutting, threading, building puzzles, doing a pegboard activity, and even when matching and copying. The ability to coordinate movement is also a very important aspect of development. We learn to move one side at a time (unilateral movement), and we then learn to coordinate both sides moving together at the same time (bilateral symmetrical coordination), in tasks like holding a bottle and drinking from it. It then advances to moving both sides in a sequence, at different times of the body (asymmetrical bilateral coordination), as in crawling, walking, skipping etc. It is a very important skill because it teaches us to sequence and time our movements in order to move in an accurate and controlled manner, which is essential in things like catching a ball or even hopping. One needs to know where to place his feet, legs and arms, in an instinctual, instant manner. When these require more planning than normal, children are slower in these areas, often missing the ball when thrown to them, missing the ball when trying to kick it, cutting uncontrollably, and colouring outside of the lines. It is important that we, as parents, see milestones for what they are – stepping stones paving a way for development. Imagine walking along a path and there is a big gap where a stepping stone should have been – you will need to take one large leap and might lose your balance and stumble for a few of the following steps. Our children need to achieve these milestones in order to prevent limitations or difficulties in future development. We wouldn’t let them miss a milestone important as learning to read, and it is essential we understand and identify crawling as a milestone with just as much value! Crawling is essential for development, and advances your child in so many ways – and the longer the crawling phase, the better. Ideally, 2-4 months of crawling before walking is best. If your child learns to walk soon after crawling, this is okay too. We don’t want to delay walking or prevent a child from walking in order to crawl for longer, but it is advised that children with a shorter crawling phase do upper arm strengthening activities to compensate for this. These include climbing a ladder, climbing up a rope, doing monkey bars, throwing and catching balls (weighted balls are better for older kids), or wheelbarrow walking. Non-crawling, or even incorrect crawling should never be ignored!
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About MeI am a Pediatric Occupational Therapist by profession, but a full-time mom to a beautiful baby girl, born in September 2014. My husband and I live in sunny South Africa. Archives
October 2015
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