This article was written in consultation with
Ziva Schapiro, OTR

From the time of a baby's birth, we eagerly wait for the day when our child will start to roll over, crawl and then walk. Unlike speech and language development, these milestones are at first glance easily determined. Either a child rolls over or he doesn't. Either he crawls or he walks. Yet, what many parents do not know is that within the field of physical development there are separate areas of development and within those areas the manner in which a child is able to accomplish a certain task, can make a big difference in his life.

Once a child learns how to walk, it may be important to examine how that child walks. Does he put one foot in front of the other? What is his gait? Is his pace steady? Once a child learns how to draw with crayons, it may be important to examine the way he draws. How does he hold the crayon? Can he put sufficient pressure on it?

In order to help you answer these questions and better understand the area of physical development, this series will give you basic background information and a developmental checklist to check on your child's development in this area. The area of physical development can be divided into two main areas:

Gross Motor Development
Fine Motor Development

There are also two areas, which can affect a child's ability to learn and may contribute to difficulty with physical tasks. These are:

Attention Skills
Sensory Integration

Here is an explanation of each of these basic terms:

• Gross Motor Development

This is the area of physical development that most parents think of first - the child's general ability to move around and use the various parts of his body. Activities like rolling over; crawling, walking, running and jumping are gross motor skills. These skills usually involve using the entire body or several parts of the body at one time.

Some of the areas that are considered when evaluating the area of gross motor development are:

Muscle Tone: How tightly or loosely a person's body is put together? If a child's body is too tight (high tone) then his movements might be jerky or disconnected. If a child's body is too loose (low tone) then her movements might be slow and lack strength. Some technical terms that are associated with these areas are Hypertonic (someone who has high tone) and Hypotonic (associated with low tone). These are professional terms and do not apply to every child whose tone happens to be either a bit tight or a bit loose. Only a professional can decide if a child's skills fit these criteria.

Muscle strength: How much strength does a child have? How much pressure can she apply with her hands and legs? How much pressure can her body withstand?

Quality of movements: Are a child's movement's smooth or does she seem to jerk her limbs? Does she seem to move either particularly slow or fast? Does it take effort for her to move around?

Range of movement: An important area in physical development is a child's ability to make movements that span the entire length of her body. A significant milestone is the ability to make movements that go from one side of the body to the other, referred to as "crossing the midline." This skill is necessary for a child to do tasks such throwing a ball or passing an object from one hand to another. This concept is also important for the area of fine motor development.

• Fine Motor Development

This term refers to skills that require smaller movements and more intricate capabilities. A generalization that is often made is that fine motor activities are skills that a child does with his hands. While this is not totally accurate, it is true that most fine motor activities involve a child's ability to use his hands properly. Overall, when we say that a child has appropriate fine motor skills, it means that he can use his hands appropriately for a child of his age.

Here are terms that are used to describe specific fine motor skills.

• Visual Motor Skills

These skills require coordination between the child's ability to see (visual skills) and his hands. In early childhood, this includes activities such as putting together puzzles and building with construction toys. (blocks, leggos)

• Grapho-Motor Skills

Any task that involves using a writing tool is considered a grapho-motor skill. These tasks include drawing, coloring, and using a pencil. (Grapho-Motor skills are also visual motor skills.)

An important term related to these areas and fine motor development in general, is eye-hand coordination. This refers to a person's ability to coordinate the information that she sees with her eyes in order to tell her hands what to do.

• Motor Planning

Professionals use the term motor planing to describe a child's ability to interact successfully with his physical environment; which means to plan, organize and carry out unfamiliar motor actions. When a child sees a new puzzle for the first time, it is not enough to have the physical ability to move the pieces around and fit them together. He also needs to know how to organize the activity so that he will be successful. (i.e. start with the ends, put the ones of the same color together, etc…). If a child has difficulty with a task, it is important to consider if he is unable to physically complete the task or if he is unable to figure out how to go about doing so.

While you can evaluate a child's fine motor skills from a very young age, until age two, the line between fine and gross motor skills is often very difficult to ascertain. The skills most closely associated with fine motor skills (drawing, puzzles, building, etc…) generally start to develop in children from ages two and up. Up until age two, a young child is not able to use her hands in a more intricate way. Among infants, babies and toddlers, therefore, physical development difficulties are not always clearly defined as gross motor or fine motor difficulties. By age three, however, the difference between these two areas is more obvious and the tasks that the child has difficulty with are defined as falling into either only one or both of these areas.

Contributing Factors:

When considering a child's motor skills the following factors need to be taken into consideration:

• Attention Skills

Another area that can contribute significantly to a child's ability to perform physical tasks is his attention span. In the last few years, a condition called Attention Deficit Disorder has become very well known and commonly diagnosed among both pre-school and school age children. While this condition can not be properly explained in a few lines, the main point is that a child's attention span can affect his ability to complete activities. It is important to point out that when a child is having difficulty learning to perform physical tasks, it is essential to consider if his abilities are affected by his ability to pay attention to what he is doing. Is he truly unable to build a tower of ten blocks -- Or is he simply too easily distracted by the child next to him who is coloring with markers?

• Sensory Integration

While many parents have heard of attention deficit disorder, few parents are aware of how their child's relationship to his senses, can affect his physical development. All children and adults, in one way or another have sensory sensitivities. There will always be certain smells that make one person feel sick and do not bother someone else, or a certain sound that makes a person's skin crawl while it does not affect someone else. But what many parents and professionals do not realize, is that there are children for whom this sensitivity keeps them from learning in a classroom or at home.

In fact, in addition to the five senses of touch, taste, smell, hearing and sight, there are two more senses that are also essential to a child's development: the movement sense (vestibular) and position in space (propriception).

All seven of these senses need to properly take in information from the environment and organize them in a way that our bodies can use. This is called sensory integration. Sometimes there are imbalances in this system that can lead to over or under sensitivity in one or several of these areas.

Being either over or under sensitive in one or several of these seven areas can affect a child's ability to perform physical tasks.

Here are some examples:

• Touch - A child might be sensitive to the feel of objects against his skin. He might hate activities such as dress up, pretend play with makeup, or arts and craft activities that involve working with playdough or clay. A child who is overly sensitive to touch may overeact when touched even lightly on the shoulder by a teach or a friend. A child who is underly sensitive may have no reaction if he falls or hurts himself.
  
  
• Smell - A child might react strongly to unusual or strong smells or not seem to notice even unusual smells such as food burning or gas leaking.
  
  
• Taste - Some children are particularly sensitive to the taste of different foods.
  
  
• Sight - Strong lights or certain types of colors may bother a child.
  
  
• Hearing - A child may be disturbed by sudden or loud noises.
  
  
• Position in Space - Some children have difficulty evaluating how much space is needed to reach a certain item. This would include putting a pegboard down on the table without tipping it over, judging if there is room for a child to crawl underneath a jungle gym and sitting down on the center of the chair. A child who seems to eternally "miss the chair" when sitting down may be having difficulty in this area.
  
  
• Movement - an overly sensitive child may fear climbing on a jungle gym, and have difficulty with gross motor activities. An underly sensitive child may be fidgety, jump on the couch all afternoon, and have difficulty sitting down to do table activities such as a puzzle.

These are but a few examples of how a child's ability to use the information he receives from his environment is critical to his ability to perform physical tasks.

When a child is having difficulty in the area of physical development, it is essential for parents and professionals that treat a child to consider how his sensory environment affects his development. In this way a parent can determine if a child really "can't" put together that puzzle or if the lights or other sounds in the room are just so disturbing to him that he is unable to do so.

It is also important for parents to understand that sensory integration is a real issue and not just a child being "picky" or "fussy." While to some children a strong smell or bright lights might be annoying, to others, the experience can be unbearable.

Evaluating Contributing Factors:

How can a parent or professional know if a child's problem is a purely physical one or if it is being affected by contributing factors such as sensory integration or attention skills? Often, making this discrimination is the hardest task of all. The first tip off that a contributing factor is affecting a child's development, is if a child can perform a task in some situations, but not in others. If a child can sit and put together 20 piece puzzles at home, but in pre-school he just moves around the pieces, then clearly the problem is not just physical. Instead, a parent and professional should consider if the child's difficulty in school is in the area of attention (too much is going on) or if he has trouble with the sensory stimuli in school (i.e. the lights are too bright, the noise of the children is too loud.)

While it is often easy to determine if a child can or cannot do a particular physical skill it can be difficult to decide if this is an exclusively physical problem or if there are other factors contributing to the child's difficulty. The key for a parent and a professional is to determine how a child's physical skills are developing. Then, if there are any difficulties, it is essential to determine if this is purely a physical difficulty or if other factors may be affecting the child's development.

Here is quick way for you, the parent, to check up on how your child is doing:

Early Childhood Physical Development Checklist:

This checklist was developed by Ziva Schapiro, OTR

Below is a tool to help you check up on how your child is doing. If you don't know which of these tasks your child can complete, just print out the form and keep it handy while working with your child. This tool does not replace consulting with a qualified professional if you are concerned about your child's development.

I will point out which area of physical development the task is connected to by using the following abbreviations:
G= Gross Motor Development
F= Fine Motor Development

If there are tasks that your child has difficulty with, note if they belong primarily to a specific area of physical development. Then also consider if any of the contributing factors that I mentioned about (sensory integration or attention skills) may be affecting his performance in these areas. Try some of the tasks again, in different situations and see if there are things he can do in one situation and not in another. This will help you know what areas to work on with him and may be relevant information to pass on to professionals, if you feel a professional consultation will be necessary.

If your child does not have all of these at the appropriate age - do not worry, children develop at different paces.

If your child has not developed many of these skills or most of the skills in a certain category, then - still do not worry - but you may want to check his development with the relevant professionals.

If after filling out these checklists you are concerned about your child's development go on to read:

Stepping In to Help: What to do if you are concerned about your child's physical development?

Click on your child's age and find out how he is doing:

One Year Old
Two Years Old
Three Years Old
Four Years Old
Five Years Old
Six Years Old

One Year Old:

(Some of the developmental milestones for this list come from What to Expect the First Year.)

Lifts head while lying on stomach (by age 3 months) (G)__
__Grasps a rattle (age 4 months) (F)
__Bring both hands together (age 4 months) )
__Rolls over one way (by age five months) (G
__Keep head level with body when pulled to a sitting position (age six months) (G)
__Rolls over both ways (by age seven months) (G)
__Sit without support (age 8 months) (G)
__Feed herself a cracker (age 8 months) (F)
__Passes an object from one hand to another (age 8 months) (F)
__Get into a sitting position from stomach (8 months) (G)
__Stands holding on to someone or something (10 months) (G)
__Pulls up to standing position from sitting position (age 10 months) (G)
__Can pick up a tiny object. (11 months) (F)
__Can walk holding on to furniture. (12 months) (G)

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Two Years Old:

This checklist was developed by Ziva Schapiro, OTR

__Walks and runs on full feet (G)
__Pulls toys with strings (G&F)
__Climbs on furniture to look out the window and can get down (G)
__Climbs stairs holding on with two feet on each stair (G)
__Builds tower of 6 blocks (F)
__Pretends to push a train made out of three blocks after watching an adult do so. (F)
__Strings 1-4 large beads (F)
__One hand starts to be dominant (F)
__Holds crayon with the whole hand (fingers straight) (F)
__Imitates an adult making circular strokes or dots (F)
(The child will make a circle or dots after watching an adult do so.)
__Copies horizontal and vertical lines (F)
__Uses spoon well (F)
__Assists in dressing (G)

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Three Years Old:

This checklist was developed by Ziva Schapiro, OTR

__Jumps in place with both feet (G)
__Kicks stationary ball (G)
__Rides tricycle (G)
__Stands on one foot for two seconds (G)
__Swings on swing when stated in motion (G)
__Builds tower of nine blocks (F)
__Snips with scissors (F)
__Completes 5-6 piece puzzle (F)
__Holds crayon with three fingers(F)
__Copies circle (can make a circle when he sees another one on a paper.) (F)
__Imitates cross (can make a cross after watching an adult draw one) (F)
__Draws person with head (F)
__Uses spoon and fork properly (without making a "big" mess) (F)

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Four Years Old:

This checklist was developed by Ziva Schapiro, OTR

__Hops on one foot 1-3 times (G)
__Plays catch with large ball (G)
__Good control of tricycle (curves and spins) (G)
__Builds tower with 10 blocks (F)
__Strings small beads (F)
__Holds writing utensil with three fingers (F)
__Copies square (F)
__Draws person wit head feet and body (F)
__30 minute attention span (5-10 minutes per activity)
__Dress/Undress independently (except for closings, i.e. buttons, zippers) (F)
__Crosses midline (F&G) (anchor to this term in the article above)
__Does not switch hands in the middle of an activity (F)
__Clear dominance in right handed children (F)

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Five Years Old:

This checklist was developed by Ziva Schapiro, OTR

__Walks on straight line (G)
__Can climb steps holding an object (G)
__Hops on each foot three times (G)
__Stands on one foot 8-10 seconds (G)
__Rides two wheeler with training wheels (G)
__Can swing by himself (G)
__Bounces and catches tennis ball (G&F)
__Builds tower 12 blocks (F)
__Can build three steps out of six blocks (F)
__Draws angled lines and triangle (F)
__Draws a person with head, body, legs and face (F
__Can color in lines (F)
__Cuts on straight lines (F)
__Holds knife in dominant hand (F)

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Six Year Old:

This checklist was developed by Ziva Schapiro, OTR

__Stands on one foot with eyes closed for 3 seconds (G)
__Walks on line in heel-toe fashion (G)
__Skips (G)
__Rides bicycle without training wheels (G)
__Jumps rope (G)
__Catches and bounces tennis ball (G)
__Draws diamond (F)
__Cuts with knife (F)
__Holds writing utensil with three fingers with movement in the fingers.
__Ties shoelaces (F)

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