Starfish Therapies

February 29, 2012

Should I Be Concerned: Gross Motor Edition (up to 15 months)

A lot of times my friends and relatives ask me questions about their child’s gross motor development (especially if they are first time parents and have nothing to compare it to) and if they should be concerned so I decided to writie up a list of items that may be an area of concern for kiddos at 3 month intervals.  This list doesn’t necessarily mean there is a problem but it doesn’t hurt to take a look and see if some of the things you are noticing continue to be a challenge.  Many times I find that if there are some slight challenges with gross motor, the earlier the parents and the kiddo get tips on how to help develop the skills, the quicker the child catches up.  I tried to take a slightly different approach than the typical look at gross motor milestones because there is such a range in milestone acquisition that often parents aren’t sure if their child is behind or not.

General Concerns:

  • Very stiff or very floppy
  • Torticollis/plagiocephaly (flat spot on the head)
  • Prefers standing all the time
  • Lack of opportunity for independent motor exploration (time spent out of equipment/carriers/bouncies/etc)
  • Profound or significant birth/medical history
  • Generally still (not moving) when awake
  • Persistent ATNR

Three Months:

  • Difficulty lifting head on belly or on back
  • Stiff legs with little to no movement on belly or on back
  • Pushes back with head
  • Tends to keep hands fisted with little to no arm movement on back
  • Challenges with bringing hands and/or head to midline on back

Six Months:

  • Items listed previously
  • Back is rounded or slumped
  • Unable to lift head up in sitting, supported or unsupported
  • Poor head control
  • Arches back and stiffens legs
  • Holds arms back and up (i.e. high guard)
  • Has stiff legs
  • Keeps legs in a frog leg position on belly or on back
  • Doesn’t like to be on their stomach
  • Thrusts into extension for movement (such as rolling or when sitting)
  • Not able to roll
  • Doesn’t bring feet to mouth or feet to hands on back
  • Doesn’t weight bear on arms when on belly
  • Doesn’t tolerate or like sitting
  • Unable to sit supported
  • Doesn’t kick legs
  • Unable to lie on side

Nine Months:

  • Items listed previously
  • Uses one hand predominantly
  • Poor use of arms in sitting
  • Difficulty crawling
  • Only uses one side of the body to move
  • Inability to straighten back
  • Can’t/won’t take weight through legs
  • Prefers lying on back rather than on belly or exploring
  • Doesn’t weight bear through upper extremities
  • Uses bunny hopping or butt scooting as only means of mobility
  • Uses w-sitting as primary method of sitting or a wide based ring sitting
  • Inability to weight shift through legs or arms
  • Inability to move legs separately from each other
  • Difficulty getting onto hands and knees

Twelve Months:

  • Items listed previously
  • Difficulty getting to stand because of stiff legs and pointed toes
  • Relies on arms rather than legs to get into standing
  • Sits with weight to one side
  • Strongly flexed or stiffly extended arms
  • Needs hands to maintain sitting
  • No desire or ability to climb onto objects
  • Avoids standing
  • Trouble transitioning between positions (i.e. sitting to hands and knees, lying down to sitting)
  • Difficulty with cruising
  • Not attempting to walk with support

Fifteen Months:

  • Items listed previously
  • Unable to take steps independently
  • Trouble maintaining standing balance
  • Walks on toes

This is just a guideline for some areas that may be cause for concern and for peace of mind may be worth having a pediatric physical therapist take a look at your kiddo.

Bly, L. (1994). Motor Skills Acquisition in the First Year.  San Antonio, TX: Therapy Skill Builders.



  1. […] have concerns about your child’s motor development, Starfish Therapies put together a great checklist of motor skills and potential red flags.  You can always contact a Pediatric PT for helpful […]

    Pingback by Motor Milestones: 7-12 months | Dinosaur Physical Therapy — April 14, 2015 @ 12:00 pm | Reply

  2. Hi,
    My LO is almost 6m old (on 6/28) but he was born almost 3w early. He is little (3% in weight, 6% in height and about 40 in head so his head is much bigger than the rest of him). He uses extension a lot (arches sometimes when sitting, hasn’t rolled back to tummy yet and while he has rolled the other way he doesn’t often, and he doesn’t like to play on either side). He does have a little reflux but doesn’t appear to be in pain. Should I give him a few more weeks since he’s really only 5m10d adjusted? He does lotsa tummy time (about 1-1.5 hr a day easily) and reaches for some toys but doesn’t pivot and sometimes seems like he can’t move or figure out how to move. He pushes up onto arms or one hand/arm but not both hands yet. Does any of this seem concerning at all? Thank you!

    Comment by Angela — June 25, 2018 @ 11:55 am | Reply

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