Why Motor Skills Matter: Improve Your Child's Physical Development to Enhance Learning and Self-Esteem

By Tara Losquadro Liddle

“This is an important book [that] offers critical insights and the hope for a bright developmental future that all children, parents, and the professionals who serve them need.” —T.B. Brazelton, M.D., Founder, Brazelton Touchpoints Center, Boston Children’s Hospital

“Why Motor Skills Matt

• Language: English
• Publisher: Koehler Books
• Release date: Jul 24, 2018
• ISBN: 9781633934580

Tara Losquadro Liddle

Tara Losquadro Liddle, Mpt, has been a pediatric physical therapist in private practice for over thirty years. She is presently working as the Regional Director of pediatric therapy at a major healthcare company while pursuing a doctoral degree in pediatric physical therapy. She is a frequent speaker at hospitals, schools, and parent groups. To learn more about Tara Liddle visit www.taraliddle.com.

Book preview

Foreword

We live in a world in which we are bombarded with information on a near constant basis. It seems that the internet has become an echo chamber that directs information to us reinforcing our previously held biases and beliefs. I am no longer surprised when I see that the person walking next to me down a steep flight of stairs has his gaze fixed on his cellphone. I hear my mother’s voice in my head: Watch where you’re going. You’re gonna fall and break your neck!

Within this context, the second edition of Why Motor Skills Matter stands out as a much-needed respite from our age of information overload. Not only is it comprehensive, accurate, and well-researched, it is a thoroughly enjoyable, well-written, and informative read. The author reminds us to take the time to unplug and really pay attention to our children. She describes how each child’s physical development is intimately intertwined with his/her intellectual and emotional development. In so doing, she provides a holistic, developmental roadmap that empowers parents to become informed, active observers and participants in their children’s development.

Playing with them is not only fun, but it’s also good for them and for us.

Each of its eleven chapters is a treasure trove of information and practical recommendations to guide parents through their children’s first five years. Following a logical progression, the author takes us through each stage of development, providing age-appropriate benchmarks and practical advice about what to look for and what to do. She provides reassuring, reasonable advice for addressing common concerns, as well as clear guidelines for seeking help from a professional.

Based on my 30 years of professional experience, first caring for newborns in the neonatal intensive care unit and now overseeing the diagnosis and treatment of children and young adults with learning challenges, I believe this book should be required reading for every clinician and educator who works with children. I would urge them to keep it close at hand so they can refer to it on a regular basis. As a parent and soon-to-be grandparent, I strongly recommend this book to anyone with young children in their lives.

I felt honored when Tara first asked me to write this foreword. That was before I learned that the foreword to the first edition was written by John Driscoll, a giant in pediatrics and newborn care, who has been a mentor, colleague, and friend to me. As Dr. Driscoll wrote in the first edition, The text is a remarkable addition to the current array of information available to guide parents through the first five years of their children’s lives. I congratulate the author for her significant contribution.

Paul B. Yellin, MD

Associate Professor of Pediatrics

New York University School of Medicine

Director, The Yellin Center for Mind, Brain, and Education

Introduction

Why Motor Skills Matter

Every time I put my two-month-old on her stomach, she cries. Am I hurting her?

Why won’t my ten-month-old stand or have his feet touch the ground? I thought he’d be standing by now.

My nine-month-old just wants to sit all day. She’s very happy, but shouldn’t she be moving around more?

I don’t have a babysitter during the days when I work out of my home. I keep my baby in her stroller or the car seat by my desk when I have to work, and in an exersaucer when I’m in the kitchen. Is that bad for her?

My two-year-old loves the playground, but absolutely refuses to go down the slide. Is it normal for him to be so scared?

My three-year-old is constantly tripping and bumping into furniture. He slides off his chair at mealtime. Is he just clumsy?

Our son’s preschool teacher feels that he is disruptive in class because he likes to lie down during story time. Why should that be an issue?

We’re such energized people, and we’re surprised by how sedate our daughter is. I know ‘girls will be girls,’ but I just have this feeling . . . am I overreacting?

When I try to fingerpaint, bake, or play in the sandbox with my daughter she won’t participate. She doesn’t like to get her hands dirty. What should I do?

As parents, deep down we know what’s best for our children’s development. We know when our children are ahead of the curve and when they need our guidance. So what happens when we stop ourselves from helping our kids? Why do we give credence to an inner voice or to others who say we are neurotic or overly protective? Why do we try to convince ourselves that our child will grow out of it, and why do we back off when instinct tells us that our intervention is needed? Our concerns about our children’s activity levels and behaviors are natural, healthy, and above all valid.

As a pediatric physical therapist with more than thirty years of experience, I have met many parents with questions about their child’s development who have not sought answers and explanations from professionals in the field. Unfortunately, the result can be well-meaning but misguided parenting. For example, the mother whose child cries when placed on his stomach may be told that she should pick her baby up. In fact, other solutions may be preferable. Or parents may feel compelled and justified in encouraging their baby to walk before he or she is ready, pressed by child development books and timetables.

So, when should you push your child to do more and when should you simply let nature dictate the pace of early development? At what point should you start to worry about the levels of fear and frustration your child may be feeling? Who decides when a child should arrive at his or her developmental milestones? And does it matter if your child reaches a milestone on time?

As parents, we may observe certain behaviors that seem like shyness or laziness. But how can we be certain of our conclusions? How can we differentiate whether these characteristics are part of the child’s natural temperament or, instead, symptoms of other delays and limitations? Although the best child development books and resources explain which physical milestones to expect, and when, they do not tell you how to determine where your child falls on a normal continuum for physical development. More importantly, these books and resources do not tell you how to ensure that your child reaches these milestones, what to do if he or she misses them, what the repercussions could be of not reaching them, and where and when to seek additional support, if necessary.

Why Motor Skills Matter will guide you through these critical issues, and more. The following chapters illustrate the many ways to enhance our babies’ and toddlers’ physical development that will benefit them for the rest of their lives.

The Importance of Monitoring Your Child’s Physical Development

Nothing is more important to parents than to ensure their children’s proper growth and development. We cook fresh foods for our infants to give them the best nutrition. We play Mozart for them with the hope of boosting their IQ. We join countless playgroups to stimulate their creativity and enhance their social development. So why do so many parents take for granted their children’s most obvious growth concern—their physical development?

It’s natural for parents to get down on the floor to play with their children. This natural action creates the perfect environment to bolster motor skills, strength, and coordination. In fact, parents underestimate the significance of such play.

There is much to learn from play. Every moment of play contributes to a child’s development. The most obvious benefits are increased physical strength and stamina. Equally important—though less obvious—is the parent-child bond that strengthens during play moments. That bond teaches and reinforces essential social skills such as sharing, cooperation, and healthy competition. Play also enhances perceptual-motor skills, language skills, attention span, and emotional development. It improves circulation, helps maintain muscle tone and posture, and helps fight obesity. Perhaps the most significant benefit of play is the establishment of routine. Repetition is a cornerstone of healthy development.

The routine of play leads to regular exercise. As adults, we understand the benefits of exercise. Many of us expend a great deal of energy exercising in the gym, playing the weekend warrior, or embracing the fitness craze du jour. So it should not surprise us to know that exercise is as critical for babies and toddlers as it is for adults. Exercise builds core physical strength and biomechanical patterns that will last a lifetime. These patterns largely determine how a child will approach and react to the world.

Importantly, physical movement is critically linked to affect emotions and cognition in a continuous cycle of sensory input and motor output. Sensory input, such as a mother’s caress on her baby’s cheek, stimulates motor output; the baby automatically turns his head to determine the source of the touch. The more input, the more output. Less sensory input contributes to a slower expansion of a child’s mind, inhibiting growth and development. If a child cannot crawl to the toy he is eyeing across the room, he will likely forget about it and lose the opportunity to explore its shape, color, texture, and taste. If physical exploration is absent, a child will not engage his mind to learn.

For example, a couple recently came to my office with their eleven-month-old son, John. He was not crawling and could not sit up on his own, yet when he was propped up, he would sit happily for hours. John’s parents assumed this was fine and that he would eventually outgrow this stage. A family friend eased the mother’s concerns. We are type-A people, she said. "Your son is different. He is happy being, not doing. Let him just be and absorb the stimuli around him."

The flaw in this belief is that a child cannot absorb all the information around him when his body cannot move freely to experience his environment. In order to process sensory information, a child must hear, see, move toward, touch, and feel all the various stimuli. Without the mobility to perform these exploratory activities a baby will not develop into a well-balanced child. Unless he receives proper intervention from parents and possibly even professionals, the child will not gain access to the sensory experiences required for healthy development.

For John, early intervention in the form of a simple routine of structured floor play at home could have prevented the concerns that brought him to my office. For this reason, John’s case illustrates why I disagree with experts who promote the notion that infants with normal nervous systems do not require specific handling and play, that they will instead adapt and grow properly simply with basic cuddling, cooing, and peekaboo games. In order to truly enrich your child’s gross and fine motor skills and speech development, parents must provide an environment replete with possibilities. Enhancements to a child’s physical environment promote emotional well-being and self-esteem. The greater a child’s self-esteem, the greater his or her ability to be resilient and navigate situations. As in the case of John, his self-esteem and his self-confidence rose in direct proportion to the improvements in his physical abilities, muscle strength, and balance.

Each infant and child is unique. Each has his own way of communicating likes and dislikes, stress factors, and natural abilities. Each develops at different rates, across a continuum. As parents, we can be energized and rewarded to discover that each child develops differently and individually.

Unfortunately, as in the case of John, parents and some medical professionals may prolong the wait and see approach. Too often a referral to a specialist is made after major issues such as delayed speech or inability to keep pace with peers present themselves, typically at two to three years of age. By then, children with minor unresolved developmental hurdles have developed compensatory movement patterns and postural instabilities, often accompanied by insecurity and shyness. Sometimes these children are labeled by peers, teachers, and/or professionals as lazy, shy, a loner, or just plain fearful. Indeed, the categorization itself makes for self-fulfilling prophecies. All is not lost, but intervention with the assistance of proper therapy should be seriously considered and a plan implemented.

There’s No Such Thing as a Lazy Child: How and Why Childhood Traits Can Be Misconstrued

She’s extremely shy.

He’s a loner.

She’s afraid of everything.

He’s just lazy.

Children are described like this everyday. Yet these conclusions are often false, misleading, and almost always harmful to a young child’s growing sense of self. Given an appropriate environment, a shy child may become a comedian, a loner may mature into an eager participant in social activities, a fearful child may learn to be a daredevil, and a lazy child may mature to an exuberant overachiever. Why, then, should these children be labeled as exhibiting traits in conflict with their true personalities? On one hand, these children may develop more slowly than other children due to their genetic makeup. Another possibility is that these children have physical delays and related sensory hurdles, for reasons not easily explained.

These developmental obstacles often manifest themselves within a child’s first year, and the signs may be misinterpreted. An infant who constantly cries may not be colicky, but may instead require fewer stimuli in order to feel calm. The four-to-five-month-old infant who won’t roll over may not be lazy or stubborn; he or she may actually fear movement. A toddler who can’t master the monkey bars may be labeled a loner when he walks away in frustration; he may in fact lack the physical strength and balance to join his friends at play. A young girl who avoids dance parties may seem shy, when in fact her coordination is delayed. She is embarrassed at the prospect of accidentally bumping into friends or stepping on their toes. The second grader who only plays goalie on his soccer team is not lazy; he may feel overwhelmed by stimuli when he tries to join the fray and chase the ball.

Parents take note; there is no such thing as a lazy child. Behavior that you may interpret as laziness is instead the manifestation of a more basic issue—a child’s delayed physical and sensory development. We must therefore strive to raise our awareness of our child’s physical abilities.

Each child develops at a different pace. Some children need extra support for a period of time. Although a child is perfectly healthy, he or she may possess some developmental lags well served by a professional diagnosis. Sometimes, as physical challenges increase, a child exhibits subtle deficiencies in movement, balance, and sensory reactions.

Recently, I met with the Jamisons, who were referred by their pediatrician. Concerned that their twenty-month-old son failed to achieve his developmental milestones within the normal time frame, the Jamisons embraced therapy. They were committed to understanding the importance of the developmental sequence—the necessary progression of graduating from one physical stage to the next—and the underlying neurological basis behind them. As devoted parents aware that they lacked sufficient knowledge of how to play effectively with their child, the Jamisons employed each of my recommendations to enhance their son’s development. They contributed significantly to their son’s developmental success. This story illustrates the concerns and results experienced by parents who have consulted with me over the years. I witness each day the positive impact from parents applying the principles described in this book.

What This Book Will Do for You

Why Motor Skills Matter illustrates the importance of touch, movement, and play in your child’s life and explains the effects of these activities on neurodevelopment over the first five years of life. It is not an instruction manual to improve your infant’s IQ level, but rather will assist parents in raising an emotionally well-balanced, more coordinated, and happier child who can easily process and integrate his or her surrounding environment. Even mild deficiencies in physical development may have a major impact on self-esteem and well-being. Armed with the tools in this book, parents can help and inspire their child to fulfill their highest potential.

In my experience as a pediatric physical therapist working with special-needs children and as a mother of two, I have found that the principles I employ professionally are universally beneficial to all infants and children. I adjusted the techniques of interactive play with my two now grown children in distinct ways due to the differences in their body types. While my daughter was early to roll over, sit up, crawl, and walk, my son was slower to move. His movements lacked stability; he sank into gravity and rounded his back posture, sitting with his legs behind him—called W sitting. When he ran, his legs dangled in all directions. While my daughter was early to exhibit physical strength, she also had her limitations; what she exhibited in strength, she lacked in flexibility. What he lacked in stability, he demonstrated in flexibility.

For my daughter, play positons and sports focusing on stretching the muscles were better, while activities focusing on strengthening the trunk muscles and limbs were dictated for my son. I encouraged both to participate in activities and sports that they loved and, of course, some they did not. Many of those latter activities and sports were the most meaningful in building their self-esteem. Both of my children became successful athletes in sports they hated at the outset. Ultimately, they loved those sports once they achieved competence in them.

Applying the principles of this book to the development of my children has helped them tremendously, not only in enhancing their posture, balance, coordination, and strength, but also in building their self-image and self-esteem from an early age. Though like most of us they have areas in which they struggle, they are both highly confident children who lead active lives.

Why Motor Skills Matter is based on the following principles:

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Achieving the developmental sequence is critical for the well-balanced child.

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Effective play sets the foundation for more challenging activities to come.

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Early exploration leads to more creative thinking.

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Achieving early proper alignment and postural control helps prevent many postural and orthopedic problems that may crop up over time.

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A sensory-rich environment promotes physical movement and development. These functions, in turn, facilitate new learning experiences. The net result of this ever-developing and expanding sensory input/motor output cycle is a greater sense of confidence in navigating the world.

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Good proximal stability and trunk control supports the emergence of fine motor skills (including handwriting), important aids to a child’s ability to learn.

Part 1 of this book provides a basic understanding of the sensory system: how it develops from infancy and how it relates to your child’s activity and emotional state. Part 2 details development throughout your child’s first year and is steeped in information regarding the formation of motor skills and sensory systems. Activities for this developmental stage are accompanied by explanations of their usefulness in enhancing gross and fine motor skills. Additionally, each chapter provides Developmental Benchmarks to help assess your child’s relative place on the developmental continuum. Included is a Well-Balanced Checklist, a summary of actions you can take to bolster your child’s development at each stage of growth. Recommended toys (to buy or fabricate) that are developmentally advantageous to your child are also listed.

Part 3 discusses your child’s continued mastery of fine and gross motor skills, as well as language development. Activities to bolster your child’s development are presented, as are sensory activities. Through these activities and the discussions that accompany them, you will be able to assess your child’s strengths and weaknesses and which exercises would be the most beneficial to him or her. Sections on Developmental Warning Signs highlight the subtle ways in which your child might be having difficulties. Common Concerns throughout the book present the most frequently asked questions by parents—from whether it’s suitable to use a walker, to addressing difficulties surrounding sports your child enjoys.

It is important not to become overly zealous and rush your baby’s development. Activities targeted for an eighteen-month-old or a two-year-old should not be given to a nine or twelve-month-old. Remember, babies need to go through the developmental sequence. Babies need to be babies; they grow up fast enough without adding to their pressures of learning and performing.

Part 4 focuses on special considerations: children with low muscle tone, premature babies, sensory processing disorders, and the most commonly seen orthopedic conditions in pediatrics. I conclude with lists of resources for parents who need further assistance, as well as recommended readings.

Finally, this book is based on a set of goals:

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Providing you with ways to build a firm foundation for good biomechanics and better postural control for your child.

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Teaching you how to use repetition as a way of practicing and building skills.

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Showing you ways to enhance the balance reactions of your child.

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Helping you understand the importance of proximal (shoulder and hip) strength and abdominal strength.

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Understanding that infants and children are not lazy—if they seem so, there may be an underlying sensory-motor cause or problem.

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Realizing, if we achieve all of these goals, our children will have fewer physical limitations and will have a greater sense of self throughout their lives.

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Recognizing that healthy premature babies have their own specific set of developmental criteria to achieve.

It is my hope that implementing the activities and suggestions in this book will positively impact your child just as they have helped the many children in my practice and my own children at home.

Learning to Move and Moving to Learn

The Continuous Cycle of Motor Output and Sensory Input

Though we may not see or understand it, the sensory system is important. Understanding the importance of the digestive, cardiovascular, and respiratory systems is easy—without them we could not survive. But without our sensory system, which is composed of a network of interrelated systems, we could not function. If we think of our brain as a computer, then our sensory system—our eyes, ears, skin, and nerves—serves as its conductors and wiring, responsible for transmitting all incoming data. In the same vein, all the information we receive about our world is transmitted by our sensory system and subsequently processed by our brain. How well this network of systems functions has a direct effect on our behavior, emotions, and our quality of movement.

It’s easy to understand how the basic sensory system helps us; our senses of vision, hearing, touch, taste, and smell all protect us in our environment. They allow us to learn about positive and dangerous input or stimuli: A child learns not to put his hand on a stove top because it will get burned; we learn not to walk out into the street if we see a speeding car or hear one honking at us; we smell smoke and think danger well before we locate the cause.

However, two critical parts of the sensory system are not as easy to understand: the vestibular system (our sense of movement) and the proprioceptive system (our sense of body position). Our vestibular sense orients our body position in relation to the surface or ground. It is responsible for our balance and automatically coordinates our eye, head, and body movements as they relate to gravity and space. Vestibular sense enables a child to stand on one leg or run up and down an incline (such as a slide) without falling.

Through our tendons, joints, and ligaments, our proprioceptive sense tells us where our body parts are relative to one another. It lets us guide our limbs without having to watch where we are putting them. For instance, the proprioceptive sense lets us know how much to bend a knee when we’re climbing a step and how to keep our body upright when we trip. It enables a pianist to read sheet music while playing because he doesn’t have to focus on locating the notes for his fingers; with enough practice, his fingers know where to find the keys.

If asked what the most important senses are, most people would answer vision and hearing, since the uses of these senses are the most obvious. Yet the senses of touch, movement, and body position are crucial for us to function on a daily basis. In fact, the tactile (touch), vestibular, and proprioceptive systems begin to function in an interrelated manner as soon as we are born. In order for us to accurately interpret our surroundings and form appropriate responses to them, all of our sensory systems need to be functioning properly and in conjunction with one another. Our ability to utilize our senses in this manner—to absorb information, sort it out, and then respond to it—is what we call sensory processing.

When the sensory systems are working properly and the environment is being interpreted appropriately, a child is able to function in an organized manner. He has good motor skills and good play skills that contribute to his feelings of competence and self-assuredness. He is able to enjoy his dance classes, partake in kickball at recess, jump rope. In short, his physical abilities facilitate his socializing, which bolsters his confidence. (This isn’t to say that there aren’t children who are extremely agile but lack strong social skills.) As we mature, an efficient sensory system does even more—it allows us to concentrate on and complete an activity without being distracted by extraneous noises or activities. It allows babies to focus on reaching an object and enables children to sit quietly and do their homework (even with background noise); it allows a mother to pay bills while keeping an ear out for her kids in the next room. If a child’s central nervous system cannot fully process or organize the information coming in from its senses, then the child won’t be able to function properly. If his experience of the world is distorted, it follows that his thinking, movement, and behavior will be distorted as well; he might not be able to concentrate, put puzzles together with relative ease, or tolerate any appropriate frustration when trying a new activity.

To parents, it may appear that the amount of information small children need to integrate is modest. If we think of all the multitasking we do on a daily basis, then an activity such as taking a bath seems like a welcome relief—not a major accomplishment. We need to put ourselves back in our babies’ booties in order to empathize, for a moment, with their reactions to the great unknowns of their emerging universe. Any new place, person, or situation can be challenging. Needless to say, as we get older our task of integration increases exponentially. I believe that how well we manage this task has a direct impact on our emotional and physical development from birth through adulthood.

The Newborn’s Developing Sense of Awareness

Prior to birth we are cozy in our mother’s womb. But the moment we begin our journey through the birth canal, we begin to sense many changes—the bumpy ride, getting stuck, being pulled out. Then, kaboom! Lights, camera, action! We don’t have a second to adjust to all these new sensory inputs—the noise, the lights, the movement. From this moment on, parents need to be aware of babies’ responses to all this input. We need to learn to read our baby’s signals or warning signs that will tell us if he is happy, tired, or stressed.

A healthy newborn receives and responds to many sensory experiences. From birth, we parents provide tactile input when we hold our babies, visual input when our babies see us, and auditory input when we speak to them. Vestibular input is provided when we rock, move, or carry our infants. The senses of taste and smell are activated when we feed them. (Interestingly, a newborn