SHEDDING LIGHT ON THE GREAT DEVELOPMENTAL DEBATE

BY LIBBY KASTEN

THE ARMY CRAWL, THE TRADITIONAL CRAWL, THE SHUFFLE-BOP-HOP CRAWL, THE DRAGGING FOOT CRAWL. DOES BABY’S CRAWL IMPACT DEVELOPMENT LATER IN LIFE? OR IS IT JUST A MYTH LAID DOWN BY OLD-FASHIONED MATRIARCHS AND NEWFANGLED THERAPISTS?

Baby Chaya was plump, playful, and absolutely adorable. She sat on the floor without support, played with the toys placed in front of her happily, and made babbling sounds. At eight months old, her mouth sported three razor-sharp incisors that were visible when she smiled or felt when she decided to have your finger for lunch.

In the summer, when she began exploring spaces other than where she was placed, we watched in fascination as our baby girl bounded around the house by bouncing in some sort of sitting position, legs spread out in front of her in a semi-circle.

Assuming this was a step prior to “real” crawling, we watched and waited for the transition. But even when the afternoons became shorter and the trees began swaying in the early fall breeze, ten-month-old Chaya still wasn’t crawling.

Aside from her inability to support herself on her hands and knees and learn the traditional crawl, there were other factors that concerned me. Chaya’s wrists would hang loosely most of the time, and she disliked tummy time. She actually displayed excellent fine motor skills like getting tiny chocolate chips or beads off the floor, but her wrists remained in a newborn-like position.

Developmental Deliberation

Of course, the experts known as family and friends said it was totally fine, even normal. So many children who are now healthy adults skip the crawling stage. Besides, low muscle tone runs in families—other than ours, of course— so why worry? Though my older children had easily met all milestones, I knew of many babies who reached them much later and were perfectly okay.

However, with my penchant for getting to the root of things without procrastination, I was not ready to let this slide just like that. Where to begin my research? Passages from what I’d read on the topic rose to the top of my mind, replete with scenarios about the developmental disadvantages of skipping the traditional crawl. My Erev Rosh Hashanah brain went so far as to dredge up the memory of a conversation with a family member who had taken her older son, who was severely delayed, to a therapy center where he crawled on all fours to help bring his cognitive levels up to par.

And yet, my baby seemed so okay, even smart. She was already responding to her name and interacting with her siblings on some level. My mind debated back and forth, “yes therapy” or “no therapy”? Was the propaganda about traditional crawling just hype?

In the meantime, Chaya bopped around, wavy locks of hair bobbing along with the rhythm to the amusement of all onlookers, except her mother. And, as I would soon find out, her babysitter.

One evening, in what must have been an uncomfortable phone call for her, yet such a relief for me, the babysitter called to gently suggest that I have Chaya evaluated for physical therapy. We discussed our collective concerns, and I hung up feeling validated and sure about my next step. Here was another adult, mother of a large family, who observed my baby for hours each week and also wasn’t in favor of “waiting it out.”

Ruling Out Underlying Developmental Issues

After doing all the research at my disposal and then listening to what my heart was telling me, I reached out to a local agency to schedule an evaluation. In the meantime, by speaking to many fellow mothers who shared their experiences, opinions, and concerns, I learned that skipping the crawling stage is a very common occurrence in babies, and its impact on future development is largely dependent on the root cause of the absence or delay.

Often—but not always—the inability to do the traditional hands-and-knees crawl is caused by a lack of balance, coordination, or cognitive and sensory skills. Therefore, if a baby isn’t crawling, and especially if other weaknesses in their physical development or play are suspected, an evaluation may be worthwhile.

Crawling and Baby’s Future

“Crawling properly is a vital part of a baby’s developmental process,” Leah Gross, OTR-L and founder of The Therapy Place in New Jersey, explains. “Skipping the crawling-on-all-fours stage usually points to an underlying weakness with the potential to cause various issues later on. For example, failing to crawl and stand when age appropriate seems to be a transient problem, but will very likely cause a child to struggle with alphabet formation, reading, and writing in elementary school. In the same way a baby coordinates their left and right sides to crawl, an older child needs to use both sides of the body for reading and writing, skills that require eye-hand coordination and midline crossing.”

In fact, for this reason, many kriah specialists nowadays focus heavily on midline exercises when working to improve students’ fluency and speed. It is their belief that by exercising coordination between the right and left side of the brain, students—even in elementary grades—will increase their ability to read faster. This is because reading requires the retrieval of alef-beis from one side of the brain and then connecting it to the nekudah from the other. Crawling is perhaps the most effective exercise in midline crossing, necessitating coordination of both hands, feet, and the rest of the body, and that may be reason enough to encourage babies to engage in this movement.

Monsey-based physical therapist Mina asserts that many children do not reach milestones like crawling due to a deficiency in coordination, core muscles, or any other skill. If left untreated, the child will usually learn to walk and talk and catch up with their peers by the time they get to school. However, their core weakness will remain under the surface, sometimes leading to challenges with handwriting and reading fluency, or a dislike of outdoor activities. This is because these children are forced to expend a lot of effort to execute daily activities that are easily enjoyed by their peers.

WHAT ARE MILESTONES ANYWAY?

Many mothers wonder if milestones are a real thing, or just another competitive edge to the never-ending rhythm of peer pressure. Leah Gross clarifies that if a child does not reach age-appropriate milestones or is not up to par with peers, it is usually a sign of an underlying issue such as poor motor skills, lack of hand-eye coordination, or sensory issues, all of which can be resolved or strengthened by a competent OT.

It may be your baby failing to produce babbling sounds at 10 months old, your toddler unable to spoon-feed herself, your 6-year-old struggling to get into pajamas on his own, or even your anxious fifth grader. After medical culprits are ruled out, an OT evaluation is recommended.

Typical Milestones

BY AGE 2: Builds a tower of a few small blocks, scribbles, turns knobs, brings spoons to the mouth, turns a few pages of a book at a time.

BY AGE 3: Strings four large beads, snips with scissors, eats without assistance.

BY AGE 4: Rolls balls with clay, uses the non-dominant hand to assist and stabilize the use of objects, can build a tower of nine small blocks.

BY AGE 5: Writes name, copies letters, cuts on the line.

BY AGE 6: Draws basic pictures, colors within lines, cuts out simple shapes.

BY AGE 7: Ties laces, writes on the line, builds with Lego blocks.

Experts concur that proper hand control when crawling can eventually impact a child’s ability to eat independently, color in line and later form alphabets, and dress themselves.

The independent crawling movement also helps develop and enhance the body’s vestibular/balance, sensory, cognitive, and problem-solving systems as well as coordination by the following:

• enabling independent exploration

• establishing body and spatial awareness, as a result of maneuvering around the environment

• compelling the use of problem-solving skills

• guiding linear (left and right) eye movement (a vital skill for social and academic activities like outdoor sports and proper writing)

• allowing for increased sensory input while moving around on various textures like grass, sand, carpet, and tiles

Therapy?

When a pair of therapists evaluated my baby, I could only widen my eyes (and lips). The sort of questions they asked caught me completely unaware.

• Does your baby put toys in her mouth during play?

• Does she bang rattles hard on the floor while playing with them?

• Does she pass items from one hand to the other when reaching for more?

• Does she follow items she throws with her eyes as they fall to the ground?

As they could observe on their own, the answers were no, no, and no again.

Of course, my older children had done these things by this age, but as a writer—not a therapist—I had not even realized to what extent Chaya was sitting or lying around with minimal physical activity or engagement most of the day. For instance, when she was handed a rattle, she shook it back and forth with the force of a calm wave of the hand in greeting. The therapist demonstrated what the shaking of a rattle should look like at that age, which I later observed on my own after a few sessions of physical therapy. At that point, Chaya was able to shake the toy fiercely, banging it on the floor and swinging it high up above shoulder height.

But when I was asked these questions at the evaluation, I realized that Chaya was barely raising her hands upward, past her shoulder. If she wanted to be lifted off the floor, she’d spread her arms out, palms up, right in front of her waistline, and emit begging sounds.

At the completion of the session, the evaluators diagnosed my baby with severely low muscle tone and failure to cross midlines, plus a variety of other terms that went right over my head, and they promised to be in touch.

On her way out, one physical therapist was kind enough to show me an exercise that significantly strengthens wrist muscle tone (see sidebar). I implemented this routine immediately, and within days, even before I received the notice of approval for early intervention services, my baby was moving about the house a lot more, suddenly utilizing her arms in several positions.

A Developmental Boost

Participating in the PT sessions was eye-opening and informative. I suddenly watched my daughter’s developmental progress from up close, and I am still in awe of the intricate beauty inherent in a developing human being. The way she responded to the simple exercises almost immediately, and then proceeded to actually crawl in less than three months, was unreal.

While closely observing our wonderful therapist, Annie, I learned early on that with young children, motivation, patterns, and consistency are key. Any intervention to strengthen core muscles must be done consistently, again and again, and the child will catch on and continue the pattern they’re taught. For example, physically helping Chaya into the crawling position and doing the right-left-right shuffle with her a few times had her constantly getting into that position and trying to shuffle on her own. Every time she did so, the muscles of her thighs, shoulders, wrists, and core got another workout, bringing her closer to the next milestone.

Clean Positioning

Although many mothers find it more convenient to keep their babies and toddlers in a swing, seat, or carrier and avoid the worn knees, grubby toes, and filthy hands getting into just about everywhere and the bath, not giving babies enough time and space to explore the world on their own hinders proper development.

Allowing babies to get into a variety of (safe) spaces and experiment with different kinds of toys (and whatever other household items they find) around the house will speed up their physical, cognitive, and sensory development.

Leah Gross, OTR-L, can be contacted via Wellspring Magazine.

Wrist Tone Strengthening Exercise

Fine motor skills are skills that require the use of the smaller hand muscles, like using pencils, scissors, Lego, or Duplo, and opening and closing buttons.

Gross motor skills include everyday physical activities like walking, running, throwing, lifting, or kicking.

Signs of weak core strength in children:

• Avoiding gross motor games and activities like climbing the monkey bars or playing outdoor sports

• Difficulty focusing in class and at home

• Inability to bear age-appropriate weight

Muscle tone is the amount of tension (or resistance to movement) in muscles.