Motor Milestones & Brain Development

Research has shown that tummy time has a positive impact on motor milestone development. Kuo et al (2008) showed that increased active prone positioning early in infancy promoted prone-specific motor milestones (rolling, crawling-on-abdomen, crawling-on-all-fours) and sitting. Ohman et al (2009) showed that infants who experienced more active tummy time dispersed throughout the day, demonstrated significantly higher Alberta Infant Motor scale (AIMS) scores at two, six and ten months. Tummy time fires into midline cerebellar pathways that are essential for motor patterning and learning. It is recommended from birth to assist with motor development (Russell, D., et al 2009).
We see a variance in crawling styles in practice, including butt-shufflingcrab-crawlingbear walking, and commando crawling. So, does the pattern in which a baby crawls matter for later motor and cognitive development? Delayed or atypical crawling patterns can be influenced by several factors including environmental influences such as lack of tummy time, babies who are carried for increased periods and the type of floor surfaces at home. Cranial-dural imbalances, orthopaedic and neurological conditions and developmental delay can also be involved (Keating, G., & Keating, R, 2014).

With a typically developing child, crawling would be expected to be present between six to eight months old. Development of a normal crawling pattern occurs in stages once the positive support reflex has developed, progressing from rocking on all fours, then possibly moving backwards or developing a symmetrical commando crawl for a short time, and then moving onto all fours and developing a cross-pattern crawl (Keating, G., & Keating, R, 2014). Often children, who have already developed an atypical crawling pattern and are confident and quick with this movement, resist attempts to change their style. Encourage parents and assure them that cross patterning and sensory feedback are beneficial for their children’s brain development and future learning. McEwan et al (1991) described the process of crawling as providing vestibular processing, improvement of balance and equilibrium, spatial awareness, hand-eye coordination, tactile input, kinesthetic awareness, and social maturation.

Clinical Application
What can we do as practitioners to promote sensory motor development within our practices and how can we support parents with healthy development at home? By assessing and encouraging a cross-crawl pattern we are supporting healthy communication between the left and right hemispheres of the brain to help facilitate and support later learning. In babies, we can encourage a smooth cross-crawl pattern when they are bearing weight on their hands when in a prone position. Whilst kneeling behind the child hold their thighs and flex their hips so they are on all fours. From this position gently rock them forward and backwards, and then progress to shift one leg forward and have another adult move their opposite arm forward. In older children from three years old, we can assess this with supine marching, observing for smooth contralateral control of the upper and lower limbs.

Sensory motor experiences can be encouraged whilst at home and should be fun and socially engaging for the child. These can include: tummy time, prone ball rocking, deep pressure massage, assisted rocking whilst in an all fours position, cross-crawling practice, and marching exercises and animal walks for older children. As chiropractors we are entrusted with the health and well-being of children in our communities and we are in a position to support families with their development and growth.
Written by Natasha Swan, Chiropractor


  • Keating, G., & Keating, R. 2014, Inspiral Resources, pp 29-30.
  • Kuo, YL., Liao, HF., Chen, PC., Hsieh, WS., & Hwang, AW. 2008,  The influence of wakeful prone positioning on motor development during the early life. J Dev Behav Paedaitr. 29(5), pp 367-376.
  • Llinas, RR. (2001), I of the Vortex.: From neurons to self. Cambridge MA: MIT Press
  • McEwan, MH., Dihoff, RE. & Brosvic, GM. 1991, Early infant crawling experience is reflected in later motor skill development. Perceptual and Motor Skills, 72, pp 75-79.
  • Ohman, A., Nilsson, S., Lagerkvist, AL., & Beckung, E. (2009), Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants? Dev Med Child Neurol, 51(7), 545-550.
  • Russell, DC., Kriel, H., Joubert, G. & Goosen, Y. 2009, Prone positioning and motor development in the first sex weeks of life. South African Journal of Occupational Therapy, 39(1).