Understanding the Factors Affecting Growth and Development in Children
When it comes to development, it’s important to remember that there are wide ranges of what’s normal. Although a standardized assessment may flag a kid as being “delayed,” these tests are based off of large populations and are an average. If you are past the average then you are considered to have a delay, but you might still actually be within “normal” range.
This is done to allow intervention services to be able to start early whenever there is more of a neurodevelopment window for acquiring a skill as opposed to waiting until a child becomes very behind before seeking out specialized therapy (the brain is more malleable earlier, which is why waiting to do certain skill until later can make it all the more difficult for them to achieve it). But for instance, a general-accepted normal for walking is between 12-16 months. If a child scores a 13 month age-equivalent, they are delayed but still considered within the normal range.
What do you do at that point? Well it depends on the parent! A number in isolation is probably nothing to get worked up about, especially if it is not a substantial delay (often considered a 40% delay or greater). But there are a lot of factors that play into the rate at which a child develops. If there are lots of factors at play for a particular child that puts them at risk for having more issues down the road, then it may be worth getting a professional opinion. But sometimes development just happens at a slightly slower rate for some kids and there is no “problem” causing it.
So let’s talk about some of the things that influence rate of development and how you can get a better idea of if your baby needs therapy in a formal setting.
Factors that Influence Development
1.)Personality
When trying to decide if your baby needs therapy for a perceived delay, personality is a big thing to consider. There are just some kids that have timid personalities—they aren’t as fearless when it comes to exploring, just requiring that extra little bit of reassurance before trying something new. And then I see kids on the other end of the spectrum, who are into absolutely everything and trying to run before they learn to walk.
Personality really does play a huge role in development. We can nurture feelings of safety as a more apprehensive child is tackling new skills so that they can have the strongest foundation possible, but there is really nothing wrong with these hardwired differences causing slight delays in the rate at which milestones are achieved.
2.) Environment
Where and how and with whom your baby spends their time all matter! If you’re considering whether your baby needs therapy or not, take look at their environment and if they’ve been getting adequate opportunity to work through some emerging motor skills.
For instance, a big question pediatric therapists get are about containers. Are containers bad for your baby? And does holding your baby cause them to be delayed developmentally?
We dive into more of this on the show, but in short, containers are less than ideal. It’s not a big deal to use them in moderation (you have to just go to the bathroom or cook dinner sometimes!) but prolonged play in a walker, jumper, bumbo, etc. should be avoided for proper hip and neurological development.
What about holding baby? Can you hold a baby too much?
In my professional opinion, no. Carrying and babywearing has so many dynamic components and social benefits as well. Infants get a lot of core activation and strengthening by fighting against gravity as you move around. Just make sure to give lots of opportunities for tummy time (which can still be on you!) along the way. And do keep in mind that as baby ages they need more opportunities for supported weight bearing.
In an ideal world you can set up a safe playard area for baby to get floor time whenever you need to set them down, though with older siblings and levels of contentment and age considerations, this may not always be possible.
3.) Muscle Tone
When trying to figure out if your baby needs therapy, muscle tone is another fuzzy area that can influence development. There are countless medical conditions that of course can explicitly cause delays. But to focus on one aspect of physical development that can impact the majority of the population, we’ll focus on muscle tone, a common one that can influence the rate of motor development but not necessarily mean that there is something “wrong.” Muscle tone can vary wildly from child to child with or without a medical condition underlying.
- A few key things to note about muscle tone:
- Muscle tone that is too high or too low can cause issues
- You can be at the high or low of end of normal and see a bit of a lag in development
- Low muscle tone– decreased force production and contraction speed, more ligamentous laxity (for example Down’s Syndrome). Having low-normal muscle tone you may see lots of w-sitting from core weakness and just being a little bit slower in general with meeting milestones. It’s not necessarily something in isolation that warrants any kind of worry, it’s more often that child’s “normal” and is not due to some underlying disease process.
- High muscle tone-the opposite end of the spectrum, higher muscle tone in the normal range can look like excessive extension patterns of movement and overcompensations with balance reactions. You may see a lot of tiptoeing and arching in infants and toddlers with high normal muscle tone. This is common with intrauterine drug exposure and brain injuries (even just mild cerebral palsy), though it can just be that child’s “normal” as well.
So how do you know if the muscle tone is so significant that your baby needs therapy to address it? With either extreme, it’s important to get your child checked out if you have concerns at all or if they’re really struggling to participate in meaningful routines like playtime, etc. If you’re concerned about their ability to get along and participate in playtime, go get a formal evaluation for custom insights for your child!
4.) Delayed reflex integration
Certain reflexes, like the STNR (Symmetrical Tonic Neck Reflex) and Landau reflex, are critical for crawling and overall motor development. Excessive use of containers can delay the integration of these reflexes, resulting in challenges like skipping crawling altogether. Understanding reflex integration is essential for addressing unexplained delays in development.
The galant reflex is an example of a primitive reflex that is influenced by birth, which helps babies turn the correct direction during the birth process. Even a roadblock as seemingly harmless as a C-section can influence reflex integration and future milestones.
We’ll do future content on reflexes because they are a really big deal, especially with seeing more use of containers (swings, bouncers, etc.) in our country today. Reflex integration is a very big piece of the puzzle when there really seems to be know clear reason why a child is seeming to be delayed. For now, here is a great resource for primitive reflexes.
Other considerations
Motor development really does start in the womb and the birth process impacts it in a big way. There are countless things that influence the rate of development. From preconception factors to the impact of the golden hour to tummy time opportunities in the early months, there are countless factors that strongly impact development. This list is simply the top ones I see that aren’t black and white indicators for if baby needs therapy, which is why it is so common for parents to know if they need to get their kid checked out.
So how do you know if your baby needs therapy?
Honestly, there is no one way to know for sure, but the best thing to do if you have concerns is to go get a professional opinion! A physical therapy evaluation can give you guidance on where your child is with motor development (I recommend finding a pediatric clinic when possible), just as a speech therapy evaluation can give you insights on their communication development. Take these things I’ve mentioned above to make the best choice on whether or not you think your baby needs therapy.
When in doubt, check it out!
As you’ll see, there are a lot of factors to development that may explain a delay that are no concern, and there are some things that should get our attention and investigate further. As a parent, you may find that it puts your mind at ease to get the advice of a trained movement and developmental expert to help you make sense of what’s going on with your child and if you should be concerned about their slightly slower development or not.
To dive deeper into each of these factors influencing infant growth and development, listen to Episode 14 of the Dr. Nurture Podcast: Top 4 Things that Impact Development: When to Know if Baby Needs Therapy
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- 17 | Strategies to Help With Colic-Tips for soothing an unsettled baby
- 16 | Transformative Self Care from a PT's Perspective (Strategies that Stick)
- 15 | Use This Strategy to Kickstart Baby’s Development: How the Golden Hour Impacts Mom and Baby
- 14 | Top 4 Things that Impact Development and When to Know if Baby Needs Therapy
- 13 | Tummy Time Hacks-PT Strategies for Tummy Time Haters
