Ep 222: Understanding Motor Milestones & Development, insights from Allison Mell, Pediatric PT

In this episode of Your Child Is Normal, I’m joined by pediatric physical therapist Allison Mell, founder of Tots on Target. We talk about baby motor development in a way that’s both reassuring and practical — including what milestones typically look like, what matters more than the exact age, and how parents can support development at home without overthinking it (or overbuying ).

We cover common reasons pediatricians refer to PT — like torticollis and head preference, tummy time struggles, late crawling, and toe walking — and Allison explains what’s normal, what deserves attention, and what a pediatric PT actually does to help. We also clear up myths (including the idea that late crawling causes ADHD or autism), talk safety around walkers, and share simple, low-tech strategies that can make a real difference.

If you’ve ever wondered, “Is this normal… and what should I do next?” this conversation will give you practical guidance on what to look for, and ideas for what you can do at home to help support your child.

Show notes:

• Milestone ranges (& why steady progress matters more than “deadlines”)
• Simple ways to support motor development at home (hint: floor time beats most gear)
• Walkers: the important safety distinction (sit-in vs push walkers)
• Torticollis: what it is, what parents can look for, and why early help matters
• Tummy time: what “counts,”  and when to pause (reflux/pain)
• Late crawling: myths vs what we actually worry about 
• Toe walking: tight muscles vs sensory seeking, and practical home ideas
• Lightning round: shoes vs barefoot, favorite low-tech movement toys, and a message for anxious parents

Tots on Target website: totsontarget.com

03:24 Milestone Timelines: Rolling, Sitting, Crawling, Walking

05:41 Simple At-Home Setup: Floor Time, Fewer Gadgets, Better Toys

08:46 Walkers Explained

11:04 Torticollis

18:30 Tummy 

21:53 Late Crawlers: Debunking Myths + Why Crawling Matters

29:03 Toe Walking 

31:56 Lightning Round: Walking Myths, Barefoot vs Shoes, Best New-Walker Footwear

Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more.

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Transcript

Unknown: 0:00

Hi everybody. Welcome back to your child is normal. I'm your host, Dr Jessica Hochman, today I'm joined by Alison Mel. She's a pediatric physical therapist, a mom of four, and founder of tots on target. In this episode, we talk about some of the most common reasons that I refer children to Pediatric Physical Therapy, including concerns like torticollis, tummy time, late, crawling, toe walking, and questions about milestones. What I especially loved about talking to Allison is how practical and reassuring her advice is. What I appreciate is that much of what she recommends are simple things that parents can do at home without needing to fill your house with a ton of stuff and gear. If you've ever felt yourself wondering, is this normal and what should I do next? This episode is for you, and if you're enjoying this podcast, I would be so grateful if you could take a moment to leave a five star review. Wherever it is you listen to podcasts, it really helps more families find the show and help spread my mission, letting parents know that their child is normal. Allison Mel, I'm so happy to have you here. You're a pediatric PT, and you're a mom of four, including twins. So tell me about your path to tots on target. So my kids are big. Now. I have twin, almost 15 year olds, almost 13 year olds and a nine and a half year old. So I am out of the TOT stage as a parent. But now I get my baby fix through the TOT spot membership. And so what I do is I educate families about baby child development, motor development, and what they should expect, how they can support it in an easy way, at home, through basic things that they can do every single day, and through the hot spot membership, specifically, I help parents who are looking for a little bit more support, if their babies are struggling, falling behind, and they need that help. And so it's been a fascinating journey of just getting into the social media world and sharing tips, and then going ahead and seeing the parents wanted more support, and then the hot spot membership was born. And I'm just curious a little more about how you got here, because you have a very popular Instagram page. You have a very, very popular program. People have reached out to you for support from over 70 countries. How did you go from becoming a pediatric PT and a mom to where you are right now? So I actually as a pediatric PT, I started out as working at a sensory gym, then I worked in a school setting, and I ended up seeing a lot of kids that were struggling with a lot of coordination things sitting properly in a desk or in circle time, struggling with their fine motor skills and self help skills. And when we did that history of, hey, what was going on in their early developmental stage, a lot of these children in their school years, their preschool, kindergarten years, were really missing a lot of those early developmental milestones. Because it really is all connected. It's like math. It's all building blocks, and so we really need to make sure that those early developmental milestones are met in order for kids to participate in their class, being able to take off their coat and hang it up and carry their backpack and go up and down the stairs and run around on the playground with their friends. And all of that actually stems from those developmental milestones that we want all babies to meet. I understand the idea that motor skills build upon each other. So for example, we can't expect a kid to ride a bike before they're walking. You can't expect a kid to run before they're walking. So I think milestones are really helpful to be aware of. I do find they can cause a lot of stress for parents because they want their kids to meet these goals, which sometimes they don't. So I guess my question for you, for people that are listening, can you briefly just talk about normal milestones that are expected, for example, rolling, sitting, crawling and walking? Yeah, and that's a really good point, because I think a lot of parents are very stressed by that. So we're not going to get the exact same replica of every child, and we don't expect that. So what we want to do is make sure that we have an understanding of what we should expect, right? Not exact replicas, but there is a typical timeframe that we do want babies to be meeting these milestones within. So the general averages are rolling, being a four to six month milestone, sitting, a six to eight month milestone, crawling seven to 10 and walking 10 to 15, which is a much bigger range, and any time within that timeframe for those milestones is considered typical. But I want to go a step further and not just say, Okay, what's the exact timeframe, right? Because the other thing, aside from just the age brackets that we want to pay attention to is, is is your baby making consistent, steady progress towards that next milestone? So for example, I can give it a little bit of wiggle room, but where's the wiggle room coming from? If your baby is doing nothing and wants to just hang out as a beached whale and is now six months, that sends a flag to me, right? Like, well, I want to see some things happening before that. I'll take crawling, for example. For crawling, we want to see them pushing them through straight arms by about, you know, six, seven months, pivoting in circles, maybe trying to plank or do a downward dog movement. So all those many milestones are what's going to help them eventually get to that crawling stage. So if they're already doing those things, they. Live there, pivoting in circles, pushing up through straight arms. That all looks great to me. But if we're at nine months and they're not doing any of that, and they're stuck on their bellies, or they're starting to do some atypical movement pattern, that's when I'm like, Okay, we want to pay a little bit more attention to it, so it's a little bit of both, right? It's the timing and it's the quality of movement that we're looking at those in tandem to see, are we seeing that consistent progress towards the milestone? And if they are again, we can give more wiggle room. But if we're not making any progress, if there are big plateaus and we're just not doing anything, I never buy into the My baby doesn't want to meet milestones. These are natural movement patterns that are supposed to develop on their own. And so if they're not, there's always a reason why. I think what parents often wonder is, what can they do to support their kids? And there's so many gadgets that we can spend our money on for kids, but how much of it do you think really makes a difference? And what are some simple things parents can do to support their advancement in their motor milestones? I 100% agree with you that they need, very, very little. An open carpet is great, in my estimation, as a PT, I say, give your baby open floor time and a couch or a coffee table to pull up on, you know, things like that. In terms of need, a coffee table with corner protectors. Yeah, I'm thinking of like a round one, you know, you know, nothing like that. Absolutely, but, but an open floor, things like that that you naturally would have. I'm great. Now, of course, as a mom, I know that your baby will engage with toys, right? There's cause and effect toys, and there's other things that you might want to have in your home just to keep your baby entertained. That is totally fine. In terms of motor development. Again, your baby needs very, very little. I also would look at a lot of the quote, unquote containers that we put our babies in have, like a station rotation throughout the day that we think that they're great for their benefit, a bouncy seat, a baby swing, an extra saucer, even a high chair, and then a stroller. All those things. When we're putting our babies in things for long periods of time, they're actually not getting the opportunity to move around and use their body against gravity the way that's actually going to help support their development. So that's not to say I owned many of these products. I obviously owned a high chair, or I owned two because I had twins. I owned strollers. I owned a swing, because sometimes all you could do with your sanity is put your baby in a swing and have them rock a little bit. That is all totally fine, everything in moderation. We want to prioritize babies being on the floor as much as possible and so again, going back to the toy question, toys are great. There are a lot of great products out there. I try to recommend less toys that play for your child, rather choose toys that your child can manipulate. I think that's a really helpful reminder that less is more, because I think as parents, we want to help them progress in their milestones. But the truth is, as you pointed out, if you just give them the space to do it and the time and the freedom to do it, they will make progress if they can exactly and that's where I say those milestones are natural. They are neurologically wired. Maybe they're neurologically wired to develop this way. They will figure out rolling or sitting, transitioning into sitting or crawling, if they have the body mechanics to do so, right? If there's nothing hindering their progress, they are going to meet those milestones. But I find things that babies can easily grab, O balls, small rattles. I love Busy Books. Babies love them. They're great. I love buying a slide. Those are great because they will grow with your child for a long time, and are things that your baby is going to engage with rather than play for them. Yes, I think what you're saying is these are they're great extras, but they're not necessary Exactly. If your child likes it, they want to play with it, it entertains them, great. But in terms of advancing their advancing their motor skills, yes, we can't expect it to make a difference 100% okay, the big question I always get is walkers. A lot of parents where their kids are at the age, where they expect them to be walking, they want to get a walker, but often pediatricians recommend against walkers. What is your take on walkers? Is it a plus, not necessary, a danger. What do you think? So there are two different types of walkers, and we have to be very specific about which ones we're talking about, right? So there are those that we place the baby inside of that that's like the sit in Walker. It's like an extra saucer on wheels. And those are absolutely, uh, no for me, like a hard No. Not only do they cause a tremendous number of falls that downstairs, and your baby has no way to protect themselves when they are in that Walker. And I've seen it where, oh no, we're, you know, just in an apartment, or there's just one step, or we don't need to worry about that. We're gated. It's just a no for me, your baby can rock back and forth. They can tip themselves over, and they cannot protect their head. They can't get out of it, and so it's an absolute No, and it's absolutely not going to help your baby walk. And I'm shocked that they're still sold honestly. And then I hear from parents, like, the grandparents bought it for the baby, right? Like the grandparents, like, here's this Walker for your baby to learn to walk. Let's go. Let's go. Let's go. And they feel bad not using them, but I really have to say, ever. Respect the grandparents. But this is one where I say, No, do not use the sit and Walker. So no, just not recommended. The difference with the push Walker is I am not against push walkers themselves. I think that they are totally fine to use, and I think that they can absolutely help with learning how to balance, how to use momentum and things like that. So a child can disengage themselves from the walker. Should they come upon a flight of stairs, the walker can go down the stairs, and the child can stay apart from the walker. So it sounds a lot safer, a lot safer. They're using their own muscles, their posture muscles, to engage. And what I find also is babies who are not strong enough will avoid them on their own. So we can't force a baby to push a push Walker. Right? Their own bodies are telling them, I can't use this yet again. It's not going to make your baby walk. When I teach a baby to walk in a session, I don't use a push Walker. We don't need it, okay. But if your baby wants to use it, it gives them more independence as they're learning the skill. I'm totally fine with that, yeah, especially if they look happy using it hard to argue with that one totally. So now I wanted to go through with you the most common reasons why I, as a pediatrician, refer my patients to see a PT, and then I just love to get from you anything that you think would be helpful for parents to know about. And of course, when they should see a pediatric PT, the first one is torticollis. I think a lot of parents aren't aware of it. They don't know what to look for. Can you tell parents what is torticollis and when should they seek help? Sure torticollis is tightening of a muscle on one side of the neck called the sternocleidoid mastoid muscle, which is a mouthful. You don't have to say it to know that your baby has torticollis. We call it the SCM for short. And what happens is the tightness of that muscle on the side of the neck causes a head tilt to one side and often a turn to the opposite side, and that muscle pops out really strong, and so that's what we'll get. We'll get that head tilt to one side consistently and a turn to the opposite side. Now the turn to the opposite side isn't always very obvious, and especially newborns at zero to three months, they often lean their head to one side, so it can be very hard to diagnose very early on, and even for a pediatrician to diagnose because they're seeing them at a well visit. And so at a well visit, if the baby is slouched over to one side, that's not uncommon for a pediatrician to see, right? So that's why I say to parents you want to pay attention to whether or not you're seeing consistency on one side all the time. Are they going back and forth, leaning to one side, or are you always seeing the right side or always seeing the left side? So if a parent sees a consistent tilt towards one side or always a consistent head turning preference or always looking towards one side. That's when I would bring it up as a parent to the pediatrician, and that way, we can be more on top of it from an earlier stage. Now, something to note about turbo Collis is often it's treated early on. I recommend going to see a PT for that, because what we want to make sure that we're doing is we're not only treating the neck, what starts as a tight muscle in the neck, which often, by the way, happens from positioning in utero. So this is something that your baby may be born with, and you didn't do anything wrong, but we want to be proactive about it, because it can lead to asymmetries down the line with some of this movement. So what I see, and I'm kind of in two conversations at the same time here. One is, we want to treat it. But we don't only want to treat the neck, because when we treat just the neck, we're going to bend to one side, we're going to turn to the opposite way. What we actually want to do is treat the whole body, which goes into my next point, which is because what starts out in the neck can lead to tightness in the shoulder, tightness in the trunk, tightness in the hips, and what that can often linked to is asymmetrical movement. So baby will then only roll towards one side. They will be able to get in and out of sitting only towards one side. They will crawl asymmetrically. They may have an asymmetrical army crawl, or a hitch crawl, or one leg is up. And we don't want that. We want to see symmetrical movement in the first year of life even a little bit beyond Yes. In addition to the tightening in the SCM, I also noticed flattening on that same side of the head quite often. The two go together as well, and then it becomes a self fulfilling prophecy. If a baby is more comfortable lying on the left side, for example, they're going to keep doing it. I liken it to if I fall asleep in the car and my head is turned to the left. Let's say, for example, My neck feels tight. It's harder for me to stretch the neck to the other side. And I feel similar with young babies. If they're used to doing it one way, and we don't help them stretch it or encourage them to move their head to the other position, they're just going to keep doing it in that same position. And as you pointed out, it can cause issues later on down the line exactly with that head flatness, that plagioccephaly, where there's flatness on one side. Think of a deflated ball. If you roll a ball that doesn't have enough air in it, right, it's going to roll, it's going to land, and then there's like this flat spot. Now it doesn't continue to roll as easily. It's actually harder for them to now move. Out of that flat spot. Okay, so it's both the tightness of the muscle and that flat spot that now is, like this divot that's harder for them to move out of. And it's, again, when you have that torticollis, if you see that flat spot, it is fixable, but we want to be proactive about it. The earlier we get on it, the more fluidity of movement we're going to have. That being said. As babies grow and move against gravity in different ways, you can see some of that asymmetrical movement come back, and we want to just address that if we do see it. So a couple of tips that I share with parents, and I'm curious if you agree, or if you have any other tips to offer, but I will tell parents to notice the sign that they prefer and to try to hold them on the opposite side. Spend a few minutes a day, a few times a day, holding them on the other side to give the opposite neck a chance to stretch. And then I'll also tell them when they're lying, for example, on their back, let's say they prefer to roll over to the left. I'll have them roll up a tight towel and kind of wedge it between the head and the neck, so that they are encouraged to stretch to the opposite direction. And then, because parents are very interesting for young babies to look at, I'll tell them to stand in the opposite direction, in the direction that they want their child to look at. And I'll tell them to try to practice that for, you know, a few minutes, multiple times a day, yes. How as a pediatric PT, is that okay? Advice? And do you have anything else that you'd like to share? So that is great first step advice, right? Anything that you can do to naturally help baby release that tight muscle is very important. What we also remember is that stretching has to also go the next degree. Sometimes just getting to that midline point isn't enough to stretch that tight side, and especially if there's also tightness in the shoulders. So what I'm going to tell parents to do. Firstly, we want to help get baby to the full opposite range. So you're going to take that opposite side of the cheek and stretch it all the way to that opposite side, so that they're really getting the full range that they might not be able to get on their own. Okay? And all you have to do it is three to five seconds to start, okay, but we are then getting a real stretch of that muscle. So that's a really important thing. We also want to stretch the shoulder. So being able to move that shoulder all the way up is really important, right? So hold that baby's arm and move it all the way around like this, or move it all the way like this when they're on the floor in a flexion. So all the way up by the ear. Get that hand all the way by the ear and down, and you could do it to both sides. And I'm telling you, you're going to feel the difference on one side to the other. The other. And then a simple stretch for the hips is taking both hips, both legs together, above the knee, and going around in circles, going around clockwise and counterclockwise. And you might feel a little bit of tension there. Or baby's whole body is moving because all the muscles in the body are connected. We really want to address the whole body. It is really important. That we do that. I'm thinking even as adults, we know that it feels good to stretch. If you've got muscle tightness, stretching can really make you feel better, and it's such a nice intervention. It's not going to cause any harm. And the earlier we do it, even if your baby squirms a little bit because they're not so comfortable, and that's okay, right? Just anything has to be a few seconds, a few seconds in each direction, but they're much more tolerant of it at an earlier stage in that 0345, month stage, once we get older, babies don't want to be stretched as much, and it gets harder, and we do it, we can absolutely address this at 910, I've even had 13 month olds who weren't diagnosed early and are now having the resulting effects. But So when is your like? When is your like? When do you like pediatricians to refer kids with torticollis to you? The earlier the better. The earlier the better. Is really, really key, because, again, it's a whole body issue, and so whatever stage we can do it, the earlier the better. Now, what about tummy time? I have a lot of parents who are discouraged because they know it's so important, and they try to do with their child, and their child just cries and fusses and doesn't enjoy it. If someone has a kid like that, can the parents skip out on official tummy time? Or what is your advice in that scenario? Tummy time is very important as a foundational skill for many reasons. It provides a tremendous amount of sensory input to the body. When babies are born, they have no sense of where their body is in space, and that is a sense called proprioception, that is something that they have to learn over time. Okay, so tummy time is providing a tremendous amount of full body contact with the floor, face down, where their shoulders, their arms, their hands, their bellies, their feet. They're all engaged with the floor, and they're getting that direct feedback that tells their brain where the body is in space, and that's part of the nervous system developing that proprioceptive sense, developing. So tummy time is the foundation of that. And what I've always learned, and I'm curious your thoughts as a pediatric PT, is that we've been encouraging tummy time a lot more because children used to go to sleep on their stomachs. That was a preferred method for children to fall asleep, was to be on their stomachs, and that gave them a chance to practice picking up their heads, looking from right to left. And now for safety, we recommend them to sleep on their backs to prevent Sid, sudden infant death syndrome. And in addition, we're seeing a lot more plasiocephaular flatness on the back of the head because of that persistent, continued time lying on their backs. And so as a result, we've been encouraging. Tummy time more, I find what's hard about it is in the first month or so, babies really aren't doing much, and parents want to be good students. They want to follow the advice that we're giving them, and they find that when they're on their stomachs, they're fussing, they're crying, they're not always happy to be there. So what I tell parents, I'm curious, if you think this is okay, advice is that if you're holding them on your chest and you're giving the baby a chance to pick their head up. Look from side to side. They're not always feeling that persistent pressure in the back of their head that can count as tummy time. So I try to take the pressure off the parents that it doesn't always have to be official time on their tummy, that time spent off the back of their head is also okay, absolutely. So babies are lifting up their head. They're moving their neck against gravity. They're turning in different directions. Eventually, they're going to get their shoulder muscles involved, right? So we want that strengthening aspect too, that can be done on your chest, so your job as a parent, lie on the couch, lie in your back, watch some TV, and you are participating in tummy time. So that is absolutely a win, even if a baby is now three months old, you want them on the floor, if they're still struggling, roll up a towel and put it across their chest, directly under their armpit. Now they have a little bit of an incline, and a lot of babies respond very, very well to that. It helps them lift up their head a little bit more, because we've changed the angle against gravity. And here's the other thing, if your baby is screaming in tummy time and seems like they are in pain. Stop. We do not push through pain during tummy time. It's one thing to have a little discomfort. They don't love the position. If they are in pain, that is a sign of reflux, and we need to go back to the pediatrician and check out what is going on medically. And that's something even me as a pediatric PT didn't know this. One of my babies had reflux screamed in tummy Tum, and I still like, look back, and I'm like, Oh my gosh. I can't believe I can't believe I made my baby, like, scream through tummy time. He had terrible reflux. And so my gift to you is knowing to not do that. We don't push through pain for no pain, no gain when it comes to baby, no pain, exactly. All right, that's good advice. Okay, so my next common referral, I would say, for pediatric PT, would be late crawlers. Can you set the record straight? Tell me about late crawlers. There's so much out there. Some parents are kids gonna have ADHD if their kid's a late crawler. Some parents are concerned it's gonna cause motor issues later on down the line, if you don't mind setting the record straight. And the second thing is, what would a pediatric PT do? And how can they help a child learn to crawl? If they're a late crawler? Sure. So I've never seen anything that says a baby who is late or doesn't crawl will have ADHD or autism. So I'm going to set the record straight. That is not I've never seen a correlation with that. There are plenty of children who did crawl and do have ADHD or autism, and there are plenty of babies who didn't crawl and do not have ADHD or autism. And I concur. I've read about this, and I've heard this from patients, so I've looked into it extensively, and I agree. I have not seen any correlation with ADHD and they crawlers. I've not seen that correlation anywhere, and I've never even heard the other PTs and OTs that I follow, that I trust do not say that. Okay, where I do see a correlation is with other motor skills, that if a child is not able to crawl, there can be correlations with other things that are difficult for them later on, more motoric based than autism. ADHD, okay, because that we've already set the record, and they've shown in studies that kids are late crawlers may show a delay in further motor skills down the line, right? And I'm going to tell you why. Okay, so with crawlers and again, it's not a matter of late or I don't care as much about the timing. Meaning the reason I care about that typical time frame is I've had parents come to me when their baby is 12 months, 13 months, those babies are not moving at all, and they were like, Oh, well, I was just told to wait and see. Wait and see. So we don't want to just wait and see for unlimited months, because we're hoping that the skill is going to come in if a baby should be able to do this within, you know, between that seven to 10 month range. Again, I will give it a little bit more if you're seeing that typical progress towards that skill, like we talked about initially, what crawling does support is that proprioceptive sense that I talked about, which is a lot of body awareness that helps in preschool and kindergarten. When a child does not have good body awareness, their brain is constantly looking, where is my body in space, and so if they don't have that sense of body awareness, it affects all those things, including personal space. They're going to bump into their friends while they're walking in line because they don't have a sense of personal space. Okay, so and, and if you think about it, crawling is the last time we weight bear through our upper bodies once we're walking there's very limited unless they're crawling through a tunnel, they're swinging on monkey bars, which is hard to do if you don't have upper body strength that this is the last time that they're weight bearing through their upper bodies and getting that deep input through their upper bodies. Okay? So it's very, very key for that proper substance and and that strengthening. So I have children that have skipped crawling, but they've gone right on to walking, and so they are making progress with their motor skills, but from what you're saying, maybe they're not getting enough time to develop their upper body strength. For child like that. That I enroll them in gymnastics so that they can do things like practicing their cartwheels and doing wheelbarrows, doing the monkey bars. Maybe it's acceptable. Maybe because those children that didn't if they didn't crawl on all fours, I always go back. There's always a reason why I've never met a baby who wasn't crawling that I didn't figure out why they weren't crawling and couldn't fix it. So maybe there's some tightness and they can't get out of sitting. They can't get themselves in and sitting. So they become butt scooters. Maybe they're stuck in army crawling because they don't have the upper body strength or the hip strength to push themselves up onto all fours. Those army crawlers who never progress to all fours often struggle with upper body strength and then a lot of fine motor strength in school. So those kids, they don't have shoulder strength, and that shoulder strength leads all the way down the arm to the hand muscles. And so those kids really struggle with coloring in the lines, cutting tying their shoes, pulling up their pants and down their pants with zippers and buttons, all those fine motor skills that they need for school based skills. A lot of those children who didn't crawl on all fours and get that upper body strengthening struggle with those skills, okay? And there are suggestions that you can make as a pediatric PT, to encourage them to crawl effectively, absolutely. So there are many things that I can do that will target those muscle groups that are weaker, alright, or if there are muscle groups that are tighter because of maybe a history of torticollis or whatever else that might have led them to have tight muscles that really limit like those babies that my baby just doesn't want to move. I've never met a baby who I've worked with who we didn't get crawling, that despite they just sat and didn't want to do anything, we always got them crawling because there's always a way to get them there. And just so I can picture it, can you mention maybe one or two things that you have parents do at home to encourage their kids to begin crawling? Sure. So again, it really depends on what you're seeing. Are we seeing the butt scooter? Are we seeing the lazy bump on the log? Are we seeing an army crawler? Right? Let's say an army crawler. Let's say an army crawler, because that's a probably our most common one. So for an army crawler, something simple that you can do at home. Have your baby army crawl over couch cushions. I want those large, not the throw pillows. Okay? I want a large couch cushion. Okay, I want you to put that on the floor, and I want them army crawling anything to get them up off the floor and crawling over something. And even for a few seconds, we are targeting those muscles much more effectively than they're compensating. Army crawling is a compensation. They're compensating. They're using other muscle groups that they do have when they don't have certain muscle groups available to them for whatever reason. Okay, and so if we can get them up and crawling over couch cushions, great. Okay, so that's one simple tip that I give. And again, if you're struggling more than we need, you know more help with that. I love that tip because, like you pointed out earlier, it's not a fancy toy. You can do it at home, and it makes sense why it would help a baby practice using their upper their upper body skills. After this, I'm going to ask my mom if I was an Army crawler, because I'm wondering if I now have an excuse as to why I was never able to do a pull up. Yeah. See, this is the reason. It's definitely a possibility. And also, then I'm going to go back to your question of, can we just then go to gymnastics? Okay, what I have found, though, with babies who didn't crawl, if they are struggling, doing cartwheels and doing gymnastics requires a lot of body awareness and a lot of strength, and so some of those kids, you put them in the class and they're really struggling, they don't want to participate because they can't do it the same as their friends. So maybe if your child is willing to participate, and they're doing it, and they're willing to go, but there's a lot of arm strength that is required for cartwheels, and so if they don't have the shoulder strength, if they don't have the hand strength to do some of those activities, they might get more tired more easily. So it really depends on the child, and that's why I say these early milestones, while I never hear a fear monger and say, Oh, if your child doesn't do this, they are going to do terribly in school. No, okay, it's never a blanket statement. There are plenty of people who never put on sunscreen, who do not get skin cancer, okay, but we do know that best practice is to put on sunscreen, right? We can't see into the future, but what can we do in the stage that we're in to help us set ourselves up best for the future? Helps to be proactive, especially if there's no harm in trying crawling. There's nothing harmful in crawling, so let's get your baby crawling, if we can. Okay, last common referral that I have for parents, and then I want to do a quick lightning round of questions for you. The last common reason why I would say I personally refer families to pediatric PTS are kids that are toe walkers. Now, a lot of times I'll have kids that are toe walkers, and everything else about them is neurologically normal, they are behaviorally normal. Give me your thoughts on toe walkers. Do you like them to be referred to pediatric PTS, and what are some quick tips that you can offer parents about walkers? Toe walking is a tricky one, and I find that most toe walkers it's not because they have tight muscles. So why would a child go up on their toes? Because their calf muscle is often tight. And if you've heard of the Achilles tendon, right, it crosses over to that heel. And so if the calf muscle is tight, that area is tight, it can lead children to be up on their toes because of the leg muscles, the calf muscles actually being tight. So if that's the case, if there's tightness in the muscle, then PT can be. Very effective. However, I do not find that most times there's tightness in that muscle. That is not why the child is toe walking. Most times, it's a deep sensory input tactic for children. So if you go up on your toes, now feel a lot more deep pressure into a smaller surface area of your body. And so this is very common for children. If they are looking for deeper sensory input, they will be up on their toes. And so it's a very hard thing to completely fix on its own. And so if there's tightness, that's something that we can stretch, and we can do it that way. If the root cause, which is most common is that proprioceptive awareness that they're looking for. It is a very, very hard thing to treat for. PTS, what I will do is I will have one of those scooter boards. They have the handles on them. They're not super expensive. Kids like my kids had them, and they zoomed around, and it's a great fun thing, and they're getting their muscles working. So great to have a scooter board. I will have the child sit on the scooter board, and now they're using their heels to get themselves around. So that's one thing that you can do. And then the last thing to say, if you're not seeing success, then orthotics can be helpful. What about simple high tops? Because they're easy to find, and I've heard that that can help anchor the heel to the ground, and it can make it easier on the toe Walker. Yeah, if you're seeing success with that, I'm fine with that. I will say, sometimes I do see with a shoe on, they'll toe walk a little bit less. So they might get up a little bit, but less degree. Oh, one thing I really this is very, very important. I do not refer babies for toe walking, for PT when they are not yet walking, or at least about six months after they're initially walking. And so if you have a brand new Walker and you're seeing toe walking, we're not concerned about that. This is when they're figuring out how to use their muscles for walking. That's a great point, because I will add to that, I see a lot of kids between the ages of three and five years old, where they are toe walkers, and then it ends up resolving on its own. Okay, so now I wanted to go through some quick questions with you as we wrap up. If that's okay, absolutely. All right. So the first one is, what's a motor development myth that you wish parents would stop worrying about that early walking is going to make them more successful. A lot of parents think that their babies should be walking by 12 months. That's not true. Up to 15 months is completely considered normal. If you're seeing continuous progress towards that milestone. I'm really fine with 16 months plus. But if they're not making any progress, I don't like the like, oh, just wait till 18 months and then we'll get help. We want to see continuous progress. See continuous progress, but 12 months is not your goal. When kids are learning to walk shoes or no shoes, no shoes, unless there's ankle instability, barefoot is best. We want a lot of sensory input. We want all those little muscles, the intrinsic muscles of the foot, to get a lot of work, because babies don't have a natural arch that has to develop over time, so the more barefootness they get, barefoot time they get, they're going to get more sensory input. But if there's ankle instability, if it's preventing your child from walking, I will make a different assessment, because that's my goal as a PT, is to make sure that we're addressing your child. But general guidance is barefoot is best. What is your favorite shoe for new walkers? Parents ask me this all the time. I don't I don't have a specific brand that I love, but what you want is a flexible sole, but it should be like a firm rubber sole, but something that you can bend that shoe in half, a nice wide toe box. We want those toes wiggling around, and please use Velcro, nothing that ties. Okay. I don't want the shoe untying and your kid tripping because of other reasons they might look cute, leave them aside. I know I just feel bad, because it's one of the questions that we ask kids as they enter kindergarten. Do you know how to tie a shoe? And a lot of parents say, Wait, I didn't even know I was supposed to work on this with them. Most don't. My own children didn't tell later, because it's a skill that has to be taught, versus the ones that I'm talking about where I'm talking about natural development, there are certain skills that need to be taught, shoe tying, bike riding, right? They're not going to all of a sudden start riding a two wheeler. They're not going to all of a sudden tie a shoe. And so there are certain things that need more practice when parents have concerns about their child's posture, what is some quick advice that you can offer parents to improve their posture? Okay? So there are different postural things, like, if we're talking about, like, foot posture, you know, the toeing in or toeing out, that a lot of times, is related to hip alignment. And we need to focus not just on the feet, but actually on the full chain. Everything is connected. So the way your baby pushes up to stand, I often talk about, like, we get into, like, a proposal stance, right one knee up, like you're going to propose to somebody, and we want to make sure that knee is facing forward when they are pushing up to stand, so our hip, knee and ankle are all in good alignment when they're pushing up to stand on right or left side. Make sure everything is symmetrical. Okay, so definitely something I'm learning from you, it's a really matters to pay attention to your body's alignment. Quality Matters. And then in terms of the back, making sure, again, that tummy time, crawling, those kind of things where we're getting good back engagement. They can play on a vertical surface. So have them play with their hands against something so that they're looking up their back is in better alignment. That way. Favorite low tech toy for movement. I'm going to say either a scooter board for older kids. I love scooter boards. A. A tunnel to get babies and toddlers crawling more. And those are probably gonna be my things I love. Also, toy slides to keep inside where they're climbing up, they're sliding down. Their abilities, they're going backwards. Enjoy the risky play. Have children engage in as much big motor movement as they possibly can. And so those three, I didn't give one a give three. And lastly, for parents who are listening and maybe they're feeling a little bit behind or anxious. What do you want them to hear? We can help. We're always looking for the reason why, because there's always a reason why, and once we figure that out, we can do targeted things that are absolutely going to help. I also want to remind parents that you are your child's best advocate. Do what you need to do to get your child the help that they need, and with somebody who you feel is doing the best job. You are in charge of your child. We are all here to support you and your child in whatever way we can. I agree 100% what a perfect message. Thank you. And lastly, tell everybody about the hot spot a little more. Tell parents, where can they find you online, where can they learn more? And who is this program especially helpful for so you can learn everything from my website tots on target.com and I run an online membership called the TOT spot. Inside you get access to all of my courses, which is rolling, sitting, crawling, walking, infant massage, plus even a course for preschool and older kids that targets strengthening through play, but my primary audience is baby development, and you get access to all of those courses. They're self paced courses. You can watch them as many times as you want. Then you also get access directly to me. So we have twice weekly group zoom calls. They're usually twice a week, varying times to accommodate all time zones. As I said, we have over 70 countries participating this membership, and that's when you get to come and speak to me directly. You get to ask me your questions. You get to show me your baby we get to problem solve together. And let's say you can't come to the calls. You also get direct access through messaging. So we have a message board that you get to post your questions. You can post videos, pictures, and I will always answer you. And so the thing is, with the courses, while they are extremely comprehensive, every baby is going to be a little different, or every baby is going to respond a little different. And I always say, if you're not seeing progress, I'm not doing my job. We have a tremendously high success rate through the program. So people do this while they're waiting for an evaluation or finding a PT. They'll come they'll join before they get a PT. They'll do it in tandem while their child is seeing a PT. Or sometimes people live in rural areas, they just can't find somebody locally. And so we have people coming for all different reasons, and they're seeing great success through the program. I will say it's nice that there's an adjunct service out there that can help parents from home that can give them advice. So I'm so happy to learn about you and to helping to spread the word Wonderful. Thank you so much. This is such a great conversation. Thank you for listening, and I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask dr, Jessica.