Gross Motor Delay

Gross Motor Delay

What is gross motor delay?

Gross motor delay describes when a child takes longer than expected to develop skills involving the large muscles of the body. These skills are important for movement, posture, balance and everyday activities.

Gross motor skills include movements such as:

• Lifting and controlling the head

• Rolling

• Sitting independently

• Crawling

• Pulling to stand

• Standing and walking

• Running and jumping

• Climbing, throwing and kicking a ball

Every child develops at their own pace. However, when a child takes longer to reach certain movement milestones, they may benefit from further assessment and support.

Gross motor delay is not a diagnosis in itself. It describes a difference in a child's development that may have several possible explanations.

With appropriate assessment and support, physiotherapy can help children practise movement skills, develop physical abilities and participate more confidently in everyday activities.

What causes gross motor delay?

There are many possible reasons why a child may experience gross motor delay. Sometimes, the cause is not immediately clear.

Possible contributing factors include:

Premature birth

Babies born prematurely may need additional time and support to develop certain movement skills. Healthcare professionals consider a baby's corrected age when assessing development, particularly during the early years.

Low muscle tone

Low muscle tone, also known as hypotonia, means that the muscles have less resistance to passive movement. It can affect posture, stability and the effort needed to control movement.

Low muscle tone is not the same as muscle weakness, although the two can occur together.

Neurological conditions

Conditions affecting the brain, spinal cord or nervous system can influence movement, balance, coordination and motor development.

Examples include cerebral palsy and other neurological conditions.

Developmental or genetic conditions

Some genetic and developmental conditions can affect the rate at which children acquire gross motor skills.

Muscle conditions

Certain conditions affecting the muscles can cause weakness or reduced endurance, making movement and the development of physical skills more difficult.

Illness or hospitalisation

A prolonged illness, surgery or an extended hospital stay may affect a child's strength, fitness and opportunities to practise movement.

Individual developmental differences

Children develop at different rates. However, persistent delays or difficulties across several movement skills should be discussed with an appropriate healthcare professional rather than automatically attributed to a slower developmental pace.

Can gross motor delay be inherited?

Gross motor delay itself is not directly inherited because it describes a developmental difficulty rather than a specific condition.

However, some underlying conditions that affect motor development can have a genetic cause or run in families. Other causes, such as premature birth or certain illnesses, are not inherited in the same way.

If a genetic or neurological condition is suspected, a healthcare professional may recommend further assessment or referral to a specialist team.

What are the different types of developmental delay?

Developmental delay can affect one or more areas of a child's development.

These areas commonly include:

• Gross motor development: sitting, standing, walking, balance and larger body movements.

• Fine motor development: using the hands and fingers for tasks such as grasping, drawing and manipulating objects.

• Speech and language development: understanding language and communicating.

• Cognitive development: learning, thinking, problem-solving and understanding.

• Social and emotional development: interacting with others, expressing emotions and developing relationships.

A child may experience a delay in one area or across several areas. Assessment helps establish which skills are affected and whether further investigation or support is needed.

Who does gross motor delay affect?

Gross motor delay can affect babies, toddlers and school-aged children.

It may become noticeable when a child is not developing movement skills at the expected stage, or when physical activities become more demanding as they grow.

For example, a child may find it difficult to sit independently, move between positions, walk steadily, climb stairs or keep up with other children during play.

Some children need support with early developmental milestones, while others may have more specific difficulties with balance, coordination, running, jumping or physical endurance.

The type and level of support required will depend on the child's individual needs and the reason for the delay.

What are the signs of gross motor delay?

Signs can vary depending on a child's age, abilities and stage of development.

Possible signs include:

• Taking longer to develop sitting, crawling, standing or walking skills

• Difficulty moving between positions

• Reduced postural control or stability

• Challenges with balance and coordination

• Difficulty running, jumping or climbing

• Frequent falls or trips

• Difficulty learning new physical skills

• Reduced strength or endurance

• Becoming tired during physical activities

• Hesitation or reduced confidence when trying unfamiliar movements

• Finding playground activities or PE more challenging than expected

One sign on its own does not necessarily indicate a developmental problem. However, if you are concerned about your child's progress, speak to your health visitor, GP, paediatrician or another appropriate healthcare professional.

If a child loses movement skills they previously had, seek prompt medical assessment. New or sudden weakness, loss of movement or other sudden neurological symptoms require urgent medical attention.

Can physiotherapy help with gross motor delay?

Yes. Paediatric physiotherapy can help children develop movement skills and address physical difficulties that may be affecting their development.

A physiotherapist can assess a child's movement, posture, strength, balance and coordination to understand their current abilities and identify areas where support may be helpful.

Physiotherapy does not replace medical or developmental assessment when an underlying cause is suspected. Instead, it can form part of a wider approach to supporting the child's development.

At Positive Steps, we aim to make therapy purposeful, engaging and appropriate for each child's individual needs.

What does physiotherapy for gross motor delay involve?

Developmental milestone support

Physiotherapy can help children practise movement skills at an appropriate level for their development.

Depending on the child, this may include:

• Head and trunk control

• Rolling

• Sitting

• Crawling

• Moving between positions

• Pulling to stand

• Standing balance

• Early walking

• Developing walking skills

Activities are adapted to the child's abilities and progressed as their skills develop.

Strength and postural control

Strength and postural control help children maintain positions and move safely.

Activities may focus on trunk stability, leg strength, weight-bearing, reaching and controlling movement during play.

Exercises are chosen according to the child's needs rather than assuming that every child with a motor delay has weak muscles.

Balance and coordination

Physiotherapy can help children practise balance and coordination through activities such as stepping, reaching, climbing, kicking and catching.

These activities can help children develop the physical skills needed for everyday movement and play.

Walking and mobility

For children learning to walk or experiencing difficulties with walking, physiotherapy may focus on:

• Standing and stepping

• Walking practice

• Balance during movement

• Changes of direction

• Moving over different surfaces

• Stairs and obstacles

• Confidence with mobility

Where needed, a physiotherapist may also assess whether a mobility aid or other equipment could support safer movement.

Running, jumping and active play

As children grow, their movement goals may include running, jumping, hopping, climbing and joining in playground games or PE.

Physiotherapy can help children practise these skills through enjoyable activities that gradually build ability and confidence.

Flexibility, positioning and comfort

Some children may experience stiffness, changes in muscle tone or difficulties maintaining comfortable positions.

Where appropriate, physiotherapy may include positioning advice, movement activities and stretching. Splints or orthoses may be considered in collaboration with the relevant healthcare professionals when clinically indicated.

Confidence and participation

Children can become frustrated when physical tasks feel difficult or when they struggle to keep up with their peers.

Physiotherapy can provide achievable challenges and opportunities to experience success. The aim is to help children feel more confident exploring movement and taking part in activities they enjoy.

What is purposeful play in physiotherapy?

Purposeful play uses enjoyable, meaningful activities to help children practise skills and develop their physical abilities.

Rather than focusing only on repetitive exercises, a physiotherapist may use toys, games, obstacles, music and imaginative activities to encourage movement.

For example, reaching for a toy can encourage postural control, stepping over obstacles can practise balance, and kicking a ball can help develop coordination and weight transfer.

Purposeful play can help children stay engaged while practising skills that are relevant to their everyday lives.

The principles of purposeful play

• Active engagement: encouraging children to take part rather than simply watching.

• Meaningful activities: connecting therapy to skills that matter to the child and family.

• Purpose and intention: choosing activities that support specific developmental or functional goals.

• Enjoyment: creating positive experiences that encourage participation.

• Repetition and exploration: providing opportunities to practise, adapt and learn new movements.

• Social interaction: where appropriate, encouraging interaction with parents, carers, siblings or peers.

Activities are tailored to each child's interests, communication and sensory needs, abilities and goals.

Hydrotherapy for gross motor delay

Hydrotherapy is physiotherapy carried out in a heated pool.

The buoyancy of the water can reduce the amount of weight placed through the body and may make some movements easier to practise. The water also provides resistance, which can be used during movement and exercise.

Depending on the child's needs, hydrotherapy may support:

• Movement and mobility

• Balance and coordination

• Strength and postural control

• Walking and stepping

• Range of movement

• Physical activity and exercise tolerance

• Confidence when exploring movement

Water-based activities can provide a different environment in which children can practise physical skills and enjoy being active.

Hydrotherapy is not necessary or suitable for every child. Its role will depend on the child's health, abilities, preferences and therapy goals.

Specialist equipment and technology

At Positive Steps, specialist equipment may be incorporated into physiotherapy when appropriate for a child's needs.

EMA treadmill

Treadmill-based activities can provide opportunities to practise walking and stepping at a suitable speed and level of challenge.

MOTOmed

MOTOmed provides assisted or active repetitive movement of the arms or legs and may be considered when appropriate for the child's abilities and goals.

BlazePods

Interactive light-based activities can be used to practise reaching, stepping, balance, coordination and reaction time in an engaging way.

Hypervibe

Whole-body vibration may be considered for selected individuals as part of a wider exercise programme when clinically appropriate.

Equipment is selected according to the child's age, abilities, underlying condition, safety considerations and goals. Not every child will need or benefit from every piece of equipment.

What are the goals of physiotherapy for gross motor delay?

Every child is different, so goals are based on their individual abilities, needs and priorities.

Goals may include:

• Supporting the development of movement milestones

• Improving postural control and stability

• Developing balance and coordination

• Building physical strength and endurance where needed

• Supporting sitting, standing and walking

• Developing running, jumping and climbing skills

• Making everyday physical activities easier

• Building confidence with movement

• Encouraging participation in play, school and family activities

• Helping families support movement development at home

Progress looks different for every child. We focus on meaningful achievements and adapt therapy as the child's needs and abilities change.

How Positive Steps can help

Positive Steps Physiotherapy provides support for children with developmental, neurological and physical difficulties.

Our aim is to give every child the freedom to move better and continue doing what they love.

We take a positive, individualised approach to physiotherapy. We look at what a child can already do, what they would like to achieve and which activities may help them progress.

Our services may include:

• Individual paediatric physiotherapy sessions

• Developmental milestone support

• Gross motor skill development

• Balance and coordination activities

• Strength and conditioning

• Play-based movement programmes

• Home exercise programmes

• Family education and guidance

• School and nursery recommendations

• Advice on adapting activities

• Support with participation in play and physical activities

• Personalised goal-setting with children and families

We aim to make therapy engaging and relevant to everyday life, helping children practise skills in ways that feel enjoyable and achievable.

Always finding what can be done. Together, we find new ways to thrive.

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Find out more about gross motor delay

If you are concerned about your child's movement or developmental milestones, speak to your health visitor, GP, paediatrician or another appropriate healthcare professional.

They can help determine whether your child would benefit from a developmental assessment, physiotherapy or referral to another specialist.

Gross motor delay can have many possible causes, so understanding the individual child's needs is an important first step.