You've Got to Crawl Before You Can Run...

When I think of babies and mobility I definitely picture them crawling all over the house. So I'm not sure when or why some pediatricians started telling parents that crawling wasn't so important; isn't a milestone; and is OK to skip. But I hear this pretty frequently and I'd like to discuss the many benefits of crawling.

Babies usually crawl between 9 and 11months of age. Let's talk about the skills that precede the 9 to 11 month age. Baby has learned to sit, hopefully with a nice straight back (or dynamic posture). He is testing his sitting balance by weight shifting off of center to reach and get toys that are spread around him. To reach really far outside his circle, baby must put weight on one arm and reach across midline. This rotary movement requires core strength and is how baby will get into hands and knees. Get down on the floor and try it. See how you naturally move from sitting to hands and knees. Babies will test their control and begin to reach further and further off their center of gravity until they finally move onto their belly or into quadruped.

Quadruped challenges the strength in the arms, hips and core. As baby initially gets into quadruped he might have his knees wide apart. He might have some swaying or arching of the spine. He might not have good activation through the shoulder blades. Rocking back and forth helps baby strengthen these muscles and challenge balance.

Some issues that can occur initially are difficulty holding head up and in midline. This may be a result of torticollis or tightness in the neck. Some babies will compensate by getting into a 3-legged crawl position with one foot forward. This keeps baby in a more upright position so he does not have to work his neck and shoulder muscles as much. But it's an asymmetrical position which is not what we want baby to be in. We never want a baby to develop more strength or range of motion in one side over another.

Another issue that may occur is fisted hands in weight bearing. Crawling and putting weight through open hands prepares littles for fine motor skills. I've often seen OTs work with older kiddos in UE weight bearing to help them develop their hand strength to use utensils, hold pencils, grip scissors, tie shoes, and work buttons or zippers. Crawling also offers sensory input for children who need help locating their bodies in space.

One other issue that occurs during the crawling phase is the transition from hands and knees into the W sit position instead of side sit. Babies that consistently transition into the W sit are compensating for a weak trunk. The W position locks the hips and pelvis and prevents crossing the midline. It gives a wide base of support and puts pressure on the hips, knees and feet which can result in "knock knees" once the child stands.

One last compensation that can occur is baby scooting on his bum instead of crawling. Babies who do this are often very fast and efficient and it can be hard to convince them to change their ways. This type of movement overuses baby's hip flexors (the muscles in the front of the thigh that get tight with sitting). Bum scooting offers no benefit to the arms and shoulders. It bypasses learning to weight shift which is necessary for walking. It eliminates crossing midline or scanning of the environment. It does not strengthen the hips, knees, and ankles in ways needed to stand. Many babies who use this type of movement have torticollis; weak core; have vestibular issues (balance or tolerance to movement like swinging); or hated tummy time (never adjusted to having their head down or in a horizontal position).

Proper crawling teaches your child how to weight shift and use contralateral (opposite arm and leg) movements that prepare him for walking. It teaches your child that mobility gives them independence. It helps prepare the feet for standing. True quadruped allows your child to scan his environment as he moves which is related to his future ability to read. Hands and knees is also the transitional position for pulling to stand at a stable surface.

I know it's a lot going on in a 2-3 months period. And I will admit, getting a child to crawl is hard work, especially if they hated tummy time. If you feel that your child is a great sitter but has no interest in movement or is demonstrating a compensatory movement pattern, you will benefit from a pediatric PT evaluation and some treatment sessions. There is no reason to wait and see because they always say, "You have to crawl before you can run."