Physical and motor development

Physical growth

Physical growth refers to an increase in a child’s body size. Although physical development is strongly controlled by genetics and brain maturation, it is also influenced by environmental factors.

In order to grow, a child needs sufficient healthy nutrition, sleep, care and prevention of diseases that harm growth. Globally, child malnutrition threatens the healthy growth and development of more than 200 million children (Unicef, 2024). The sufficiency and quality of sleep and its effects on the physical and psychological development of young children have been identified and are the subject of lively research (Barry, 2022).

Growth determines a child’s experiences and changes the way caregivers respond to a child. The mobility of crawlers and toddlers leads to more restrictions from parents.

Body growth can be seen in early childhood as changes in height, weight and body proportions. While the average length of newborns is about 50 cm, they are about 75 cm when they are one year old and a little over 120 cm when they are six years old. Correspondingly, the weight increases from an average birth weight of 3.5 kg to a weight of slightly more than 20 kg in six-year-olds. The limbs of a newborn baby look very long compared to the rest of the body, but the proportions change very soon as the head and middle body grow (Saari et al., 2011).

Motor development

The development of the foetus and the small child follows a certain order and progresses from head to feet (the so-called cephalocaudal direction) and from the midline of the body to the extremities (the so-called proximodistal direction). The head-to-feet development direction manifests itself, among other things, in the fact that the foetus’s head is anatomically quite developed before its legs take their final shape. In accordance with the developmental direction from the midline to the extremities, the middle parts of the body are able to function before the extremities, such as the wrists and fingers. Functional readiness develops in the same way: performances that belong to the child’s overall motor skills, such as walking, running and jumping, develop before the fine motor movements of the wrist and fingers that require precision (Magill & Anderson, 2010).

In a longitudinal study conducted in Jyväskylä, parents wrote down their observations of the development of their children’s vocalizations and motor skills during the first year of life (Lohvansuu et al., 2021). They marked the children’s key developmental achievements on the forms prepared for this purpose (see Figure motor and vocalization development). In the first trimester (0–4 months), the functions related to grasping develop, as well as overall motor skills represented by turning the head and rolling from the stomach to the back and vice versa. In the second trimester (5–8 months), the child practices handling objects and learns to sit and move from one place to another by crawling. In the last trimester (9–12 months), the grasping grip becomes more precise so that the child picks up small objects with the tips of the fingers with the help of the bent thumb and forefinger. At this age, children also stand up and start moving by taking support. A child walks the first 10–15 steps without support at the age of one year, on average.

Although the development of motor skills is typically described as the emergence of individual skills, motor development actually occurs as the parallel learning of several skills, where a certain skill requires the learning of another skill. For example, learning to walk requires, among other things, 1) the development of alternate step movement patterns, 2) sufficient body control and balance and 3) the development of sufficient muscle strength. Different conditions typically develop at different times, and only when all conditions are met does the child walk. The smoothness of walking is the result of the improvement of coordination between the different areas of development (Thelen, 1995).

In the following years of early childhood (ages 2–6), a child’s basic motor skills develop, which include balance skills, movement skills and handling skills (Iivonen & Sääkslahti, 2014). Table 1 summarizes the milestones of a child’s motor development in early childhood. During these years, many fine motor skills are also developed, which are needed in games, especially in using a pen and drawing. At around two years old, a child can run, jump and kick a ball, put on and take off some clothes and roughly use a spoon.

Although table 1. have compiled fairly precise age periods when a certain skill appears on average, there is significant individual variation in development. There can be considerable differences in the acquisition of motor skills, even among children of the same family. For example, some children learn to walk at the age of 9 months, while other children learn to walk at the age of one and a half. Similarly, children can learn motor skills in a different order—one child may stand before crawling, while another child learns crawling first and then stands up.

Milestones of a child’s motor development in early childhood (based on Dosman et al., 2012).

There is a wide range of what is considered normal, as some children gain skills earlier or later than others. Toddlers who were born prematurely may reach milestones later.

Two-year-old child: The child jumps, runs and kicks a ball. The child can throw the ball a short distance (often over the head with both hands). The child can copy a vertical line on paper, put on and take off some clothes and use a spoon. The child can stack six cubes on top of each other.

At two years old, children exhibit more advanced motor skills, such as jumping, running and kicking a ball. They can throw a ball and bean bag a short distance, often using both hands to toss it over the head. Fine motor skills also improve and start to show independence in daily activities, such as putting on and taking off some clothes.

Three-year-old child: Children at this age are walking, running, kicking and throwing. They are exploring their world and picking up new skills. They can ride a tricycle, climb stairs alternately with each foot, copy a horizontal line or circle on paper, use a fork and spoon well, and take off shoes and socks. These children can stack 10 cubes on top of each other.

Four-year-old child: A four-year-old child can jump on one foot, walk downstairs alternately with each foot, walk backwards along a line, cut paper in half and draw a person with a body, head and four limbs.

Five-year-old child: The child can catch a ball, stand on one leg for short periods of time, colour pictures, hold a pen with three fingers and wash and dry hands independently.

Motor development requires and embodies the functioning of the human mind. Motor and psychological development are fundamentally connected, even though they are typically treated separately. For example, visual perception and hand movements are not questions of the gradual coordination of two separately developing areas, but the child actively observes his environment in order to move and moves in order to observe. Campos et al. (2000) suggested that skills related to movement, such as crawling and walking, are developmental transitions that decisively change children’s perceptual functions and spatial cognitions.

Motor and psychological development are, therefore, fundamentally connected to each other, even though they are typically treated as separate. The connections between motor and language development have been studied in 0–7-year-olds as part of the Child Language Development and Familial Dyslexia Risk project (Lohvansuu et al., 2021). The aim was to determine the connection between early motor development and language development (1.5–5.5 years old) and reading at the end of the first school year (Viholainen, 2006).

The delay in early motor development was connected to later linguistic development, especially in children whose family had a risk of reading difficulties, such that they had a smaller vocabulary, had a weaker command of the inflectional forms of the Finnish language and were slower readers (Viholainen et al., 2002). In addition, the control of early motor skills was found to be important for children’s later cognitive development, as Campos et al. (2000) and Heineman et al. (2018) have also presented. The problems of early motor development seem to have connections with the occurrence of autism spectrum disorders (LeBarton & Landa, 2019).

Supporting physical and motor development

The attachment relationship is a significant emotional bond that arises between the baby and the adult who cares for him and creates the basis for the child’s sense of security (read more xxx in eTALE). When the child’s ability to self-regulate is just developing, the attachment relationship creates the basis for the child’s experience that an adult is available and supporting it, if needed.

Although the formation of a secure attachment relationship does not depend on whether or not the mother breastfeeds her baby, breastfeeding supports the formation of a secure attachment relationship between mother and child. Research has shown that breastfeeding has very positive health effects for both babies and mothers. These benefits are accentuated in low-income families and in developing countries (Prentice, 2022). Breastfeeding has been found to reduce the morbidity of children and mothers in the short and long term. Breastfeeding, for example, reduces infections and has a favourable effect on the child’s growth, enhances the development of the central nervous system and the immune system and facilitates the maturation of the intestines and the microbiota. Breastfeeding has many health benefits for the mother as well; for example, it helps in achieving a normal weight and protects against breast and ovarian cancer and type 2 diabetes.

More than 99% of infant deaths occur in low- and middle-income countries. Breastfeeding reduces early deaths and protects against certain diseases, such as diarrhoea or pneumonia, which are the main causes of death in infants. Globally, less than half of babies are breastfed (North et al., 2022). In Finland, the situation is better, and breastfeeding has become more common. Around 94 per cent of children were fully or partially breastfed, and at the age of four months, only 15 per cent of babies were not breastfed at all. Of the babies approaching the age of one, 58 per cent were still breastfed. Young and less educated mothers who were the only adults in the family breastfed their children less than other mothers (Ikonen et. al., 2019).

Even after infancy, adequate, versatile and healthy nutrition is important for children’s all-round development. In children, the need for energy per weight is greater than in adults, and malnutrition has a negative effect on children’s growth and motor and cognitive development. For this reason, child malnutrition is a key risk factor for children’s development, especially in developing countries. In developed countries, obesity in children, on the other hand, is a growing health risk. Overweight usually begins to accumulate from the age of three onwards—16‒17 percent of five-year-old Finnish children are overweight. Dietary habits and sufficient daily physical activity play an important role in the prevention of obesity. Overweight children should be encouraged to move at their own pace and as often as possible (Sääkslahti, 2018).

Sleep and its quality have a positive connection with children’s physical development and growth, as well as cognitive development. Connections have been shown, for example, to the development of memory, language and executive control (Tham et al., 2017). However, sleep disorders in young children are a common problem that affects the lives of families with children. The smaller the number of children in the family, the more children’s sleep problems and parents’ insufficient night sleep burden the parents. The baby needs its parents’ help in establishing sleep rhythm, but a tired parent may not be able to act consistently.

Newborns sleep an average of 16 hours, one-year-olds sleep about 12–13 hours and seven-year-olds sleep 9–10 hours a day (Iglowstein et al., 2013). Parents’ psychological well-being, sensitivity to their children’s needs and bedtime routines affect their children’s ability to fall asleep. Sometimes, the family also needs outside help with sleep problems to support coping. It is a good idea to start investigating the sleep problems of infants and older children by keeping a sleep diary, which is used to track sleep for at least a week. Various sleep schools are a good way to help the child find a sleep rhythm and a circadian rhythm suitable for all family members.

Since the skin is our oldest and largest sensory organ, the importance of physical contact (e.g. stroking and massaging) related to early caregiving situations has also been increasingly recognized as one of the prerequisites for healthy physical development. Touching and stroking are also ways in which adults calm and soothe a child from the time they are born. A lack of touch has been found to be connected to a delay in children’s development, and on the other hand, touch and massage have proven to be a good way to support children with developmental risks. Much research has been done also on the importance of exercise and physical activity in people over five years old, and based on systematic reviews, it is known that physical activity has positive effects on skeletal development and cardiometabolic (cardiovascular and metabolic diseases) health.

The importance of physical activity and exercise in childhood is an important factor in influencing overweight and obesity in children (Pate et al., 2019). In children under the age of one, the clearest positive effects of exercise have been observed on the development of skeletal and motor skills, as well as cognitive development. In 1‒3-year-olds, the clearest effects of exercise have been observed on skeletal development, and in 3‒5-year-olds, these effects have been observed on the prevention of obesity, the development of motor skills and indicators of psychosocial and cardiometabolic health (Timmons et al., 2012). How children’s physical activity and movement can be supported at different age stages is described in detail here (link to concrete examples here).

From the point of view of parents and those who work with children, the question of whether it is also possible to influence the cognitive development and learning of the child with exercises aimed at physical activity and thus prevent the development of learning difficulties in advance is very interesting (Jylänki et al. (2022) conducted a systematic review of interventions aimed at supporting the basic motor skills of 3‒7-year-olds. Based on the 35 studies included in the review, they concluded that such interventions seem to have positive effects on children’s cognitive development. The effects were most evident in operational control, language development, recognition of numbers and memory functions. The clearest effects were produced by interventions that included training of basic motor skills (walking, running, jumping, throwing, catching, kicking and punching) and increasing physical activity.

Motor difficulties

Children rapidly acquire new skills during the first years of life, such as rolling over, crawling, walking and manipulating objects. These skills involve the voluntary control of movement to achieve specific goals. By pre-school age, children typically have mastered basic motor skills, including balance, movement and object manipulation. In middle childhood (ages 7–12), children’s motor control improves, resulting in smoother movements and greater coordination. This period of skill refinement sets the stage for more advanced physical play and coordination, and motor skills can be classified as gross or fine, depending on the muscles involved. Gross motor skills are crucial for posture control and provide a foundation for fine motor skills, such as writing.

However, some children face challenges in motor development, where acquiring new motor skills is more difficult. These children exhibit motor learning difficulties, often diagnosed as developmental coordination disorders (DCDs). In everyday language, these children are sometimes described as clumsy. These difficulties impact their ability to perform motor tasks smoothly and automatically, which significantly affect their daily life and development (Blank et al., 2019).

Core challenges in DCD

Children with DCD face difficulties in regulating motor functions, particularly in anticipating actions, timing and controlling movements. This can lead to slower movement initiation, difficulty with coordination and frequent collisions with objects or people. Learning new motor skills is often a laborious task. These challenges extend to daily activities, such as dressing, playing and participating in sports. Key factors contributing to these difficulties include deficits in action control, working memory, planning and stimulus control (Blank et al., 2019).

Social and emotional impacts

Motor learning difficulties can also have significant social and emotional consequences. Children with DCD are often excluded from physical activities that require speed and agility, such as team sports or ball games, leading to reduced enjoyment of play and physical activity. Some children may view physical activities as ‘hard work’, which discourages participation and exacerbates their motor challenges. This reluctance to engage in physical activity can further hinder the development of motor skills and limit opportunities for social interaction, thereby contributing to feelings of isolation (Blank et al., 2019).

Long-term effects on physical and psychosocial well-being

In the long term, motor difficulties are linked to poor physical fitness and sedentary behaviours in adulthood, which increase the risk of obesity, cardiovascular issues and poor muscle strength. The avoidance of physical activity due to difficulties in motor control can create a vicious cycle of inactivity, reinforcing weak motor skills and contributing to health problems.

Emotionally and socially, children with motor learning difficulties are at greater risk for issues such as anxiety, depression, low self-esteem and social difficulties. The impact is heightened when these motor challenges co-occur with attention difficulties or hyperactivity. These issues can be partly explained by shared genetic factors but also by the significant role that motor and sports skills play in children’s social lives. Developing motor skills and increasing physical activity not only helps improve physical fitness but also boosts emotional well-being, improves self-concept and potentially prevents mental health issues (Blank et al., 2019).

Causes of motor learning difficulties

Motor learning difficulties (DCD) are caused by a combination of genetic, neurobiological and cognitive factors that influence the development and functioning of the nervous system, particularly brain structures involved in motor control and learning. The hereditary influence on motor difficulties is comparable to other developmental disorders, with research suggesting a 70% genetic contribution to DCD (Martin et al., 2006).

Key brain structures involved in motor coordination and learning include:

• Frontal lobes: These are crucial for movement planning and execution.
• Parietal lobes: They process feedback about body movements and posture.
• Cerebellum: It is essential for posture control, movement regulation and muscle activation.

These structures are interconnected and work together to plan and regulate motor actions. Abnormalities in these areas may contribute to the challenges faced by children with DCD. Motor learning difficulties can also be explained by cognitive factors, particularly issues in the automation of motor skills and the formation of internal movement models.

Automation failure: Normally, motor skills become automatic through practice. In children with DCD, dysfunction in the cerebellum may prevent this automation, making movement laborious and inconsistent.

Internal movement models: When the brain plans a movement, it generates an ‘efferent copy’ of the intended action that is compared with the actual body feedback. If discrepancies are detected, corrective signals are sent to refine the movement. A dysfunction in the brain’s ability to compare intended versus actual movement may result in errors and delays in motor learning. These difficulties are also referred to as problems in motor imagery.

These cognitive challenges are deeply intertwined with the physical aspects of motor difficulties and highlight the complex neurocognitive processes involved in motor learning. Children with DCD do not merely have physical motor deficits but also face underlying cognitive challenges that contribute to their difficulties.

Motor learning and its support

Motor learning involves acquiring and refining motor skills through practice. However, for children with motor learning difficulties, learning new skills may take longer, and their movement patterns may be less efficient and more prone to errors. The current research highlights several key insights into the learning process:

• Slow learning process: Motor skills are learned more slowly in children with DCD, especially in the early stages of learning (Jelsma et al., 2015).
• Inaccurate Movements: Despite regular practice, these children may struggle to execute movements accurately and may develop atypical strategies, such as mixing up the order of movements (Goodgold-Edwards & Cermak, 1990).
• Feedback processing: A key challenge is the inability to use internal feedback (i.e. how their body feels during movement) effectively, which can hinder the learning process. These children often rely more on external feedback from others to correct their actions (Gomez & Sirigu, 2015).

Difficulties may arise at different stages of learning motor skills:

• Initial learning stage: Children with DCD may find it difficult to develop seamless movement sequences.
• Reinforcement and stabilization: Even after initial learning, these children might face challenges in stabilizing the skill and making it automatic.
• Application of skills: The transfer of learned motor skills to new situations or environments can be particularly challenging for children with motor learning difficulties.

Motor learning can still be achieved despite difficulties, but it requires a structured, supportive approach:

• Practice: Adequate practice is key. Motor skills need repeated practice to become automated. This process can be slow but eventually leads to greater proficiency (Biotteau et al., 2016).
• Real-life integration: It is essential to incorporate motor learning tasks into daily activities. This helps children connect motor skills to practical, meaningful tasks, enhancing the likelihood of transfer and application (e.g. walking, dressing or playing).
• Motivation: Maintaining motivation is crucial. Children with motor learning difficulties may lose interest if the learning process feels frustrating or if progress is slow. Encouraging self-driven goal setting and offering opportunities for success can foster a sense of achievement and engagement.
• Feedback: Providing feedback that supports the internal feedback system (the child’s awareness of its own movements) and external guidance (from the instructor or therapist) is essential for effective learning. Children’s ability to monitor and adjust their own movements is a valuable skill (Gomez & Sirigu, 2015).

Conclusions

Motor learning difficulties, including DCD, are a complex condition that affects not only children’s physical skills but also their emotional and social development. Early identification and intervention are crucial in supporting children in overcoming these challenges. By focusing on developing motor skills and promoting physical activity, children can experience improvements in both their physical health and psychosocial wellbeing.

Motor learning difficulties, or DCDs, arise from a combination of genetic, neurological and cognitive factors that disrupt the development of key brain structures involved in motor regulation and learning. Understanding the genetic basis, brain areas and cognitive mechanisms involved is crucial for developing effective interventions to support children with DCDs and help them overcome these challenges. Motor learning difficulties can manifest early in a child’s life, with delays in fundamental motor skills such as crawling, walking or coordinating complex movements. These difficulties are often first noticed around the ages of 3–6, although problems with motor skills may be identified as early as age 5 (Cantell et al., 2003). The earlier the identification of motor difficulties, the sooner support can be provided to foster the child’s overall development. Delayed milestones, such as walking later than 15 months, significantly increase the likelihood of DCDs. Observing delays in age-appropriate motor skills can prompt earlier interventions, which is crucial for better long-term outcomes.

Motor learning difficulties, such as those seen in children with DCDs, can be addressed through targeted and consistent practice, effective feedback and the gradual integration of motor skills into daily activities. Early identification and intervention, combined with a supportive individualized approach, can help children overcome challenges in motor skill development. By fostering motivation and providing a structured learning environment, children with motor learning difficulties can build skills that enhance their physical abilities and overall well-being.

You will find more information on motor development from the Literacy Part of the eTALE (Motor and visuo-motor skills).

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