Crawling. Does it really matter?

#crawlingmatters. So why has the CDC overlooked it?

Well, let's talk a bit about crawling first:

Crawling isn't just about learning to move (although that's huge in itself). When Ruby (actually, any baby) learns to crawl and moves around for a few months by crawling, she is busy developing the body and brain connections that will support her function and learning for the rest of her life.

Here are some of the things that crawling is crucial for and that Ruby is developing while she crawls:

👉 vision including focussing near and far, using both eyes together, working out that her vision can lead where her body can now take her

👉 strength (core, limb, hand and neck strength)

👉 coordination,

👉 independence,

👉 bilateral actions with left and right sides of the body working together

👉 an understanding of where she is in space and how she can now interact more independently within that world,

👉 locomotion & motivation connections -- she sees something, she can get there to investigate it further by herself

👉 she decides when she moves and can do that safely and securely well before her balance system, and her body is ready for two-legged walking.

She is integrating primitive reflexes so that they are mature in her central nervous system and don't interfere with her later movements, body functions and learning processes.

She is developing:

 👉 postural reflexes,

👉 developing postural control,

👉 planning and linking motor patterns of movement with different sections of her brain (brain development) – it's cognitive, motor and sensory brain activity with social and emotional benefits

👉 AND  sooo much more.

Crawling is a crucial developmental milestone that should happen at about 6 - 8 months of age. It is critical in maturing our body systems and helping them work together to support us in later life throughout our lives. It all starts to come together when we crawl. We can use our vision to see something that isn't near us, organise our body to support and move us towards it, get there and investigate our world on our own. All of that is foundational and fundamental for our later learning and functional success. Our body supports the growth and development of our brain. Part of our natural "programming" to establish good body-brain connections, support sensory integration, mature our central nervous systems, and help us develop cognitively, socially and emotionally includes these sorts of developmental movement activities.

We can't crawl straight away. Our body has had to mature to get there. This process includes the maturation of our sensory and motor control systems. But at about 6 – 8 months, we start to gain control over our movements. We begin to plan and implement movements to achieve outcomes that we have some control over. Our postural reflexes are developing. We begin to have voluntary postural control that isn't subject to primitive reflex responses that have dominated our movement patterns for the previous 6 – 8 months.

Crawling is important.

The children we see in our practices with learning challenges have often skipped or passed very quickly through the motor development stages of creeping and crawling. Crawling impacts later functional and learning success and must be acknowledged as a significant part of the developmental process. It is too important not to notice it. It's too important not to look for it. It's too important to overlook it.

So, why has the CDC overlooked it?  

"What?!!!" -- I hear the outrage!

Recently, the CDC (the national public health agency of the United States, the Centers for Disease Control and Prevention) has revised the publication of many of its developmental milestones. 

The CDC seems (at surface level) to have removed the milestone of crawling and adjusted many milestones to the 75^th percentile, which has basically added about 4 – 6 months to most of the milestones, in some cases more.

This 'update' has created quite a social media storm and outrage from those who work with children and families experiencing developmental delay, particularly those in the USA. And, justifiably so, in my opinion. They argue the CDC has just "normalised" developmental delay.  The new milestones imply it isn't a big deal if your child doesn't talk, walk or crawl at key ages that we are currently familiar with, and that raise "Developmental Delay" red flags for us now. The "red flags" have moved further down the line, and some are really well hidden.  Like crawling.

To find any mention of crawling as a milestone, you need to dig deep into their "Milestone Development" App (which they promote on their website). You'll find crawling is mentioned at about nine months of age. The written material on the website is very cursory and brief. As a neurodevelopmental educator, it is frightening to see this "normalisation" of developmental delay and the apparent "skimming over" the importance of these aspects of development. Overlooking, no, let's be blunt. Eliminating "crawling" in the brief descriptions makes one think, "maybe it's not important then." And we know it is crucial. Parents need to understand the significance of motor development for later function and learning success.

The CDC changes in the USA concern me in Australia because we tend to follow where the US leads. It makes me wonder and ask, "Why have they changed them?" But that's probably another very long conversation, and it will likely include topics like "We can postpone intervention if we've normalised the delay, and that reduces the strain on the support systems." And all sorts of other things. In short, I can't answer why; we just know they have.

What concerns me most is that implicit in this approach is the apparent removal of an emphasis on motor development. It tends to wash over it and imply "it will come". It fosters a passive response to development instead of active involvement that promotes an understanding of the role of movement for functional and learning success. It is short-sighted and doesn't help parents understand the importance or significance of milestones. It still separates emotional, social, cognitive and motor development from each other. We know they are all interlinked and at the core of brain development is movement.

When the CDC's new guidelines were first released, I saw an article that suggested they were updating the percentile rankings for milestones from the 50^th percentile to the 75^th percentile. That is,  rather than saying, "Fifty per cent of babies should be… by this age", it now states that "75% of babies should be ….. by this age." So they've basically shifted the goalposts out a bit further. The result is that it will normalise developmental concerns about delays with the implication that we can postpone intervention.

We need to remember that milestones like those produced by the CDC  are arbitrary descriptors and indicators. The fact that the CDC can change them as they have illustrates that.

As neurodevelopmental practitioners, we need to keep the focus on the developmental sequence, the importance of movement, opportunity, and the growth of understanding about these processes. We need to keep promoting that sequences of developmental movement all serve an essential part in the development of our children, and we shouldn't overlook those sequences. Age is significant as a descriptor and indicator of timing, but age isn't all that matters; the activity matters. The opportunity for movement and development matters. Babies are active creatures that require active involvement and support to help them grow and develop into mature, well-functioning children who will later become mature independent adults.  

The changes in the CDC inspire outrage. But, perhaps there is an opportunity here for us to have conversations that really matter. Yes, there is a window of developmental stages and ages that we call "milestones", but there is individual difference within those ranges. So, let's look at the child in front of us, at the activity we need to see. Let's look at the sequence of development. Let's focus on what is happening with the child, and let's use age and milestones as an indicator, not as a rule.

Let's help parents understand the significance of developmental movement sequences and the importance of environmental opportunity to develop our body systems.

Let's not brush these issues under the carpet by moving goalposts.

Your thoughts?

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