Under 5's

The neuro community service offers advice, support and reassurance to referred children and their parents/carers between 0-5 years of age with present with neurological, neuromuscular, developmental and musculoskeletal conditions.

Common conditions

  • Global Developmental Delay (GDD)
  • Cerebral Palsy
  • Talipes
  • Down’s Syndrome
  • In-toeing
  • Perthes

Developmental milestones

Each child is an individual and develops at different rates and speeds. The following normal variants below are guidelines only.

If you feel your child is extremely developing far below what is expected of them, please do not hesitate to seek advice and guidance from your health professionals.

Expected age — 0-3 months

Expected activities:

  • While lying on tummy, pushes up on arms
  • While lying on tummy, lifts and holds head up
  • Able to move fists from closed to open
  • Able to bring hands to mouth
  • Moves legs and arms off of surface when excited

Expected age — 4-6 months

Expected activities:

  • Uses hands to support self while sitting
  • Rolls from back to tummy and tummy to back
  • While standing with support, accepts entire weight with legs
  • Reaches for nearby toys while on tummy
  • While lying on back, reaches both hands to play with feet
  • While lying on back, transfers a toy from one hand to the other

Expected age — 7-9 months

Expected activities:

  • Sits without support
  • Sits and reaches for toys without falling
  • Moves from tummy or back into sitting
  • Starts to move with alternate leg and arm movement e.g. creeping, crawling
  • Picks up head and pushes through elbows during Tummy Time
  • Turns head to visually track objects while sitting
  • Shows more control while rolling and sitting
  • Picks up small objects with thumbs and fingers
  • In simple play imitates others

Expected age — 10-12 months

Expected activities:

  • Pulls to stand and cruises along furniture
  • Stands alone and takes several independent steps
  • Moves in and out of various positions to explore environment and get desired toys
  • Maintains balance in sitting when throwing objects
  • Claps hands
  • Releases objects into a container with a large opening
  • Uses thumb and pointer finger to pick up tiny objects

Expected age — 13-18 months

Expected activities:

  • Walks independently
  • Squats to pick up a toy
  • Stacks two objects

Expected age — 2 years

Expected activities:

  • Walks smoothly and turns corners
  • Begins running
  • Is able to pull or carry a toy while walking
  • Climbs onto/down from furniture without assistance
  • Walks up and down steps with support
  • Picks up toys from the floor without falling over

Expected age — 3 years

Expected activities:

  • Imitates standing on one foot
  • Imitates simple bilateral movements of limbs (e.g. arms up together)
  • Climbs jungle gym and ladders
  • Pedals a tricycle
  • Walks up/down stairs alternating feet
  • Jumps in place with two feet together
  • Able to walk on tip toes
  • Catches using body

Expected age — 4 years

Expected activities:

  • Stands on one foot for up to 5 seconds
  • Kicks a ball forwards
  • Throws a ball overarm
  • Catches a ball that has been bounced
  • Runs around obstacles
  • Able to walk on a line
  • Able to hop on one foot
  • Jumps over an object and lands with both feet together

Expected age — 5 years

Expected activities:

  • Able to walk up stairs while holding an object
  • Walks backward toe-heel
  • Jumps forward 10 times without falling
  • Skips forwards after demonstration
  • Hangs from a bar for at least 5 seconds
  • Steps forward with leg on same side as throwing arm when throwing a ball
  • Catches a small ball using hands only

Expected age — 6 years

Expected activities:

  • Runs lightly on toes
  • Able to walk on a balance beam
  • Able to skip using a skipping rope
  • Can cover 2 metres when hopping
  • Demonstrates mature throwing and catching patterns
  • Mature (refined) jumping skills

Paediatric Gait

A mature gait pattern is not properly established until 7 years of age. Any referrals for the assessment of abnormal gait should be as specific as possible, based upon knowledge of normal child development.

Normal development of feet:

  • Children are not born with mini adult feet and legs. Most children go through a period of being bow-legged as babies and then having mild knock-knees between the ages of four and six.
  • Many children go through a phase of being pigeon-toed or in-toeing. This is often due to the position of the bones in the child’s legs and feet before birth. It improves gradually up to the age of eight as the child grows.
  • Out-toeing in one or both feet is very common up to the age of two and does not require treatment.
  • All babies are flat-footed until they start to walk, and the arch of the foot gradually develops up to the age of five or six.
  • Curly and overlapping toes are commonly seen in new-born babies.
  • A period of tiptoe standing or toe-walking is normal in the early stages of standing and walking.

In-toeing, flat feet and knock-knees are often associated with excessive mobility of the joints – such as being able to do the ‘splits’. Children with this kind of range of movement in their joints sometimes complain of pain in their knees and ankles after exercise and may also appear rather clumsy. These problems usually get better as the child grows and their muscles become stronger.

Frequent Falls 

It is normal for children to fall frequently before the age of 3 years, particularly if they have been late to start walking.

If you are concerned that a child is not moving symmetrically, please liaise with the Paediatric Physiotherapy department.