“He will always find a way to slouch, no matter what we do.”
That’s what Joseph’s mom shared with me during the assessment of his gross motor skills when he was first beginning care in our office. And, oh, man, she was certainly right.
When he sat on the bench, he had to slouch and lean against the wall or his mother. When he went to stand up, it took an enormous amount of effort, so much so that he really never could stand all the way straight… but just simply ended up slouching while standing. And even when he walked and moved around, he was slouched, crooked, and entirely exhausted.
Joseph was 12 years old and presented to our clinic for help with daily challenges associated with his autism, ataxia, and chronic constipation diagnosis, but the first thing that caught my attention and needed to be addressed was his significant gross motor delays and struggles.
Because his body was so “wound up + worn out” simultaneously, he sought additional movement stimulation via constant stimming and other behaviors.
We knew that if we were going to help with his daily challenges with sleep, constipation, social anxieties, and communication, we had to first vastly improve his gross motor skills, because they are intricately linked to each of those functions and conditions.
What Are Gross Motor Skills?
Gross motor skills are the foundation of childhood development, involving movements that require large muscle groups and whole-body coordination. These movements engage the skeletal muscles of the arms, legs, trunk, and core, as well as the stabilizing muscles that enable whole-body movement. These movements include sitting upright, walking, running, jumping, climbing, riding a bike, playing sports, etc.
Most pediatric practitioners will focus primarily on how the ‘torso’ or ‘core’ is functioning when they assess a child for gross motor development, but we feel strongly that if we think of more as the spine or even the ‘neurospinal’ system, it helps parents and practitioners get a fuller picture of what’s really going on with gross motor skills.
Simply put, before any movement is initiated in the arms or legs, nerves and muscles within the neurospinal system must first activate and coordinate. This is why the spine and the core are perfectly synonymous for this discussion.
Since that is where the core and entire central nervous system is located, it’s important to break down the neurospinal system just a bit further as well, into these three main parts:
- Cervical (neck) region
- Thoracic (torso) region
- Lumbopelvic (core) region
And perhaps even more important when sorting out gross motor skills and function, is to talk about the ‘transition zones’ within the neurospinal system, which is where those key regions link up and coordinate together.
Gross motor development also involves balance and coordination, body awareness, and motor control, all of which depend on proper nervous system function. Like all motor functions, whether gross or fine motor skills, coordination is essential. If all the nerves and muscles are not communicating with each other in an efficient, coordinated fashion, things don’t develop and function the way they should.
How Gross Motor Skills Develop
Babies and children develop gross motor control in a predictable pattern called cephalocaudal development—meaning from head to toe. Understanding how motor development progresses helps explain why some children struggle and where the real root cause may be hiding.
Before your child can walk, they must first gain head control, then trunk control and sitting balance, and finally leg strength and coordination. This head-to-toe sequence is neurologically hardwired. A baby can’t skip steps; they need to master neck strength before they can sit independently, and they need to sit independently before they can pull to standing.
The same principle applies to development from the center outward—what experts call proximodistal development. Core stability must develop before arm and leg coordination becomes refined. This is why the neurospinal system and postural control are so foundational to all gross motor movements.
Here’s what this means practically: If there’s neurological interference in the upper cervical and thoracic regions—the very top of the developmental sequence—it disrupts everything that should develop below it. The nervous system is trying to build a house from the top down when the foundation isn’t stable.
Think back to Joseph’s story. His slouched posture wasn’t a muscle problem—his INSiGHT Scans showed excessive tone and tension in the cervical and thoracic regions, the very areas that should have developed properly first. This upstream neurological dysfunction prevented proper development down the chain to his core, pelvis, and legs. His body was “wound up” at the top and “worn out” at the bottom because all the neurological energy was being consumed by the interference in the upper regions.
This is why understanding the head-to-toe developmental pattern is so critical; it reveals exactly where to look when gross motor delays show up.
The Three Types of Gross Motor Skills
Gross motor movements fall into three main categories that work together to create coordinated, purposeful movement:
1. Locomotor Skills involve moving the body through space—rolling, crawling, walking, running, jumping, hopping, skipping, climbing, and swimming. These are the movements that get your child from one place to another.
2. Stationary Skills involve movement while staying in place—standing balance, sitting upright, bending, twisting, turning, stretching, and maintaining posture. Even though the child isn’t traveling, these movements require significant motor coordination and core strength.
3. Object Control Skills involve manipulating objects—throwing, catching, kicking, batting, and rolling balls. These skills combine gross motor control with timing and hand-eye or foot-eye coordination.
All three types require seamless coordination between the nervous system, skeletal muscles, and postural control systems. When children struggle with multiple types of movements, can’t balance, AND can’t throw a ball AND avoid running, it’s often a sign of neurological dysfunction affecting motor control across the board, not just weakness in individual muscles.
This is where most traditional approaches miss the mark. They focus on strengthening specific skills in each category without addressing the neurological coordination that makes all three types possible in the first place.
Why Are Gross Motor Skills Important?
There are three (3) main reasons why gross motor skills are so important to childhood development and overall health of all kinds. They are:
- Gross motor skills must develop before fine motor skills
- Gross motor development is intricately linked to overall brain development and function
- Gross motor development is also involved with other crucial basic health functions, like digestion (gut microbiome) and immune function
Delays and challenges with gross motor skills impact everyday activities far beyond just sports or playground play. Children struggle with self-care tasks like getting dressed, which requires standing on one leg to put pants on without falling over, climbing into car seats, getting in and out of bed, and navigating stairs safely.
Poor gross motor development directly affects a child’s ability to sit upright at a desk with proper postural control. This seemingly simple task requires core stability, trunk control, and sustained muscle strength—all of which depend on proper neurospinal function. When children can’t maintain good posture, it impacts their handwriting, attention span, and academic performance. Carrying a heavy backpack, transitioning between classrooms, and participating in playground skills all require the gross motor foundations that many struggling kids simply don’t have.
As children master balance and coordination, they also develop body awareness, understanding where their bodies are in space and how to control them. This spatial awareness is crucial for safety, sports participation, and overall confidence. Kids who struggle with gross motor skills often become hesitant and anxious about physical activities, and may withdraw from peer interactions that involve movement.
And finally, while not discussed as often as they should be in the standard pediatrician or PT/OT world, problems with gross motor skills are absolutely a factor in common childhood problems such as chronic ear infections, respiratory infections, and constipation.
What are the Gross Motor Skills Developmental Milestones?
Tracking gross motor developmental milestones helps parents understand typical childhood development and recognize potential concerns early. However, it’s essential to remember that each child develops at their own pace—these milestones are guidelines, not absolute deadlines. Some children walk at 10 months, others at 15 months, and both can be perfectly healthy.
This list will help you determine where your child stands with their current gross motor skills and development:
- Newborns-2 months: Turns head from both sides while on back, lifts head, and is able to turn to both sides while on the belly, performs regular tummy time on the floor to strengthen neck and shoulder muscles
- 3-4 months: Raises head in line with trunk when pulled to sit, tolerates tummy time well, rolls from belly to back
- 5 months: rolls from back to belly, brings feet to mouth, lying on back, pivots in a circle while on the belly to each side
- 6-8 months: sits alone, catches self with loss of balance when sitting, crawls on belly
- 9-11 months: crawls on hands and knees, pulls to standing position, cruises around furniture, walks with two hands held
- 11-12 months: walks with one hand held, stands alone for a few seconds
- 13-14 months: crawls upstairs, achieves independent walking, stands up from the floor without support
- 15-18 months: kicks a ball forward, crawls down the stairs (on the belly, feet first), can run even if they fall easily
- 2 years: walks up and down stairs alone, walks and runs fairly well, jumps in place with both feet off the ground
- 3 years: balance on one foot for a few seconds, catch a large ball, ride a tricycle
- 4 years: Run, jump, and climb well, is beginning to skip
- 5 years: climbs well, begins to skate and swim, rides a bicycle without training wheels
What Would Struggles With Gross Motor Skills Look Like?
For most children, delays and challenges with gross motor skills are quite readily apparent. Often, the biggest signs are a child who fatigues extremely easily with even the most basic physical activities, is always slouched and bent over, and, in time, starts to avoid physical activities altogether.
Even when they are sitting at the table or desk, they will often struggle to maintain proper postural control. Additionally, when they move from one posture to another, it takes a lot of time and effort and happens in a very disorganized, inefficient manner.
You might notice your child avoids climbing, refuses to try a tricycle, or can’t kick a ball. They may have difficulty with motor coordination, movements look clumsy, uncoordinated, or require excessive effort compared to their peers.
In school settings, poor gross motor development shows up as difficulty sitting upright at a desk, frequently leaning on the table or wall for support, and becoming easily fatigued during physical activities like PE class or recess. While other kids their age are running, jumping, and playing confidently, your child may hesitate, tire quickly, or simply avoid physical challenges altogether.
What Causes Gross Motor Delays? The Perfect Storm
If your child is struggling with gross motor development, you’re probably wondering what caused it. The answer isn’t usually one single thing; it’s what we call The “Perfect Storm”.
Most parents have been told their child’s delays are genetic, or “just how they’re built,” or that they’ll “grow out of it.” But time and time again, when we look at the INSiGHT Scans of children with gross motor delays, we see a clear pattern, and it’s a neurological pattern that began long before the symptoms showed up.
Stage 1: Prenatal Stress
The foundation begins before birth. When a mother experiences chronic stress during pregnancy, whether physical, chemical, or emotional, it affects fetal brain development. Elevated cortisol levels can impact how the nervous system forms and functions, even before your baby takes their first breath.
This doesn’t mean mothers caused their child’s struggles—it means we live in a stressful world, and babies are affected by that stress in utero. The nervous system is forming during this time, and chronic stress can alter its development in ways that make a child more vulnerable to future challenges.
Stage 2: Birth Trauma
The birth process itself is the most common source of neurological trauma we see in children with gross motor delays. Birth interventions like forceps, vacuum extraction, and C-sections create pulling and twisting forces on the delicate cervical spine and brainstem. Even ‘normal’ vaginal births can involve significant force.
This physical trauma creates subluxation—neurological interference in the upper cervical and thoracic regions. Remember our discussion about head-to-toe development? If there’s interference at the very top of the developmental sequence, everything below it struggles to develop properly.
Stage 3: Early Childhood Stressors
After birth, the storm continues building. Chronic ear infections leading to rounds of antibiotics, disrupted gut-brain function, environmental toxins, physical falls, and accumulated stress all compound the pressure on an already vulnerable nervous system. Each stressor adds another layer of interference.
The Accumulation Effect
Here’s what parents need to understand: It’s not just the C-section. It’s not just the antibiotics. It’s not just the prenatal stress. It’s the accumulation of all these factors hitting a nervous system that’s already compromised from the beginning.
This explains why some children develop gross motor delays while others don’t—every child has a different threshold, and every child experiences a different combination of stressors. Some kids can handle more before their system gets overwhelmed. Others reach their tipping point with fewer stressors.
Understanding this cascade is crucial because it explains why traditional approaches often plateau. If you’re only addressing the weak muscles (the symptom) without addressing the neurological interference (the cause), progress will be limited, no matter how many exercises you do.
Addressing Gross Motor Delays
The first place a child with gross motor delays is likely to end up is with pediatric physical therapy or occupational therapy. Therapists perform a comprehensive examination of muscle strength, balance, motor coordination, and postural control. All exercises and therapies are traditionally designed to activate and strengthen the core, improving core stability.
But while that is still the focus of most traditional practitioners and therapists, for kids with gross motor skills, we frequently find that something deeper is going on first. And if that first developmental issue is not addressed and taken care of, then their progress and results with PT/OT will be limited and short-lasting.
The inherent challenge we are discussing here is something that affects neuromuscular tone first, a condition called subluxation. This neurological dysfunction has two main parts that are both intricately connected to problems with gross motor function:
- Altered tone + tension (too much + too little)
- Incoordinate + imbalance
The biggest ‘hidden secret’ to helping kids with gross motor delays is not simply addressing their lack of tone or weak core muscles, but actually first addressing the increased and excessive tone found in their neurospinal system, specifically the neck and upper torso regions.
For the most part, only Pediatric Chiropractors are trained to fully analyze and assess tone and tension in the neck and neurospinal system, which is likely why it’s so overlooked and not addressed in the vast majority of gross motor development cases.
This is why so many parents report to us that, despite many months or years of therapy and working on things as much as they can with stretching and strengthening exercises at home, their child still struggles to make progress and often plateaus with traditional therapies. When that happens, it’s a clear sign that subluxation of the cervical and thoracic spine is the true root cause of the child’s challenges.
The science behind all this is really quite simple. If all of that neuromuscular tone and tension is ‘jammed up’ and ‘stuck’ in the upper regions of the neurospinal system, there simply isn’t enough ‘left over’ to then activate the core, the pelvis, and the arms and legs.
To get an even clearer picture of what’s happening here, let’s look back at Joseph’s case and his EMG (electromyography) Scans below.
The markings and notes made on his INSiGHT Scans tell you everything you need to know about why his posture picture above at the start of this article is the way it is – he was both ‘wound up and worn out’ at the same time. His cervical and thoracic regions had excessive tone and tension, and his neuro-core was weak and exhausted.
Now, take a look at where he was after just one week of getting neurologically-focused, tonal adjustments!
He still has a long way to go to get all the way there, but after just one week, he’s not only sitting up so much better, but his mother also reported he was craving physical activity for the first time in his life instead of avoiding it! He wanted to go for walks, run on the treadmill, and said he even wanted to lift weights!
At PX Docs, we focus on root cause, natural, drug-free care solutions. We do not cure gross motor delays or any conditions. Our Neurologically-Focused approach focuses on addressing the neurological interference that may be preventing your child’s nervous system from functioning optimally and allowing their body to develop as it should.
When to Be Concerned: Red Flags in Gross Motor Development
While each child develops at their own pace, certain red flags warrant deeper investigation:
- Your child is significantly behind developmental milestones for their age (not just a few weeks, but several months)
- One side of the body moves differently from the other, or your child consistently favors one side
- Your child actively avoids physical activities that they should be able to enjoy at their age
- Muscle tone seems either too loose and floppy (hypotonia) or too stiff and rigid
- Your child has lost gross motor skills they previously had, any regression is concerning
- Pediatric physical therapy has shown minimal progress after 3-6 months of consistent work
If you notice these red flags, talk to your pediatrician about developmental concerns. And if traditional therapy hasn’t provided the progress you hoped for, it may be time to look deeper at the neurological foundations that make gross motor development possible in the first place.
Look Deeper with the INSiGHT Scans
For now, thousands and thousands of parents we’ve been able to help find the answers and action steps they have been looking for all along to help their child get over and past their gross motor delays!
It all starts with a neurological assessment that goes deeper than a traditional pediatrician or therapy assessment and focuses entirely on the central nervous system, spine, and subluxation.
If the challenges discussed in this article sound like your child, then reach out to one of our PX Docs and get scheduled for your 5-Point Clinical Process and INSiGHT Scans today! If you are concerned about your child, we encourage you to visit the PX Docs directory to find a Neurologically-Focused practitioner near you.
