Fysioterapeuten 8-2020

14 FYSIOTERAPEUTEN 8/20 FAG ESSAY «Jimmy is all around the house, it is difficult to keep track of him!», Jimmy’s mom says in a cheerful tone. The maternity group is gathered once again. Five 8-month old in- fants and their moms. They chat about fee- ding, sleeping, diapers, and motor milesto- nes. One of the infants, little Heather, is not crawling around, and her mum Sarah feels a certain pressure. Seeing the infants together, it is obvious that her daughter is not as active as her peers, which rise her concerns. Why isn’t Heather moving around? Will she ever get up from that floor? Am I doing somet- hing wrong? She wonders anxiously. Being in Sarah’s shoes is an unpleasant feeling, and these shoes have been worn by many parents before. The doubt of the de- velopment of one`s own precious children is an unpleasant feeling most parents can recall. Looking at this situation from an outside perspective raises several questions and thoughts: Is the acceptance for diver- sity when it comes to motor function and development in children too narrow? Is this diversity a problem, and if so, for whom? And how can we understand it? Lifelong competition Some people might see all aspects of life as an endless competition. It starts at the first breath: What was the length and weight of the baby? When did you see the first smile, at what age did they say their first word? Being prior in a field is seen as a strength. To compare and compete with peers is a natural affair and a social inherent instinct. Thus, the race of attaining motor milestones can be understood as one of many compe- titions in life. My experience after assessing more than 600 infants in my PhD-project, is that parents seem proud of having children that are ahead of their motor developmen- tal schedule, while parents of infants with a slower development kind of apologize on behalf of their infants, describing them as lazy. As a pediatric physiotherapist I have the knowledge and experience of the broad diversity in typical motor development. Ho- wever, I also meet the infants and children with established motor difficulties, who struggle with simple everyday tasks and play activities. When they enter school and physical education, they are often lagging behind in play, need more time for dressing or have difficulties kicking or catching a ball. Motor development cannot be distin- guished from psychological development as these two constructs are fundamentally rela- ted. New motor skills create new opportuni- ties for exploration and learning that initiate cascades of development across diverse psy- chological domains (1). The development of gross motor abilities, has been shown to in- fluence infants’ independence and self-care. For example, walking without assistance is followed by emotional changes reflecting autonomy and assertiveness, promoting social skills and attachment (2). Research has pointed that children with good motor skills are more popular and serve higher status than children with poor motor skills. Further, children with poor motor skills are less likely to be included in play, which in turn leads to a vicious circle of less move- ment experiences and less experiences in social interaction (3). Hence, children with motor precocity might have a head start in developing social relationships and friends- hips, which in turn nourishes the competi- tion of motor development. Milestone mafia Several parents have experienced comments from the neighbour next-door that their child is not walking yet, while all the three sons of the neighbour attained independent walking before they ate their first birthday cake. The media and providers of merchan- dise has a notion of what is within typical development, or what is healthy. Economic profit is probably a motive for narrowing the window of typical development when they encourage you to buy all kinds of aids to promote crawling, walking, reaching and talking. Parents are surrounded by inputs on the plea and expectations of motor develop- ment by a milestone ‘mafia’. However, hu- mans are not pre-programmed robots that will develop in a fixed way. The evidence tells us that there are big between-individual variability regarding pace and trajectory of motor development, and the trajectory is not linear (4). Even if the motor development the first two years of life is a rapid process, it happens in various tempo. Perhaps it can be seen as the different gaits of a horse. So- metimes, motor development is slowed like in walking, and in some periods, it goes in the tempo of full gallop. Sometimes, the mo- tor development seems to be paused, while other aspects of development are present, like communication and social emotional skills. Back to the horse metaphor, the popu- larity of a thoroughbred racing horse seems to trump the calm draft horse. Do we have a similar tendency among ourselves, favou- ring the rapid developing infants? Naming is framing The way we word ourselves when it comes to motor function, both as professionals and laymen, may nourish the exaltation of rapid motor development. We have admira- tion and recognition in our voice when we talk about the children who are early in the achievement of motor milestones. A mother once told me about the reactions from col- leagues as she brought her early walking daughter to work: «Amazing! She is definite- ly a smart girl!», the colleagues commented. Contrary, there is seldom cheerfulness when you hear about infants who takes their time and have a slower trajectory. The voice of the Milestone mafia or a tribute to diversity? Perspectives on typical motor function in infancy Kine Melfald Tveten , spesialist barne- og ungdomsfysioterapi (MNFF). Ph.d.-stipendi- at ved Høgskulen på Vestlandet.  kine.mefald.tveten@hvl.no. Dette  fagessayet ble akseptert 5. oktober 2020. Fagessay vurderes av fagredak- tør. Ingen interessekonflikter oppgitt. Prosjektet dette fagessayet er basert på finansieres av Fond til etter- og videreut- danning av fysioterapeuter og Høgskulen på Vestlandet. Fagessayet ble først publisert på www.fysioterapeuten.no