I don’t know about you - but some days, navigating social media as a parent and professional can feel…interesting to say the least.

While there is SO much incredible information at our fingertips (which is truly amazing!), there are also so many things to consider when it comes to seeing, taking in, and/or applying the information we are seeing to our lives & our family’s lives.

The reality is, social media & the internet can be a bit like the Wild Wild West at times, if you ask me. While there is SO much great, quality information being shared - there is also so much being shared that is….. not so great - and with very little to no regulation on what circulates, it can be SO hard to determine where the information you are consuming falls.

After receiving multiple messages about crawling information circling around last week, I decided to share my thoughts as a pediatric physical therapist and mom of 3 little ones on both the crawling conversation AND the big picture when considering narratives on social media. For context, the information I’m commenting on below is commentary that “there is no research that crawling is beneficial or necessary to development.” (which is simply not true for the record)- but let’s dig into it! Hopefully, this is helpful so you can form your own opinions on this when presented with the full picture of information, and ultimately make the decisions for you and YOUR family that feel most aligned!

Is There Research About Crawling Being Beneficial for Development?

First - I just wanted to be clear, there is TONS of research supporting the immense benefits of crawling on hands & knees, which is what I’m referring to when I say crawling in these stories.

Those benefits range from strengthening, coordination, motor control, communication between both sides of the brain, reciprocal movement that requires both sides of the brain to work together, development of spinal curves, fine motor strength (that even ties into future hand writing legibility), visual motor control and development of eye convergence, depth perception development, I could truly go on and on. Even in some of our top rehabilitation hospitals working with adults, integrating crawling into rehab for brain and neurological injuries is a common intervention because we KNOW what it does for the brain & body.

Now what that DOESN’T mean is that all of the humans that have skipped crawling are doomed in those areas!!!!!! ***So please do not panic in any way****

Even IF you or your baby skipped crawling, you can ALWAYS, always go back down to the floor and play in crawling and get lots and lots of benefits! And just to be clear - there ARE tons of people functioning just fine in the world that skipped crawling, so please don’t take this as an all or nothing thing.

If you are feeling defensive, or immediately thinking “I didn’t crawl and I’m fine!” - that’s okay! I get it, and that is AWESOME for you, I’m genuinely glad to hear it. But there IS more to consider - so I’m going to be sharing what that is from my perspective as a practicing pediatric physical therapist. If that is going to be hard for you to hear, it may be worth heading out of this blog now and protecting your peace!

In my opinion, aside from the fact it’s inaccurate, there are TWO really important things a blanket statement like ‘there is no research that crawling is beneficial or necessary for development’ does not at all consider.

ONE: Consideration of the 3 pillars of evidence based practice in medicine

TWO: Consideration that what the crawling research is ACTUALLY lacking isn’t about benefits or necessity, but more about needing more *high quality* research comparing those who skip or have a variation of crawling as compared to those who do crawl on hands and knees (both in the long and short term) and another important aspect of THIS is related to research on babies/children/vulnerable populations’ in general.

Going to dig into all of this next.

Evidence Based Practice In Medicine

If you’re not familiar with it, health care providers following evidence based practice consider 3 pillars:

Knowing & understanding the available research on said topic
Using their clinical expertise and experience in said area
Their patient/family values and goals.

While research is ABSOLUTELY an important part of those 3 pillars, it is NOT the only thing that matters. Because if we know anything in healthcare, it’s that we know very little and the evidence is constantly evolving, usually YEARS and YEARS later. So considering the research we DO have, alongside what we see literally day in and day out as practicing clinicians in the field, is absolutely crucial. Because often times, we are seeing the impacts of decisions made and the “years later research” play out in real time, right in front of us. And then the advocating starts. And then the funding for research starts. And then the “years later” research starts to develop.

See: more examples than I can give of societal shifts and changes in things like public health policies and medical recommendations as we learn more, hopefully know better, & hopefully do better.🙃

Does It Matter If A Child Skips Crawling?

If a child skips crawling, or even just skips milestones in general, there IS a reason for it. But please hear me out if that bristles you, I will explain what I mean! Whether it’s something super small they work through on their own and we are never the wiser, or something that requires a little bit of intentional intervention, or something that requires a bigger amount of intervention (and maybe it still doesn’t happen or doesn’t happen in the way we ‘expect’) - human motor development follows a predictable path and it has done so since the beginning of time as a baby/child develops into a bipedal adult.

We have innate reflexes wired into our brains, many of which even start in utero- and they are a huge catalyst for development, and then they’ll continue to support the progression for our brains and bodies along that predictable path. We have human anatomy and physiology- similarities every single human has. Those hard wired human attributes don’t change because of public health policies or the medical recommendations. Take for example, our anatomy. Just from the in utero positioning of being all curled up, the muscles on their back are lengthened, which makes them ready to strengthen first during tummy time. Then baby rolls to their back. Once on their back, the next set of milestones start in prep for rolling back to belly, because tummy time acted to lengthen the front muscles in prep for them. Then baby rolls back to belly. Then pre-crawling skills start to explode like pivoting on their belly, pushing backwards, army crawling, etc. into hands and knees crawling, then pulling to stand and the progression through upright skills first WITH hand support and then WITHOUT as they develop the strength, postural control and balance to move efficiently against gravity and ultimately walk.

And during all of that one of the most important things happening as they progress along that path is related to spine development. Also in prep for being able to move against gravity.

In utero, the spine starts as a big C shape (again, picture all curled up), as opposed to the S shaped spine of a bipedal adult.

As baby presses up during tummy time, lifts their head, looks around, presses up & starts to roll- the neck & upper back curves start to take on what will be their adult shapes. Then baby pushes into hands and knees/crawls and starts to sit, which develops the lower back curve. Then they pull to stand and move against gravity on two limbs, which develops their lowest spinal curve. Ultimately giving us the S spine of an adult

Human development is ALSO predictability hard wired to progress starting at the head and moving to the toes (called cephalocaudal) AND starting the joints closest to our bodies for stability and progressing towards the hands and feet for mobility. That’s why baby first lifts their head, then presses up/uses hands/chest/back, then gains control of their hips/pelvis and pushes back into hands and knees, sitting, and ultimately progresses all the way down to the feet for walking & balancing in standing.

Pretty freakin incredible right?

And understanding all of that about infant motor development is why there are 3 pillars to evidence based medicine. Because it is the combination of the research AND the ‘anecdotal’/clinical experience/education piece. We know how ‘typical’ typical human development really is. Which is what makes us able to tease out the why behind the atypical, even if it’s something like reflux impacting floor time tolerance, a baby preferring to sit, spending more time in containers, societal influence and trends, etc etc etc. AND THEN make recommendations and intervene accordingly so the progression we expect can hopefully progress.

And then finally, yes, absolutely considering our patient and their families values. For example - if YOUR anecdotal experience is that you come from a long line of crawling skippers, and you could care less about your babe doing it - THAT IS YOUR PREROGATIVE. But, I can not suggest enough that that decision is made under the (at minimum) surveillance of a medical professional.

And as a professional in this space, I have a very real sense of responsibility to at least provide the information and knowledge I have to you, within MY area of expertise- so that you can make an informed decision that aligns most with your and your family’s values.

But can you see how ONLY considering the research (and a skewed view of it at that) is REALLY just kind of flat out irresponsible.

What Crawling Research is Really Lacking

In my opinion, what the crawling research IS lacking is more about the impact of skipping crawling as compared to those who do crawl- both short and long term.

And I am NOT saying that it shouldn’t be something we continue to actively research, but I just want to highlight how challenging *high quality* research can be to obtain, especially when it comes to pediatrics/“vulnerable populations”. It is so difficult to conduct flawless studies in real time on children. Aside from massive gaps in funding for pediatric research, there is also significantly heightened ethical, regulatory and safety standards for research that involves children- and those are huge factors to consider when looking at gaps in literature.

There is also very little way to predict which babies will progress through that typical developmental path and which will have a ‘hiccup’. AND, which of those hiccups will be one they easily work through on their own OR one that snowballs into impacting other areas. And it would obviously be completely unethical to intentionally create situations where progression through the ‘expected’ motor milestone trajectory is impacted, just to see immediate and future outcomes. Truly - absolutely no internal review board would approve a study that proposed something like withholding physical therapy or other interventions for a child not crawling, in order to monitor immediate and long term impacts.

Which leaves us with research that is often more retrospective, which will just never be high quality, unfortunately. But again, is worth considering and consider exactly why those 3 pillars of evidence based medicine are SO important, ESPECIALLY in pediatrics.

Will The Crawling Milestone Debate Ever End?

Ultimately, there is a reason health professionals are pretty unanimously up in arms over the whole crawling debate. And it has nothing to do with fear mongering, or trying to induce anxiety, or even because we have skewed/biased approaches because of the populations we often work with (which yes, can absolutely happen).

It’s because we see the importance of hands and knees crawling on so many areas of development AND the impacts of skipping it can have EVERY SINGLE DAY. It’s because we KNOW ‘typical’ development, and human anatomy and kinesiology inside and out because it is our area of expertise. We HAVE to know typical so that we can effectively evaluate, assess and treat atypical development and help our patients and their families thrive, because that is what EVERY human deserves.

And because of that, we are passionate, and we are fired up, and we want to and WILL continue to fight for our babies AND your babies. Whether the ‘great crawling debate’ formally ends or not - I hope this has given you a well rounded picture and some food for thought when it comes to navigating not only conquering crawling with your little one, but navigating social media and the online space in general as a parent in today’s day and age.

Mock up image of all the milestones and motherhood milestone resources - milestone pdf, walking masterclass, roll & sit masterclass, mastering crawling course, mastering tummy time course

Want More?

For developmental questions, tips and guidance related to milestones about tummy time, rolling & sitting, crawling and walking, check out KC’s developmental Masterclasses linked here.

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