Points for Concern: 6 to 9 Months

Girl crawling on mat and grasping toyBabies who are not trying to reach or pull toys to themselves, or not actively moving to things and people in the environment, need further examination and attention. Check major health indicators; head circumference, weight, height and their rate of growth. Make sure they are documented in the Mother Child Protection Card and any issues are being addressed. Find out also about the early experiences of these babies and their daily routine to see if they have adequate opportunities for movement and exploration. Please refer to Disabled Village Children, Chapter 3: “Early Stimulation and Development Activities” for activities and ideas.  
Another reason for disinterest in movement could be problems in tone. Please refer to Disabled Village Children, Chapter 9: Cerebral Palsy. Motor impairment or delay is often accompanied by some loss of vision or hearing. Always refer for detailed clinical examinations and conduct functional observation. Most children have some vision and will respond to bright colours and movement, but may see many objects as indistinct, blurry shapes that do not stimulate interest and motivate movement. Test vision and try modifying the materials, environments and activities to increase the child’s internal motivation to move. Slumped or delayed sitting may also indicate the presence of low vision. For testing, please refer “Observational testing of vision” and Helping Children Who Are Blind, Chapter 4 “Finding out what your child can see”. Such children will also typically show other signs such as not trying to initiate reach toward objects or not initiating movement through rolling or creeping. Read “Help your child see more easily” and “Help me learn with confidence” for ways to modify the environment. Refer to Chapter 5: Activities for the young baby and Chapter 10: Movement in Helping Children Who Are Blind can give you some ideas to help the child. 
If by the end of this period you see differences in the way in which a child sits – for example sitting in W sitting, children not able to sit The regression or loss of skills at any age is always a matter of concern and the child must be referred for clinical assessmentwithout support or sitting slumped forward with legs very wide apart – it is an indication of some issue with the muscle tone. Refer to Disabled Village Children, Chapter 9: Cerebral Palsy for activity ideas. Observe whether the spine is straight or whether there is a significant curvature of the spine and refer for clinical support Refer also to Postural Support
Observing babies playing with toys gives us a chance to see how effectively they are using their hands. Signs of problems in this area include the baby not able to use the thumb and index finger to pick objects, not transferring objects between hands, not using both hands to reach, grasp or play or being unable to release effectively. Refer to “Development of hand function in the first year”, “sequential development of grasp” and the activity sheets for “Fisted hands” and “Playing with both hands”. 
When babies are unusually fussy about accepting certain textures or smells in food, clothes, or toys, consider whether they have sensory issues. Refer to “Sensory Integration”. Babies should be introduced to spoon feeding at this age. Babies may push food out with their tongue in a first response to the new taste or as they learn the different movement patterns required as they transition from the suck-swallow patterns of the very young infant. However, if you see continued difficulties in feeding that are not helped by providing a stable seating position and good feeding techniques, consider referring for further evaluation. 
If the child is not showing interest in people, preference for familiar people, or searching for hidden toys it could point to poor early experiences. Talk to the caregivers to understand early experiences and the current routine of the baby. Enrich the baby’s environment and experiences by adapting the environment and routine. Check also whether the issues are due to motor or sensory problems. Please refer to Disabled Village Children, Chapter 35: “Early Stimulation and Development Activities” for activities and ideas.  
If there is a reduction in vocalization or no variety in vocalization, or if the child is not responding to simple commands, please check hearing and begin activities to encourage listening skills and build early language and communication. Please refer to Helping Children who are Deaf, Chapter 5: What can your child hear? for testing. Please also refer Chapters 2, 3, & 4 in the same book and “Communication Decision Tree” in the Communication Resources Folder for activity suggestions.  Please also ensure referral and follow up with appropriate clinical services.