Domain 8: Physical Health & Development

Physical and mental health are significant determinants of school readiness. Teaching teams learn about specific strategies that ensure children can achieve their maximum potential in these areas.  Overall health and physical fitness include three elements:  gross motor skills, fine motor skills, and health status and practices.  

The following is an excerpt from the Head Start Leaders Guide to Positive Child Outcomes.

Girls and boys in a semi-circle enjoy a large motor activity that incorporates jumping, balancing, and following directions. Introduction to Physical Health & Development
     Stages of Physical Growth and Development
Domain Element: Gross Motor Skills
Domain Element: Fine Motor Skills
Domain Element: Health Status & Practices
     Strategies for Physical Health & Well-Being
     Strategies for Health and Safety Practices

Introduction to Physical Health and Development

Throughout its history, Head Start has placed major emphasis on promoting children's health, both physical and mental, as a significant determinant of school readiness. The Head Start Program Performance Standards (2002) include a comprehensive set of requirements for programs regarding children's health and physical well-being. These include, but are not limited to, sensory and developmental screening and procedures for ongoing assessment of progress. Head Start programs ensure that children have a medical home, a primary health provider, and continuity of care. Head Start programs also ensure that children receive regular dental check-ups and good nutrition. The provision of these comprehensive services continues as a hallmark of the Head Start program and is one of its success stories. The provision of these comprehensive services continues as a hallmark of the Head Start program and is one of its success stories.

     The Domain of Physical Health & Development in the Child Outcomes Framework is designed to augment the larger work of providing health services in Head Start. The Framework describes the outcomes for children's learning and development that are most clearly the responsibility of teachers and other members of the educational staff. Although teachers work collaboratively with health personnel, they also have a responsibility to infuse health knowledge and physical development goals in the curriculum.

     The Physical Health & Development Domain of the Framework includes three Elements: gross motor skills, fine motor skills, and health status and practices. Each of these elements supports children's overall health and physical fitness and can enhance a child's progress in other Domains. For example, gross motor skills lead to growing confidence and pride in accomplishments (social and emotional development, self-concept). Children use their fine motor skills to experiment with writing tools and materials (literacy, early writing). Good health and physical fitness, extremely important in their own right, also contribute to learning and development in all Domains during early childhood and beyond.

     Gross motor skills involve moving the whole body and using larger muscles of the body such as those in the arms and legs. They include skills such as gaining control of the head, neck, and torso to achieve a standing or sitting position. They also include locomotor skills such as walking, throwing, and stretching. Children develop many gross motor skills as they move and explore freely in a safe, supportive environment. When they can coordinate their movements children are ready to learn how to pedal a tricycle; turn somersaults; and catch, throw, and kick balls. At times children require instruction to learn these skills. To become proficient, most children need numerous opportunities to practice using their skills.

     Fine motor skills involve use of the small muscles found in individual body parts, especially those in the hands and feet. Children use their fine motor skills to grasp, hold, and manipulate small objects and tools. As they gain eye-hand coordination, they learn to direct the movements of their fingers, hands, and wrists to perform more complex tasks. With access to appropriate materials and activities, children can practice and refine both their fine and gross motor skills during a variety of experiences and while performing self-help routines. For example, children might draw and write with markers, manipulate a computer mouse, use eating utensils, put on and take off dress-up clothes, and use a magnifying glass to examine an insect.

     In Head Start, children's health has always been a priority. The third element of the Physical Health & Development Domain, health status and practices, refers to children's overall physical condition — growth, strength, stamina, and flexibility. A child's physical condition is dependent on a number of factors, including heredity, gender, and access to good nutrition and health care. Also key is participation in fitness- enhancing activities such as playing tag, climbing a ladder, jumping on a mattress, swinging from a rope, and chasing bubbles. Physical fitness can enhance young children's ability to learn and protect them from health conditions such as heart disease, obesity, diabetes, and other chronic ailments. When children feel fit and healthy, they are likely to gain self-esteem, have less stress, enjoy playing, and eagerly take on new challenges.

     Health status and practices also include children's growing independence in carrying out personal routines, their awareness of health and safety concerns, and their ability to follow rules and take steps to keep themselves safe and healthy. Such awareness and independence grow when children participate in group and individual routines such as setting the table for meals and washing their hands. Children can learn about health and safety concerns and practices in the context of daily life at home, at Head Start, and through connections with their medical home.

     Head Start plays an active role in supporting the three related Elements in this Domain. Classroom teachers, family child care teachers, and home visitors need to be familiar with the typical sequence and processes through which children develop and refine fine and gross motor skills and with the components of physical fitness. They must also know about sanitary practices that promote good hygiene, the nutritional needs of young children, and safety practices that prevent or reduce injuries. Staff should integrate opportunities for children to use fine and gross motor skills, enhance health and physical fitness, and learn about health and safety concepts and practices throughout the curriculum.

Physical Health and Development Strategies

To promote overall physical development and health

  • Create safe indoor and outdoor learning environments that invite children to move their bodies, explore their surroundings, and practice fine and gross motor skills.
  • Provide materials and equipment that allow children to practice fine and gross motor skills and challenge them to gain new ones.
  • Involve families by sharing information about physical health and development and suggested home activities.
  • Serve as enthusiastic role models for practices that support health and physical fitness.
  • Participate with children as they engage in physical activities and daily routines.
  • Allow and encourage children to do things for themselves whenever it is feasible and safe to do so.
  • Talk about what we are doing and why it supports our own and the children's fitness, nutrition, health, and safety.
  • Use a variety of teaching strategies, including demonstration and direct instruction when appropriate, to help children become proficient in use of physical skills.

Stages of Physical Growth and Development

As in other Domains, each child's physical growth and development are highly individualized and dependent on characteristics and influences such as heredity, environmental factors, nutrition, age, gender, disabilities, and access to health care. Nevertheless, several general principles govern the direction and sequence of physical development:

  • The direction of muscle development is from head to toe. Children learn to lift their heads before they can raise their torsos, use their arms, and stand with and without support.
  • The sequence of muscle development begins with those closest to the center of the body and progresses to those in the extremities — hands and feet. Most children learn to crawl before they can pick up objects using the thumb and forefinger (pincer grasp). Thus, children refine their gross motor movements, such as those used to walk or throw, before they can control the small motor skills used to zip a jacket or turn pages in a book.

     Young children enjoy moving, exploring, and being able to do things for themselves. With access to appropriate materials and equipment, opportunities to practice fine and gross motor skills, and skilled adult guidance, children can expand their physical abilities.

Domain Element: Gross Motor Skills

From birth to about two years of age, children learn primarily through their senses and motor actions. Infants are born with reflexive, involuntary movements. Some reflexes, such as blinking and swallowing, serve to protect the child. Others, for example, kicking legs alternately, are precursors of later motor skills (in this case, walking). As infants grow and mature, the higher brain centers of the nervous system begin to govern their movements. They learn to control voluntary movements such as grasping and mouthing a toy and pulling up to standing.

     The fundamental movements children develop and refine during the preschool years include:

  • locomotor movements, such as walking, running, leaping, jumping, hopping, through which the body proceeds in a horizontal or vertical direction from one place to another;
  • gross motor movements, such as throwing, catching, kicking, through which the body gives or receives force from objects;
  • fine motor manipulative movements, such as tying shoes, coloring, cutting with scissors, which emphasize control, precision, and accuracy; and
  • stability movements, such as balancing, dodging, starting, stopping, in which the body remains in place but moves around its horizontal or vertical axis.

      Maturation plays a major role in a child's physical development during the first two years. To develop fundamental movement skills, however, children usually require more than access to a supportive environment and adults (Gallahue & Ozman 1995). Young children can learn to throw or kick a ball at a beginning level. To become proficient — and be able to use the skill throughout life — they need both instruction and opportunity to practice (NASPE 2002). Young children who become proficient in fundamental movement skills are more likely to engage in sports and other fitness activities throughout childhood and when they are adults. Their natural interest in physical skills and activities is enhanced so they can become adults who live long, active lives. It is important for Head Start teachers to give children developmentally appropriate instruction and opportunities to practice motor skills. To do this effectively, staff need to observe and keep track of children's progress in order to know how and when to offer encouragement and guidance, and new challenges and opportunities for additional practice.

     Perceptual-motor development is an important part of learning fundamental movement skills. Perceptual-motor skills include large motor skills, fine motor skills, simple auditory, visual, and tactile-kinesthetic skills, and body awareness skills. Children develop and use simple auditory, visual, and tactile-kinesthetic skills while using their senses to collect, monitor, interpret, and respond to information from an environment filled with a variety of:

  • interesting sounds and rhythms to hear;
  • pictures, displays, and other things to look at; and
  • textures and objects to feel.


     Body awareness skills grow as children learn about the parts of their bodies, how much space their bodies take up, and how to control their bodies as they move from one place to another (NASPE 2002).

Gross Motor Skills Indicators

Domain Element
Physical Health & Development Gross Motor Skills
  • Shows increasing levels of proficiency, control, and balance in walking, climbing, running, jumping, hopping, skipping, marching, and galloping.
  • Demonstrates increasing abilities to coordinate movements in throwing, catching, kicking, bouncing balls, and using the slide and swing.

Gross Motor Skills Strategies

To support development of gross motor skills

  • Follow a daily schedule that allows children to spend ample time each day in structured and unstructured physical activity. Such a schedule allows children to alternate using their gross motor skills in physical activities with opportunities to rest and recover energy. Engaging in physical activity for one or more hours a day can also help children maintain healthy weight levels (NASPE 2002).
  • Plan structured physical activities that introduce a variety of movement skills individually, with a partner, and then in a small group (NASPE 2002). Offer balls of different sizes and materials, such as rubber, foam, inflatable plastic to roll, kick, throw, or catch; plan balancing activities; and introduce tumbling.
  • Provide sufficient space, toys, and equipment for child-initiated physical activities outdoors. Wheeled toys, slides, climbers, and other playground equipment sized for preschoolers can encourage children to pedal, climb, push, pull, balance, swing, hang, and slide. Cardboard boxes, tunnels, balance beams, jump ropes, plus a variety of balls and bats provide additional movement options (NASPE 2002).
  • Offer sufficient indoor space for gross motor activities so children can move without getting in each other's way. Some examples follow (Koralek 1994):
    • Hallways are ideal for riding tricycles, rolling balls, tossing bean bags into baskets, playing relay games, building with large blocks, marching to music, and bowling (use plastic containers as pins).
    • A classroom loft lets children climb up stairs or a rope ladder, slide down a pole, swing (hang the swing on hooks when not in use), or jump off a low platform.
    • Provide room for music and movement activities; put mats on the floor for tumbling; play cooperative games using hula hoops, streamers, parachutes, and beach balls.
    • Participate in physical activities with children. This simple strategy allows adults to model movement skills, offer individualized assistance, learn how children approach and respond to physical challenges, and encourage children to practice and refine their skills. It also helps staff reduce stress and stay fit.
  • Plan activities that promote perceptual-motor development (Poest et al. 1990):
    • Time awareness/coordination: Use nursery rhymes, chants, songs, and marches to help children learn to move to a steady beat.
    • Body and visual awareness: Ask children to imitate body movements. Move as slowly as needed for children to achieve success. At first, model the movement and use verbal instructions. Later, just model or just give verbal directions. Gradually make the task more challenging by changing the speed, tempo, rhythm, or directions.
    • Provide opportunities for children to experience obstacle courses in order to understand their bodies in space and direction. Give guidance on how to move through each part of the course so children can build understanding of directions in space such as over, under, around, and through.

Domain Element: Fine Motor Skills

Strength, control, and coordination of hand, finger, and wrist movements are part of fine motor development. Strength is needed to cut with scissors; control allows for buttoning and zipping; coordination is used to put together puzzles and thread beads on laces. Development of fine motor skills also relies on sensory awareness. Children use their senses to collect information about objects in the environment and use this information to coordinate movements. Fine motor skills allow children to explore how things work, get dressed, use writing tools, put puzzles together, arrange blocks in sequence, prepare snacks and meals, and engage in many more activities that require hand, finger, and wrist movements. Eye-hand coordination is needed for many fine motor tasks.
     Children use their fine motor skills in relation to several other Domains. For example, they:

  • build their understanding of math concepts by sorting and manipulating objects, including geometric shapes; by making patterns with stringing beads; and by using measuring tools;
  • experiment and make scientific discoveries by handling collections, filling and emptying containers at the sand or water table, exploring a new software program, and holding and looking through a magnifying glass;
  • explore language and literacy by handling books and using writing tools; and
  • express creativity while using rhythm instruments, cutting and gluing paper scraps, doing fingerplays, and using dramatic play props and dress-up clothes.

      Head Start settings include children with a wide range of fine motor abilities. This is due, in part, to children's individual timing for development and, in part, to the range of experiences children have before coming to Head Start. Some children can hold and scribble with crayons, while others can copy a few letters. Some tear paper while others use scissors with ease. Some might roll and poke holes in playdough. More experienced children use props such as rolling pins and plastic knives. Some have never used a computer mouse. Others use a mouse with ease. To promote each child's fine motor development, Head Start offers materials and activities that support and challenge a range of skills.

Fine Motor Skills Indicators

Domain Element
Physical Health & Development Fine Motor Skills
  • Develops growing strength, dexterity, and control needed to use tools such as scissors, paper punch, stapler, and hammer.
  • Grows in hand-eye coordination in building with blocks, putting together puzzles, reproducing shapes and patterns, stringing beads, and using scissors.
  • Progresses in abilities to use writing, drawing, and art tools, including pencils, markers, chalk, paint brushes, and various types of technology.

Fine Motor Skills Strategies

To support development of fine motor skills

  • Provide materials for a range of fine motor ability levels, including table blocks in several sizes, puzzles of varying complexity, computer software with several levels of complexity, small and large beads with thick and thin laces, and hand puppets and finger puppets.
  • Offer and adapt activities to allow children to participate with success. When making bread, children can shape the dough into round loaves or braided ones; while making a group collage, children can tear or cut pieces of paper to add to the creation; while making puppets to re-enact a story, children can choose which materials to use and what to do with them.
  • Plan an approach that allows children to be actively involved in routines. Make sure the schedule provides enough time for children's participation. Children can fold napkins; put on and take off coats, hats, and boots; mix paint and wash paintbrushes; and pour from small pitchers.
  • Focus on the use of multiple senses in planning learning experiences for children. During meals and food preparation activities, talk about the way foods look, smell, and taste; on a walk, point out sights, sounds, and textures; listen to the sounds of different rhythm instruments with eyes closed.
  • Observe children using fine motor skills and intervene, when needed, with an appropriate teaching behavior such as modeling how to hold a crayon or giving instruction on how to use scissors safely.
  • Continue to assess children's progress in fine motor abilities and offer materials, equipment, and opportunities that allow the child to practice. When the child seems ready to move on, offer challenges that will help the child progress without getting frustrated.

Domain Element: Health Status & Practices

As noted earlier, children's physical growth, strength, stamina, and flexibility depend in part on individual characteristics and influences. Children who receive good nutrition and medical and dental checkups and who exercise are more likely to be physically fit and in good health than those who lack these essential resources. Head Start plays a role in enhancing children's overall health status and allowing them to be successful now and in the future.
     Physical fitness is defined as "a condition where the body is in a state of well-being and readily able to meet the physical challenges of everyday life" (NASPE 2002). Four separate components contribute to physical fitness:

  • The cardio-respiratory (aerobic) system includes the heart, lungs, and blood. When working well, this system provides the stamina needed to actively participate for a long period of time.
  • Muscular strength and endurance allow for effective use of muscles. Strength allows a young child to use force to perform a task such as kicking a ball or hammering a nail. Endurance is the ability to keep moving without stopping due to fatigue.
  • Flexibility is the ability to bend and stretch easily. It helps to prevent muscle and tendon injuries.
  • Body composition refers to weight and body fat. Excess fat puts stress on the ligaments, tendons, bones, and tissues that support the body's weight.

     Head Start offers an environment and experiences that contribute to children's physical fitness. In addition, staff encourage healthy eating, exercising, and movement habits that support lifelong fitness. They plan family events that incorporate active, cooperative games children and adults can play together. Effective practices for supporting development of gross motor skills can also promote physical fitness. Here are some additional guidelines (Werner et al. 1996):

  • Allow children to choose what to do and when to move on to something else. One way to do this is by creating several play stations: Roll a ball at a target, toss a ball into a hoop on the floor, throw a ball at a target, jump through hoops placed on the floor, jump over boxes on the floor.
  • Create simple, open-ended fitness activities that allow every child, regardless of skill level, to be successful. For example, jog around the playground every day when the class first goes outdoors.
  • Provide demonstrations that support visual learners. Give step-by-step directions while modeling how to throw or kick a ball or jump with two feet.
  • Keep directions simple; use key words along with modeling. For example, say "Up" and raise arms; say "Down" and touch the ground; say "Around" while turning completely around.
  • Offer variety and change activities often. Young children tend to have short attention spans so they may lose interest if they have to do the same thing for too long.
  • Allow maximum practice opportunity. Provide enough equipment for everyone and play games in which everyone is actively involved at all times rather than having to wait for a turn to participate.
  • Encourage frequent active play. Motivate children to engage in vigorous activities by showing enthusiasm, making it fun, and volunteering to do something active with them.
  • Most preschool children are eager to perform personal care routines such as dressing and brushing teeth on their own. Head Start teachers can support children’s growing independence as they plan the environment, provide materials, develop a schedule, and respond to individuals.
  • Preschool children rely on adults to keep them safe and healthy; however, most are ready to begin learning how to follow basic health and safety rules and practices that promote physical and emotional well-being and prevent or reduce accidents. Health and safety education is effective when delivered through informal, "teachable moments," and through planned activities. Learning opportunities arise as children learn to buckle their seat belts in the van that takes them to and from the program; look both ways to cross the street while walking to a nearby playground; help wipe the tables after lunch; and sneeze into their elbows to avoid the spread of germs. Planned activities related to health and safety can support progress in other Domains including science, mathematics, literacy, creative arts, and social-emotional development.

Health Status & Practices Indicators

Domain Element
Physical Health & Development Health Status and Practices
  • Progresses in physical growth, strength, stamina, and flexibility.
  • Participates actively in games, outdoor play, and other forms of exercise that enhance physical fitness.
  • Shows growing independence in hygiene, nutrition, and personal care when eating, dressing, washing hands, brushing teeth, and toileting.
  • Builds awareness and ability to follow basic health and safety rules such as fire safety, traffic and pedestrian safety, and responding appropriately to potentially harmful objects, substances, and activities.

Strategies to Promote Physical Health and Well-Being

To promote physical health and well-being

  • Provide individual storage areas, such as cubbies and low hooks, so children can store their clothing and personal items.
  • Place tissues, soap, paper towels, and other personal hygiene items within children's reach so they can care for their own needs without adult assistance.
  • Include sufficient time in the daily schedule for children to do things for themselves without feeling rushed.
  • Provide a child with just enough help, rather than stepping in and taking over. For example, hold the bowl while a child uses a large spoon to serve himself; untie a child's laces so she can remove her shoes on her own.

Strategies to Teach Children Health and Safety Practices

To teach children health and safety practices

  • Provide play materials related to health and safety. For example, include safety road signs for block play; books about healthy foods, and walking safely in traffic; props for doctor and dentist offices; empty containers of healthy foods such as oatmeal, fruits, and vegetables; items for washing dolls and doll clothes such as soap, sponges, a clothesline and clothespins, and a small basin; and doll highchairs with safety belts.
  • Involve children in setting basic health and safety rules. Talk about why a rule is needed, what might happen if children forget to follow the rule, and how the rule will keep them safe and healthy. Use visual and verbal reminders to help children remember the rule.
  • Model health and safety practices and give step-by-step explanations of what and why the practices are necessary and effective.
  • Review and discuss safety rules and practices, when necessary, especially before experiences such as a cooking activity or a neighborhood walk. Discuss the use of safe practices in context, such as when stopping at the corner to watch for traffic before crossing the street.
  • Conduct regular fire and emergency drills. After the drill, discuss what happened and why it would keep children safe in an actual fire or emergency.

Head Start ensures that children have opportunities to build fine and gross motor skills and are encouraged to stay healthy and fit. Physical skills allow children to learn in other Domains and to enjoy moving their bodies and playing games, now and in the future. Children with well-developed motor skills feel proud of their accomplishments. Their sense of competence serves as a strong foundation for additional learning. Furthermore, English language learners may show competence in physical skills which can help them feel more confident about their other activities and skills.

"Domain 8: Physical Health & Development." The Head Start Leaders Guide to Positive Child Outcomes. HHS/ACF/ACYF/HSB. 2003. English.

Last Reviewed: October 2009

Last Updated: September 5, 2014