At the start of the third year the motor skills are being tried out and improved or refined; this may result in many falls at the beginning. By the end of the third year the movements are more fluid and controlled. The toddler walks safely and independently, carries things around and climbs on chairs and other objects, seeking a challenge. Going down stairs is achieved step by step initially but, by the end of the third year, can be done by alternating the feet. The child enjoys balancing on things; doing so on a beam as narrow as 20 cm is possible. He/she enjoys swinging and throws large balls with both hands. Catching is usually more coincidental. By the end of the third year a child learns to ride a tricycle (Becker, Steding-Albrecht 2006).

The child plays on simple apparatus in the playground without help. He/she can aim a distance of 1–2 m successfully when throwing and a ball can be caught at chest height with the arms. The child can stand on one leg for about 2 s and can crawl under a gymnastic bench and do a summersault. Jumping over a rope is only possible with both legs together at first. Overall, the quality of movement improves and the muscle tone matches the task better.

A scooter, tricycle or other pedal toy can be steered safely; the child is able to pedal and steer at the same time. A hindrance can be avoided. The child can jump 30–50 cm forwards from standing and can jump over a rope with the feet singly. In the playground he/she climbs and plays on a gym apparatus a great deal. He/she can stand on one leg for 3–4 s (Becker, Steding-Albrecht 2006).

It is best to provide an opportunity with suitable play equipment where the child can play and exercise according to his/her age, in as normal a manner as possible so that he/she can be observed and analysed. A room with space for freedom of movement is best. To minimise the risk of falling or bumping there should be little furniture, and what there is should not have sharp corners. Gymnastic mats, for example from Airex®, provide a good surface for simple balancing or ball games, etc. because they reduce pressure on painful blisters. For crawling or other movements on the floor, such mats are unsuitable because there is too much friction, which causes the development of blisters. Smooth parquet flooring or firm mats with a smooth covering are more suitable.

Before starting the child should be inspected for blisters and open wounds. If removal of bandaging is painful and complicated, then the parents should be consulted. It must be taken into consideration that pain on particularly prominent places such as knees, elbows, abdomen, instep and soles of the feet can lead to avoidance tactics in certain movements or tasks.

Parental questionnaire focusing on the early motor development

For children with epidermolysis bullosa (EB)

Motor development