Crossing Midline: What, Why, and How?

What does it mean to “cross midline,” and why is it important?

The ability to cross midline involves moving a body part across the center of the body (midline) to the opposite side in a smooth or fluid manner. This movement is essential for learning to use both sides of the body together. This skill is closely associated with brain development, as the two sides, or hemispheres, of the brain must communicate to coordinate learning and movement. Crossing midline promotes a child’s ability to reach for and explore new toys or objects, learn to creep and crawl, develop patterns for self-feeding, and interact more fully with the environment as infants and toddlers. As children continue to grow, crossing midline becomes an important skill needed for the development of fine and visual motor coordination.

If a child is unable to cross midline, they may tend to use their left hand to complete activities on the left side of the body and their right hand to complete activities on the right side of the body, impeding their ability to develop a preferred or dominant hand. Hand dominance impacts a child’s ability to use tools effectively, including pencils, markers, and scissors, so difficulty crossing midline often affects handwriting, cutting, and other school-related fine motor tasks. A child’s ability to smoothly cross midline with their eyes, arms, and legs also plays a significant role in developing reading skills, eye-hand coordination, gross motor skills, and independence with self-care tasks and impacts overall quality of movement within age-appropriate activities and routines.

Difficulties with crossing midline may be present if your child:

  • Uses their left hand to complete tasks on the left side of the body and their right hand to complete tasks on the right side of the body
  • Switches writing utensils between hands to avoid crossing midline during writing, drawing, or coloring activities
  • Demonstrates difficulty coordinating smooth gross motor movements that involve both sides of the body (for example, skipping, catching/throwing/kicking a ball)
  • Rotates their trunk to retrieve objects during play or seated activities instead of reaching across midline

How can midline crossing and coordination be encouraged at home?

You can support continued development of your child’s ability to smoothly cross midline during a variety of daily activities, using toys and items you likely already have at home:

  • Pour water back and forth between two cups while in the bathtub, ensuring the second cup is positioned on the opposite side of the body as the first cup.
  • Color with crayons or markers, ensuring one hand stabilizes the paper and the other is used to draw or scribble. Larger paper will encourage a greater reach across midline.
  • Dig in the dirt or sand. Have your child sit, kneel, or squat on the ground. Place a bucket on one side of your child and a shovel on the other side. Encourage your child to dig with the shovel and then transfer it to the other side of their body to dump the dirt in the bucket, ensuring they do not switch the shovel to the other hand as they cross midline. This activity can also be modified by using one hand to pick up small stones and placing them in the bucket on the opposite side of the body.
  • Play tennis or baseball, which require the arms to work together to cross midline during each swing. Encourage your child to hold the bat or racquet with both hands and ensure that both arms and hands cross the body during the swing.
  • Play tug-of-war or have a pillow fight. Your child’s arms and hands will naturally move back and forth across midline during each activity while promoting overall strength and coordination.
  • Play with a large car mat, draw roads across a large piece of paper, or use tape to create a figure eight pattern on the floor. Encourage your child to use one hand to push cars along the road or path while their body remains in place.
  • Set up activities to specifically target crossing midline by positioning pieces on one side of your child’s body and positioning the container on the opposite side. Encourage your child to use one hand to retrieve a piece and then place it in the container or on the designated space. This works well when participating in container play, completing shape sorters and puzzles, and placing objects, such as coins into a piggy bank or pompoms into a jar.
  • Play Twister! This game will naturally encourage your child to cross midline with both arms and legs as they match body parts to the colored dots on each turn.
  • Play Simon Says, ensuring that when you are Simon, you direct your child to engage by crossing midline and using both sides of their body to complete each task (for example, “Simon Says, touch your left hand to your right knee” or “Simon Says, skip around the table”).
  • Place stickers on one of your child’s arms or attach clothespins to the clothing on one side of their body and encourage them to use the opposite hand to remove them.

Continued practice with crossing midline will promote overall fine motor, visual motor, and gross motor coordination for improved independence in self-care, recreational, and school-related activities throughout your child’s day.

Questions or concerns?

If you have questions or concerns about your child’s ability to cross midline, please contact us at info@playworkschicago.com or 773-332-9439.

Caitlin Chociej, MS, OTR/L
Occupational Therapist

 

References:

Cermak, S., Quintero, E.J., and Cohen, P.M. (1980). Developmental Age Trends in Crossing the Body Midline in Normal Children. The American Journal of Occupational Therapy, 34(5), 313-319. https://dx.doi.org/10.5014/ajot.34.5.313

Photo Credit: Pragyan Bezbaruah via Pexels

What’s So Fine About Fine Motor Coordination?

Do you remember back when you first learned to zip up your own jacket? How about tie your shoes? Write your name for the first time? Color carefully to stay inside the lines? You may not have known it then, but as a child you built many of the fine motor coordination skills you still use every day. When you think of “coordination” you might think of playing sports or swimming, and you would be right! However, when we talk about fine motor skills, we also use the word “coordination” to describe how many different muscles in your hands are working together to accomplish the smallest of movements.

Fine motor coordination involves learning many different skills simultaneously in order to have more control and precision over tools or objects in order to be accurate. These skills include having strength in the small muscles within your hand and fingers, developing a good grasp on tools, moving items around your hand without dropping them, and developing precise targeting. As your child practices these skills, he/she will refine these skills to help learn the foundational skills in many different areas of development. In general, large motor skills (stability of the head, core, controlled limb movements), become more consistently accurate before fine motor skills.

What skills should my child have now?

  • Around 12 months: Pulling off socks, starts to finger feed self with small table foods, can use a spoon to dip, grasps objects of different sizes, uses their whole hand to grasp around writing utensils, places and releases small objects down on a flat surface
  • Around 24 months: Pulling off untied shoes, can use a fork to pierce food, and a spoon efficiently to transfer food, shows an interest in scissors but may not be able to open and close them with one hand, may use a pronated (thumb side of hand down) grasp on writing utensils, they are starting to pick up small items and tuck them into their palm, they are starting to place items from the inside of their palm down by passing them to the finger tips, they consistently rotate items 90 degrees using just their finger pads (such as when taking the top off a small twist top jar)
  • Around 36 months: Unbuttoning large buttons on a jacket, pulling on socks with some help, can open and close scissors, and snip through paper, may continue to use a pronated (thumb side of hand down) grasp on writing utensils
  • Around 3rd birthday: Putting shoes with Velcro fasteners, putting on socks, zipping and unzipping a jacket (help putting both sides together at bottom), buttons large buttons on a jacket, starts to use scissors to cut through paper, over the next year practices pushing scissors forward to cut on a line, starts using a three-finger grasp that is looser and their arms and shoulder move lots when coloring
  • Around 4th birthday: Able to put together jackets that have a snap or hook fastener, some snaps on pants, zipping jacket independently, puts on shoes (needs help with tying laces), can put a belt through loops, pushes scissors to cut out simple shapes, over the next year starts cutting curved lines and circles, your child continues to get more efficient and accurate with drawing with their three-finger grasp, they are able to separate two pieces of paper by rubbing their fingers together
  • Around 5th birthday: Can tie knots, improved accuracy with scissors, the child uses a dynamic grasp (three fingers on utensil near the tip, their shoulder/arm are stable, their fingers and wrist are controlling movements, they are more accurate and efficient with this grasp, they can adjust their grasp on a pencil by moving it between their fingers
  • Around 6th birthday: Can tie a bow, independently manage shoes, other clothing fasteners, can cut more complex figures, they can flip a pencil around to reach the eraser without picking up and moving the pencil, they can pick up small items sequentially while holding other small items in their hands

My child isn’t ready to tie their shoes or write yet; why do these skills matter now?

Fine motor coordination skills are built over a long period of time, and gradually get more complex as a child gets older. Foundational skills in this area, such as grasping tools and moving small items from the palm to tips of the fingers, are key for later important skills such as writing, typing, cutting, money management, using utensils to eat, tying shoes, and managing fasteners on clothing. A child may become successful and efficient with navigating these skills as they continue to develop other skills through play and participation in daily routines.

Why do occupational therapists work on these skills?

Occupational therapists focus on these skills because they are a part of our daily living skills, from putting toothpaste on our toothbrush, to getting dressed, to participating in school, and feeding ourselves! Children use their fine motor coordination skills during daily living activities, in education, and in play, all areas which are covered by the domain of occupational therapy! During an occupational therapy evaluation, a therapist would look more in depth at your child’s fine motor coordination skills for their age.

What can I do?

  • Play games while picking up small items with kitchen tongs, chopsticks attached at the top with a rubber band and paper, or a straw bent in half to form tongs
  • Snap/button art boards
  • Puzzles with different snaps, buckles, locks to open
  • Read books with flaps to lift up to reveal pictures below
  • Practice tearing paper with your child, crumpling it up between your fingers, and using it in an art project, such as gluing it onto a snowman outline to make it 3-D.
  • Make a paper cup lantern by pushing a paper clip through the side of the cup and place an LED tea light inside
  • String beads or pasta on spaghetti noodles, string, or pipe cleaners
  • Make PlayDoh with salt, flour, and cream of tartar. Roll it into snakes, small balls, build tiny snowmen
  • Let your child practice opening items in the house for food consumption, such as bags of chips, twist off applesauce pouches/water bottles,
  • Tape small animals to a baking sheet and practice pulling the small pieces of tape off
  • Cut a slot in the top of an oats container. Have your child practice placing popsicle sticks in the slot; recreate this activity with Q-tips and a plastic lid with a straw hole, sort coins into different piggy banks
  • Stretch rubber bands around the outside of a small jar
  • Pull pom poms or other small items out of a kitchen whisk
  • Decorate cookies and allow your child to pick up the small sprinkles and push them into the dough
  • Let your child have as much practice as possible with fasteners (snaps, buttons, zippers, and shoe tying)
  • Cut through different layers/thicknesses of paper (tissue paper, paper, paper plates, cardboard)
  • Increase your child’s opportunities to practice writing outside of school by having the child write the score of a game, write letters to family members, write the list of items needed at the store
  • Use a stylus if your child plays games on a device. There are apps to practice coordination while using a stylus such as: iTrace, LetterSchool, Dexteria Jr, Writing Wizard, Trace it/Try it
  • Paint using the ends of Q-tips to make small dots on paper to draw fireworks
  • When recycling boxes, have your child cut the box instead of breaking it down for extra scissor practice
  • Allow your child to practice peeling fruit, picking the stems off the ends of beans, etc.
  • Hide toys in small jars and bottles, and have the child practice getting them out by twisting open the top

Questions or concerns?

If you have questions or concerns about your child’s fine motor coordination, please contact us at info@playworkschicago.com of 773-332-9439

Caroline Stevens, MS, OTR/L
Occupational Therapist

References: Fleming-Castaldy, Rita. (2019). National occupational therapy certification exam review and study guide. 8thedition. Therapyed.

Photo Credit: Markus Spiske via unsplash.com

The ABCs: Strategies for Handwriting

Despite our ever changing world of technology, handwriting remains an essential part of school curriculums and mode of daily communication. Legible and efficient handwriting allows your child to participate in school tasks and keep up with their homework load. Your child may be reluctant to participate in handwriting tasks if it is difficult or if it takes him or her extra time to complete the task. Handwriting doesn’t have to be only copying letters or sentences. Let’s learn how to make handwriting more motivating for your child, so it is less like “work” and more like “play!”

What are the underlying components of handwriting?

  • Fine motor coordination: Handwriting requires the coordination of our small hand muscles and the ability to use both hands for two separate tasks (i.e. holding the pencil and stabilizing the paper).
  • Visual motor and visual perceptual skills: Copying or creating letters requires hand-eye coordination, or using visual input to guide hand movements. Visual perceptual skills also include our ability to discriminate between letters, as well as remember the letters written on the board in order to copy them to our paper.
  • Motor planning: Our ability to use the information in our environment to create, execute, and carry out the motor action of creating letters or sentences. If your child has motor planning difficulties, they may have difficulty with letter formation and legibility.
  • In-hand manipulation: The skill of “shifting” consists of moving the pencil up and down, using your fingers to make small adjustments to your pencil grasp. In order to erase with a pencil, “rotation” is utilized by rotating the pencil to use the eraser and then back to resume writing.
  • Proprioception: The sense of knowing where his/her body is in space allows your child to use the appropriate force on writing utensils.

What can I do to help promote handwriting skills with my child?

  • Promote visual perceptual skills:
    • Mazes
    • Dot-to-dots
    • Word finds
    • Scavenger hunts
  • Do the “Wet-Dry-Try” method:
    • Write a letter on a chalkboard
    • Provide your child with a small wet sponge and a small dry sponge
    • Have your child write the letter using a wet sponge, then using a dry sponge
    • Finally, have your child use chalk to create the letter themselves
  • For older children, try these functional handwriting activities:
    • Write a letter to Santa, the Tooth Fairy, etc.
    • Write a grocery list
    • Help create the family calendar by writing down events
    • Write out a packing list for a trip
  • Promote fingertip grasping patterns by breaking crayons in half. This makes it difficult for your child to grasp the crayon with their whole hand, facilitating a more age-appropriate grasp with fingertips.
  • Facilitate grasping with hand-strengthening activities:
    • Hide beads or coins in Theraputty or PlayDoh and have your child retrieve the small items by pulling apart and pinching the putty
    • Have your child pick up items with a tweezer such as cotton balls, pom poms, or beads. You can also have your child place these items into an egg carton or cut-up foam pool noodles to address fine motor precision
    • Have your child place different sized clothespins on a picture or board
    • Make a 2-inch slit in a tennis ball. Place small items (beads, coins) inside of the tennis ball and have your child retrieve the small items by using their whole hand to squeeze the ball and retrieving items with the opposite hand.

Ways to encourage sensory-based learning with handwriting:

  • Practice forming letters in shaving cream! You can also use food coloring to die the shaving cream.
  • Try sensory bags: You will need a gallon freezer bag. Fill the freezer bag with clear hair gel, then add a few drops of food coloring. Feel free to add glitter! Mix the contents and apply tape over the top of the Ziploc bag. Have your child practice letter formations by tracing over the sensory bag, you can also place a piece of white paper underneath the bag to increase their visual feedback.
  • Write letters on foam sheets for increased sensory input by requiring your child to firmly press their writing utensil into the foam.
  • Encourage letter formation with motivating sensory media: Create letters with Wikki Stix, PlayDoh, beads, or pipe cleaners.
  • Use motivating visual input: Practice letters with a Lite Brite game or using rainbow scratch paper.
  • Turn out the lights and practice forming letters in the dark with a flashlight.
  • Use sidewalk chalk or washable window chalk.
  • For a movement break, have your child attempt to form letters with their body.

Questions or concerns?

If you have questions or concerns about your child’s responses to noise, please contact us at info@playworkschicago.com or 773-332-9439.

Robyn Geist, MS, OTR/L
Occupational Therapist

Feder, K.P. & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology 49, 312-317.

Photo Credit: Robin Brenner via brooklinelibrary.org

Why OT?: Destigmatizing the Need for Therapy

“Why was my child recommended for occupational therapy, they don’t have a job!” You might have many questions if your child has completed an occupational therapy evaluation and was recommended to receive occupational therapy services. What does this mean, exactly?

What is occupational therapy?

The term “occupational” does not refer to one’s employment, in this instance. Occupationscan be defined as activities that support the health, well-being, and development of an individual (American Occupational Therapy Association, 2014). An occupational therapist’s job is to increase the engagement and participation in meaningful daily activities that support your child’s learning, growing, and most of all, fun! There are a wide variety of circumstances that may affect your child’s optimal engagement in day-to-day activities at home, at school, or in the community.

How is occupational therapy going to help my child?

The benefit of occupational therapy is that practitioners are equipped for focusing therapy on a widevariety of skills required in your child’s daily life, such as:

  • Fine motor skills
    • Your child uses fine motor skills to write their name on their school work and to tie their shoes before heading out to play!
  • Visual motor skills
    • Your child utilizes visual motor skills when playing catch in the park and to copy written work from the chalkboard in the classroom.
  • Self-help skills
    • Self-help skills help get your child out the door in the morning! Your child needs to eat, get dressed, and use the bathroom to start their day.
  • Gross motor skills
    • Gross motor skills are required to walk to the front door and down the stairs safely to begin your child’s commute to school.
  • Sensory processing and regulation
    • Your child’s body is constantly processing sensory information in their environment to attend to and enjoy their world.
  • Executive functioning skills
    • When recalling the steps of their favorite family board game and following their teacher’s instructions, they are using their executive functioning skills, i.e., working memory, sequencing, and problem solving.
  • Social interaction skills
    • Your child utilizes their social interaction skills to make new friends and keep familiar ones.

What does it mean if my child was recommended occupational therapy?

Receiving a recommendation for therapy can be difficult and may bring about many questions and concerns regarding your child. Common concerns after receiving a recommendation for your child to receive therapy are “Will my child be singled-out from their peers?” or “Will my child always need therapy?”  When your child receives a recommendation for therapy, it does not necessarily mean that there is something wrong. A recommendation for occupational therapy does mean that a trained therapist has noted suspected concerns that warrant further evaluation. As an occupational therapist, many times I am asked, “Do you work with children with disabilities?” and my answer is, “Yes I do, but not exclusively!” Just as pediatric occupational therapists work on a wide variety of skills, we also work with a wide variety within the pediatric population. An occupational therapist will utilize a holistic approach to empower your child and your family so they can live their life to the fullest in their daily routines, school activities, and excitement within the community.

Questions or concerns?

If you have questions or concerns about your child’s engagement in meaningful daily activities, please contact us at info@playworkschicago.com or 773-332-9439.

Reagan Lockwood, MOT, OTR/L
Occupational Therapist

Reference: American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain & process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

Photo Credit: Photo by Thiago Cerqueira on Unsplash

Fine Motor Skills: Is your Child Falling Behind?

Fine motor coordination is the capacity of the small muscles of the upper body to allow for controlled movements of the fingers and hands. They include the ability to hold a writing utensil, eat with a fork, open containers, and fasten clothing.  These small movements correspond with larger muscles such as the shoulder girdle, back, and core to provide stability for gross motor functioning and with the eyes for hand-eye coordination. Weaknesses in fine motor skills are often the result of poor hand strength and poor motor coordination.

Fine Motor Red Flags in School-Aged Children

As a former Kindergarten teacher, at the start of each school year, I welcomed an array of children in my classroom with a variety of fine motor skillsets.  Since children have such varying preschool experiences, generally, their skills will vary based on the activities to which they have been exposed. If a child has had the opportunity to practice cutting with scissors, for example, he or she will likely be able to accomplish snipping a piece of paper by 2.5. Fine motor development occurs at an irregular pace, but follows a step-by-step progression and builds onto previously acquired skills. By the approximate ages listed below, your child should be able to demonstrate these skills:

2 to 2.5 Years

  • Puts on and takes off socks and shoes
  • Can use a spoon by himself, keeping it upright
  • Draws a vertical line when given a visual example or after an adult demonstrates
  • Holds crayon with fingers, not fist

2.5 to 3 Years

  • Builds a tower of blocks
  • Draws horizontal & vertical lines when given a visual example or after an adult demonstrates
  • Unscrews a lid from a jar
  • Snips paper with scissors
  • Able to string large beads
  • Drinks from an open cup with two hands, may spill occasionally

3 to 3.5 Years

  • Can get himself dressed & undressed independently, still needs help with buttons, may confuse front/back of clothes and right/left shoe
  • Draws a circle when given a visual example or after an adult demonstrates
  • Can feed himself solid foods with little to no spilling, using a spoon or fork
  • Drinks from an open cup with one hand
  • Cuts 8×11” paper in half with scissors

3.5 to 4 Years

  • Can pour water from a half-filled pitcher
  • Able to string small beads
  • Uses a “tripod” grasp (thumb and tips of first two fingers) to draw, but moves forearm and wrist as a unit
  • Uses fork or spoon to scoop food away from self and maneuver to mouth without using other hand to help food onto fork/spoon

4 to 4.5 Years

  • Maneuvers scissors to cut both straight and curved lines
  • Manages zippers and snaps independently, buttons and unbuttons with minimal assistance
  • Draws and copies a square and a cross
  • Uses a “tripod” grasp (thumb and tips of first two fingers) to draw, but begins to move hand independently from forearm
  • Writes first name with or without visual example

4.5 to 5 Years

  • Can feed himself soup with little to no spilling
  • Folds paper in half with edges meeting
  • Puts key in a lock and opens it

5 to 6 Years

  • Can get dressed completely independently, including buttons and snaps, able to tie shoelaces
  • Cuts square, triangle, circle, and simple pictures with scissors
  • Draws and copies a diagonal line and a triangle
  • Uses a knife to spread food items
  • Consistently uses “tripod” grasp to write, draw, and hold feeding utensils while moving hand independently from forearm
  • Colors inside the lines
  • Writes first name without a visual example, last name may be written with visual
  • Only uses one hand for writing tasks, rather than switching between them

By age 7, children are usually adept at most fine motor skills, but refinement continues into late childhood.  If you notice your young child demonstrating difficulties in above “red flag” areas, it may be time to consult with an occupational therapist.

Jen Brown, MS, OTR/L
Director of Occupational Therapy Services

Resources:

Beery, K.E., & Beery, N.A. (2006). The Beery-Buktenica Developmental Test of Visual Motor Integration. Minneapolis: NSC Pearson

Folio, M.R., & Fewell, R.R. (2000). Peabody Developmental Motor Scales, 2nd Ed. Austin: Pro-Ed.

Retherford, K.S. (1996). Normal Development: A Database of Communication and Related Behaviors. Greenville, SC: Super Duper Publications