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

Baby Boot Camp: The Importance of Tummy Time

Tummy time promotes development, strength, and a new visual perspective for your baby. Growing babies require many hours of sleep, which means your baby spends a large amount of time on his or her back to maintain a safe position while sleeping. Tummy time is pivotal during waking hours to strengthen the head, neck, and shoulder muscles and promote head control. Tummy time also gives your baby a fresh new perspective on the world as they can interact with toys and reach for objects in the environment. Tummy time is fundamental to your baby’s development and builds skills that promote later milestones of rolling over, crawling, and playing.

Getting started with Tummy Time

Tummy time can be started at any age, it is even recommended for newborns! Tummy time should always be a supervised activity. Gradually introduce your baby to tummy time by placing them on your stomach or chest in a reclined position such as laying on the couch. This allows your baby to continue bonding and interacting with you and may help them tolerate this new position. Start with short intervals on a safe and firm surface, such as the floor, for two to three minutes per day. You can progress up to 20 to 30 minutes of tummy time per day depending on your baby’s tolerance. Aim for tummy time at a time of day when he or she is alert, such as after nap time. Remember to always pay attention to your baby’s needs and look for signs of tiredness, such as crying or laying their head down on the floor.

How can I promote a successful tummy time experience?

  • Provide extra support with a bolster
    • Try rolling up a thin towel or blanket to make a bolster
    • Place the bolster under your baby’s chest with his or her arms positioned over the roll and hands in front
    • Always keep your baby’s chin in front of the roll to ensure their airway remains open
  • Promote weight bearing
    • Make sure your baby distributes his or her weight to both sides of the body in order to equally strengthen
  • Promote reaching for play
    • Get down on the floor with your baby to promote engagement and motivation
    • Hold a toy in front of your baby to encourage head control and reaching
    • Place toys in a circle around your baby to promote reaching in all directions
  • Try out other positions
    • Side-lying: Lay your baby on his or her side and support their back with your hand or a rolled towel. Place your baby’s arms out in front to promote reaching and play in this position.
    • Airplane: Lay down and hold your baby in your arms while he or she is on their belly. This a fun and motivating new perspective for babies with head control.
  • Make tummy time a routine
    • Incorporate tummy time during everyday tasks such as diaper changes, songs, toweling off, or reading a book.
    • Try burping your baby with him or her laying across your lap on their tummy
  • Make it a multi-sensory experience
    • Use a visually stimulating blanket or towel
    • Try placing your baby on a variety of textured blankets or mats
    • Use a mirror to motivate your baby to lift his or her head to see their reflection and encourage self-recognition
    • Alternate between various safe surfaces in your home such as carpet, tile, or wood

What are red flags to look out for? 

  • Pay attention if your baby shows a head preference. For optimal development, your baby should look to both sides equally. Does he or she have a strong preference towards one side?
  • Does your baby have difficulty weight bearing on one side of the body? For development, it is important that your baby strengthen both sides of the body and weight bear equally through both hands and arms.
  • Does your baby have a flat patch on the side or back of the head? Is your baby’s head asymmetrical? Flat patches may develop due to a strong head preference or increased time spent on their back.

If your child is demonstrating some of the observations above, consider contacting one of our occupational therapists or the Illinois Early Intervention system for more information.

Questions or concerns?

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

Robyn Geist, MS, OTR/L
Occupational Therapist

Reference: Pumerantz, Christa & Zachry, Anne (2018). Tips for living life to its fullest: Establishing tummy time routines to enhance your baby’s development. American Occupational Therapy Association.

Photo Credit: Moswyn via iStock.com

Home Bodies: Gross Motor Activities You Can Do at Home

What are gross motor skills?

Your child’s gross motor skills allow them take their first steps, play their favorite sports, and sit upright in their chair at school. Gross motor skills involve stabilization of our large muscle groups and active movement of our whole body to carry out these meaningful activities. In order to develop age-appropriate gross motor skills your child will utilize the following body mechanisms: muscle strength, muscle tone, activity tolerance, motor planning, postural control, body awareness, balance, coordination, and proprioception (our sense our body position and body movement).  If your child is having difficulty with their gross motor skills, they may appear to be clumsy, have difficulty completing activities of daily living such as dressing, or avoid physical activity.

Laying the Foundation

In order to develop more refined skills, such as fine motor skills, your child will need to build a foundation of age-appropriate gross motor skills. For example, in order to complete fine motor tasks at school, your child must first demonstrate appropriate trunk strength and postural control in order to sit upright in their chair. Once your child develops appropriate trunk strength and postural control, he/she will need to develop gross motor shoulder stability in order to prevent his/her shoulder from moving when engaged in writing activities. It is when these gross motor abilities of trunk strength, postural control, and shoulder stability are present when your child is able to develop more refined skills. Our gross motor skills lay the foundation for the more sophisticated and intricate small muscle movements.

Home Work

In a literature review of fundamental movement skills conducted, researchers found a positive relationship between children’s development of gross motor skills and health benefits such as increased physical activity and decreased sedentary behavior*.

At-home gross motor activities are just a jump, skip, and a hop away:

  • Obstacle Course: indoor obstacle courses are a wonderful way to get your child crawling through tunnels, jumping over “lava,” and running to the finish line. This also provides additional opportunities for supplemental sensory input for increasing overall regulation!
  • Yoga: yoga is excellent for incorporating whole body movements, core strengthening, and increasing our sense of proprioception. In order to further develop our body awareness, have your child imitate yoga poses in front of a mirror in order to increase his/her understanding of how his/her body is positioned in space. Yogarilla cards are a great resource for various yoga poses in a fun format for your child.
  • Dance Party: join in on the fun with your child and throw a dance party! Choose action-based songs, such as “I’m Going on a Bear Hunt.” Incorporate action-based songs that involve activities requiring the use of both the upper and lower extremities to utilize your child’s motor planning and coordination skills.
  • Play Catch: a simple back and forth game of catch with either a ball, balloon, or bean bag can facilitate development of motor planning, body awareness, and bilateral coordination. Additionally, with the balloon allowing more time to move throughout space, encourage your child to keep it off the floor utilizing different body parts, such as their feet or even their elbows.
  • Simon Says: have your child participate in a gross motor version of Simon Says. For example, you can state, “Simon says jump up and down. Simon says touch your toes. Simon says stand on one leg.”
  • Animal Walks: completing animal walks such as bear walks, frog jumps, crab walks, etc. Your child might even want to create their own kind of animal walk!
  • Bubbles: blow bubbles and have your child pop them with a body part that you designate. Try to blow the bubbles on each side of his/her body in order to promote crossing their body.
  • Tummy Time: If your child is not yet walking, encouraging him/her to spend time on his/her stomach will allow him/her to bear weight onto their arms. For example, you can place your infant’s desired toys around them in a circle so he/she has to bear weight onto his/her arms to reach out for them. If your child is walking, increasing the amount of time your child is bearing weight on his/her arms such as in a crawling position or lying on his/her stomach strengthens his/her shoulders, arms, and hands for the development of more precise fine motor skills. This can be done by playing games or completing puzzles in an all-fours position or army crawling during transitions.
  • Clapping Games: using both hands in coordination to complete clapping games such as patty cake are a material-free way to practice gross motor skills such as bilateral coordination and motor planning.
  • Stand Up: create a vertical surface for your child’s arts and crafts activities. When standing and using a work station in front of him/her (such as a piece of paper taped on the wall) instead of below them, your child is actively engaging and strengthening the muscles in his/her shoulders, arms, and wrists to promote gross motor development.

Questions or concerns?

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

Reagan Lockwood, MS, OTR/L
Occupational Therapist

*Reference: Lubans, D.R., Morgan, P.J., Cliff, D.P. et al. Sports Med (2010) 40: 1019. https://doi.org/10.2165/11536850-000000000-00000

Photo Credit: Photo by Julia Raasch on Unsplash

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