Motor Skills

General Strategies for Gross Motor Development

• Floor Time: Having lots of time to move without an constraint (i.e. without being placed in a car seat, bouncer, walker, etc.) is so important for meeting motor milestones! Babies need time to explore their bodies and movement to develop strength, skill and coordination. It also helps to prevent or help flat spots on baby's head. See this article for more discussion on the importance of floor time.
• Avoid (excessive) use of equipment- Since free movement is so important for motor skill development, it is important to avoid placing baby in a "container" for long periods of time. A container is defined as any piece of equipment that holds baby in a specific position and does not allow for free movement. Examples of "containers" include car seats, swings, baby walkers, bouncers, etc. Try to limit your use of these to 1 hour per day or less. Try to think of them as ways to keep baby safe and secure while you need to do a quick task where you can't hold them like use the bathroom. 
• Carry baby! Carrying your child in your arms whenever possible versus strapping baby into a car seat helps with motor skill acquisition. When you carry your baby, they are actually practicing their balance, adapting to changes in position, and experiencing the effects of gravity. This can help with head control, balance, and strength.

Tummy Time

What is "Tummy Time? 

Tummy time is the time during waking hours that your baby spends on his/her tummy. Tummy time is crucial for development of motor milestones such as rolling, crawling and We know that sleeping on the back is safest for sleep (see the American Academy of Pediatrics "Back to Sleep" site for more information), it is important to give your baby time on their tummy throughout the day. 

When can tummy time start? 

As soon as babies are born! Holding your baby on a parent's/caregivers chest is a great way to bond and start give baby some tummy time. Putting your baby on their tummy across your lap also counts.

Help! My baby hates Tummy Time!

Some babies seems to cry whenever they are placed on their tummies so you are not alone! There are many ways to do tummy time and the important thing is to keep it interesting and positive for your baby! This means starting with just a few seconds of tummy time in the beginning and picking them up before they get too upset to help them develop a good association with being on their bellies. You might try placing a small mirror, a book or toy or even getting down so that you are face to face with them to keep it interesting. See this Pathways Tummy Time video for more suggestions!

How much Tummy Time is recommended for my baby?

There is no limit to how much tummy time is too much during waking hours (remember back to sleep is essential). By 3-4 months of age, babies should have about 90 minutes of tummy time per day. This can be broken up into a few-minute chunks spread throughout the day. Finding ways to incorporate tummy time into daily routines (after diaper changes, after bath, upon waking up from a nap etc) can help you meet the recommended tummy time amount without adding stress!

Rolling

Rolling is an important skill that helps babies learn that they can move their own bodies to explore their environments. Rolling to get to a toy also helps with cognitive development! Babies typically roll over tummy to back first (but they might roll back to tummy first!) and can start around 4 months. By 6 months they usually can roll both directions.

• When placing your child on the floor for floortime/playtime, place toys off to the side, slightly above their heads. Use rattles or toys that make noise to engage their attention and having them stretch to reach for it.
• If a child is close to rolling (i.e.can get to their side), you can help them by placing your hand at their hip and just giving them as little help as they need to accomplish a roll
• Position a child to play on their side by placing a rolled up blanket or towel behind them or just placing your leg behind them so they can't automatically roll onto their back. This helps them experience gravity in a new way on their bodies and can help with rolling skills. 
• Encourage baby to move and roll both right and left when you're playing with them.

Sitting

Sitting independently is a complex task of being able to control the head and the trunk against gravity. Babies usually develop the skill of independent sitting around  Giving your baby lots of unrestricted time on the floor helps them develop the strength and coordination necessary for sitting. 

Crawling

Crawling on hands and knees is a complex skill that requires strength in baby's whole body to help them get into this position and move forwards. Babies typically begin crawling on their bellies around 7-9 months and will then get up on their knees to rock and learn how to shift their weight around 9 months and finally crawl forward on their hands and knees sometime between 9 and 11 months old. 

Help your baby build strength for crawling by giving them opportunities to play on their knees. This might look like taking a cushion off of the couch, placing it on the floor with some toys or a book on top and help your baby prop on their knees with their forearms on the cushion to play.

Standing

Being able to stand with good balance is a key step to walking! After your child begins crawling, they will want to start pulling up onto furniture and other objects to practice standing. 

Activities that will help your child with their standing skills:

• playing on knees is a good precursor to building strength in the muscles used for standing
• helping them pull up onto furniture and placing toys at the top so they will play there for an extended period of time

When your child is skilled at pulling up to stand on furniture you can try turning them around so their back is to the surface (this requires more strength and balance). When in this position you can hand them a toy or read them a book to distract them and help them hold this position.

Try standing at a refrigerator or a wall which gives less support than a couch or table.

Walking

Independent walking typically develops between 12-16 months but not considered delayed until 18 months. Below are some tips to encourage independent walking:

• Encourage barefoot exploration. It helps develop the muscles of the foot that make the arch
• Encourage play using both hands. It helps take the focus away from external support
• Cruising on the couch and between surfaces (i.e. couch and coffee table, couch and ottoman)
• Introduce dynamic support - like a shopping cart, pushing a big ball
• Try climbing big ramp, stairs, climbing slide to promote leg and trunk disassociation and strengthening

Reaching for Objects

Reach for the Stars! 

• Reaching towards people and objects are one way that an infant learns about their environment! Infants are motivated to reach for objects of various sizes and textures to learn more about what they are. 
• Encourage your child to reach, even before you think they can! Some parents wait until their child shows interest in reaching for a toy or an earring (or hair!). Children need practice to learn. Motivate your child to reach for different baby-safe objects...they may surprise you! 
• If your child has difficulty reaching for a toy while on their back, try side-lying! As your baby gets stronger and reaches more consistently, try encouraging them to roll onto their backs and over to get the object. You may see your child's first roll! 
• Give your infant an opportunity to reach in a variety of positions, such as supported sitting, on their tummies, side-lying, on their back, etc. Some positions may be more difficult than others, but providing a wide variety of positions increases your child's learning potential about their body and their environment!

Visual-tracking and Eye-hand Coordination

Building the Connection Between Our Eyes and Our Hands! 

Infants begin to explore their world through vision and movement. As infants and toddlers practice using their eyes and hands together for tasks (like reaching, grasping, releasing, etc.), they are strengthening this connection that will support them as they grow older and begin to read, write, play music or sports, and more! Some infants are born with or develop visual impairments that may require unique solutions to help them learn about themselves and their environment. Please review our webpage "Infants and Toddlers with Visual Impairments" to learn more. 

Here are a few basic strategies to help infants and children develop strong visual skills! 

• When your child is an infant, begin by having them track you or objects in a variety of directions (up, down, side to side, across the body, diagonal). Watch how long they can hold their gaze on the object. You can do this from a variety of positions: laying on back, laying on stomach during tummy time, support sitting, sitting alone, side-lying, etc. Eye muscles need to be strengthened too! 
• Use any objects with wheels (car, trains, etc.) and build a road or track for your child to follow with their hands and eyes! 
• Gather different objects in your house and practice putting into holes of various sizes. You can make them by putting different sized holes into a tissue or cardboard box, or use different sized bowls and cups. 
• Puzzles - toddlers are able to do simple puzzles involving circle, square, and triangle shapes. You can rearrange the puzzle in various ways and encourage your toddler to find the correct spot. As your child progresses, you can try other simple form puzzles. 
• Sensory bins! Make a bin using whatever you have around the house - beans, rice, straw, etc. Place your child's toys or other objects inside the bin and hide them. Have your child try to find the items. Ask them to try just using their eyes only at first. 
• Stacking objects - this can involve stacking cans, books, boxes, bowls, etc. 
• Balls and bubbles - play catch or have your child track the bubbles as they fly through the air!

Grasping Objects

• When your child is 1-3 months of age, you will notice that your child will grasp onto anything that is placed in the palm of their hand, such as your finger, a rattle, or other object. This is the "grasp reflex," and is part of normal development. If your child's grasp reflex continues beyond the age of 3 months, consult your pediatrician or the occupational or physical therapist on your team. 
• Your child's grasp will begin to develop starting from the pinky/palm and becoming more complex as they practice using their hands during play and self-care activities. A younger infant with hold larger items using all their fingers and palm and grow to using a more mature grasp of the index finger and thumb. Below are some strategies to help develop your child's grasp: 
  • Encourage your child to use both hands equally when playing. A child's hand dominance is not yet determined until the age of 8. 
  • Provide your child with a wide variety of safe toys and items to hold. Supervise your child during playtime, especially if using smaller toys. 
  • Place a variety of items inside a container and ask your child to get you a specific toy. 
  • Build towers with tissue boxes, cardboard, cans, blocks, and more!
  • Let an older toddler color with different sized crayons, markers, chalk, paintbrushes, and more.
  • Use snack-time as a way to improve fine motor skills as well. Give your toddler a few pieces of a small food (like cheerios, yogurt melts, little pieces of veggies or fruits) and encourage them to use their index finger and thumb to pick it up. If there are too many foods on the tray or table, your child will most likely scoop them all up at once!

Using Two-Hands Together

Strategies and Activities to Encourage the Use of Both Hands for Infants and Toddlers 

Each activity is recommended with direct supervision from a parent or guardian. 

Everyday activities 

Encourage your child to do these activities using both hands. Some of these activities will require supervision. 

• At snack or meal times, encourage your child to eat finger foods with both hands equally.
• Drink from a cup using two hands. 
• During bath-time, play splashing and clapping games, squeeze sponges, play with cups, bowls, spoons, funnels, floating and wind-up toys. 
• During bath-time, encourage your child to wash his tummy, face, hands or hair. Try singing ‘This Is the Way We Wash Our Hands’ and show him the actions that you want him to do. 
• Help with dressing such as taking off socks or pants, putting arms up when getting tops on or off, or finding his shoes.
• Help around the house – pick up toys and put them into a toy box, put clothes into the dirty washing basket or into the washing machine. 
• Help with shopping – hold unbreakable items (such as toilet paper), put items into the trolley. 

(Royal Children’s Hospital, 2005)

Sensory Play! 

Sensory play can be a great way to encourage the use of both hands and to build confidence in playing with a variety of textures and movement. Sometimes, children have difficulty processing sensory information. Some children may seek more sensory input, while other children may avoid sensory input. This can involve the classic senses of vision, hearing, touch, smell, and taste, as well as the sense of balance and movement and the sense of knowing the position of one’s body in space. 

• Be sure to include lots of bilateral (two handed) activities so they are actively using both hands together. Try to be creative and fun!
• A tray full of - chocolate pudding, whipped cream, jello - makes a great place to "paint" with two hands - also nice to lick the stuff off both hands. 
• The classic containers of rice, beans, sand for weight bearing. Use a small plastic container and bury treasures in it. Encourage weight bearing on the either hand into the container while she searches for treasures or search with the other hand. (Also, works for toes and feet). 
• Have the child wear colorful rings and bracelets 
• Let him paint with washable markers (make sure your markers are safe for this) 
• Refrigerated cookie dough is wonderful for play with both hands 
• "Indoor bean sandbox". Take a shoebox sized plastic container and fill it with all kinds of raw beans and macaroni noodles, etc. Use it just like a sandbox with shovels and pails. This is a great activity for scooping and pouring. Not for children less than 1 year old and adult supervision recommended. 
• Ride a ride-on toy, holding on with two hands

(Children's Hemiplegia and Stroke Association, N.A.)

Other Bilateral Activities (Two-Hands)

• Catch large balls with both hands
• Bilateral upper extremity weight bearing activities and unilateral reach to both sides (works on lengthening the involved side)
• In the Kitchen: holding a bowl with one hand and mixing with the other
• Build towers, blocks, stacking rings, and nesting cups
• Music - banging a drum, playing piano, dancing

(Children's Hemiplegia and Stroke Association, N.A.)

For the Wrist (Flexion and Extension of the hand) 

Flexion of the wrist means letting the hand drop, fingers pointing downward. Extension of the wrist means letting the hand extend, fingers pointing upward. Children with hemiplegia often have problems lifting their hand toward extension. Strategies include: 

• Finger painting on easel 
• Shaving cream on the wall of the bathtub 
• Pudding on a marker board easel to help with wrist 
• Leaning into the wall with one hand while playing with the other hand. 
• Batting a lightweight ball or balloon (like volleyball). 

(Children's Hemiplegia and Stroke Association, N.A.)

References

Children's Hemiplegia and Stroke Association. Hand Play

Pre-Writing Skills

Preparing Your Child for the Art of Writing! 

• Between the ages of 2 and 2 1/2 years old, most children are able to imitate (create after immediate demonstration) both a vertical or horizontal line, as well as a circle. 
• By the age of 3, your child may be able to copy (from a picture without demonstration) both a vertical and horizontal line, as well as a circle. 
• There are a variety of ways to help your child prepare for handwriting and creating art: 
  • Finger-painting - practice lines and circles, squiggles, etc. Make a picture. Make it fun! 
  • Side-walk Chalk
  • Draw on a vertical surface - place paper on the wall, use an easel, use shaving cream in the bathtub on the wall, and more. Writing or drawing on a vertical surface places the hand and wrist in the correct position needed for handwriting. 
  • Use tweezers or tongs with supervision to pick up small objects to build strength in the hands and fingers. 

Writing Utensil Grasps: 

• Age 1 - 1/2 years old: Palmer Supinate Grasp - "scribbling phase" - the writing utensil is held in the palm with the palm slightly facing up and thumb lays over top. The shoulder and elbow move much more than fingers and wrists
• 2 - 3 years old: Digital Pronate Grasp - "upside down grasp" - the writing utensil is held in the palm with the palm facing downwards and thumb pointed towards the paper. This is a more complex grasp than the palmer supinate grasp, but still uses more shoulder and elbow mobility and stability to make pre-writing strokes. 
• Ages 3 and up: Static Tripod Grasp, Dynamic Tripod Grasp, and other Mature Grasps - the static tripod grasp or "fisted grasp" is a transitional grasp that will eventually lead to more mature grasps as the child gets older. Research has shown that there are many mature and functional ways to hold a writing utensil. It is more important to provide a child with the opportunities to practice pre-writing, drawing, coloring, and more when they are younger, in order to build the strength and endurance needed for writing letters and numbers, art class, and more.