Why Hands and Knees?

Crawling, in general, is so important for babies to explore their environment, which is how they learn. Crawling helps them explore new things within a timely manner. But why do therapists say it is so important to crawl on hands and knees instead of the many other types of crawling, as shown in Figure 1 below? Bottom scooting, army crawling, or other types of unique crawling patterns allow infants to access their environments. However, these patterns do not provide all of the benefits that crawling on hands and knees provides.

Crawling on your hands and knees does many things to help promote development of other gross motor skills. It strengthens the shoulder girdle, helps to develop the arches of the hand, and stretches out ligaments in the wrist and hand needed for fine motor skills. These changes help support the child as they begin to do more things with their upper extremities, such as pushing to stand, climbing, and, later, handwriting skills. Crawling on hands and knees also assists with strengthening the back extensor muscle group. Strength in these muscles is crucial for standing balance and control with walking.

Alternating movements occur when crawling on hands and knees, which helps the body learn to move in a “reciprocal” pattern. Humans walk in a reciprocal way, meaning their arm swings forward as they advance the leg on the opposite side. Crawling in this way will help with the transition to walking. This type of movement also makes both sides of the brain communicate, promoting cognitive development¹. Crawling on hands and knees may also help develop body scheme, motor planning, visual perception, and eye-hand coordination.

When Babies Choose Not to Crawl on Hands and Knees

Some infants may chose to bottom scoot because hands and knees crawling can be difficult. One study found that there is a link with low muscle tone, delay in gross motor skills, and hip flexion postures (knees bent up toward chest) in a group of 30 children whose mode of transportation was to bottom scoot³. The human body wants to use the least amount of energy and get the most amount of movement for it. If the child has difficulty maintaining hands and knees, they may choose a more stable posture to access their environment.

Crawling in different ways can lead to decreased hip and core strength, muscle length abnormalities, and hip range of motion restrictions in the future. This may make it difficult for children to develop complex motor skills, such as throwing, kicking, running, or jumping. While many children who never crawl have no noticeable impairments later in life, if you are noticing your child bottom scooting or crawling in a different way and are concerned, physical therapy may be able to help them gain the strength they need in order to crawl on hands and knees, giving them all benefits that crawling on hands and knees provides.

Hands and knees and types of crawling — Figure 1: Example of many different types of crawling.

If you have questions or concerns about your child’s crawling, call MOSAIC today at (406) 388-4988 to schedule a free screen.

References:

What is Midline Crossing and Why is it Important?

When therapy professionals throw out the term midline crossing, we are referring to an imaginary line that runs from the head to the toes and separates the left and right sides of the body. Midline crossing plays a significant role in daily life skills because it allows the body to smoothly perform practical life, self-care, and recreational tasks. Some tasks that involve midline crossing include driving a car, taking a shower, cooking, moving food in our mouth from one side to the other, and playing sports.

Midline crossing is important on a physical level and a neurological level. On the neurological level, the left and right sides of the brain are responsible for different tasks. They need to communicate with each other to make these tasks functional. When both sides of the brain do not communicate, coordinated learning and movement do not occur.

On the physical level, our bodies typically cross midline spontaneously when we develop a dominant hand preference. When our body does not cross midline, both hands tend to work equally (left upper extremity works on the left side of the body and the right upper extremity works on the right side of the body). Equal practice sounds good, but when this occurs it can be very difficult to establish hand dominance. Fine motor skills may be delayed or poor, negatively impacting the skills necessary for school (i.e. handwriting, coloring, reading, etc.). Without midline crossing, trunk rotation will not occur. Lack of trunk rotation can present as poor core stability, a stiff body, or moving the whole body as a unit.

activities to encourage midline crossing at home:

Household tasks such as dusting, cleaning mirrors, wiping down benches, and vacuuming
Marching or dancing to music using both arms and legs (flossing is a great dance move)
Sorting games (reach from one side and put into a container on the other side without switching hands)
Using ribbons or streamers to make figure 8’s in the air
In infants, hold one arm down and place toy on opposite side of the body to reach for
Have the infant track toys with eyes while laying on their back
Give babies plenty of tummy time
Play hand gesture games (this little piggy), and show your child how reach across their body to touch their toes

If you suspect concerns regarding midline crossing in your child, please feel free to contact MOSAIC. If your child is already seeing a therapist, let them know!

Tips to Prevent Falls During the Winter Months

Falls are the leading cause of fatal and non-fatal injuries for older individuals. But you do not have to be advanced in years to be at risk of falling. Winter is an especially dangerous time in Montana with weather conditions producing snow, ice, and other hazards. However, there are steps you can take to prevent falls during the winter and decrease your risk of fall related injuries.

Recommendations to Prevent Falls

Wear shoes with good traction on the bottom. If conditions are especially icy, use YakTrax or other traction cleats. These attach to the bottom of your shoes. They are a relatively cheap (around $20 on average) and can make a world of difference.
Take shorter steps and walk more flat footed when walking on icy or snowy conditions.
If needed, use an assistive device such as a cane to help steady yourself. Special attachments for the cane tip are made specifically for snowy and icy conditions and can be purchased online, PriceRite, or similar stores.
Be extra cautious in parking lots. When getting out of your car, use the door to steady yourself and make sure your feet are both firmly on the ground before stepping away from your car. Use the main, cleared paths instead of taking shortcuts between cars. These are often more difficult areas to clear and are likely to be more icy.
Plan ahead and pay attention to the weather. If you don’t need to go outside first thing in the morning after a snowfall, stay inside and wait for the weather and sidewalks to clear. If needed, hire someone to clear your sidewalks and/or driveway.
Keep your hands free and out of your pockets. Wear gloves and be ready to catch yourself if needed.

Improving your balance and strength are other ways to decrease your risk of falls. Physical therapy can help pinpoint exactly what to work on to prevent falls, especially during the winter. Call MOSAIC at (406) 388-4988 to schedule an evaluation today.

Does Your Baby Have a Flat Head?

Your baby has a flat head. What do you do? More and more babies are getting referred to physical therapy. There are two main types of flat heads. Brachycephaly is when the back of the head is flat, causing the head to be wider than it is long. Plagiocephaly is when one side of the back of the head is flat. Brachycephaly is usually caused by a baby spending too much time lying on their back, while plagiocephaly is usually caused by a condition called torticollis.

Torticollis is caused by shortening of the muscles on one side of a baby’s neck. This usually results in tilting of the head to one side and turning to the other side. Common causes include the position of the baby in utero, traumatic birth, positioning in the same way in car seats/swings/carriers, and holding or feeding a baby on only one side.

Implications

Left untreated, torticollis can lead to a flat head. If a baby has a preference to turn to one side, they are probably turning that direction when they sleep, resulting in one side of the head getting flat. Torticollis and plagiocephaly can lead to facial asymmetry, gross motor delays, asymmetric motor development, visual motor impairment, and impairments in feeding, speech, and handwriting.

Signs and Symptoms:

Head held tilted to one side (ear to shoulder)
Inability to turn and look both left and right
One shoulder held higher
Only rolls back to stomach or stomach to back to one direction
Flat or bald spots on one side of the back of the head
Difficulty breast feeding, especially when one side is more difficult than the other
Poor tolerance of tummy time

What You Can Do To Prevent/Fix Your Baby’s Flat Head:

TUMMY TIME! Supervised tummy time is the best way to prevent abnormal head shapes, increase neck strength, and promote gross motor development. Shoot for at least 30 minutes every day, broken up into shorter chunks as needed. Gradually increase this time as your baby gets stronger and tolerates tummy time more. Eventually, your baby should prefer to be on their stomach so they can interact with and explore their environment.
Limit awake time in swings, bouncers, rock ‘n’ plays, and car seats. Make sure your baby’s head is in midline (straight, not tilted or turned to one side) when this type of equipment is used.
Try to avoid sleeping in swings, rock ‘n’ plays, or car seats, even for naps.
Use a carrier, such as an Ergo or Moby, to wear your baby.
Alternate which end of the crib or changing table that you place your baby on to sleep or change diapers.
Put your baby on their back to sleep. Turn your baby’s head opposite directions each time you lay them down.
Change the side that you hold, carry, and feed your baby on (if you are bottle feeding).
Read this fact sheet by the American Physical Therapy Association to learn more.

What If I Suspect My Baby Has a Flat Head or Torticollis?

While torticollis is often due to factors beyond our control, it can be corrected with appropriate treatment. Torticollis typically requires skilled intervention to guide a family on what steps to take at home. Start treatment as early as possible, even right after birth. Treatment is easier when started early. If you think your baby has torticollis, you can:

Call and ask for a physical therapist to do a free screen.
Call and set up a physical therapy evaluation (most physical therapists can request a prescription from your doctor).
Ask your doctor to make a referral to a physical therapist.

Call MOSAIC at (406) 388-4988 for more information or if you have questions or concerns that you would like to speak to a therapist about.

Developmental Communication Milestone Series: 12 Months

What does communication at 12 months of age look like? At 12 months babies become active participants in their environments. They begin participating in familiar routines and social games adults play with them. They continue to learn language by hearing the same words/phrases paired with familiar activities, repetition of actions and words, having adults explain what is happening, reading the same books multiple times, etc. Babies also start making consistent sounds at this age and start to use these sounds or “word approximations,” with meaning and understanding. They also create babbling sounds that go on and on as if they are talking. Babies also continue to express themselves consistently using facial expressions and gestures at this age.

What communication should babies have by 12 months?

Participate in clapping when playing patty-cake
Wave hi/bye when shown how people greet each other
Copy simple gestures when they see someone familiar doing them
Follow directions such as, “Give me your shoe.”
Look or move toward a person calling their name
Point to a cookie on their plate when asked, “Where’s your cookie?”
Giggle before you even finish “This Little Piggy” because they anticipate the tickling part at the end
Put a block in a cup and then take it out when asked, “Where is the block?”

Expressively babies should be:

Babbling consistently with strands that sound like adult speech
Reach arms over head after finishing a snack to indicate “all done”
Shake their head and turn away when you try to keep feeding them bananas after they have been pointing to Cheerios
Repeat syllables with language like inflection when pointing to an out of reach toy
Using meaningful word approximations such as “ba-ba” for bottle or “ma-ma” when they see their mommy

Your baby may need additional support if they:

Do not look toward the person whose name is being called when asked, “Where’s mama?”
Do not respond to waving hi/bye
Look at your face rather than up in the sky when you excitedly say, “Hear the airplane?”
Make only a few babbles and not many repetitive sounds
Show little interest in communicating wants and needs or making choices when they are offered
Do not initiate social games such as peek-a-boo
Express anger/frustration when adults do not understand what they are trying to communicate

Check out 18 Month Communication Milestones to learn what your child should develop next. If you have questions or concerns about your toddler’s speech development, call MOSAIC Rehabilitation at (406) 388-4988. We offer free 15 minutes screens and are happy to answer any questions you might have.

W Sitting: Why Do Therapists Care ?

W sitting is the opposite of sitting cross-legged or crisscross applesauce sitting. In a W sit, a child’s bottom is on the floor with feet on either side of the hips and toes pointed out. W sitting is common in children, especially in children who in-toe or have low muscle tone, increased flexibility, or poor core muscles. As therapists, we often caution parents about allowing their children to sit in a W position. But why? Most orthopedists are not concerned about how W sitting affects the joints and alignment of the lower extremities. There is very little (or no) evidence to suggest that W sitting causes orthopedic issues.

So why do we care? Kids will often use the W sit position as a transitional movement, that is, to move into and out of other postures. W sitting has the potential to limit development in other areas when used as a sustained posture for playing or floor work. This is not to say that no child should sit in this position. However, for most typically developing children, sitting in alternative positions will challenge the body and allow other systems to mature.

W sitting position may limit the development of:

Core and Postural Muscles – The W sit position increases a child’s base of support. This, in turn, requires them to use less muscle activation and energy to maintain balance and an upright position.
Pelvic and Spinal Stability – The W sit position is extremely stable. Children who sit in this position do not have to learn how to keep their hips and their back from collapsing in positions of instability, such as tall kneeling and standing on 1 foot.
Vestibular Activation – W sitting can slow vestibular function and delay the development of equilibrium and protective reflexes. This can lead to inability to maintain clear vision during rapid head movements. Stable vision is critical for learning to read and write and for developing fine and gross motor control.
Visual Exploration – A child’s hips, core, trunk, and head don’t move as much or as often in a W sit. Therefore, they don’t move their eyes as much to fixate on toys and their environment.

Children who continue to prefer W sitting may develop problems in these areas:

Delayed Hand Dominance – W sitting limits trunk rotation and inhibits midline crossing. Children who W sit will use their right hand to grab objects on their right and their left hand to grab objects on their left.
Poor Protective & Equilibrium Reactions – Kids who W sit do not lose their balance in this position. They do not have to learn how to right their trunk when leaning forward, backward, or to the side. Consequently, they don’t learn to stop from falling when they move too far outside of their base of support.
Decreased Body Awareness – Kids who W sit have less awareness of where their body is at in space.
Poor Balance & Gross Motor Skills – Because W sitting limits trunk rotation, children do not learn how to weight shift from front to back and side to side, which is a skill needed to maintain balance while running, jumping, skipping, and playing on the playground.
Difficulty with the Transition to Kindergarten – Kids are expected to be able to sit on the floor with their legs crossed or upright at a desk in school. So, kids that W sit often do not have the strength or skills to be able to successfully maintain a floor sit with legs crossed or an upright trunk position at a desk.

Encourage alternative sitting options, including:

Cross Legged/Crisscross Applesauce
Short Kneel (Feet pointed straight back and directly under the bottom)
Prone (Lying on the stomach)
Long Sit (Sitting on the bottom with legs together and knees straight)
Side Sit (Sitting with bottom on the ground and knees bent with both legs out to the same side).

A pediatric physical or occupational can help. Call MOSAIC at (406) 388-4988 if you have concerns and would like to schedule a free screen.