Help Your Child Develop the “Crossing the Midline” Skill

What is “crossing the midline”?

By the age of 3 or 4 years old, a child should have mastered the bilateral skill (using both sides of the body together) called “crossing the midline”. This is the ability to move one hand, foot, or eye into the space of the other hand, foot or eye. We cross midline when we scratch an elbow, cross our ankles, and read left to right. Crossing the midline of your body helps build pathways in the brain and is an important prerequisite skill required for the appropriate development of various motor and cognitive skills. Children who have difficultly crossing the body’s midline often have trouble with skills such as reading, writing, completing self care skills and participating in sports & physical activities. These skills require a type of coordination that comes from experience with “cross-lateral motion,” which is movement involving the left arm and right leg, or the right arm and left leg at the same time. 

Establishing a “worker hand” and a “helper hand” is a sign that the brain is maturating and lateralization is occurring, and is strongly correlated with the ability to cross the midline. Both sides of the brain need to talk to each other for the “worker hand” and the “helper hand” to work together and compliment each other. Coordinating both sides of the body can be difficult for the child who avoids crossing midline. Often, these children have not yet established a hand preference, sometimes using their left and sometimes using their right to draw, color, write, eat, and throw.

Affects on children who do not develop the bilateral skill:

Furthermore, when a child has difficulty crossing midline, it can affect his/her ability to read. While the child is moving his/her eyes from left to right across the page, the eyes will stop at midline to blink and refocus; however, when this happens, the child will very frequently lose his/her place on the line and become confused as to where they left off. It also affects handwriting, as diagonal lines cross the midline, and the child may need to stop in the middle of the page to switch hands when writing from left to right. Many self care and daily living skills require crossing midline. For example, perfecting the skill of putting socks or shoes on requires one hand to cross over to the other side of the body.

Children who have difficulty crossing midline may appear ambidextrous because they are often observed using both hands, but they actually have a hidden neuroprocessing issue. Both sides of their brains are not communicating, resulting in decreased coordination, decreased motor control of movements and difficulties achieving higher level skills. Often, these children end up with two unskilled hands.

Activities to help develop the ability to cross the midline:

To help develop efficient crossing of the midline, provide children with a variety of two-handed (bilateral) activities. Try some of the below activities to help build more pathways in the brain and to develop the ability to cross the midline, improve coordination, and improve overall functional performance on a daily basis.

Right brain/left brain teasers-

a. Pop bubbles with only one hand (they will have to reach across their body to pop the bubbles floating on the opposite side).

b. Reach for bean bags, balls, stuffed animals, or other objects across midline, then throwing at a target.

c. Draw large figure eights (the infinity sign or an 8 turned on its side) on paper, on the floor with a finger, in the air with a finger, or drive a matchbox car around a figure eight pattern.

d. Let the child play with sand, scooping sand from one side of the body and putting it into a bucket on the opposite side of the body without switching hands.

e. Let the child pretend to drive a car with a ball in his/her hands to use as a steering wheel and encourage the crossing of his/her arms as he/she turns the ‘steering wheel’ OR to make this similar in style to most of the others—pretend to drive a car with a ball in both hands to use as a steering wheel and cross both arms while turning the “steering wheel”.

f. Play flashlight tag. In a dimmed room, lie on your backs and have the child follow your flashlight beam projected on the wall with his own flashlight.

g. Touch the opposite elbow and knee.

h. Cross one foot over the other while walking sideways.

i. Do “grapevine” walks.

j. Knee slap walk- Walk around raising each knee while touching/slapping it with the opposite hand (or elbow). Change it to a skip while touching the opposite knee as it comes up.

k. Windmill-stand with feet spread apart and arms extended out to the sides. Bend over at waist and tap right hand to left foot. Stand back up and then bend and tap left hand to right foot.

l. Point your left finger out and put your right thumb up. Switch them, and switch, and switch, and switch…

m. Hold your nose, then cross the other hand over and grab your opposite ear. Slap your thighs and switch your hands…switch, slap, switch, slap…

n. Write your name in the air while rotating your foot in a circle clockwise.

o. Wash the car and make sure the arms cross midline while scrubbing.

NSPT offers services in BucktownEvanstonDeerfieldLincolnwoodGlenviewLake BluffDes PlainesHinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!


12 replies
  1. Joaneburga
    Joaneburga says:

    Don’t younger children need to cross midline too. I thought by 8 months old babies should be able to cross midline while on their backs and then progress the activity in sitting then standing. I enjoyed the article because it helps to explain it to parents. Thanks, Joan B., P.T.

  2. Susan Pirie
    Susan Pirie says:

    Thank you for sharing advice. My son is now 7 and has problems with crossing pathways. He also has issue with eyesight in that one eye has perfect vision and the other is very longsightedness with no 3d vision. Is this common in children with midline skill problems? Many thanks

    • Daphne Johnston
      Daphne Johnston says:

      My son sees 20/20 but has double vision. He didn’t even know that was abnormal! We were lucky enough to find vision therapy and they were the ones who discovered his midline issues. I strongly recommend you find somewhere that offers vision therapy.

  3. Jessie
    Jessie says:

    This makes a lot of sense, my four year old son with autism has this issue. I was wondering why in OT they were making him reach with his left hand for something on the right side of the table. Thank-you for this

  4. Carol
    Carol says:

    I’m working with a student recently diagnosed with this and found several of these techniques helpful. However, I am skeptical of letter n: the foot rotation and hand movement. I myself cannot do this nor can several people I have asked to try: including adults and children of various ages. My foot tends to switch to counterclockwise as I write. I am left-handed if that gives you more insight. Could you comment on this? Thank you.

    • Marissa Edwards
      Marissa Edwards says:

      Thank you for reaching out with your question. The intention of this exercise is to work on dissociating the upper extremities from lower extremities. It is not crucial that this is performed correctly, but the purpose is for the brain to focus on this dissociation in order to promote more separation of the upper and lower extremities, as well as promote bilateral coordination if you perform with opposite hand and foot. A simpler variation of this activity is Duck Walks and Pigeon Walks. Duck walks are done with toes externally rotated and hands internally rotated; while Pigeon Walks are done with toes internally rotated and hands externally rotated. An additional strategy to promote this dissociation is to hold onto an object with palms down during Duck Walks, and hold onto an object with palms up during Pigeon Walks. Hope this is helpful!


Trackbacks & Pingbacks

  1. […] In addition to these reflexive skills, baby gyms can also facilitate babies’ development of the ability to bring two hands together at the midline of the body while laying on their back while they hold a toy (around 1-3 months), reach for an object with two hands together at midline (around 4-5 months) and reach across the midline of their body. The ability to come to and cross the invisible vertical line down the middle of the body (and across the middle horizontally) is a SUPER important skill for children to develop! It strengthens the structure in the middle of the brain called the Corpus Callosum (learn more here) and is a huge part of babies being able to learn to crawl. It also helps them develop two-handed coordination (“bilateral skills”) and hand dominance as they move through the toddler and preschool years. In addition to practicing midline crossing while using a baby gym, little ones can practice crossing midline through music (read more here) and play (read here for ideas from another OT)! […]

  2. […] skills are being developed while you and your child are reading. Page turning is a movement that crosses the body’s midline, an important precursor to developing hand dominance and a requirement for the development of other […]

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *