Posts

Why Crossing Midline is Important for Development

As babies grow and develop certain milestones are often celebrated, such as rolling, sitting, crawling, and walking. As a pediatric occupational therapist, one of the milestones I always celebrate might not be visible to the untrained eye. Crossing midline, defined as the ability to reach across the body’s invisible midline with your arms or legs to perform tasks on the opposite side of the body, is a required skill for many higher level coordination activities. Blog Crossing Midline Main-Landscape

This skill typically develops around 18 months of age. Oftentimes when children are referred for occupational therapy due to poor fine motor skills, handwriting, or coordination, they are not crossing midline efficiently.

Some ways to observe whether or not your child is crossing midline efficiently include:

  • Watching to see if your child switches hands during drawing tasks. Do they switch from left hand to right hand to avoid their arm crossing over when drawing lines across paper?
  • Evaluating hand dominance: by age 6, children should have developed a hand dominance. Children with poor midline integration may not yet have developed a hand dominance.
  • Tracking an object across midline: this can be observed during reading, as decreased midline integration can lead to poor ocular motor skill development required for scanning.
  • Observing ball skills: children who are not yet crossing midline may have a difficult time crossing their dominant leg over their non-dominant leg to kick a ball forward.
  • Assessing self-care skills: putting on socks, shoes, and belts may be extremely difficult as these are activities that require one hand to cross over to assist the other in the process.

Children who have difficulty crossing midline may not be able to keep up with their peers, which may cause increased frustration during participation at school and in social situations. In addition, crossing midline is a required skill needed in order to complete more challenging bilateral coordination activities, such as cutting with scissors, using a fork and knife to cut food, tying shoe laces, writing out the alphabet, and engaging in sports.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

 Meet-With-An-Occupational-Therapist

Exersaucers

The Dangers of Jumpers, Exersaucers, and Sit-and-Play Walkers

I recently read an article posted on parents.com about baby development that touted the benefits of exersaucers and Jonny Jumps. Let me put an end to that notion right now. While I understand the necessity of such devices for small periods of time (meal preps and bathroom breaks can be near impossible without them), these devices should in no way substitute free play on the ground or be used as a way to “strengthen” young children’s legs.

For the remainder of this article I am discussing  devices that support the pelvis while the legs are in a weight-bearing to semi-weight-bearing position, including but not limited to: jumpers, exersaucers, sit-and play walkers.

The Dangers of Jumpers, Exersaucers,
and Sit-and-Play WalkersThe Dangers of Jumpers, Exersaucers, and Sit-and-Play Walkers

Places Children in Weight-Bearing Position before Muscles are Ready
When a child is not physically strong enough to support their body weight in a standing position, they will assume a position of flexion (knees bent, hips and trunk bent forward). If the child is pulling to stand at a stable surface, this weakness may result in a collapse at the knees or a fall backward. However, when a child is strapped into a device supporting their pelvis and trunk, they are unable to drop to the floor. Instead the child assumes a semi-weight bearing flexed position. Many advertisements for such devices depict the child in this flexed semi-weight bearing position.

Teaches Weight-Bearing through Balls of Feet (rather than heels)
Many times children will bear weight through the balls of their feet while in these devices. Usually because the device is not adjusted to the appropriate height and the child is trying to reach the ground, or the child is not strong enough and is in a flexed position while trying to reach the ground. Repetitive weight bearing through the forefoot creates a motor learning pattern that can be continued on into regular gait. We call this types of walking, through the forefoot, toe-walking.

Poor Alignment of Lower Extremity
The semi-weight bearing flexed position that children may assume when placed in sustained weight bearing before their muscles are mature enough for standing has already been described above. This position can result in: 1) excessive stain and force through the pelvis to support the trunk, or 2) excessive hip external rotation, excessive knee flexion and weight bearing through lateral knee, and/or excessive weight bearing with ankles in maximum plantar flexion(toes pointed down). Excessive time in these abnormal positions can lead to a multitude of musculoskeletal problems later on, including: toe-walking, hip stabilizer weakness, increased falls, knee pain, out-toeing.

To limit the negative effects of jumpers, it is recommended that children spend no more than 20 minutes a day in them. In fact, time spent in all positioning devices should be limited to a total of 30 minutes per day to allow for optimal gross motor development.

NPST offers physical therapy services in Bucktown, Evanston, Highland Park, Lincolnwood (coming soon), Glenview and the Neuropsychology Diagnostic and Testing Center in Des Plaines. If you have questions, or concerns, about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!