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St. David's Center is offering limited center-based services in accordance with guidelines from the Minnesota Department of Health at our Minnetonka and Minneapolis locations, including day treatment programs and pediatric therapy. The majority of our early intervention services will continue to be provided by telehealth. Close

Even before babies are born, parents are programmed to think about how to help their children grow and succeed. The reality is that every child is different. Some children are very internally motivated to move and gain skills, while others need more external motivations and engagement. The foundational motor skills that are developed in the first year of life lay the groundwork for higher-level motor skills and learning.

In this installment of our two-part series on infant and toddler motor skills, I will 1) include occupational therapy exercises that are intended to help provide ideas around developing these essential developmental skills from birth, 2) identify why they are so important, and 3) share what to avoid when trying to facilitate motor development.

The good news is, many of the games we love to play with our little ones will help to foster this development. Play is crucial for development and learning, and you as caregivers will recognize some of the games you play at home in this list (yes, even tummy time!)

Antigravity positions: Most motor skills, both gross motor and fine motor, require what is referred to as postural control. The ability to maintain and move in and out of antigravity positions (think moving up into the air, or against gravity) is the foundation for strong postural control. Antigravity motor development starts as an infant, as they begin to gain the strength to flex their core and bring their arms and legs to midline (toward their stomachs) when lying on their back (also known as happy baby pose). The opposing antigravity position would be tummy time, or positions where extension of the trunk and neck are required. We will review tummy time later in this article. Although there are many reasons babies and children may avoid playing on their back or dislike tummy time, these skills are essential to motor development, and modifications may be necessary; however, engaging children in these postures should not be avoided or overlooked. Let’s look at supine and prone antigravity positions:

Supine (lying face up against gravity): Most parents are familiar with infant activity gyms that include dangling stimulation for the infant to look at and attempt to bat or grab. The goal of this developmental toy is to develop antigravity engagement of arms and legs at midline which engage the core, as well as the visual system to develop visual tracking.

Try these games with younger children, or children that are not mobile or walking. Each of these activities can be modified for any age.

  • Peekaboo: Have your child on your lap or the floor, lying on their back so your face is above their body. Play peekaboo behind their feet. Next, pause, and have them lift their feet back up to your face. You can also do this seated on the floor. When you (the adult) are the stimulus, this also helps develop social skills and engagement, which is preferred over objects.

Modifications: This activity can be altered, depending on what your children engages with most. If they like tickles, that can be the external motivation they need. If lying flat on their back is too difficult, do the same activities at an incline by using a wedge or if the child is on your lap, bend your knees and lean your body back so they don’t have as far to raise their feet.

  • Sock Puppets: Engage both arms and legs to promote flexion against gravity by placing something on their feet. You can take a large sock and make it bright and colorful, there are sock puppets that can be purchased, or even use something that is orally motivating if your child is very young, to help encourage them to bring their feet to their mouth. The idea is for them to touch the sock puppet or other medium on their feet and eventually manipulate it (take it off, put it in their mouth, etc).

Modifications: This, too, can be done on an incline to minimize gravity. If the child needs assistance at first, you can help bring their limbs into midline, so they see what is on their foot.

  • The Sit Tip: This can be done in so many ways and is a great way to engage your child socially. Essentially you want to promote flexion (think of a crunch, with the chin tucked and the tummy muscles shortened) with assistance from the pulling of the arms.
    • For younger children or kids who have difficulty, you can support the child on a wedge or other incline like your legs. Place your thumbs in their palm so they are grabbing them and wrap your index finger so your have light pressure where their wrist meets their thumb. Pump the arms between flexion (bent arm) and extension (straight arm). Try this motion to the tune of a song, such as Row, Row, Row Your Boat, and when you feel their arms contract with elbows bent, you will see their chin tuck and come into a seated position.
    • Variation for children who can support their own head and neck when held by an adult. If they can support their head and neck when you hold them on your hip, try this variation: Stand up and place them on your hip. Hold one or both of their hands like in the above exercise. Dance around and see if you can feel their legs tighten together and make this more difficult by adding different types of movement like bouncing or a spin. Once they can maintain postural control on your hip doing this, you can dip them backwards and dip them in small increments at a time. Do not dip them far enough that their head falls back.

Prone positions (lying with tummy down)

  • Tummy time: It is not uncommon to have children between two and nine months engage in tummy time. This position can be adapted for all ages and is great to help integrate primitive reflexes, develop good shoulder and neck stability, isolate muscles in hands to develop more refined motor skills, and engage the visual system. If you are raising a little one, chances are you have heard about tummy time. The goal is for your child to engage in play on their tummy in a few minute increments multiple times a day when they are under 6 months of age, or if their skills fall below that age range. This is hard work! It is not uncommon for babies to cry in this position, but adaptation is key, not avoidance. Start small and gradually work up.

Mastering motor control in this position is the foundation for good postural control, balance, and stability. Here are some suggestions for making tummy time more manageable and engaging. In this position the goal is to help promote neck extension so looking down at an electronic device or a book isn’t ideal. Placing the book up on a vertical surface may help. Some additional tips:

    • Place them on your tummy: If you lay on your back either flat or at an incline, and place your little one on your belly, try to get them to look up at you. You can make silly sounds to interact and engage with them.
    • For the movers: Place your little one on an exercise ball and roll them back and forth in front of a mirror so they can see themselves. You can also have a sibling or other parent/caregiver in front, while the kiddo rocks back and forth. As always, ensure you are supporting the child to avoid a fall.
    • For very young babies that haven’t yet developed their eyesight, high contrast books can be enticing to look at. Peter Linenthal has a line of books with black and white high contract pictures that many babies enjoy and give them a focal point while on their tummy.

As you can see, there’s a lot to think about! The good news is that most of these activities are a natural progression for little ones, so knowing what to look for and/or how to support these motor skills. Check back next week where we’ll cover sitting independently, crawling, and walking.

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