"How to Help Infants Attain Gross Motor Skills: Practical Ideas for the Home Daycare Provider"   Julie Wattenber...
Goals of today’s lecture <ul><li>You will review the gross motor milestones of infants from 0-12 months of age </li></ul><...
Typical Development  In the First Year
Reminder <ul><li>In the following developmental progression, months are used to detail what an infant should be doing at e...
First Month <ul><li>First Month </li></ul><ul><li>Your baby is just learning how to lift and turn her head when she is on ...
Second Month <ul><li>Two Months  </li></ul><ul><li>He is starting to feel a bit floppy. This is because he has lost all of...
Three Months <ul><li>Three Months </li></ul><ul><li>Your baby has learned how to activate their muscles and now is startin...
Exercises to facilitate Developmental 0-3 months <ul><li>Positioning Suggestions </li></ul><ul><li>Large boppy pillow for ...
Positioning Suggestions 0-3 months <ul><li>Supine (on back) on large boppy pillow or on your lap to facilitate midline ori...
Carrying Suggestions 0-3 months <ul><li>When you carry a baby, you should always be sure that you are preventing any archi...
Pick Up Suggestions 0-3 months <ul><li>Every time you pick a baby up you should rotate him to sitting.  </li></ul><ul><ul>...
Exercises 0 – 3 months <ul><li>Sitting on ball – holding at upper trunk </li></ul><ul><ul><li>The higher you hold a baby a...
Exercises 0-3 months <ul><li>Bicycles  </li></ul><ul><ul><li>Bicycles help with gas as well with improving rotation of the...
Exercises 0-3 months <ul><li>Lower trunk stretch </li></ul><ul><ul><li>This helps to lengthen the muscles of the lower bac...
Exercises 0-3 months <ul><li>Supine on lap with facilitation of hand to hand and hand to mouth </li></ul><ul><ul><li>Hand ...
Exercises 0-3 months <ul><li>Side-lying play </li></ul><ul><ul><li>Side-lying play is good for babies who are prone to ext...
Three Months <ul><li>Three Months </li></ul><ul><li>Your baby has learned how to activate their muscles and now is startin...
Four Months <ul><li>Fourth Month </li></ul><ul><li>Your baby is getting really strong into flexion off the surface.  This ...
Five Months <ul><li>Five Months </li></ul><ul><li>Your infant is really starting to move.  On his back, he has gained more...
Sixth Month <ul><li>Six Months </li></ul><ul><li>Your baby is starting to move around, time to be cautious!!  Your baby is...
Exercises to facilitate Development 3-6 months <ul><li>Positioning Suggestions </li></ul><ul><li>Supine with large boppy p...
Positioning Suggestions 3-6 months <ul><li>Supine (on back) with large boppy pillow under bottom.  </li></ul><ul><ul><li>P...
Carrying Suggestions 3-6 months <ul><li>When you carry a baby, you should always be sure that you are preventing any archi...
Pick Up Suggestions 3-6 months <ul><li>Every time you pick a baby up you should rotate him to sitting.  </li></ul><ul><ul>...
Exercises 3-6 months <ul><li>Sitting on the ball </li></ul><ul><ul><li>Progressing to lower on the trunk with side to side...
Exercises 3-6 months <ul><li>Prone over legs with hands on the floor </li></ul><ul><ul><li>To increase activation of the a...
<ul><li>Rotation to sitting on your lap </li></ul><ul><ul><li>This exercise is very similar to rotating the baby up to sit...
Exercises 3-6 months <ul><li>Facilitation of Rolling </li></ul><ul><ul><li>Rolling from back to front is a really importan...
Exercises 3-6 months <ul><li>Sitting practice </li></ul><ul><ul><li>Tripod sitting (sitting with upper extremity support s...
Hand to feet in supine – rolling side to side <ul><li>Facilitate hands to feet when in supine (on back) </li></ul><ul><ul>...
Sixth Month <ul><li>Six Months </li></ul><ul><li>Your baby is starting to move around, time to be cautious!!  Your baby is...
Seventh Month <ul><li>Seven Months </li></ul><ul><li>Your baby is starting to explore positions where her belly is off the...
Eighth Month <ul><li>Eight Months </li></ul><ul><li>Your baby is getting very strong.  He prefers to play in prone and sit...
Ninth Month <ul><li>Nine Months </li></ul><ul><li>Your baby should be a pro at getting around on her hands and knees and t...
Exercises to facilitate Development 6-9 months <ul><li>Positioning Suggestions </li></ul><ul><li>Sitting independently, pl...
Positioning Suggestions 6-9 months <ul><li>Position toys laterally </li></ul><ul><ul><li>This facilitates lateral movement...
Carrying Suggestions 6-9 months <ul><li>Carry upright </li></ul><ul><ul><li>Encourage baby to hold onto you more as you ca...
Pick Up Suggestions 6-9 months <ul><li>Every time you pick a baby up you should rotate him to sitting.  </li></ul><ul><ul>...
Exercises 6-9 months <ul><li>Sitting on the ball </li></ul><ul><ul><li>As your baby gets bigger, she is getting a lot stro...
Exercises 6-9 months <ul><li>Walking on hands off lap or with a foam roller </li></ul><ul><ul><li>This exercise will teach...
Exercises 6-9 months <ul><li>Transitioning to four point </li></ul><ul><ul><li>Your baby needs to feel comfortable placing...
Exercises 6-9 months <ul><li>Four point positioning </li></ul><ul><ul><li>You may use a foam roll or your leg to keep your...
Exercises 6-9 months <ul><li>Transition side sitting to tall kneeling </li></ul><ul><ul><li>This is an important transitio...
Why creeping is important <ul><li>Hands and knees crawling is the preferred way for babies to get around.  </li></ul><ul><...
Ways to facilitate hands and knees crawling <ul><li>Pushing a small item – while on knees (e.g. stool, phone book) </li></...
Ninth Month <ul><li>Nine Months </li></ul><ul><li>Your baby should be a pro at getting around on her hands and knees and t...
Tenth Month <ul><li>Ten Months </li></ul><ul><li>Your baby is really wanting to be upright in standing a lot and he is tra...
Eleventh Month <ul><li>Eleven Months </li></ul><ul><li>Your baby is starting to cruise along furniture.  This is getting e...
Twelfth Month <ul><li>Twelve Months </li></ul><ul><li>Your baby is really getting big.  You are marvel at her progress as ...
Exercises to facilitate Development 9-12 months <ul><li>Positioning Suggestions </li></ul><ul><li>Sitting independently </...
Carrying Suggestions 9-12 months <ul><li>Carry upright </li></ul><ul><ul><li>Encourage baby to hold onto you more as you c...
Pick Up Suggestions 9-12 months <ul><li>Every time you pick a baby up you should rotate him to sitting.  </li></ul><ul><ul...
Exercises 9-12 months <ul><li>Sitting on the ball </li></ul><ul><ul><li>As your baby gets bigger, she is getting a lot str...
Exercises 9-12 months <ul><li>Facilitation of crawling/climbing </li></ul><ul><ul><li>Allow your baby to practice crawling...
Exercises 9-12 months <ul><li>½ kneel to stand at a surface </li></ul><ul><ul><li>Facilitate your baby to bring one leg up...
Exercises 9-12 months <ul><li>Bench sitting </li></ul><ul><ul><li>Have your baby sit on a small bench or a small playgroun...
Exercises 9-12 months <ul><li>Sit to stand at a bench </li></ul><ul><ul><li>When your baby is at the 11-12 month developme...
Exercises 9-12 months <ul><li>Facilitation of cruising </li></ul><ul><ul><li>Your baby is getting very confident now when ...
Reminders/Disclaimers <ul><li>These exercises are only suggestions for how you can help babies that may be struggling with...
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How To Hellp Infants And Children Develop Their Gross Motor Skills Practical Suggestions For The Home Daycare Provider Short Version

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This was created for daycare providers, but provides good tips for families as well on exercises for normal development.

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  • How To Hellp Infants And Children Develop Their Gross Motor Skills Practical Suggestions For The Home Daycare Provider Short Version

    1. 1. &quot;How to Help Infants Attain Gross Motor Skills: Practical Ideas for the Home Daycare Provider&quot; Julie Wattenberg, PT, MPT, DPT Adventist Paulson Pediatric Rehabilitation Center Independent Provider, Early Intervention Pediatric Physical Therapist January 20, 2009
    2. 2. Goals of today’s lecture <ul><li>You will review the gross motor milestones of infants from 0-12 months of age </li></ul><ul><li>You will learn some easy exercises to help facilitate gross motor milestone attainment for infants at different ages/stages of development </li></ul>
    3. 3. Typical Development In the First Year
    4. 4. Reminder <ul><li>In the following developmental progression, months are used to detail what an infant should be doing at each month. </li></ul><ul><li>However, please think of these as stages in development. If an infant is not demonstrating gross motor skills at the age reported, then please adjust accordingly and use the exercise suggestions for a bit longer than the “age” expected </li></ul>
    5. 5. First Month <ul><li>First Month </li></ul><ul><li>Your baby is just learning how to lift and turn her head when she is on her stomach. She is lengthening out of the physiologic flexion that she had when she was born. She is unable to hold her head in the middle when she is on her back and has difficulties holding her head up. </li></ul>
    6. 6. Second Month <ul><li>Two Months </li></ul><ul><li>He is starting to feel a bit floppy. This is because he has lost all of the physiologic flexion tone. When he is on his back, he is moving his head side to side and seems to be very limp. When on his tummy, he is not able to hold his head in the middle. At this age, he is learning how to activate his muscles on one side or the other, but has trouble activating them on both sides of a joint at the same time. </li></ul>
    7. 7. Three Months <ul><li>Three Months </li></ul><ul><li>Your baby has learned how to activate their muscles and now is starting to learn how to activate them together, on either side of the joint. This means that the baby is more stable when it comes to head control. Your baby really likes to be in the middle. By three months your baby should be able to hold his head in the middle when on his back, show a nice chin tuck when on his stomach and have independent head control when held. </li></ul>
    8. 8. Exercises to facilitate Developmental 0-3 months <ul><li>Positioning Suggestions </li></ul><ul><li>Large boppy pillow for midline orientation of hands </li></ul><ul><li>Small boppy or rolled towel for prone </li></ul><ul><li>Carrying/Pick Up Suggestions </li></ul><ul><li>Carry in supine, facilitate flexion, not extension </li></ul><ul><li>Prone carry to improve tummy time – this should be used with caution and should not be used with kids who like to extend all the time </li></ul><ul><li>Rotation to sitting every time you pick up a baby </li></ul><ul><li>Exercise Suggestions </li></ul><ul><li>Sitting on ball – holding at upper trunk </li></ul><ul><li>Prone on the ball - maintaining elbows under shoulders </li></ul><ul><li>Bicycles and Abdominal Massage for Gas </li></ul><ul><li>Lower trunk stretch in supine </li></ul><ul><li>Supine in lap with facilitation of hand to hand and hand to mouth </li></ul><ul><li>Side-lying play – elongation of posterior muscles </li></ul>
    9. 9. Positioning Suggestions 0-3 months <ul><li>Supine (on back) on large boppy pillow or on your lap to facilitate midline orientation of hands </li></ul><ul><ul><li>Use rings to bring toys close to baby’s chest to facilitate downward gaze and swatting of toys </li></ul></ul><ul><li>Prone with small boppy or rolled towel under chest </li></ul><ul><ul><li>This shifts the baby’s weight posterior (toward bottom) so that she can more effectively lift and turn her head. </li></ul></ul><ul><ul><li>You can help by placing your hand on her bottom. This will also bring the weight backward </li></ul></ul><ul><ul><li>Babies should start being on their tummy from DAY 1 for at least 30 minutes per day </li></ul></ul>
    10. 10. Carrying Suggestions 0-3 months <ul><li>When you carry a baby, you should always be sure that you are preventing any arching </li></ul><ul><ul><li>Carry the baby in a flexed position, do not allow the head to extend </li></ul></ul><ul><ul><li>Flex up and hold one leg so that the baby cannot extend. </li></ul></ul><ul><ul><li>This will prevent abnormal muscle activation and movement patterns that so many infants are demonstrating now </li></ul></ul><ul><li>You can carry a baby in prone and when they are little this is a great position as they can get that feeling of comfort when being in prone. </li></ul><ul><ul><li>However, if you have a child who likes to arch and extend all the time, this is not a good option for this child as they get older as they are demonstrating unbalanced extension </li></ul></ul>
    11. 11. Pick Up Suggestions 0-3 months <ul><li>Every time you pick a baby up you should rotate him to sitting. </li></ul><ul><ul><li>This helps to strengthen the muscles on the side of the body and the rotational muscles that are important for smooth dissociated movement </li></ul></ul>
    12. 12. Exercises 0 – 3 months <ul><li>Sitting on ball – holding at upper trunk </li></ul><ul><ul><li>The higher you hold a baby at his/her trunk, the less she has to work. Therefore, since a baby from 0-3 months is not very strong in their head, you will have to hold them higher on their trunk </li></ul></ul><ul><li>Prone on the ball - maintaining elbows under shoulders </li></ul><ul><ul><li>The ball is a GREAT place to work on prone skills for babies who have trouble tolerating prone positioning </li></ul></ul><ul><ul><li>You can move the ball forward and back to increase or decrease the work. </li></ul></ul><ul><ul><li>Be sure you are providing support at the arms so that the baby learns how to push through the surface and is not using unbalanced extension </li></ul></ul><ul><ul><li>You can use this trick on the floor to in facilitate the baby learning to push through the surface </li></ul></ul>
    13. 13. Exercises 0-3 months <ul><li>Bicycles </li></ul><ul><ul><li>Bicycles help with gas as well with improving rotation of the pelvis </li></ul></ul><ul><li>Abdominal Massage </li></ul><ul><ul><li>Abdominal massage also helps with gas. Be sure you are moving the gas from the baby’s right to her left </li></ul></ul><ul><ul><li>Strokes include: I love you, waterfall and knees to chest </li></ul></ul>
    14. 14. Exercises 0-3 months <ul><li>Lower trunk stretch </li></ul><ul><ul><li>This helps to lengthen the muscles of the lower back and upper back, especially for babies who are prone to extension postures </li></ul></ul><ul><ul><li>This also helps to facilitate activation of the abdominals. </li></ul></ul><ul><ul><li>Place your hand under the low back and maintain this position. Place toys on baby’s feet to attract attention to her feet </li></ul></ul>
    15. 15. Exercises 0-3 months <ul><li>Supine on lap with facilitation of hand to hand and hand to mouth </li></ul><ul><ul><li>Hand to hand and hand to mouth are very important skills for a baby to have </li></ul></ul><ul><ul><li>It helps a baby learn to self calm and is foundational for later skills </li></ul></ul>
    16. 16. Exercises 0-3 months <ul><li>Side-lying play </li></ul><ul><ul><li>Side-lying play is good for babies who are prone to extension. </li></ul></ul><ul><ul><li>This position lengthens the muscles in the back of their body </li></ul></ul><ul><ul><li>This position also allows the baby to active their arms and legs without significant gravity implications </li></ul></ul><ul><ul><li>You may use massage in this position and bring your hand from the middle of the back towards the wrist as well as the middle of the bottom toward the ankle. This will help to facilitate elongation of the posterior muscles (back muscles) </li></ul></ul>
    17. 17. Three Months <ul><li>Three Months </li></ul><ul><li>Your baby has learned how to activate their muscles and now is starting to learn how to activate them together, on either side of the joint. This means that the baby is more stable when it comes to head control. Your baby really likes to be in the middle. By three months your baby should be able to hold his head in the middle when on his back, show a nice chin tuck when on his stomach and have independent head control when held. </li></ul>
    18. 18. Four Months <ul><li>Fourth Month </li></ul><ul><li>Your baby is getting really strong into flexion off the surface. This is not because they have spent so much time on their back that they are getting better at flexor strength, it is because they have spent so much time on their belly that they gained strength in their flexor muscles. When your baby is on her back, she is able to bring her arms off the surface and her feet off the surface and often is able to tough her knees. Sometimes, it is hard for her to stay here, though, and she falls to her side. When she falls to her side, she is just learning how to activate her muscles on the side of her neck, so she might lift her head off the surface when on her side. Your baby should feel really confident on her tummy now and should be able to tolerate it without fuss for at least 3-5 minutes at a time. </li></ul>
    19. 19. Five Months <ul><li>Five Months </li></ul><ul><li>Your infant is really starting to move. On his back, he has gained more strength in his belly to bring his pelvis off the floor and reach for his feet. This helps to lengthen the hamstrings and strengthen the abdominal muscles to prepare him to sit. On his tummy, your baby is doing a great job pushing up on his hands and in sitting, your baby is able to prop sit. All of this pushing and reaching for his feet, teaches your baby how to use his triceps, the muscle on the back of his arm. This means that when on his back, your baby is becoming really good at reaching for toys. </li></ul>
    20. 20. Sixth Month <ul><li>Six Months </li></ul><ul><li>Your baby is starting to move around, time to be cautious!! Your baby is now starting to roll from his back to his tummy. He is also sitting independently. Also, your baby really likes his tummy and likes to play on his tummy for a long time. </li></ul>
    21. 21. Exercises to facilitate Development 3-6 months <ul><li>Positioning Suggestions </li></ul><ul><li>Supine with large boppy pillow under bottom to facilitate abdominal activaiton and hands to knees/feet </li></ul><ul><li>Prone positioning continues for at least 30 minutes per day </li></ul><ul><li>Supine on a large boppy pillow to facilitate reaching and bringing the arms forward if baby is having difficulties with this still </li></ul><ul><li>Bumbo seats may be used for a limited time </li></ul><ul><li>Do not use exersaucers, johnny jump ups or walkers </li></ul><ul><li>Carrying/Pick Up Suggestions </li></ul><ul><li>Carry in supine, facilitate flexion, not extension </li></ul><ul><li>Prone carry to improve tummy time – this should be used with caution and should not be used with kids who like to extend all the time </li></ul><ul><li>Rotation to sitting every time you pick up a baby </li></ul><ul><li>Exercise Suggestions </li></ul><ul><li>Sitting on the ball – progressing to lower on the trunk – side to side weight shifts </li></ul><ul><li>Prone on the ball – progressing to side to side weight shifts </li></ul><ul><li>Prone on hands off your lap </li></ul><ul><li>Rotation to sitting on your lap </li></ul><ul><li>Facilitation of rolling </li></ul><ul><li>Sitting practice with/without boppy pillow </li></ul><ul><li>Sitting balance on daycare provider’s lap with weight shift </li></ul><ul><li>Hand to feet in supine – rolling side to side </li></ul>
    22. 22. Positioning Suggestions 3-6 months <ul><li>Supine (on back) with large boppy pillow under bottom. </li></ul><ul><ul><li>Place toys on a play gym on rings to bring them close to baby’s feet so that he kicks the toys independently </li></ul></ul><ul><ul><li>This will help to strengthen his belly muscles </li></ul></ul><ul><li>Supine with boppy pillow under shoulders </li></ul><ul><ul><li>This will bring arms towards the toys. </li></ul></ul><ul><ul><li>Use rings to bring the toys down closer to the baby so accidental movements will result in batting of the toys </li></ul></ul><ul><ul><li>Decrease use of the boppy when baby is able to reach for toys independently when in supine (usually around 5 months) </li></ul></ul><ul><li>Prone positioning </li></ul><ul><ul><li>At least 30 minutes per day </li></ul></ul><ul><ul><li>Baby should be able to tolerate prone positioning without the blanket roll </li></ul></ul><ul><ul><li>Baby’s tolerance for prone should be increasing </li></ul></ul>
    23. 23. Carrying Suggestions 3-6 months <ul><li>When you carry a baby, you should always be sure that you are preventing any arching </li></ul><ul><ul><li>Carry the baby in a flexed position, do not allow the head to extend </li></ul></ul><ul><ul><li>Flex up and hold one leg so that the baby cannot extend. </li></ul></ul><ul><ul><li>This will prevent abnormal muscle activation and movement patterns that so many infants are demonstrating now </li></ul></ul><ul><li>You can carry a baby in prone and when they are little this is a great position as they can get that feeling of comfort when being in prone. </li></ul><ul><ul><li>However, if you have a child who likes to arch and extend all the time, this is not a good option for this child as they get older as they are demonstrating unbalanced extension </li></ul></ul>
    24. 24. Pick Up Suggestions 3-6 months <ul><li>Every time you pick a baby up you should rotate him to sitting. </li></ul><ul><ul><li>This helps to strengthen the muscles on the side of the body and the rotational muscles that are important for smooth dissociated movement </li></ul></ul><ul><ul><li>By four months, baby should start to lift head laterally when you pick her up </li></ul></ul>
    25. 25. Exercises 3-6 months <ul><li>Sitting on the ball </li></ul><ul><ul><li>Progressing to lower on the trunk with side to side weight shifts shifts </li></ul></ul><ul><ul><li>By four months old your baby is just starting to develop her side to side control of her trunk and head. You can help facilitate this by moving her on the ball. </li></ul></ul><ul><ul><li>Shapes on the ball, move your baby’s bottom in circles, stars, square etc. </li></ul></ul><ul><li>Prone on the ball – lateral and anterior/posterior weight shifts </li></ul>
    26. 26. Exercises 3-6 months <ul><li>Prone over legs with hands on the floor </li></ul><ul><ul><li>To increase activation of the arms, lift your back leg (the leg farthest from the head of the baby) </li></ul></ul><ul><ul><li>This will facilitate triceps activation, teaches the baby how to push through their hands and works to open up the baby’s hands </li></ul></ul>
    27. 27. <ul><li>Rotation to sitting on your lap </li></ul><ul><ul><li>This exercise is very similar to rotating the baby up to sitting. </li></ul></ul><ul><ul><li>When you are holding a baby after they have been weight bearing through the ground on their hands, facilitate them up to sitting on your lap. This will strengthen their oblique muscles and lateral neck and trunk muscles </li></ul></ul>Exercises 3-6 months
    28. 28. Exercises 3-6 months <ul><li>Facilitation of Rolling </li></ul><ul><ul><li>Rolling from back to front is a really important skill </li></ul></ul><ul><ul><li>It is the first skill where infants become independent with their mobility </li></ul></ul><ul><ul><li>The important thing when helping a baby roll is to WAIT for them to activate their lateral neck muscles </li></ul></ul><ul><ul><li>It is very important to facilitate over both sides </li></ul></ul>
    29. 29. Exercises 3-6 months <ul><li>Sitting practice </li></ul><ul><ul><li>Tripod sitting (sitting with upper extremity support starts at the same time that your baby pushes on her hands on her tummy </li></ul></ul><ul><li>Sitting with 1-2 boppy pillows </li></ul><ul><li>Sitting balance on daycare provider’s lap </li></ul><ul><ul><li>When you are sitting with a baby on your lap, feel free to move your legs up and down, while holding the baby at her trunk slowly to let the baby practice reacting the balance challenges </li></ul></ul>
    30. 30. Hand to feet in supine – rolling side to side <ul><li>Facilitate hands to feet when in supine (on back) </li></ul><ul><ul><li>This also helps to lengthen the hamstrings, activate the abdominal muscles, and lengthen the muscles in the back of the body </li></ul></ul><ul><ul><li>Place toys on baby’s feet to encourage her to get her feet </li></ul></ul><ul><ul><li>Encourage her to eat her toes as this helps to activate the abdominals more and deepen the stretch </li></ul></ul>
    31. 31. Sixth Month <ul><li>Six Months </li></ul><ul><li>Your baby is starting to move around, time to be cautious!! Your baby is now starting to roll from his back to his tummy. He is also sitting independently. Also, your baby really likes his tummy and likes to play on his tummy for a long time. </li></ul>
    32. 32. Seventh Month <ul><li>Seven Months </li></ul><ul><li>Your baby is starting to explore positions where her belly is off the surface. These positions include laying on her side while one hand/arm is supporting and the other is playing. She also is starting to enjoy rocking on her hands and knees with her belly off the surface. She may even be trying to do a pike position where she straightens her legs and brings her bottom toward the ceiling. What a strong little girl! She loves to sit and play and is starting to explore the space to the side of her where she may be just starting to transition to four point independently. </li></ul>
    33. 33. Eighth Month <ul><li>Eight Months </li></ul><ul><li>Your baby is getting very strong. He prefers to play in prone and sitting, and rarely plays on his back anymore. Your baby may be getting well by transitioning from sitting to four point and may even be starting to transition from the floor to sitting on her own. She may be crawling on her belly to get around. This is ok for a short period of time, but soon we want to see her get to her hands and knees to crawl. As your baby becomes more mobile, she will want to explore things that are higher than the floor. This drives her to transition from sitting to her knees at higher surfaces. </li></ul>
    34. 34. Ninth Month <ul><li>Nine Months </li></ul><ul><li>Your baby should be a pro at getting around on her hands and knees and travels this way for long distances. She is loving exploring the world, especially higher surfaces. This drives her to want to climb higher and higher . . . even up the stairs. She may even be pulling to stand at low couches, but she prefers to use her arms more than her legs at this stage. You better get those gates! Your baby is not only sitting in the ring position, but has enough trunk strength that she can sit in a variety of sitting positions including on her heels, side sitting, on a small bench and long sitting. </li></ul>
    35. 35. Exercises to facilitate Development 6-9 months <ul><li>Positioning Suggestions </li></ul><ul><li>Sitting independently, place toys laterally (at side) instead of in front of baby to stimulate lateral movement </li></ul><ul><li>Prone – your baby should love to be in prone and not like supine much anymore </li></ul><ul><li>Do not use exersaucers, johnny jump ups or walkers </li></ul><ul><li>Carrying/Pick Up Suggestions </li></ul><ul><li>Carry upright – encourage baby to hold onto you more as you carry him if he tolerates this </li></ul><ul><li>Rotation to sitting every time you pick up your baby </li></ul><ul><li>Exercise Suggestions </li></ul><ul><li>Ball – sitting on ball progressing to holding at pelvis due to improved trunk control and demanding more activation </li></ul><ul><li>Ball – prone on ball – progressing to more demanding positions where your baby has to lift her head against gravity as she comes closer to the ground and reaches for a toy </li></ul><ul><li>Walking on hands off lap or with a foam roller </li></ul><ul><li>Side sitting with upper extremity weight bearing </li></ul><ul><li>Transitioning to four point </li></ul><ul><li>Four point positioning </li></ul>
    36. 36. Positioning Suggestions 6-9 months <ul><li>Position toys laterally </li></ul><ul><ul><li>This facilitates lateral movement and transitioning from sitting to prone and/or sitting to four point </li></ul></ul><ul><li>Prone </li></ul><ul><ul><li>Your baby should love to be in prone now and prefers sitting and prone over supine </li></ul></ul>
    37. 37. Carrying Suggestions 6-9 months <ul><li>Carry upright </li></ul><ul><ul><li>Encourage baby to hold onto you more as you carry him if he tolerates this now </li></ul></ul>
    38. 38. Pick Up Suggestions 6-9 months <ul><li>Every time you pick a baby up you should rotate him to sitting. </li></ul><ul><ul><li>Your baby should really be helping with this transition now and will be pushing with her arm as she gets up. </li></ul></ul><ul><ul><li>You will also start to see her activate the side of her trunk muscles and her head </li></ul></ul>
    39. 39. Exercises 6-9 months <ul><li>Sitting on the ball </li></ul><ul><ul><li>As your baby gets bigger, she is getting a lot stronger in the trunk and the head </li></ul></ul><ul><ul><li>Hold your baby at her pelvis to demand more trunk activation when sitting on the ball </li></ul></ul><ul><li>Prone on the ball </li></ul><ul><ul><li>Your baby is getting really strong now when in prone, start to challenge her more by bringing her closer to the ground and asking her to pick up toys from the ground </li></ul></ul>
    40. 40. Exercises 6-9 months <ul><li>Walking on hands off lap or with a foam roller </li></ul><ul><ul><li>This exercise will teach your baby how to move their arms forward which will prepare them for forward motion as they learn to crawl </li></ul></ul><ul><ul><li>This exercise also strengthens the shoulder girdle and trunk </li></ul></ul><ul><li>In the first picture, your baby is learning how to accept weight on her hands when gently moved forward at an increased speed (protective extension). </li></ul><ul><li>In the second pictures, your baby is learning how to shift her weight and reach for a toy, and/or move forward a few steps with her hands </li></ul>
    41. 41. Exercises 6-9 months <ul><li>Transitioning to four point </li></ul><ul><ul><li>Your baby needs to feel comfortable placing weight on one arm and slightly lifting her bottom off the floor to reach for a toy before she can go all the way to four point, so practice this first </li></ul></ul><ul><ul><li>As your baby becomes more confident with this, you can facilitate her to go all the way from sitting to four point </li></ul></ul><ul><ul><li>Place your hand on her belly during the transition to help her to remember to activate her belly </li></ul></ul><ul><ul><li>It is absolutely ok to go from sitting to prone, in fact encouraged during this stage, your baby does not have to stop at four point </li></ul></ul>
    42. 42. Exercises 6-9 months <ul><li>Four point positioning </li></ul><ul><ul><li>You may use a foam roll or your leg to keep your baby in a four point position </li></ul></ul><ul><ul><li>When you get her into this position, you may rock her front to back </li></ul></ul><ul><ul><li>Only do what she tolerates </li></ul></ul>
    43. 43. Exercises 6-9 months <ul><li>Transition side sitting to tall kneeling </li></ul><ul><ul><li>This is an important transition as it allows your baby to gain strength of the side of her hip muscles necessary for independent crawling </li></ul></ul><ul><ul><li>You can do this on a roll, your leg or on the side of a couch or a stair </li></ul></ul>
    44. 44. Why creeping is important <ul><li>Hands and knees crawling is the preferred way for babies to get around. </li></ul><ul><ul><li>It takes a lot more strength for a baby to creep on his/her hands and knees than it does to crawl on his belly or scoot on her bottom. </li></ul></ul><ul><ul><li>Typically if a baby is scooting on her bottom to get around or crawling on her belly there is a reason that she is demonstrating this pattern. </li></ul></ul>
    45. 45. Ways to facilitate hands and knees crawling <ul><li>Pushing a small item – while on knees (e.g. stool, phone book) </li></ul><ul><li>Facilitation of creep on hands and knees </li></ul><ul><ul><li>Place your baby on hands and knees. Shift weight posteriorly (backward) so that her belly is on her knees. This decreases the need for increased strength of the upper extremities and provides increased support for the lower extremities and belly </li></ul></ul><ul><ul><li>Move one arm forward and then the opposite leg. Continue to progress </li></ul></ul><ul><ul><li>If your baby likes to extend her legs out, you will need to keep a bit of pressure back with her bottom on her heels to prevent her from extending </li></ul></ul><ul><li>Wheelbarrow walking when moving off your lap (see next) </li></ul><ul><li>Place toys laterally to your baby to facilitate him to transition to the side to get the toys - versus being in front of her </li></ul>
    46. 46. Ninth Month <ul><li>Nine Months </li></ul><ul><li>Your baby should be a pro at getting around on her hands and knees and travels this way for long distances. She is loving exploring the world, especially higher surfaces. This drives her to want to climb higher and higher . . . even up the stairs. She may even be pulling to stand at low couches, but she prefers to use her arms more than her legs at this stage. You better get those gates! Your baby is not only sitting in the ring position, but has enough trunk strength that she can sit in a variety of sitting positions including on her heels, side sitting, on a small bench and long sitting. </li></ul>
    47. 47. Tenth Month <ul><li>Ten Months </li></ul><ul><li>Your baby is really wanting to be upright in standing a lot and he is transitioning to standing using his legs more than his arms. He often chooses to stand via ½ kneel. Your baby now able to lower himself to the floor independently from standing, instead of falling to the floor like he did last month! He is even starting to squat down to pick up a toy from the floor and returning to standing on his own. He is doing a lot of playing in standing, often with his belly off the surface. He is doing a lot of looking from side to side and weight shifting in preparation for cruising next month. </li></ul>
    48. 48. Eleventh Month <ul><li>Eleven Months </li></ul><ul><li>Your baby is starting to cruise along furniture. This is getting exciting! She is becoming very strong with her legs and trunk, such that she is able to occasionally stand without her belly on the surface for a few seconds. She may even start to cruise between objects that are really close. </li></ul>
    49. 49. Twelfth Month <ul><li>Twelve Months </li></ul><ul><li>Your baby is really getting big. You are marvel at her progress as she is standing from the floor independently from the middle of the room and starting to take some steps. She seems clumsy at first as she tries to take a few steps between objects that are a bit further apart, but she is going to very soon become a proficient walker. </li></ul>
    50. 50. Exercises to facilitate Development 9-12 months <ul><li>Positioning Suggestions </li></ul><ul><li>Sitting independently </li></ul><ul><li>Standing at a surface </li></ul><ul><li>Prone – your baby should prefer sitting and standing postures more than prone at this time </li></ul><ul><li>Do not use exersaucers, johnny jump ups or walkers </li></ul><ul><li>Carrying/Pick Up Suggestions </li></ul><ul><li>Carry upright – encourage baby to hold onto you more as you carry him if he tolerates this </li></ul><ul><li>Rotation to sitting every time you pick up your baby </li></ul><ul><li>Exercise Suggestions </li></ul><ul><li>Ball sitting and prone (see 6-9 months) </li></ul><ul><li>Facilitation of crawling up a surface (unstable surface and/or stairs) </li></ul><ul><li>Walking on hands </li></ul><ul><li>½ kneel to stand at a surface </li></ul><ul><li>Squat to stand at a surface </li></ul><ul><li>Four point standing (L shaped) </li></ul><ul><li>Pushing in a four point stand </li></ul><ul><li>Pushing weighted objects </li></ul><ul><li>90/90 sitting on bench or small ball </li></ul><ul><li>Sit to stand from a small bench </li></ul><ul><li>Facilitation of cruising </li></ul><ul><li>Facilitation of floor to stand via plantargrade </li></ul>
    51. 51. Carrying Suggestions 9-12 months <ul><li>Carry upright </li></ul><ul><ul><li>Encourage baby to hold onto you more as you carry him if he tolerates this now </li></ul></ul>
    52. 52. Pick Up Suggestions 9-12 months <ul><li>Every time you pick a baby up you should rotate him to sitting. </li></ul><ul><ul><li>Your baby is likely able to do this transition on her own now and will likely do it for you if your just place your hand on her pelvis or ask her to sit up. </li></ul></ul>
    53. 53. Exercises 9-12 months <ul><li>Sitting on the ball </li></ul><ul><ul><li>As your baby gets bigger, she is getting a lot stronger in the trunk and the head </li></ul></ul><ul><ul><li>Hold your baby at her pelvis to demand more trunk activation when sitting on the ball </li></ul></ul><ul><li>Prone on the ball </li></ul><ul><ul><li>Your baby is getting really strong now when in prone, start to challenge her more by bringing her closer to the ground and asking her to pick up toys from the ground </li></ul></ul>
    54. 54. Exercises 9-12 months <ul><li>Facilitation of crawling/climbing </li></ul><ul><ul><li>Allow your baby to practice crawling up the stairs </li></ul></ul><ul><ul><li>Place a bunch of pillows next to the couch and allow him to climb up the pillows </li></ul></ul><ul><ul><li>Place the ball next to the couch and help him climb up the ball and onto the couch </li></ul></ul><ul><li>Walking on hands </li></ul><ul><ul><li>As your baby wants to get off your lap, gently hold up her pelvis so that she can walk off your lap on her hands. This will strengthen her trunk, gluts and shoulder girdle </li></ul></ul>
    55. 55. Exercises 9-12 months <ul><li>½ kneel to stand at a surface </li></ul><ul><ul><li>Facilitate your baby to bring one leg up when holding onto a surface </li></ul></ul><ul><ul><li>As your baby becomes stronger at pulling to stand, she should no longer be pulling up with arms more than legs, help her up with one leg first </li></ul></ul><ul><ul><li>Be sure to switch legs </li></ul></ul><ul><li>Squat to stand at a surface </li></ul><ul><ul><li>While your baby is holding onto a surface, place a toy on the floor or a stool (which is higher and easier) and encourage her to get the toy </li></ul></ul><ul><ul><li>Help her bend her knees and support her bottom so that she gradually lowers and comes back up to standing </li></ul></ul><ul><li>Four point standing </li></ul><ul><ul><li>Four point standing is when a child is standing with their hands on a lower surface (such as a stool) </li></ul></ul><ul><ul><li>This position makes her really use her abdominal muscles </li></ul></ul><ul><li>Pushing in four point standing </li></ul><ul><ul><li>Encourage her to push an object in this position ( a small trunk, stool, milk crate, telephone book etc.) </li></ul></ul><ul><li>Pushing weighted objects </li></ul><ul><ul><li>Placing bags of rice or beans or heavy balls/weights concealed in push toys are a good way to provide increased resistance for pushing </li></ul></ul><ul><ul><li>This increased resistance provides increased abdominal strengthening and plantarflexor strengthening as well as shoulder girdle strengthening </li></ul></ul><ul><ul><li>If you are available to help, you resist the object as it is coming forward to provide added incentive for your baby </li></ul></ul>
    56. 56. Exercises 9-12 months <ul><li>Bench sitting </li></ul><ul><ul><li>Have your baby sit on a small bench or a small playground ball </li></ul></ul><ul><ul><li>Place toys slightly out of your baby’s reach so that she has to use her trunk to get the item </li></ul></ul>
    57. 57. Exercises 9-12 months <ul><li>Sit to stand at a bench </li></ul><ul><ul><li>When your baby is at the 11-12 month developmental level, she is ready to start working on sit to stand from a bench </li></ul></ul><ul><ul><li>You can provide a target, such as a basketball hoop and a small ball to help her get to standing </li></ul></ul><ul><ul><li>You do not have to facilitate at the arms. You may be able to get the baby to stand by gently tapping at her belly and her bottom as well as providing a good incentive for her to stand to </li></ul></ul><ul><ul><li>It will be more successful at first if you have her stand to a surface such as a couch and later have her stand independently </li></ul></ul>
    58. 58. Exercises 9-12 months <ul><li>Facilitation of cruising </li></ul><ul><ul><li>Your baby is getting very confident now when he is standing at a surface. You now are going to help him move side to side </li></ul></ul><ul><ul><li>Holding onto the pelvis, lift one hand up and press the opposite down </li></ul></ul><ul><ul><li>On the up side, the baby’s leg will lift off the ground and move out </li></ul></ul><ul><ul><li>Then swich hands the up goes down to weight the leg and the down goes up to bring the opposite leg to the standing leg </li></ul></ul><ul><ul><li>Repeat until you get to your destination </li></ul></ul><ul><li>Facilitation of floor to stand via plantargrade </li></ul><ul><ul><li>The best way to facilitate floor to stand is to pair it with a verbal command such as “1-2-THRE-eeeee” </li></ul></ul><ul><ul><li>Each time you facilitate floor to stand you say 1-2-3 (with an emphasis on the THR- EEEE) so that when you want your baby to stand independently and she is able to do it, you just say 1-2-3 and she stands </li></ul></ul><ul><ul><li>In order to faciliate standing, get your baby in hands and knees, her hands must stay on the floor </li></ul></ul><ul><ul><li>Bring one leg up and say 1, the other and say 2 then the bring her weight backwards and slightly up and say THRE-eeee as she stands up by herself . . . Very proud! </li></ul></ul>
    59. 59. Reminders/Disclaimers <ul><li>These exercises are only suggestions for how you can help babies that may be struggling with their developmental skills and how you can progress the strengths of those babies that are even on track </li></ul><ul><li>Please use caution when doing these exercises as you can harm a baby if you do anything too forcefully </li></ul><ul><li>If you suspect a baby is delayed in their development, please let the parents know so the family can receive a proper evaluation with proper and individualized exercise instruction from a qualified pediatric physical therapist </li></ul><ul><li>If you have any questions, please do not hesitate to contact me at [email_address] </li></ul>

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