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How to Help Infants Attain Gross Motor Skills:How to Help Infants Attain Gross Motor Skills:
Practical Ideas for caregivers of infants 0-12 monthsPractical Ideas for caregivers of infants 0-12 months
Julie Wattenberg, PT, MPT, DPTJulie Wattenberg, PT, MPT, DPT
Babies First FitnessBabies First Fitness
www.babiesfirstfitness.comwww.babiesfirstfitness.com
Pediatric Physical Therapist, Early Intervention Credentialed ProviderPediatric Physical Therapist, Early Intervention Credentialed Provider
March 21, 2017March 21, 2017
Goals of today’s lectureGoals of today’s lecture
• You will review the gross motor milestonesYou will review the gross motor milestones
of infants from 0-12 months of ageof infants from 0-12 months of age
• You will learn some easy exercises to helpYou will learn some easy exercises to help
facilitate gross motor milestone attainmentfacilitate gross motor milestone attainment
for infants at different ages/stages offor infants at different ages/stages of
developmentdevelopment
Typical DevelopmentTypical Development
In the First YearIn the First Year
ReminderReminder
• In the following developmental progression,In the following developmental progression,
months are used to detail what an infant shouldmonths are used to detail what an infant should
be doing at each month.be doing at each month.
• However, please think of these as stages inHowever, please think of these as stages in
development. If an infant is not demonstratingdevelopment. If an infant is not demonstrating
gross motor skills at the age reported, thengross motor skills at the age reported, then
please adjust accordingly and use the exerciseplease adjust accordingly and use the exercise
suggestions for a bit longer than the “age”suggestions for a bit longer than the “age”
expectedexpected
First MonthFirst Month
First MonthFirst Month
Your baby is just learning howYour baby is just learning how
to lift and turn her head whento lift and turn her head when
she is on her stomach. She isshe is on her stomach. She is
lengthening out of thelengthening out of the
physiologic flexion that shephysiologic flexion that she
had when she was born. Shehad when she was born. She
is unable to hold her head inis unable to hold her head in
the middle when she is on herthe middle when she is on her
back and has difficultiesback and has difficulties
holding her head up.holding her head up.
Second MonthSecond Month
Two MonthsTwo Months
He is starting to feel a bitHe is starting to feel a bit
floppy. This is because he hasfloppy. This is because he has
lost all of the physiologiclost all of the physiologic
flexion tone. When he is on hisflexion tone. When he is on his
back, he is moving his headback, he is moving his head
side to side and seems to beside to side and seems to be
very limp. When on his tummy,very limp. When on his tummy,
he is not able to hold his headhe is not able to hold his head
in the middle. At this age, hein the middle. At this age, he
is learning how to activate hisis learning how to activate his
muscles on one side or themuscles on one side or the
other, but has troubleother, but has trouble
activating them on both sidesactivating them on both sides
of a joint at the same time.of a joint at the same time.
Three MonthsThree Months
Three MonthsThree Months
Your baby has learned how toYour baby has learned how to
activate their muscles and now isactivate their muscles and now is
starting to learn how to activatestarting to learn how to activate
them together, on either side ofthem together, on either side of
the joint. This means that thethe joint. This means that the
baby is more stable when it comesbaby is more stable when it comes
to head control. Your baby reallyto head control. Your baby really
likes to be in the middle. By threelikes to be in the middle. By three
months your baby should be ablemonths your baby should be able
to hold his head in the middleto hold his head in the middle
when on his back, show a nicewhen on his back, show a nice
chin tuck when on his stomachchin tuck when on his stomach
and have independent headand have independent head
control when held.control when held.
Exercises to facilitateExercises to facilitate
Developmental 0-3 monthsDevelopmental 0-3 months
Positioning SuggestionsPositioning Suggestions
• Large boppy pillow for midline orientation of handsLarge boppy pillow for midline orientation of hands
• Small boppy or rolled towel for proneSmall boppy or rolled towel for prone
Carrying/Pick Up SuggestionsCarrying/Pick Up Suggestions
• Carry in supine, facilitate flexion, not extensionCarry in supine, facilitate flexion, not extension
• Prone carry to improve tummy time – this should be used with caution and should notProne carry to improve tummy time – this should be used with caution and should not
be used with kids who like to extend all the timebe used with kids who like to extend all the time
• Rotation to sitting every time you pick up a babyRotation to sitting every time you pick up a baby
Exercise SuggestionsExercise Suggestions
• Sitting on ball – holding at upper trunkSitting on ball – holding at upper trunk
• Prone on the ball - maintaining elbows under shouldersProne on the ball - maintaining elbows under shoulders
• Bicycles and Abdominal Massage for GasBicycles and Abdominal Massage for Gas
• Lower trunk stretch in supineLower trunk stretch in supine
• Supine in lap with facilitation of hand to hand and hand to mouthSupine in lap with facilitation of hand to hand and hand to mouth
• Side-lying play – elongation of posterior musclesSide-lying play – elongation of posterior muscles
Positioning Suggestions 0-3Positioning Suggestions 0-3
monthsmonths
• Supine (on back) on large boppySupine (on back) on large boppy
pillow or on your lap to facilitatepillow or on your lap to facilitate
midline orientation of handsmidline orientation of hands
– Use rings to bring toys close to baby’s chUse rings to bring toys close to baby’s ch
• Prone with small boppy or rolledProne with small boppy or rolled
towel under chesttowel under chest
– This shifts the baby’s weightThis shifts the baby’s weight
posterior (toward bottom) so thatposterior (toward bottom) so that
she can more effectively lift andshe can more effectively lift and
turn her head.turn her head.
– You can help by placing yourYou can help by placing your
hand on her bottom. This will alsohand on her bottom. This will also
bring the weight backwardbring the weight backward
– Babies should start being on theirBabies should start being on their
tummy from DAY 1 for at least 30tummy from DAY 1 for at least 30
minutes per dayminutes per day
Carrying Suggestions 0-3 monthsCarrying Suggestions 0-3 months
• When you carry a baby, youWhen you carry a baby, you
should always be sure that youshould always be sure that you
are preventing any archingare preventing any arching
– Carry the baby in a flexedCarry the baby in a flexed
position, do not allow the head toposition, do not allow the head to
extendextend
– Flex up and hold one leg so thatFlex up and hold one leg so that
the baby cannot extend.the baby cannot extend.
– This will prevent abnormal muscleThis will prevent abnormal muscle
activation and movement patternsactivation and movement patterns
that so many infants arethat so many infants are
demonstrating nowdemonstrating now
• You can carry a baby in prone andYou can carry a baby in prone and
when they are little this is a greatwhen they are little this is a great
position as they can get thatposition as they can get that
feeling of comfort when being infeeling of comfort when being in
prone.prone.
– However, if you have a child whoHowever, if you have a child who
likes to arch and extend all thelikes to arch and extend all the
time, this is not a good option fortime, this is not a good option for
this child as they get older as theythis child as they get older as they
are demonstrating unbalancedare demonstrating unbalanced
extensionextension
Pick Up Suggestions 0-3Pick Up Suggestions 0-3
monthsmonths
• Every time you pick a baby up you should rotate him to sittingEvery time you pick a baby up you should rotate him to sitting
(click on link for blog post and video)(click on link for blog post and video)
– This helps to strengthen the muscles on the side of the body andThis helps to strengthen the muscles on the side of the body and
the rotational muscles that are important for smooth dissociatedthe rotational muscles that are important for smooth dissociated
movementmovement
Exercises 0 – 3 monthsExercises 0 – 3 months
• Sitting on ball – holding at upper trunkSitting on ball – holding at upper trunk
– The higher you hold a baby at his/herThe higher you hold a baby at his/her
trunk, the less she has to work.trunk, the less she has to work.
Therefore, since a baby from 0-3 monthsTherefore, since a baby from 0-3 months
is not very strong in their head, you willis not very strong in their head, you will
have to hold them higher on their trunkhave to hold them higher on their trunk
• Prone on the ball - maintaining elbowsProne on the ball - maintaining elbows
under shouldersunder shoulders
– The ball is a GREAT place to work onThe ball is a GREAT place to work on
prone skills for babies who have troubleprone skills for babies who have trouble
tolerating prone positioningtolerating prone positioning
– You can move the ball forward and backYou can move the ball forward and back
to increase or decrease the work.to increase or decrease the work.
– Be sure you are providing support at theBe sure you are providing support at the
arms so that the baby learns how to pusharms so that the baby learns how to push
through the surface and is not usingthrough the surface and is not using
unbalanced extensionunbalanced extension
– You can use this trick on the floor to inYou can use this trick on the floor to in
facilitate the baby learning to pushfacilitate the baby learning to push
through the surfacethrough the surface
Exercises 0-3 monthsExercises 0-3 months
• BicyclesBicycles
– Bicycles help with gas asBicycles help with gas as
well with improving rotationwell with improving rotation
of the pelvisof the pelvis
• Abdominal MassageAbdominal Massage
– Abdominal massage also helps wAbdominal massage also helps w
– Strokes include: I love you, waterStrokes include: I love you, water
(click on link for blog post(click on link for blog post
regarding abdominalregarding abdominal
massage)massage)
Exercises 0-3 monthsExercises 0-3 months
• Lower trunk stretchLower trunk stretch
– This helps to lengthen theThis helps to lengthen the
muscles of the lower backmuscles of the lower back
and upper back, especiallyand upper back, especially
for babies who are prone tofor babies who are prone to
extension posturesextension postures
– This also helps to facilitateThis also helps to facilitate
activation of the abdominals.activation of the abdominals.
– Place your hand under thePlace your hand under the
low back and maintain thislow back and maintain this
position. Place toys onposition. Place toys on
baby’s feet to attractbaby’s feet to attract
attention to her feetattention to her feet
Exercises 0-3 monthsExercises 0-3 months
• Supine on lap withSupine on lap with
facilitation of hand tofacilitation of hand to
hand and hand to mouthhand and hand to mouth
– Hand to hand and hand toHand to hand and hand to
mouth are very importantmouth are very important
skills for a baby to haveskills for a baby to have
– It helps a baby learn to selfIt helps a baby learn to self
calm and is foundational forcalm and is foundational for
later skillslater skills
Exercises 0-3 monthsExercises 0-3 months
• Side-lying playSide-lying play
– Side-lying play is good forSide-lying play is good for
babies who are prone tobabies who are prone to
extension.extension.
– This position lengthens theThis position lengthens the
muscles in the back of theirmuscles in the back of their
bodybody
– This position also allows theThis position also allows the
baby to active their arms andbaby to active their arms and
legs without significant gravitylegs without significant gravity
implicationsimplications
– You may use massage in thisYou may use massage in this
position and bring your handposition and bring your hand
from the middle of the backfrom the middle of the back
towards the wrist as well astowards the wrist as well as
the middle of the bottomthe middle of the bottom
toward the ankle. This willtoward the ankle. This will
help to facilitate elongation ofhelp to facilitate elongation of
the posterior muscles (backthe posterior muscles (back
muscles)muscles)
Three MonthsThree Months
Three MonthsThree Months
Your baby has learned how toYour baby has learned how to
activate their muscles and now isactivate their muscles and now is
starting to learn how to activatestarting to learn how to activate
them together, on either side ofthem together, on either side of
the joint. This means that thethe joint. This means that the
baby is more stable when it comesbaby is more stable when it comes
to head control. Your baby reallyto head control. Your baby really
likes to be in the middle. By threelikes to be in the middle. By three
months your baby should be ablemonths your baby should be able
to hold his head in the middleto hold his head in the middle
when on his back, show a nicewhen on his back, show a nice
chin tuck when on his stomachchin tuck when on his stomach
and have independent headand have independent head
control when held.control when held.
Four MonthsFour Months
Fourth MonthFourth Month
Your baby is getting really strong intoYour baby is getting really strong into
flexion off the surface. This is notflexion off the surface. This is not
because they have spent so muchbecause they have spent so much
time on their back that they are gettingtime on their back that they are getting
better at flexor strength, it is becausebetter at flexor strength, it is because
they have spent so much time on theirthey have spent so much time on their
belly that they gained strength in theirbelly that they gained strength in their
flexor muscles by pushing through theflexor muscles by pushing through the
ground. When your baby is on herground. When your baby is on her
back, she is able to bring her arms offback, she is able to bring her arms off
the surface and her feet off the surfacethe surface and her feet off the surface
and often is able to tough her knees.and often is able to tough her knees.
Sometimes, it is hard for her to staySometimes, it is hard for her to stay
here, though, and she falls to her side.here, though, and she falls to her side.
When she falls to her side, she is justWhen she falls to her side, she is just
learning how to activate her muscleslearning how to activate her muscles
on the side of her neck, so she mighton the side of her neck, so she might
lift her head off the surface when onlift her head off the surface when on
her side. Your baby should feel reallyher side. Your baby should feel really
confident on her tummy now andconfident on her tummy now and
should be able to tolerate it withoutshould be able to tolerate it without
fuss for at least 3-5 minutes at a time.fuss for at least 3-5 minutes at a time.
Five MonthsFive Months
Five MonthsFive Months
Your infant is really starting toYour infant is really starting to
move. On his back, he hasmove. On his back, he has
gained more strength in his bellygained more strength in his belly
to bring his pelvis off the floor andto bring his pelvis off the floor and
reach for his feet. This helps toreach for his feet. This helps to
lengthen the hamstrings andlengthen the hamstrings and
strengthen the abdominal musclesstrengthen the abdominal muscles
to prepare him to sit. On histo prepare him to sit. On his
tummy, your baby is doing a greattummy, your baby is doing a great
job pushing up on his hands andjob pushing up on his hands and
in sitting, your baby is able to propin sitting, your baby is able to prop
sit. All of this pushing andsit. All of this pushing and
reaching for his feet, teaches yourreaching for his feet, teaches your
baby how to use his triceps, thebaby how to use his triceps, the
muscle on the back of his arm.muscle on the back of his arm.
This means that when on hisThis means that when on his
back, your baby is becoming reallyback, your baby is becoming really
good at reaching for toys.good at reaching for toys.
Sixth MonthSixth Month
Six MonthsSix Months
Your baby is starting toYour baby is starting to
move around, time to bemove around, time to be
cautious!! Your baby iscautious!! Your baby is
now starting to roll fromnow starting to roll from
his back to his tummy.his back to his tummy.
He is also sittingHe is also sitting
independently. Yourindependently. Your
baby also really likes hisbaby also really likes his
tummy and likes to playtummy and likes to play
on his tummy for a longon his tummy for a long
time.time.
Exercises to facilitate DevelopmentExercises to facilitate Development
3-6 months3-6 months
Positioning SuggestionsPositioning Suggestions
• Supine with large boppy pillow under bottom to facilitate abdominal activaiton and hands to knees/feetSupine with large boppy pillow under bottom to facilitate abdominal activaiton and hands to knees/feet
• Prone positioning continues for at least 30 minutes per dayProne positioning continues for at least 30 minutes per day
• Supine on a large boppy pillow to facilitate reaching and bringing the arms forward if baby is having difficultiesSupine on a large boppy pillow to facilitate reaching and bringing the arms forward if baby is having difficulties
with this stillwith this still
• Do not use exersaucers, johnny jump ups or walkersDo not use exersaucers, johnny jump ups or walkers
Carrying/Pick Up SuggestionsCarrying/Pick Up Suggestions
• Carry in supine, facilitate flexion, not extensionCarry in supine, facilitate flexion, not extension
• Prone carry to improve tummy time – this should be used with caution and should not be used with kids who likeProne carry to improve tummy time – this should be used with caution and should not be used with kids who like
to extend all the timeto extend all the time
• Rotation to sitting every time you pick up a babyRotation to sitting every time you pick up a baby
Exercise SuggestionsExercise Suggestions
• Sitting on the ball – progressing to lower on the trunk – side to side weight shiftsSitting on the ball – progressing to lower on the trunk – side to side weight shifts
• Prone on the ball – progressing to side to side weight shiftsProne on the ball – progressing to side to side weight shifts
• Prone on hands off your lapProne on hands off your lap
• Rotation to sitting on your lapRotation to sitting on your lap
• Facilitation of rollingFacilitation of rolling
• Sitting practice with/without boppy pillowSitting practice with/without boppy pillow
• Sitting balance on daycare provider’s lap with weight shiftSitting balance on daycare provider’s lap with weight shift
• Hand to feet in supine – rolling side to sideHand to feet in supine – rolling side to side
Positioning Suggestions 3-6Positioning Suggestions 3-6
monthsmonths
• Supine (on back) with large boppySupine (on back) with large boppy
pillow under bottom.pillow under bottom.
– Place toys on a play gym on rings toPlace toys on a play gym on rings to
bring them close to baby’s feet so thatbring them close to baby’s feet so that
he kicks the toys independentlyhe kicks the toys independently
– This will help to strengthen his bellyThis will help to strengthen his belly
musclesmuscles
• Supine with boppy pillow underSupine with boppy pillow under
shouldersshoulders
– This will bring arms towards the toys.This will bring arms towards the toys.
– Use rings to bring the toys down closer to the baby so accidental movements will result in batting ofUse rings to bring the toys down closer to the baby so accidental movements will result in batting of
– Decrease use of the boppy when babyDecrease use of the boppy when baby
is able to reach for toys independentlyis able to reach for toys independently
when in supine (usually around 5when in supine (usually around 5
months)months)
• Prone positioningProne positioning
– At least 30 minutes per dayAt least 30 minutes per day
– Baby should be able to tolerate proneBaby should be able to tolerate prone
positioning without the blanket rollpositioning without the blanket roll
– Baby’s tolerance for prone should beBaby’s tolerance for prone should be
increasingincreasing
Carrying Suggestions 3-6 monthsCarrying Suggestions 3-6 months
• When you carry a baby, youWhen you carry a baby, you
should always be sure that youshould always be sure that you
are preventing any archingare preventing any arching
– Carry the baby in a flexedCarry the baby in a flexed
position, do not allow the head toposition, do not allow the head to
extendextend
– Flex up and hold one leg so thatFlex up and hold one leg so that
the baby cannot extend.the baby cannot extend.
– This will prevent abnormal muscleThis will prevent abnormal muscle
activation and movement patternsactivation and movement patterns
that so many infants arethat so many infants are
demonstrating nowdemonstrating now
• You can carry a baby in prone andYou can carry a baby in prone and
when they are little this is a greatwhen they are little this is a great
position as they can get thatposition as they can get that
feeling of comfort when being infeeling of comfort when being in
prone.prone.
– However, if you have a child whoHowever, if you have a child who
likes to arch and extend all thelikes to arch and extend all the
time, this is not a good option fortime, this is not a good option for
this child as they get older as theythis child as they get older as they
are demonstrating unbalancedare demonstrating unbalanced
extensionextension
Pick Up Suggestions 3-6Pick Up Suggestions 3-6
monthsmonths
• Every time you pick a baby up you should rotate him to sittingEvery time you pick a baby up you should rotate him to sitting
– This helps to strengthen the muscles on the side of the body and the rThis helps to strengthen the muscles on the side of the body and the r
– By four months, baby should start to lift head laterally when youBy four months, baby should start to lift head laterally when you
pick her uppick her up
Exercises 3-6 monthsExercises 3-6 months
• Sitting on the ballSitting on the ball
– Progressing to lower on the trunk with side to side weight shifts shiftsProgressing to lower on the trunk with side to side weight shifts shifts
– By four months old your baby is just starting to develop her side to side control ofBy 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.her trunk and head. You can help facilitate this by moving her on the ball.
– Shapes on the ball, move your baby’s bottom in circles, stars, square etc.Shapes on the ball, move your baby’s bottom in circles, stars, square etc.
• Prone on the ball – lateral and anterior/posterior weight shiftsProne on the ball – lateral and anterior/posterior weight shifts
Exercises 3-6 monthsExercises 3-6 months
• Prone over legs withProne over legs with
hands on the floorhands on the floor
– To increase activation ofTo increase activation of
the arms, lift your back legthe arms, lift your back leg
(the leg farthest from the(the leg farthest from the
head of the baby)head of the baby)
– This will facilitate tricepsThis will facilitate triceps
activation, teaches theactivation, teaches the
baby how to push throughbaby how to push through
their hands and works totheir hands and works to
open up the baby’s handsopen up the baby’s hands
• Rotation to sitting on your lapRotation to sitting on your lap
– This exercise is very similar to rotating the baby up to sitting.This exercise is very similar to rotating the baby up to sitting.
– When you are holding a baby after they have been weight bearingWhen you are holding a baby after they have been weight bearing
through the ground on their hands, facilitate them up to sitting on yourthrough the ground on their hands, facilitate them up to sitting on your
lap. This will strengthen their oblique muscles and lateral neck andlap. This will strengthen their oblique muscles and lateral neck and
trunk musclestrunk muscles
– Another option of this exercise is observed in this video and blogpost from babAnother option of this exercise is observed in this video and blogpost from bab
Exercises 3-6 monthsExercises 3-6 months
Exercises 3-6 monthsExercises 3-6 months
• Facilitation of RollingFacilitation of Rolling
– Rolling from back toRolling from back to
front is a really importantfront is a really important
skillskill
– It is the first skill whereIt is the first skill where
infants becomeinfants become
independent with theirindependent with their
mobilitymobility
– The important thingThe important thing
when helping a baby rollwhen helping a baby roll
is to WAIT for them tois to WAIT for them to
activate their lateral neckactivate their lateral neck
musclesmuscles
– It is very important toIt is very important to
facilitate over both sidesfacilitate over both sides
Exercises 3-6 monthsExercises 3-6 months
• Sitting practiceSitting practice
– Tripod sitting (sitting withTripod sitting (sitting with
upper extremity support startsupper extremity support starts
at the same time that yourat the same time that your
baby pushes on her hands onbaby pushes on her hands on
her tummyher tummy
• Sitting with 1-2 boppy pillowsSitting with 1-2 boppy pillows
• Sitting balance on caregiversSitting balance on caregivers
laplap
– When you are sitting with aWhen you are sitting with a
baby on your lap, feel free tobaby on your lap, feel free to
move your legs up and down,move your legs up and down,
one side at a time, whileone side at a time, while
holding the baby at her trunkholding the baby at her trunk
slowly to let the baby practiceslowly to let the baby practice
reacting the balancereacting the balance
challengeschallenges
Hand to feet in supine – rolling side to sideHand to feet in supine – rolling side to side
• Facilitate hands to feetFacilitate hands to feet
when in supine (on back)when in supine (on back)
– This also helps to lengthenThis also helps to lengthen
the hamstrings, activate thethe hamstrings, activate the
abdominal muscles, andabdominal muscles, and
lengthen the muscles in thelengthen the muscles in the
back of the bodyback of the body
– Place toys on baby’s feet toPlace toys on baby’s feet to
encourage her to get herencourage her to get her
feetfeet
– Encourage her to eat herEncourage her to eat her
toes as this helps totoes as this helps to
activate the abdominalsactivate the abdominals
increase the hamstring theincrease the hamstring the
stretchstretch
Sixth MonthSixth Month
Six MonthsSix Months
Your baby is starting to moveYour baby is starting to move
around, time to be cautious!!around, time to be cautious!!
Your baby is now starting toYour baby is now starting to
roll from his back to hisroll from his back to his
tummy. He is also sittingtummy. He is also sitting
independently. Also, yourindependently. Also, your
baby really likes his tummybaby really likes his tummy
and likes to play on hisand likes to play on his
tummy for a long time.tummy for a long time.
Seventh MonthSeventh Month
Seven MonthsSeven Months
Your baby is starting to exploreYour baby is starting to explore
positions where her belly is off thepositions where her belly is off the
surface. These positions includesurface. These positions include
laying on her side while onelaying on her side while one
hand/arm is supporting and thehand/arm is supporting and the
other is playing. She also isother is playing. She also is
starting to enjoy rocking on herstarting to enjoy rocking on her
hands and knees with her belly offhands and knees with her belly off
the surface. She may even bethe surface. She may even be
trying to do a pike position wheretrying to do a pike position where
she straightens her legs andshe straightens her legs and
brings her bottom toward thebrings her bottom toward the
ceiling (down dog). What a strongceiling (down dog). What a strong
little girl! She loves to sit and playlittle girl! She loves to sit and play
and is starting to explore theand is starting to explore the
space to the side of her where shespace to the side of her where she
may be just starting to transition tomay be just starting to transition to
four point independently.four point independently.
Eighth MonthEighth Month
Eight MonthsEight Months
Your baby is getting very strong.Your baby is getting very strong.
He prefers to play in prone andHe prefers to play in prone and
sitting, and rarely plays on hissitting, and rarely plays on his
back anymore. Your baby may beback anymore. Your baby may be
getting well by transitioning fromgetting well by transitioning from
sitting to four point and may evensitting to four point and may even
be starting to transition from thebe starting to transition from the
floor to sitting on his own. He mayfloor to sitting on his own. He may
be crawling on his belly to getbe crawling on his belly to get
around. This is ok for a shortaround. This is ok for a short
period of time, but soon we wantperiod of time, but soon we want
to see him get to his hands andto see him get to his hands and
knees to crawl. As your babyknees to crawl. As your baby
becomes more mobile, he willbecomes more mobile, he will
want to explore things that arewant to explore things that are
higher than the floor. This driveshigher than the floor. This drives
him to transition from sitting to hishim to transition from sitting to his
knees at higher surfaces.knees at higher surfaces.
Ninth MonthNinth Month
Nine MonthsNine Months
Your baby should be a pro at gettingYour baby should be a pro at getting
around on her hands and knees andaround on her hands and knees and
travels this way for long distances.travels this way for long distances.
She is loving exploring the world,She is loving exploring the world,
especially higher surfaces. This drivesespecially higher surfaces. This drives
her to want to climb higher and higher .her to want to climb higher and higher .
. . even up the stairs. She may even. . even up the stairs. She may even
be pulling to stand at low couches, butbe pulling to stand at low couches, but
she prefers to use her arms more thanshe prefers to use her arms more than
her legs at this stage. You better gether legs at this stage. You better get
those gates! Your baby is not onlythose gates! Your baby is not only
sitting in the ring position, but hassitting in the ring position, but has
enough trunk strength that she can sitenough trunk strength that she can sit
in a variety of sitting positionsin a variety of sitting positions
including on her heels, side sitting, onincluding on her heels, side sitting, on
a small bench and long sitting.a small bench and long sitting.
Exercises to facilitate DevelopmentExercises to facilitate Development
6-9 months6-9 months
Positioning SuggestionsPositioning Suggestions
• Sitting independently, place toys laterally (at side) instead of in front of baby to stimulate lateral movemenSitting independently, place toys laterally (at side) instead of in front of baby to stimulate lateral movemen
(click link for a video)(click link for a video)
• Prone – your baby should love to be in prone and not like supine (back) much anymoreProne – your baby should love to be in prone and not like supine (back) much anymore
• Do not use exersaucers, johnny jump ups or walkersDo not use exersaucers, johnny jump ups or walkers
Carrying/Pick Up SuggestionsCarrying/Pick Up Suggestions
• Carry upright – encourage baby to hold onto you more as you carry him if he tolerates thisCarry upright – encourage baby to hold onto you more as you carry him if he tolerates this
• Rotation to sitting every time you pick up your babyRotation to sitting every time you pick up your baby (click link for a video)(click link for a video)
Exercise SuggestionsExercise Suggestions
• Ball – sitting on ball progressing to holding at pelvis due to improved trunk control and demandingBall – sitting on ball progressing to holding at pelvis due to improved trunk control and demanding
more activationmore activation
• Ball – prone on ball – progressing to more demanding positions where your baby has to lift herBall – 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 toyhead against gravity as she comes closer to the ground and reaches for a toy
• Walking on hands off lap or with a foam rollerWalking on hands off lap or with a foam roller
• Side sitting with upper extremity weight bearingSide sitting with upper extremity weight bearing
• Transitioning to four point (click on link for blog post)Transitioning to four point (click on link for blog post)
• Four point positioningFour point positioning
Positioning Suggestions 6-9Positioning Suggestions 6-9
monthsmonths
• Position toys laterallyPosition toys laterally
– This facilitates lateralThis facilitates lateral
movement and transitioningmovement and transitioning
from sitting to prone and/orfrom sitting to prone and/or
sitting to four point (click onsitting to four point (click on
link for blogpost)link for blogpost)
• ProneProne
– Your baby should love to be inYour baby should love to be in
prone now and prefers sittingprone now and prefers sitting
and prone over supineand prone over supine
Carrying Suggestions 6-9 monthsCarrying Suggestions 6-9 months
• Carry uprightCarry upright
• Encourage baby toEncourage baby to
hold onto you more ashold onto you more as
you carry him if heyou carry him if he
tolerates this nowtolerates this now
Pick Up Suggestions 6-9Pick Up Suggestions 6-9
monthsmonths
• Every time you pick a baby up you should rotate him toEvery time you pick a baby up you should rotate him to
sitting. (click on link for video)sitting. (click on link for video)
– Your baby should really be helping with this transition now andYour baby should really be helping with this transition now and
will be pushing with her arm as she gets up.will be pushing with her arm as she gets up.
– You will also start to see her activate the side of her trunkYou will also start to see her activate the side of her trunk
muscles and her headmuscles and her head
Exercises 6-9 monthsExercises 6-9 months
• Sitting on the ballSitting on the ball
– As your baby gets bigger, sheAs your baby gets bigger, she
is getting a lot stronger in theis getting a lot stronger in the
trunk and the headtrunk and the head
– Hold your baby at her pelvis toHold your baby at her pelvis to
demand more trunk activationdemand more trunk activation
when sitting on the ballwhen sitting on the ball
• Prone on the ballProne on the ball
– Your baby is getting reallyYour baby is getting really
strong now when in prone,strong now when in prone,
start to challenge her more bystart to challenge her more by
bringing her closer to thebringing her closer to the
ground and asking her to pickground and asking her to pick
up toys from the groundup toys from the ground
Exercises 6-9 monthsExercises 6-9 months
• Walking on hands off lap or with aWalking on hands off lap or with a
foam roller (or a rolled up yoga mat)foam roller (or a rolled up yoga mat)
– This exercise will teach your baby howThis exercise will teach your baby how
to move their arms forward which willto move their arms forward which will
prepare them for forward motion asprepare them for forward motion as
they learn to crawlthey learn to crawl
– This exercise also strengthens theThis exercise also strengthens the
shoulder girdle and trunkshoulder girdle and trunk
• In the first picture, your baby isIn the first picture, your baby is
learning how to accept weight on herlearning how to accept weight on her
hands when gently moved forward athands when gently moved forward at
an increased speed (protectivean increased speed (protective
extension).extension).
• In the second pictures, your baby isIn the second pictures, your baby is
learning how to shift her weight andlearning how to shift her weight and
reach for a toy, and/or move forward areach for a toy, and/or move forward a
few steps with her handsfew steps with her hands
Exercises 6-9 monthsExercises 6-9 months
• Transitioning to four pointTransitioning to four point
– Your baby needs to feelYour baby needs to feel
comfortable placing weight on onecomfortable placing weight on one
arm and slightly lifting her bottomarm and slightly lifting her bottom
off the floor to reach for a toyoff the floor to reach for a toy
before she can go all the way tobefore she can go all the way to
four point, so practice this firstfour point, so practice this first
– As your baby becomes moreAs your baby becomes more
confident with this, you canconfident with this, you can
facilitate her to go all the way fromfacilitate her to go all the way from
sitting to four pointsitting to four point
– Place your hand on her bellyPlace your hand on her belly
during the transition to help her toduring the transition to help her to
remember to activate her bellyremember to activate her belly
– It is absolutely ok to go fromIt is absolutely ok to go from
sitting to prone, in factsitting to prone, in fact
encouraged during this stage,encouraged during this stage,
your baby does not have to stopyour baby does not have to stop
at four pointat four point
Exercises 6-9 monthsExercises 6-9 months
• Four point positioningFour point positioning
– You may use a foam rollYou may use a foam roll
or your leg to keep youror your leg to keep your
baby in a four pointbaby in a four point
positionposition
– When you get her intoWhen you get her into
this position, you maythis position, you may
rock her front to backrock her front to back
– Only do what sheOnly do what she
toleratestolerates
Exercises 6-9 monthsExercises 6-9 months
• Transition side sitting toTransition side sitting to
tall kneelingtall kneeling
– This is an importantThis is an important
transition as it allows yourtransition as it allows your
baby to gain strength of thebaby to gain strength of the
side of her hip musclesside of her hip muscles
necessary for independentnecessary for independent
crawlingcrawling
– You can do this on a roll,You can do this on a roll,
your leg or on the side of ayour leg or on the side of a
couch or a staircouch or a stair
Why creeping is importantWhy creeping is important
Hands and knees crawling is theHands and knees crawling is the
preferred way for babies to get around.preferred way for babies to get around.
– It takes a lot more strength for aIt takes a lot more strength for a
baby to creep on his/her handsbaby to creep on his/her hands
and knees than it does to crawl onand knees than it does to crawl on
his belly or scoot on her bottom.his belly or scoot on her bottom.
– Typically if a baby is scooting onTypically if a baby is scooting on
her bottom to get around orher bottom to get around or
crawling on her belly there is acrawling on her belly there is a
reason that she is demonstratingreason that she is demonstrating
this pattern, including but notthis pattern, including but not
limited to poor core strength, poorlimited to poor core strength, poor
shoulder girdle strength andshoulder girdle strength and
stability, muscle imbalance,stability, muscle imbalance,
asymmetrical head position.asymmetrical head position.
Ways to facilitate hands and kneesWays to facilitate hands and knees
crawlingcrawling
• Pushing a small item – while on knees (e.g. stool, phone book)Pushing a small item – while on knees (e.g. stool, phone book)
• Facilitation of creep on hands and kneesFacilitation of creep on hands and knees
– Place your baby on hands and knees. Shift weight posteriorly (backward) so that her belly isPlace 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 andon her knees. This decreases the need for increased strength of the upper extremities and
provides increased support for the lower extremities and bellyprovides increased support for the lower extremities and belly
– Move one arm forward and then the opposite leg. Continue to progressMove one arm forward and then the opposite leg. Continue to progress
– If your baby likes to extend her legs out, you will need to keep a bit of pressure back withIf 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 extendingher bottom on her heels to prevent her from extending
• Wheelbarrow walking when moving off your lap (see next)Wheelbarrow walking when moving off your lap (see next)
• Place toys laterally to your baby to facilitate him to transition to the side to get thePlace toys laterally to your baby to facilitate him to transition to the side to get the
toys - versus being in front of her (click on link for blog post)toys - versus being in front of her (click on link for blog post)
Ninth MonthNinth Month
Nine MonthsNine Months
Your baby should be a pro at gettingYour baby should be a pro at getting
around on her hands and knees andaround on her hands and knees and
travels this way for long distances.travels this way for long distances.
She is loving exploring the world,She is loving exploring the world,
especially higher surfaces. This drivesespecially higher surfaces. This drives
her to want to climb higher and higher .her to want to climb higher and higher .
. . even up the stairs. She may even. . even up the stairs. She may even
be pulling to stand at low couches, butbe pulling to stand at low couches, but
she prefers to use her arms more thanshe prefers to use her arms more than
her legs at this stage. You better gether legs at this stage. You better get
those gates! Your baby is not onlythose gates! Your baby is not only
sitting in the ring position, but hassitting in the ring position, but has
enough trunk strength that she can sitenough trunk strength that she can sit
in a variety of sitting positionsin a variety of sitting positions
including on her heels, side sitting, onincluding on her heels, side sitting, on
a small bench and long sitting.a small bench and long sitting.
Tenth MonthTenth Month
Ten MonthsTen Months
Your baby is really wanting to beYour baby is really wanting to be
upright in standing and he isupright in standing and he is
transitioning to standing using histransitioning to standing using his
legs more than his arms. He oftenlegs more than his arms. He often
chooses to stand via ½ kneel.chooses to stand via ½ kneel.
Your baby now able to lowerYour baby now able to lower
himself to the floor independentlyhimself to the floor independently
from standing, instead of falling tofrom standing, instead of falling to
the floor like he did last month!the floor like he did last month!
He is even starting to squat downHe is even starting to squat down
to pick up a toy from the floor andto pick up a toy from the floor and
returning to standing on his own.returning to standing on his own.
He is doing a lot of playing inHe is doing a lot of playing in
standing, often with his belly offstanding, often with his belly off
the surface. He is doing a lot ofthe surface. He is doing a lot of
looking from side to side andlooking from side to side and
weight shifting in preparation forweight shifting in preparation for
cruising next month.cruising next month.
Eleventh MonthEleventh Month
Eleven MonthsEleven Months
Your baby is starting to cruiseYour baby is starting to cruise
along furniture (sidewaysalong furniture (sideways
walking). This is gettingwalking). This is getting
exciting! She is becoming veryexciting! She is becoming very
strong with her legs and trunk,strong with her legs and trunk,
such that she is able tosuch that she is able to
occasionally stand without heroccasionally stand without her
belly on the surface for a fewbelly on the surface for a few
seconds. She may even startseconds. She may even start
to cruise between objects thatto cruise between objects that
are really close.are really close.
Twelfth MonthTwelfth Month
Twelve MonthsTwelve Months
Your baby is really getting big.Your baby is really getting big.
You are marvel at her progressYou are marvel at her progress
as she is standing from theas she is standing from the
floor independently from thefloor independently from the
middle of the room and startingmiddle of the room and starting
to take some steps. Sheto take some steps. She
seems clumsy at first as sheseems clumsy at first as she
tries to take a few stepstries to take a few steps
between objects that are a bitbetween objects that are a bit
further apart, but she is goingfurther apart, but she is going
to very soon become ato very soon become a
proficient walker.proficient walker.
Exercises to facilitate DevelopmentExercises to facilitate Development
9-12 months9-12 months
Positioning SuggestionsPositioning Suggestions
• Sitting independentlySitting independently
• Standing at a surfaceStanding at a surface
• Prone – your baby should prefer sitting and standing postures more than prone at this timeProne – your baby should prefer sitting and standing postures more than prone at this time
• Do not use exersaucers, johnny jump ups or walkersDo not use exersaucers, johnny jump ups or walkers
Carrying/Pick Up SuggestionsCarrying/Pick Up Suggestions
• Carry upright – encourage baby to hold onto you more as you carry him if he tolerates thisCarry upright – encourage baby to hold onto you more as you carry him if he tolerates this
• Rotation to sitting every time you pick up your baby (click on link for video)Rotation to sitting every time you pick up your baby (click on link for video)
Exercise SuggestionsExercise Suggestions
• Ball sitting and prone (see 6-9 months)Ball sitting and prone (see 6-9 months)
• Facilitation of crawling up a surface (unstable surface and/or stairs)Facilitation of crawling up a surface (unstable surface and/or stairs)
• Walking on handsWalking on hands
• ½ kneel to stand at a surface½ kneel to stand at a surface
• Squat to stand at a surfaceSquat to stand at a surface
• Four point standing (L shaped)Four point standing (L shaped)
• Pushing in a four point standPushing in a four point stand
• Pushing weighted objects (click on link for blog post)Pushing weighted objects (click on link for blog post)
• 90/90 sitting on bench or small ball90/90 sitting on bench or small ball
• Sit to stand from a small benchSit to stand from a small bench
• Facilitation of cruisingFacilitation of cruising
• Facilitation of floor to stand via plantargradeFacilitation of floor to stand via plantargrade
Carrying Suggestions 9-12 monthsCarrying Suggestions 9-12 months
• Carry uprightCarry upright
• Encourage baby toEncourage baby to
hold onto you more ashold onto you more as
you carry him if heyou carry him if he
tolerates this nowtolerates this now
Pick Up Suggestions 9-12 monthsPick Up Suggestions 9-12 months
• Every time you pick a baby up you should rotateEvery time you pick a baby up you should rotate
him to sitting. (click on link for video)him to sitting. (click on link for video)
– Your baby is likely able to do this transition on herYour baby is likely able to do this transition on her
own now and will likely do it for you if your just placeown now and will likely do it for you if your just place
your hand on her pelvis or ask her to sit up.your hand on her pelvis or ask her to sit up.
Exercises 9-12 monthsExercises 9-12 months
• Sitting on the ballSitting on the ball
– As your baby gets bigger, sheAs your baby gets bigger, she
is getting a lot stronger in theis getting a lot stronger in the
trunk and the headtrunk and the head
– Hold your baby at her pelvis toHold your baby at her pelvis to
demand more trunk activationdemand more trunk activation
when sitting on the ballwhen sitting on the ball
• Prone on the ballProne on the ball
– Your baby is getting reallyYour baby is getting really
strong now when in prone,strong now when in prone,
start to challenge her more bystart to challenge her more by
bringing her closer to thebringing her closer to the
ground and asking her to pickground and asking her to pick
up toys from the groundup toys from the ground
Exercises 9-12 monthsExercises 9-12 months
• Facilitation of crawling/climbingFacilitation of crawling/climbing
– Allow your baby to practice crawling up the stairsAllow your baby to practice crawling up the stairs
– Place a bunch of pillows next to the couch and allow him to climb up the pillowsPlace a bunch of pillows next to the couch and allow him to climb up the pillows
– Place the ball next to the couch and help him climb up the ball and onto the couchPlace the ball next to the couch and help him climb up the ball and onto the couch
• Walking on handsWalking on hands
– As your baby wants to get off your lap, gently hold up her pelvis so that she can walk offAs 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 girdleyour lap on her hands. This will strengthen her trunk, gluts and shoulder girdle
Exercises 9-12 monthsExercises 9-12 months
• ½ kneel to stand at a surface½ kneel to stand at a surface
– Facilitate your baby to bring one leg up when holding onto a surfaceFacilitate your baby to bring one leg up when holding onto a surface
– As your baby becomes stronger at pulling to stand, she should no longer be pulling up withAs 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 firstarms more than legs, help her up with one leg first
– Be sure to switch legsBe sure to switch legs
• Squat to stand at a surfaceSquat to stand at a surface
– While your baby is holding onto a surface, place a toy on the floor or a stool (which is higherWhile 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 toyand easier) and encourage her to get the toy
– Help her bend her knees and support her bottom so that she gradually lowers and comesHelp her bend her knees and support her bottom so that she gradually lowers and comes
back up to standingback up to standing
• Four point standingFour point standing
– Four point standing is when a child is standing with their hands on a lower surface (such asFour point standing is when a child is standing with their hands on a lower surface (such as
a stool)a stool)
– This position makes her really use her abdominal musclesThis position makes her really use her abdominal muscles
• Pushing in four point standingPushing in four point standing
– Encourage her to push an object in this position ( a small truck, stool, milk crate, telephoneEncourage her to push an object in this position ( a small truck, stool, milk crate, telephone
book, diaper box etc.)book, diaper box etc.)
– See blog post – the power of pushingSee blog post – the power of pushing
• Pushing weighted objects in standingPushing weighted objects in standing
– Placing bags of rice or beans or heavy balls/weights concealed in push toys are a good wayPlacing bags of rice or beans or heavy balls/weights concealed in push toys are a good way
to provide increased resistance for pushingto provide increased resistance for pushing
– This increased resistance provides increased abdominal strengthening and plantarflexorThis increased resistance provides increased abdominal strengthening and plantarflexor
strengthening as well as shoulder girdle strengtheningstrengthening as well as shoulder girdle strengthening
– If you are available to help, you resist the object as it is coming forward to provide addedIf you are available to help, you resist the object as it is coming forward to provide added
incentive for your babyincentive for your baby
Exercises 9-12 monthsExercises 9-12 months
• Bench sittingBench sitting
– Have your baby sit onHave your baby sit on
a small bench or aa small bench or a
small playground ballsmall playground ball
– Place toys slightly outPlace toys slightly out
of your baby’s reachof your baby’s reach
so that she has to useso that she has to use
her trunk to get theher trunk to get the
itemitem
Exercises 9-12 monthsExercises 9-12 months
• Sit to stand at a benchSit to stand at a bench
– When your baby is at the 11-12When your baby is at the 11-12
month developmental level, she ismonth developmental level, she is
ready to start working on sit toready to start working on sit to
stand from a benchstand from a bench
– You can provide a target, such as aYou can provide a target, such as a
basketball hoop and a small ball tobasketball hoop and a small ball to
help her get to standinghelp her get to standing
– You do not have to facilitate at theYou do not have to facilitate at the
arms. You may be able to get thearms. You may be able to get the
baby to stand by gently tapping atbaby to stand by gently tapping at
her belly and her bottom as well asher belly and her bottom as well as
providing a good incentive for herproviding a good incentive for her
to stand toto stand to
– It will be more successful at first ifIt will be more successful at first if
you have her stand to a surfaceyou have her stand to a surface
such as a couch and later have hersuch as a couch and later have her
stand independentlystand independently
Exercises 9-12 monthsExercises 9-12 months
• Facilitation of cruisingFacilitation of cruising
– Your baby is getting very confident now when he is standing at a surface. You now areYour baby is getting very confident now when he is standing at a surface. You now are
going to help him move side to sidegoing to help him move side to side
– Holding onto the pelvis, lift one hand up and press the opposite downHolding onto the pelvis, lift one hand up and press the opposite down
– On the up side, the baby’s leg will lift off the ground and move outOn the up side, the baby’s leg will lift off the ground and move out
– Then swich hands the up goes down to weight the leg and the down goes up to bring theThen swich hands the up goes down to weight the leg and the down goes up to bring the
opposite leg to the standing legopposite leg to the standing leg
– Repeat until you get to your destinationRepeat until you get to your destination
• Facilitation of floor to stand via plantargradeFacilitation of floor to stand via plantargrade
– The best way to facilitate floor to stand is to pair it with a verbal command such as “1-2-The best way to facilitate floor to stand is to pair it with a verbal command such as “1-2-
THRE-eeeee”THRE-eeeee”
– Each time you facilitate floor to stand you say 1-2-3 (with an emphasis on the THR- EEEE)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 justso that when you want your baby to stand independently and she is able to do it, you just
say 1-2-3 and she standssay 1-2-3 and she stands
– In order to faciliate standing, get your baby in hands and knees, her hands must stay on theIn order to faciliate standing, get your baby in hands and knees, her hands must stay on the
floorfloor
– Bring one leg up and say 1, the other and say 2 then the bring her weight backwards andBring 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!slightly up and say THRE-eeee as she stands up by herself . . . Very proud!
Red Flags that shouldRed Flags that should
prompt assessmentprompt assessment
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• Rolling prior to three monthsRolling prior to three months evaluate for hypertoniaevaluate for hypertonia
• Head observed to rotate or tilt to one side onlyHead observed to rotate or tilt to one side only 
evaluate for Torticollis, visual deficitsevaluate for Torticollis, visual deficits Click here for a link to aClick here for a link to a
printout if you suspect preference of tilt or rotation to one side or the other *printout if you suspect preference of tilt or rotation to one side or the other *
also recommend that they speak with their pediatrician.also recommend that they speak with their pediatrician.
• Persistent fisting by three monthsPersistent fisting by three months  evaluate forevaluate for
neuromuscular dysfunctionneuromuscular dysfunction
• Failure to alert to environmental stimuliFailure to alert to environmental stimuli  evaluate forevaluate for
sensory impairmentsensory impairment
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• Head lag when pulled to sit after 4 months of ageHead lag when pulled to sit after 4 months of age 
evaluate for hypotoniaevaluate for hypotonia
• Failure to reach for objects by 5 monthsFailure to reach for objects by 5 months  evaluate forevaluate for
motor, visual or cognitive deficitsmotor, visual or cognitive deficits
• Inability to prop sit by 6 monthsInability to prop sit by 6 months  evaluate for hypotoniaevaluate for hypotonia
• Absent smile by 4-6 monthsAbsent smile by 4-6 months  evaluate for visual loss,evaluate for visual loss,
attachment problems, maternal major depressionattachment problems, maternal major depression
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• Persistence of primitive reflexes after 6 monthsPersistence of primitive reflexes after 6 months 
evaluate for neuromuscular disorderevaluate for neuromuscular disorder
• Absent babbling by 6 monthsAbsent babbling by 6 months  evaluate for hearingevaluate for hearing
deficitdeficit
• Absent stranger anxiety by 7 monthsAbsent stranger anxiety by 7 months  may be related tomay be related to
multiple care providersmultiple care providers
• W sitting and bunny hopping at 7 monthsW sitting and bunny hopping at 7 months  evaluate forevaluate for
hypertonia or hypotoniahypertonia or hypotonia
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• No back and forth sharing of sounds, smiles or other facialNo back and forth sharing of sounds, smiles or other facial
expression by age 9 months or thereafterexpression by age 9 months or thereafter  evaluate forevaluate for
autism of pervasive developmental disorderautism of pervasive developmental disorder
• Lack of tool use (crayon, spoon) by 12 monthsLack of tool use (crayon, spoon) by 12 months  evaluateevaluate
for fine motor or cognitive delayfor fine motor or cognitive delay
• Lack of imitative play by 18 monthsLack of imitative play by 18 months  evaluate for hearingevaluate for hearing
deficit or cognitive/socialization deficit, evaluate for autismdeficit or cognitive/socialization deficit, evaluate for autism
• Hand dominance prior to 18 monthsHand dominance prior to 18 months  evaluate forevaluate for
hemiplegia or brachial plexus injuryhemiplegia or brachial plexus injury
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• Lack of prodeclarative pointing by 16 months of ageLack of prodeclarative pointing by 16 months of age 
evaluate for autism due to problem in social relatednessevaluate for autism due to problem in social relatedness
• No first word, other than mama/dada by 18 monthsNo first word, other than mama/dada by 18 months 
evaluate for auditory expressive language delayevaluate for auditory expressive language delay
• Does not follow simple 1 step commands by 15 monthsDoes not follow simple 1 step commands by 15 months
 evaluate for receptive language delayevaluate for receptive language delay
• Persistent poor transitions by 24 monthsPersistent poor transitions by 24 months  evaluate forevaluate for
pervasive developmental disorderpervasive developmental disorder
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• No two word sentences by 2 yearsNo two word sentences by 2 years  evaluate forevaluate for
auditory expressive language delayauditory expressive language delay
• Advanced non-communicative speech (echolalia) by 24Advanced non-communicative speech (echolalia) by 24
monthsmonths evaluate for autism or pervasiveevaluate for autism or pervasive
developmental disorderdevelopmental disorder
• Any loss of speechAny loss of speech  babbling or social skills at anybabbling or social skills at any
age, evaluate for autism or pervasive developmentalage, evaluate for autism or pervasive developmental
disorder.disorder.
• (Adapted from Family Practice Notebook,(Adapted from Family Practice Notebook,
www.fpnotebook.com)www.fpnotebook.com)
Reminders/DisclaimersReminders/Disclaimers
• These exercises are only suggestions for how you canThese exercises are only suggestions for how you can
help babies progress their developmental skills whetherhelp babies progress their developmental skills whether
they are demonstrating delays or are on trackthey are demonstrating delays or are on track
developmentallydevelopmentally
• Please use caution when doing these exercises as youPlease use caution when doing these exercises as you
can harm a baby if you do anything too forcefullycan harm a baby if you do anything too forcefully
• If you suspect a baby is delayed in their development,If you suspect a baby is delayed in their development,
please let the doctor know so the family can receive aplease let the doctor know so the family can receive a
proper evaluation with proper and individualized exerciseproper evaluation with proper and individualized exercise
instruction from a qualified pediatric physical therapistinstruction from a qualified pediatric physical therapist
• If you have any questions, please do not hesitate toIf you have any questions, please do not hesitate to
contact me at jwattenberg@hotmail.comcontact me at jwattenberg@hotmail.com
www.babiesfirstfitness.comwww.babiesfirstfitness.com
Like Babies First Fitness on Facebook.Like Babies First Fitness on Facebook.
Sign up at www.babiesfirstfitness.com to receive newSign up at www.babiesfirstfitness.com to receive new
posts to your email.posts to your email.

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How to help infants attain gross motor skills: Practical Ideas for caregivers of infants 0-12 months old

  • 1. How to Help Infants Attain Gross Motor Skills:How to Help Infants Attain Gross Motor Skills: Practical Ideas for caregivers of infants 0-12 monthsPractical Ideas for caregivers of infants 0-12 months Julie Wattenberg, PT, MPT, DPTJulie Wattenberg, PT, MPT, DPT Babies First FitnessBabies First Fitness www.babiesfirstfitness.comwww.babiesfirstfitness.com Pediatric Physical Therapist, Early Intervention Credentialed ProviderPediatric Physical Therapist, Early Intervention Credentialed Provider March 21, 2017March 21, 2017
  • 2. Goals of today’s lectureGoals of today’s lecture • You will review the gross motor milestonesYou will review the gross motor milestones of infants from 0-12 months of ageof infants from 0-12 months of age • You will learn some easy exercises to helpYou will learn some easy exercises to help facilitate gross motor milestone attainmentfacilitate gross motor milestone attainment for infants at different ages/stages offor infants at different ages/stages of developmentdevelopment
  • 3. Typical DevelopmentTypical Development In the First YearIn the First Year
  • 4. ReminderReminder • In the following developmental progression,In the following developmental progression, months are used to detail what an infant shouldmonths are used to detail what an infant should be doing at each month.be doing at each month. • However, please think of these as stages inHowever, please think of these as stages in development. If an infant is not demonstratingdevelopment. If an infant is not demonstrating gross motor skills at the age reported, thengross motor skills at the age reported, then please adjust accordingly and use the exerciseplease adjust accordingly and use the exercise suggestions for a bit longer than the “age”suggestions for a bit longer than the “age” expectedexpected
  • 5. First MonthFirst Month First MonthFirst Month Your baby is just learning howYour baby is just learning how to lift and turn her head whento lift and turn her head when she is on her stomach. She isshe is on her stomach. She is lengthening out of thelengthening out of the physiologic flexion that shephysiologic flexion that she had when she was born. Shehad when she was born. She is unable to hold her head inis unable to hold her head in the middle when she is on herthe middle when she is on her back and has difficultiesback and has difficulties holding her head up.holding her head up.
  • 6. Second MonthSecond Month Two MonthsTwo Months He is starting to feel a bitHe is starting to feel a bit floppy. This is because he hasfloppy. This is because he has lost all of the physiologiclost all of the physiologic flexion tone. When he is on hisflexion tone. When he is on his back, he is moving his headback, he is moving his head side to side and seems to beside to side and seems to be very limp. When on his tummy,very limp. When on his tummy, he is not able to hold his headhe is not able to hold his head in the middle. At this age, hein the middle. At this age, he is learning how to activate hisis learning how to activate his muscles on one side or themuscles on one side or the other, but has troubleother, but has trouble activating them on both sidesactivating them on both sides of a joint at the same time.of a joint at the same time.
  • 7. Three MonthsThree Months Three MonthsThree Months Your baby has learned how toYour baby has learned how to activate their muscles and now isactivate their muscles and now is starting to learn how to activatestarting to learn how to activate them together, on either side ofthem together, on either side of the joint. This means that thethe joint. This means that the baby is more stable when it comesbaby is more stable when it comes to head control. Your baby reallyto head control. Your baby really likes to be in the middle. By threelikes to be in the middle. By three months your baby should be ablemonths your baby should be able to hold his head in the middleto hold his head in the middle when on his back, show a nicewhen on his back, show a nice chin tuck when on his stomachchin tuck when on his stomach and have independent headand have independent head control when held.control when held.
  • 8. Exercises to facilitateExercises to facilitate Developmental 0-3 monthsDevelopmental 0-3 months Positioning SuggestionsPositioning Suggestions • Large boppy pillow for midline orientation of handsLarge boppy pillow for midline orientation of hands • Small boppy or rolled towel for proneSmall boppy or rolled towel for prone Carrying/Pick Up SuggestionsCarrying/Pick Up Suggestions • Carry in supine, facilitate flexion, not extensionCarry in supine, facilitate flexion, not extension • Prone carry to improve tummy time – this should be used with caution and should notProne carry to improve tummy time – this should be used with caution and should not be used with kids who like to extend all the timebe used with kids who like to extend all the time • Rotation to sitting every time you pick up a babyRotation to sitting every time you pick up a baby Exercise SuggestionsExercise Suggestions • Sitting on ball – holding at upper trunkSitting on ball – holding at upper trunk • Prone on the ball - maintaining elbows under shouldersProne on the ball - maintaining elbows under shoulders • Bicycles and Abdominal Massage for GasBicycles and Abdominal Massage for Gas • Lower trunk stretch in supineLower trunk stretch in supine • Supine in lap with facilitation of hand to hand and hand to mouthSupine in lap with facilitation of hand to hand and hand to mouth • Side-lying play – elongation of posterior musclesSide-lying play – elongation of posterior muscles
  • 9. Positioning Suggestions 0-3Positioning Suggestions 0-3 monthsmonths • Supine (on back) on large boppySupine (on back) on large boppy pillow or on your lap to facilitatepillow or on your lap to facilitate midline orientation of handsmidline orientation of hands – Use rings to bring toys close to baby’s chUse rings to bring toys close to baby’s ch • Prone with small boppy or rolledProne with small boppy or rolled towel under chesttowel under chest – This shifts the baby’s weightThis shifts the baby’s weight posterior (toward bottom) so thatposterior (toward bottom) so that she can more effectively lift andshe can more effectively lift and turn her head.turn her head. – You can help by placing yourYou can help by placing your hand on her bottom. This will alsohand on her bottom. This will also bring the weight backwardbring the weight backward – Babies should start being on theirBabies should start being on their tummy from DAY 1 for at least 30tummy from DAY 1 for at least 30 minutes per dayminutes per day
  • 10. Carrying Suggestions 0-3 monthsCarrying Suggestions 0-3 months • When you carry a baby, youWhen you carry a baby, you should always be sure that youshould always be sure that you are preventing any archingare preventing any arching – Carry the baby in a flexedCarry the baby in a flexed position, do not allow the head toposition, do not allow the head to extendextend – Flex up and hold one leg so thatFlex up and hold one leg so that the baby cannot extend.the baby cannot extend. – This will prevent abnormal muscleThis will prevent abnormal muscle activation and movement patternsactivation and movement patterns that so many infants arethat so many infants are demonstrating nowdemonstrating now • You can carry a baby in prone andYou can carry a baby in prone and when they are little this is a greatwhen they are little this is a great position as they can get thatposition as they can get that feeling of comfort when being infeeling of comfort when being in prone.prone. – However, if you have a child whoHowever, if you have a child who likes to arch and extend all thelikes to arch and extend all the time, this is not a good option fortime, this is not a good option for this child as they get older as theythis child as they get older as they are demonstrating unbalancedare demonstrating unbalanced extensionextension
  • 11. Pick Up Suggestions 0-3Pick Up Suggestions 0-3 monthsmonths • Every time you pick a baby up you should rotate him to sittingEvery time you pick a baby up you should rotate him to sitting (click on link for blog post and video)(click on link for blog post and video) – This helps to strengthen the muscles on the side of the body andThis helps to strengthen the muscles on the side of the body and the rotational muscles that are important for smooth dissociatedthe rotational muscles that are important for smooth dissociated movementmovement
  • 12. Exercises 0 – 3 monthsExercises 0 – 3 months • Sitting on ball – holding at upper trunkSitting on ball – holding at upper trunk – The higher you hold a baby at his/herThe higher you hold a baby at his/her trunk, the less she has to work.trunk, the less she has to work. Therefore, since a baby from 0-3 monthsTherefore, since a baby from 0-3 months is not very strong in their head, you willis not very strong in their head, you will have to hold them higher on their trunkhave to hold them higher on their trunk • Prone on the ball - maintaining elbowsProne on the ball - maintaining elbows under shouldersunder shoulders – The ball is a GREAT place to work onThe ball is a GREAT place to work on prone skills for babies who have troubleprone skills for babies who have trouble tolerating prone positioningtolerating prone positioning – You can move the ball forward and backYou can move the ball forward and back to increase or decrease the work.to increase or decrease the work. – Be sure you are providing support at theBe sure you are providing support at the arms so that the baby learns how to pusharms so that the baby learns how to push through the surface and is not usingthrough the surface and is not using unbalanced extensionunbalanced extension – You can use this trick on the floor to inYou can use this trick on the floor to in facilitate the baby learning to pushfacilitate the baby learning to push through the surfacethrough the surface
  • 13. Exercises 0-3 monthsExercises 0-3 months • BicyclesBicycles – Bicycles help with gas asBicycles help with gas as well with improving rotationwell with improving rotation of the pelvisof the pelvis • Abdominal MassageAbdominal Massage – Abdominal massage also helps wAbdominal massage also helps w – Strokes include: I love you, waterStrokes include: I love you, water (click on link for blog post(click on link for blog post regarding abdominalregarding abdominal massage)massage)
  • 14. Exercises 0-3 monthsExercises 0-3 months • Lower trunk stretchLower trunk stretch – This helps to lengthen theThis helps to lengthen the muscles of the lower backmuscles of the lower back and upper back, especiallyand upper back, especially for babies who are prone tofor babies who are prone to extension posturesextension postures – This also helps to facilitateThis also helps to facilitate activation of the abdominals.activation of the abdominals. – Place your hand under thePlace your hand under the low back and maintain thislow back and maintain this position. Place toys onposition. Place toys on baby’s feet to attractbaby’s feet to attract attention to her feetattention to her feet
  • 15. Exercises 0-3 monthsExercises 0-3 months • Supine on lap withSupine on lap with facilitation of hand tofacilitation of hand to hand and hand to mouthhand and hand to mouth – Hand to hand and hand toHand to hand and hand to mouth are very importantmouth are very important skills for a baby to haveskills for a baby to have – It helps a baby learn to selfIt helps a baby learn to self calm and is foundational forcalm and is foundational for later skillslater skills
  • 16. Exercises 0-3 monthsExercises 0-3 months • Side-lying playSide-lying play – Side-lying play is good forSide-lying play is good for babies who are prone tobabies who are prone to extension.extension. – This position lengthens theThis position lengthens the muscles in the back of theirmuscles in the back of their bodybody – This position also allows theThis position also allows the baby to active their arms andbaby to active their arms and legs without significant gravitylegs without significant gravity implicationsimplications – You may use massage in thisYou may use massage in this position and bring your handposition and bring your hand from the middle of the backfrom the middle of the back towards the wrist as well astowards the wrist as well as the middle of the bottomthe middle of the bottom toward the ankle. This willtoward the ankle. This will help to facilitate elongation ofhelp to facilitate elongation of the posterior muscles (backthe posterior muscles (back muscles)muscles)
  • 17. Three MonthsThree Months Three MonthsThree Months Your baby has learned how toYour baby has learned how to activate their muscles and now isactivate their muscles and now is starting to learn how to activatestarting to learn how to activate them together, on either side ofthem together, on either side of the joint. This means that thethe joint. This means that the baby is more stable when it comesbaby is more stable when it comes to head control. Your baby reallyto head control. Your baby really likes to be in the middle. By threelikes to be in the middle. By three months your baby should be ablemonths your baby should be able to hold his head in the middleto hold his head in the middle when on his back, show a nicewhen on his back, show a nice chin tuck when on his stomachchin tuck when on his stomach and have independent headand have independent head control when held.control when held.
  • 18. Four MonthsFour Months Fourth MonthFourth Month Your baby is getting really strong intoYour baby is getting really strong into flexion off the surface. This is notflexion off the surface. This is not because they have spent so muchbecause they have spent so much time on their back that they are gettingtime on their back that they are getting better at flexor strength, it is becausebetter at flexor strength, it is because they have spent so much time on theirthey have spent so much time on their belly that they gained strength in theirbelly that they gained strength in their flexor muscles by pushing through theflexor muscles by pushing through the ground. When your baby is on herground. When your baby is on her back, she is able to bring her arms offback, she is able to bring her arms off the surface and her feet off the surfacethe surface and her feet off the surface and often is able to tough her knees.and often is able to tough her knees. Sometimes, it is hard for her to staySometimes, it is hard for her to stay here, though, and she falls to her side.here, though, and she falls to her side. When she falls to her side, she is justWhen she falls to her side, she is just learning how to activate her muscleslearning how to activate her muscles on the side of her neck, so she mighton the side of her neck, so she might lift her head off the surface when onlift her head off the surface when on her side. Your baby should feel reallyher side. Your baby should feel really confident on her tummy now andconfident on her tummy now and should be able to tolerate it withoutshould be able to tolerate it without fuss for at least 3-5 minutes at a time.fuss for at least 3-5 minutes at a time.
  • 19. Five MonthsFive Months Five MonthsFive Months Your infant is really starting toYour infant is really starting to move. On his back, he hasmove. On his back, he has gained more strength in his bellygained more strength in his belly to bring his pelvis off the floor andto bring his pelvis off the floor and reach for his feet. This helps toreach for his feet. This helps to lengthen the hamstrings andlengthen the hamstrings and strengthen the abdominal musclesstrengthen the abdominal muscles to prepare him to sit. On histo prepare him to sit. On his tummy, your baby is doing a greattummy, your baby is doing a great job pushing up on his hands andjob pushing up on his hands and in sitting, your baby is able to propin sitting, your baby is able to prop sit. All of this pushing andsit. All of this pushing and reaching for his feet, teaches yourreaching for his feet, teaches your baby how to use his triceps, thebaby how to use his triceps, the muscle on the back of his arm.muscle on the back of his arm. This means that when on hisThis means that when on his back, your baby is becoming reallyback, your baby is becoming really good at reaching for toys.good at reaching for toys.
  • 20. Sixth MonthSixth Month Six MonthsSix Months Your baby is starting toYour baby is starting to move around, time to bemove around, time to be cautious!! Your baby iscautious!! Your baby is now starting to roll fromnow starting to roll from his back to his tummy.his back to his tummy. He is also sittingHe is also sitting independently. Yourindependently. Your baby also really likes hisbaby also really likes his tummy and likes to playtummy and likes to play on his tummy for a longon his tummy for a long time.time.
  • 21. Exercises to facilitate DevelopmentExercises to facilitate Development 3-6 months3-6 months Positioning SuggestionsPositioning Suggestions • Supine with large boppy pillow under bottom to facilitate abdominal activaiton and hands to knees/feetSupine with large boppy pillow under bottom to facilitate abdominal activaiton and hands to knees/feet • Prone positioning continues for at least 30 minutes per dayProne positioning continues for at least 30 minutes per day • Supine on a large boppy pillow to facilitate reaching and bringing the arms forward if baby is having difficultiesSupine on a large boppy pillow to facilitate reaching and bringing the arms forward if baby is having difficulties with this stillwith this still • Do not use exersaucers, johnny jump ups or walkersDo not use exersaucers, johnny jump ups or walkers Carrying/Pick Up SuggestionsCarrying/Pick Up Suggestions • Carry in supine, facilitate flexion, not extensionCarry in supine, facilitate flexion, not extension • Prone carry to improve tummy time – this should be used with caution and should not be used with kids who likeProne carry to improve tummy time – this should be used with caution and should not be used with kids who like to extend all the timeto extend all the time • Rotation to sitting every time you pick up a babyRotation to sitting every time you pick up a baby Exercise SuggestionsExercise Suggestions • Sitting on the ball – progressing to lower on the trunk – side to side weight shiftsSitting on the ball – progressing to lower on the trunk – side to side weight shifts • Prone on the ball – progressing to side to side weight shiftsProne on the ball – progressing to side to side weight shifts • Prone on hands off your lapProne on hands off your lap • Rotation to sitting on your lapRotation to sitting on your lap • Facilitation of rollingFacilitation of rolling • Sitting practice with/without boppy pillowSitting practice with/without boppy pillow • Sitting balance on daycare provider’s lap with weight shiftSitting balance on daycare provider’s lap with weight shift • Hand to feet in supine – rolling side to sideHand to feet in supine – rolling side to side
  • 22. Positioning Suggestions 3-6Positioning Suggestions 3-6 monthsmonths • Supine (on back) with large boppySupine (on back) with large boppy pillow under bottom.pillow under bottom. – Place toys on a play gym on rings toPlace toys on a play gym on rings to bring them close to baby’s feet so thatbring them close to baby’s feet so that he kicks the toys independentlyhe kicks the toys independently – This will help to strengthen his bellyThis will help to strengthen his belly musclesmuscles • Supine with boppy pillow underSupine with boppy pillow under shouldersshoulders – This will bring arms towards the toys.This will bring arms towards the toys. – Use rings to bring the toys down closer to the baby so accidental movements will result in batting ofUse rings to bring the toys down closer to the baby so accidental movements will result in batting of – Decrease use of the boppy when babyDecrease use of the boppy when baby is able to reach for toys independentlyis able to reach for toys independently when in supine (usually around 5when in supine (usually around 5 months)months) • Prone positioningProne positioning – At least 30 minutes per dayAt least 30 minutes per day – Baby should be able to tolerate proneBaby should be able to tolerate prone positioning without the blanket rollpositioning without the blanket roll – Baby’s tolerance for prone should beBaby’s tolerance for prone should be increasingincreasing
  • 23. Carrying Suggestions 3-6 monthsCarrying Suggestions 3-6 months • When you carry a baby, youWhen you carry a baby, you should always be sure that youshould always be sure that you are preventing any archingare preventing any arching – Carry the baby in a flexedCarry the baby in a flexed position, do not allow the head toposition, do not allow the head to extendextend – Flex up and hold one leg so thatFlex up and hold one leg so that the baby cannot extend.the baby cannot extend. – This will prevent abnormal muscleThis will prevent abnormal muscle activation and movement patternsactivation and movement patterns that so many infants arethat so many infants are demonstrating nowdemonstrating now • You can carry a baby in prone andYou can carry a baby in prone and when they are little this is a greatwhen they are little this is a great position as they can get thatposition as they can get that feeling of comfort when being infeeling of comfort when being in prone.prone. – However, if you have a child whoHowever, if you have a child who likes to arch and extend all thelikes to arch and extend all the time, this is not a good option fortime, this is not a good option for this child as they get older as theythis child as they get older as they are demonstrating unbalancedare demonstrating unbalanced extensionextension
  • 24. Pick Up Suggestions 3-6Pick Up Suggestions 3-6 monthsmonths • Every time you pick a baby up you should rotate him to sittingEvery time you pick a baby up you should rotate him to sitting – This helps to strengthen the muscles on the side of the body and the rThis helps to strengthen the muscles on the side of the body and the r – By four months, baby should start to lift head laterally when youBy four months, baby should start to lift head laterally when you pick her uppick her up
  • 25. Exercises 3-6 monthsExercises 3-6 months • Sitting on the ballSitting on the ball – Progressing to lower on the trunk with side to side weight shifts shiftsProgressing to lower on the trunk with side to side weight shifts shifts – By four months old your baby is just starting to develop her side to side control ofBy 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.her trunk and head. You can help facilitate this by moving her on the ball. – Shapes on the ball, move your baby’s bottom in circles, stars, square etc.Shapes on the ball, move your baby’s bottom in circles, stars, square etc. • Prone on the ball – lateral and anterior/posterior weight shiftsProne on the ball – lateral and anterior/posterior weight shifts
  • 26. Exercises 3-6 monthsExercises 3-6 months • Prone over legs withProne over legs with hands on the floorhands on the floor – To increase activation ofTo increase activation of the arms, lift your back legthe arms, lift your back leg (the leg farthest from the(the leg farthest from the head of the baby)head of the baby) – This will facilitate tricepsThis will facilitate triceps activation, teaches theactivation, teaches the baby how to push throughbaby how to push through their hands and works totheir hands and works to open up the baby’s handsopen up the baby’s hands
  • 27. • Rotation to sitting on your lapRotation to sitting on your lap – This exercise is very similar to rotating the baby up to sitting.This exercise is very similar to rotating the baby up to sitting. – When you are holding a baby after they have been weight bearingWhen you are holding a baby after they have been weight bearing through the ground on their hands, facilitate them up to sitting on yourthrough the ground on their hands, facilitate them up to sitting on your lap. This will strengthen their oblique muscles and lateral neck andlap. This will strengthen their oblique muscles and lateral neck and trunk musclestrunk muscles – Another option of this exercise is observed in this video and blogpost from babAnother option of this exercise is observed in this video and blogpost from bab Exercises 3-6 monthsExercises 3-6 months
  • 28. Exercises 3-6 monthsExercises 3-6 months • Facilitation of RollingFacilitation of Rolling – Rolling from back toRolling from back to front is a really importantfront is a really important skillskill – It is the first skill whereIt is the first skill where infants becomeinfants become independent with theirindependent with their mobilitymobility – The important thingThe important thing when helping a baby rollwhen helping a baby roll is to WAIT for them tois to WAIT for them to activate their lateral neckactivate their lateral neck musclesmuscles – It is very important toIt is very important to facilitate over both sidesfacilitate over both sides
  • 29. Exercises 3-6 monthsExercises 3-6 months • Sitting practiceSitting practice – Tripod sitting (sitting withTripod sitting (sitting with upper extremity support startsupper extremity support starts at the same time that yourat the same time that your baby pushes on her hands onbaby pushes on her hands on her tummyher tummy • Sitting with 1-2 boppy pillowsSitting with 1-2 boppy pillows • Sitting balance on caregiversSitting balance on caregivers laplap – When you are sitting with aWhen you are sitting with a baby on your lap, feel free tobaby on your lap, feel free to move your legs up and down,move your legs up and down, one side at a time, whileone side at a time, while holding the baby at her trunkholding the baby at her trunk slowly to let the baby practiceslowly to let the baby practice reacting the balancereacting the balance challengeschallenges
  • 30. Hand to feet in supine – rolling side to sideHand to feet in supine – rolling side to side • Facilitate hands to feetFacilitate hands to feet when in supine (on back)when in supine (on back) – This also helps to lengthenThis also helps to lengthen the hamstrings, activate thethe hamstrings, activate the abdominal muscles, andabdominal muscles, and lengthen the muscles in thelengthen the muscles in the back of the bodyback of the body – Place toys on baby’s feet toPlace toys on baby’s feet to encourage her to get herencourage her to get her feetfeet – Encourage her to eat herEncourage her to eat her toes as this helps totoes as this helps to activate the abdominalsactivate the abdominals increase the hamstring theincrease the hamstring the stretchstretch
  • 31. Sixth MonthSixth Month Six MonthsSix Months Your baby is starting to moveYour baby is starting to move around, time to be cautious!!around, time to be cautious!! Your baby is now starting toYour baby is now starting to roll from his back to hisroll from his back to his tummy. He is also sittingtummy. He is also sitting independently. Also, yourindependently. Also, your baby really likes his tummybaby really likes his tummy and likes to play on hisand likes to play on his tummy for a long time.tummy for a long time.
  • 32. Seventh MonthSeventh Month Seven MonthsSeven Months Your baby is starting to exploreYour baby is starting to explore positions where her belly is off thepositions where her belly is off the surface. These positions includesurface. These positions include laying on her side while onelaying on her side while one hand/arm is supporting and thehand/arm is supporting and the other is playing. She also isother is playing. She also is starting to enjoy rocking on herstarting to enjoy rocking on her hands and knees with her belly offhands and knees with her belly off the surface. She may even bethe surface. She may even be trying to do a pike position wheretrying to do a pike position where she straightens her legs andshe straightens her legs and brings her bottom toward thebrings her bottom toward the ceiling (down dog). What a strongceiling (down dog). What a strong little girl! She loves to sit and playlittle girl! She loves to sit and play and is starting to explore theand is starting to explore the space to the side of her where shespace to the side of her where she may be just starting to transition tomay be just starting to transition to four point independently.four point independently.
  • 33. Eighth MonthEighth Month Eight MonthsEight Months Your baby is getting very strong.Your baby is getting very strong. He prefers to play in prone andHe prefers to play in prone and sitting, and rarely plays on hissitting, and rarely plays on his back anymore. Your baby may beback anymore. Your baby may be getting well by transitioning fromgetting well by transitioning from sitting to four point and may evensitting to four point and may even be starting to transition from thebe starting to transition from the floor to sitting on his own. He mayfloor to sitting on his own. He may be crawling on his belly to getbe crawling on his belly to get around. This is ok for a shortaround. This is ok for a short period of time, but soon we wantperiod of time, but soon we want to see him get to his hands andto see him get to his hands and knees to crawl. As your babyknees to crawl. As your baby becomes more mobile, he willbecomes more mobile, he will want to explore things that arewant to explore things that are higher than the floor. This driveshigher than the floor. This drives him to transition from sitting to hishim to transition from sitting to his knees at higher surfaces.knees at higher surfaces.
  • 34. Ninth MonthNinth Month Nine MonthsNine Months Your baby should be a pro at gettingYour baby should be a pro at getting around on her hands and knees andaround on her hands and knees and travels this way for long distances.travels this way for long distances. She is loving exploring the world,She is loving exploring the world, especially higher surfaces. This drivesespecially higher surfaces. This drives her to want to climb higher and higher .her to want to climb higher and higher . . . even up the stairs. She may even. . even up the stairs. She may even be pulling to stand at low couches, butbe pulling to stand at low couches, but she prefers to use her arms more thanshe prefers to use her arms more than her legs at this stage. You better gether legs at this stage. You better get those gates! Your baby is not onlythose gates! Your baby is not only sitting in the ring position, but hassitting in the ring position, but has enough trunk strength that she can sitenough trunk strength that she can sit in a variety of sitting positionsin a variety of sitting positions including on her heels, side sitting, onincluding on her heels, side sitting, on a small bench and long sitting.a small bench and long sitting.
  • 35. Exercises to facilitate DevelopmentExercises to facilitate Development 6-9 months6-9 months Positioning SuggestionsPositioning Suggestions • Sitting independently, place toys laterally (at side) instead of in front of baby to stimulate lateral movemenSitting independently, place toys laterally (at side) instead of in front of baby to stimulate lateral movemen (click link for a video)(click link for a video) • Prone – your baby should love to be in prone and not like supine (back) much anymoreProne – your baby should love to be in prone and not like supine (back) much anymore • Do not use exersaucers, johnny jump ups or walkersDo not use exersaucers, johnny jump ups or walkers Carrying/Pick Up SuggestionsCarrying/Pick Up Suggestions • Carry upright – encourage baby to hold onto you more as you carry him if he tolerates thisCarry upright – encourage baby to hold onto you more as you carry him if he tolerates this • Rotation to sitting every time you pick up your babyRotation to sitting every time you pick up your baby (click link for a video)(click link for a video) Exercise SuggestionsExercise Suggestions • Ball – sitting on ball progressing to holding at pelvis due to improved trunk control and demandingBall – sitting on ball progressing to holding at pelvis due to improved trunk control and demanding more activationmore activation • Ball – prone on ball – progressing to more demanding positions where your baby has to lift herBall – 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 toyhead against gravity as she comes closer to the ground and reaches for a toy • Walking on hands off lap or with a foam rollerWalking on hands off lap or with a foam roller • Side sitting with upper extremity weight bearingSide sitting with upper extremity weight bearing • Transitioning to four point (click on link for blog post)Transitioning to four point (click on link for blog post) • Four point positioningFour point positioning
  • 36. Positioning Suggestions 6-9Positioning Suggestions 6-9 monthsmonths • Position toys laterallyPosition toys laterally – This facilitates lateralThis facilitates lateral movement and transitioningmovement and transitioning from sitting to prone and/orfrom sitting to prone and/or sitting to four point (click onsitting to four point (click on link for blogpost)link for blogpost) • ProneProne – Your baby should love to be inYour baby should love to be in prone now and prefers sittingprone now and prefers sitting and prone over supineand prone over supine
  • 37. Carrying Suggestions 6-9 monthsCarrying Suggestions 6-9 months • Carry uprightCarry upright • Encourage baby toEncourage baby to hold onto you more ashold onto you more as you carry him if heyou carry him if he tolerates this nowtolerates this now
  • 38. Pick Up Suggestions 6-9Pick Up Suggestions 6-9 monthsmonths • Every time you pick a baby up you should rotate him toEvery time you pick a baby up you should rotate him to sitting. (click on link for video)sitting. (click on link for video) – Your baby should really be helping with this transition now andYour baby should really be helping with this transition now and will be pushing with her arm as she gets up.will be pushing with her arm as she gets up. – You will also start to see her activate the side of her trunkYou will also start to see her activate the side of her trunk muscles and her headmuscles and her head
  • 39. Exercises 6-9 monthsExercises 6-9 months • Sitting on the ballSitting on the ball – As your baby gets bigger, sheAs your baby gets bigger, she is getting a lot stronger in theis getting a lot stronger in the trunk and the headtrunk and the head – Hold your baby at her pelvis toHold your baby at her pelvis to demand more trunk activationdemand more trunk activation when sitting on the ballwhen sitting on the ball • Prone on the ballProne on the ball – Your baby is getting reallyYour baby is getting really strong now when in prone,strong now when in prone, start to challenge her more bystart to challenge her more by bringing her closer to thebringing her closer to the ground and asking her to pickground and asking her to pick up toys from the groundup toys from the ground
  • 40. Exercises 6-9 monthsExercises 6-9 months • Walking on hands off lap or with aWalking on hands off lap or with a foam roller (or a rolled up yoga mat)foam roller (or a rolled up yoga mat) – This exercise will teach your baby howThis exercise will teach your baby how to move their arms forward which willto move their arms forward which will prepare them for forward motion asprepare them for forward motion as they learn to crawlthey learn to crawl – This exercise also strengthens theThis exercise also strengthens the shoulder girdle and trunkshoulder girdle and trunk • In the first picture, your baby isIn the first picture, your baby is learning how to accept weight on herlearning how to accept weight on her hands when gently moved forward athands when gently moved forward at an increased speed (protectivean increased speed (protective extension).extension). • In the second pictures, your baby isIn the second pictures, your baby is learning how to shift her weight andlearning how to shift her weight and reach for a toy, and/or move forward areach for a toy, and/or move forward a few steps with her handsfew steps with her hands
  • 41. Exercises 6-9 monthsExercises 6-9 months • Transitioning to four pointTransitioning to four point – Your baby needs to feelYour baby needs to feel comfortable placing weight on onecomfortable placing weight on one arm and slightly lifting her bottomarm and slightly lifting her bottom off the floor to reach for a toyoff the floor to reach for a toy before she can go all the way tobefore she can go all the way to four point, so practice this firstfour point, so practice this first – As your baby becomes moreAs your baby becomes more confident with this, you canconfident with this, you can facilitate her to go all the way fromfacilitate her to go all the way from sitting to four pointsitting to four point – Place your hand on her bellyPlace your hand on her belly during the transition to help her toduring the transition to help her to remember to activate her bellyremember to activate her belly – It is absolutely ok to go fromIt is absolutely ok to go from sitting to prone, in factsitting to prone, in fact encouraged during this stage,encouraged during this stage, your baby does not have to stopyour baby does not have to stop at four pointat four point
  • 42. Exercises 6-9 monthsExercises 6-9 months • Four point positioningFour point positioning – You may use a foam rollYou may use a foam roll or your leg to keep youror your leg to keep your baby in a four pointbaby in a four point positionposition – When you get her intoWhen you get her into this position, you maythis position, you may rock her front to backrock her front to back – Only do what sheOnly do what she toleratestolerates
  • 43. Exercises 6-9 monthsExercises 6-9 months • Transition side sitting toTransition side sitting to tall kneelingtall kneeling – This is an importantThis is an important transition as it allows yourtransition as it allows your baby to gain strength of thebaby to gain strength of the side of her hip musclesside of her hip muscles necessary for independentnecessary for independent crawlingcrawling – You can do this on a roll,You can do this on a roll, your leg or on the side of ayour leg or on the side of a couch or a staircouch or a stair
  • 44. Why creeping is importantWhy creeping is important Hands and knees crawling is theHands and knees crawling is the preferred way for babies to get around.preferred way for babies to get around. – It takes a lot more strength for aIt takes a lot more strength for a baby to creep on his/her handsbaby to creep on his/her hands and knees than it does to crawl onand knees than it does to crawl on his belly or scoot on her bottom.his belly or scoot on her bottom. – Typically if a baby is scooting onTypically if a baby is scooting on her bottom to get around orher bottom to get around or crawling on her belly there is acrawling on her belly there is a reason that she is demonstratingreason that she is demonstrating this pattern, including but notthis pattern, including but not limited to poor core strength, poorlimited to poor core strength, poor shoulder girdle strength andshoulder girdle strength and stability, muscle imbalance,stability, muscle imbalance, asymmetrical head position.asymmetrical head position.
  • 45. Ways to facilitate hands and kneesWays to facilitate hands and knees crawlingcrawling • Pushing a small item – while on knees (e.g. stool, phone book)Pushing a small item – while on knees (e.g. stool, phone book) • Facilitation of creep on hands and kneesFacilitation of creep on hands and knees – Place your baby on hands and knees. Shift weight posteriorly (backward) so that her belly isPlace 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 andon her knees. This decreases the need for increased strength of the upper extremities and provides increased support for the lower extremities and bellyprovides increased support for the lower extremities and belly – Move one arm forward and then the opposite leg. Continue to progressMove one arm forward and then the opposite leg. Continue to progress – If your baby likes to extend her legs out, you will need to keep a bit of pressure back withIf 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 extendingher bottom on her heels to prevent her from extending • Wheelbarrow walking when moving off your lap (see next)Wheelbarrow walking when moving off your lap (see next) • Place toys laterally to your baby to facilitate him to transition to the side to get thePlace toys laterally to your baby to facilitate him to transition to the side to get the toys - versus being in front of her (click on link for blog post)toys - versus being in front of her (click on link for blog post)
  • 46. Ninth MonthNinth Month Nine MonthsNine Months Your baby should be a pro at gettingYour baby should be a pro at getting around on her hands and knees andaround on her hands and knees and travels this way for long distances.travels this way for long distances. She is loving exploring the world,She is loving exploring the world, especially higher surfaces. This drivesespecially higher surfaces. This drives her to want to climb higher and higher .her to want to climb higher and higher . . . even up the stairs. She may even. . even up the stairs. She may even be pulling to stand at low couches, butbe pulling to stand at low couches, but she prefers to use her arms more thanshe prefers to use her arms more than her legs at this stage. You better gether legs at this stage. You better get those gates! Your baby is not onlythose gates! Your baby is not only sitting in the ring position, but hassitting in the ring position, but has enough trunk strength that she can sitenough trunk strength that she can sit in a variety of sitting positionsin a variety of sitting positions including on her heels, side sitting, onincluding on her heels, side sitting, on a small bench and long sitting.a small bench and long sitting.
  • 47. Tenth MonthTenth Month Ten MonthsTen Months Your baby is really wanting to beYour baby is really wanting to be upright in standing and he isupright in standing and he is transitioning to standing using histransitioning to standing using his legs more than his arms. He oftenlegs more than his arms. He often chooses to stand via ½ kneel.chooses to stand via ½ kneel. Your baby now able to lowerYour baby now able to lower himself to the floor independentlyhimself to the floor independently from standing, instead of falling tofrom standing, instead of falling to the floor like he did last month!the floor like he did last month! He is even starting to squat downHe is even starting to squat down to pick up a toy from the floor andto pick up a toy from the floor and returning to standing on his own.returning to standing on his own. He is doing a lot of playing inHe is doing a lot of playing in standing, often with his belly offstanding, often with his belly off the surface. He is doing a lot ofthe surface. He is doing a lot of looking from side to side andlooking from side to side and weight shifting in preparation forweight shifting in preparation for cruising next month.cruising next month.
  • 48. Eleventh MonthEleventh Month Eleven MonthsEleven Months Your baby is starting to cruiseYour baby is starting to cruise along furniture (sidewaysalong furniture (sideways walking). This is gettingwalking). This is getting exciting! She is becoming veryexciting! She is becoming very strong with her legs and trunk,strong with her legs and trunk, such that she is able tosuch that she is able to occasionally stand without heroccasionally stand without her belly on the surface for a fewbelly on the surface for a few seconds. She may even startseconds. She may even start to cruise between objects thatto cruise between objects that are really close.are really close.
  • 49. Twelfth MonthTwelfth Month Twelve MonthsTwelve Months Your baby is really getting big.Your baby is really getting big. You are marvel at her progressYou are marvel at her progress as she is standing from theas she is standing from the floor independently from thefloor independently from the middle of the room and startingmiddle of the room and starting to take some steps. Sheto take some steps. She seems clumsy at first as sheseems clumsy at first as she tries to take a few stepstries to take a few steps between objects that are a bitbetween objects that are a bit further apart, but she is goingfurther apart, but she is going to very soon become ato very soon become a proficient walker.proficient walker.
  • 50. Exercises to facilitate DevelopmentExercises to facilitate Development 9-12 months9-12 months Positioning SuggestionsPositioning Suggestions • Sitting independentlySitting independently • Standing at a surfaceStanding at a surface • Prone – your baby should prefer sitting and standing postures more than prone at this timeProne – your baby should prefer sitting and standing postures more than prone at this time • Do not use exersaucers, johnny jump ups or walkersDo not use exersaucers, johnny jump ups or walkers Carrying/Pick Up SuggestionsCarrying/Pick Up Suggestions • Carry upright – encourage baby to hold onto you more as you carry him if he tolerates thisCarry upright – encourage baby to hold onto you more as you carry him if he tolerates this • Rotation to sitting every time you pick up your baby (click on link for video)Rotation to sitting every time you pick up your baby (click on link for video) Exercise SuggestionsExercise Suggestions • Ball sitting and prone (see 6-9 months)Ball sitting and prone (see 6-9 months) • Facilitation of crawling up a surface (unstable surface and/or stairs)Facilitation of crawling up a surface (unstable surface and/or stairs) • Walking on handsWalking on hands • ½ kneel to stand at a surface½ kneel to stand at a surface • Squat to stand at a surfaceSquat to stand at a surface • Four point standing (L shaped)Four point standing (L shaped) • Pushing in a four point standPushing in a four point stand • Pushing weighted objects (click on link for blog post)Pushing weighted objects (click on link for blog post) • 90/90 sitting on bench or small ball90/90 sitting on bench or small ball • Sit to stand from a small benchSit to stand from a small bench • Facilitation of cruisingFacilitation of cruising • Facilitation of floor to stand via plantargradeFacilitation of floor to stand via plantargrade
  • 51. Carrying Suggestions 9-12 monthsCarrying Suggestions 9-12 months • Carry uprightCarry upright • Encourage baby toEncourage baby to hold onto you more ashold onto you more as you carry him if heyou carry him if he tolerates this nowtolerates this now
  • 52. Pick Up Suggestions 9-12 monthsPick Up Suggestions 9-12 months • Every time you pick a baby up you should rotateEvery time you pick a baby up you should rotate him to sitting. (click on link for video)him to sitting. (click on link for video) – Your baby is likely able to do this transition on herYour baby is likely able to do this transition on her own now and will likely do it for you if your just placeown now and will likely do it for you if your just place your hand on her pelvis or ask her to sit up.your hand on her pelvis or ask her to sit up.
  • 53. Exercises 9-12 monthsExercises 9-12 months • Sitting on the ballSitting on the ball – As your baby gets bigger, sheAs your baby gets bigger, she is getting a lot stronger in theis getting a lot stronger in the trunk and the headtrunk and the head – Hold your baby at her pelvis toHold your baby at her pelvis to demand more trunk activationdemand more trunk activation when sitting on the ballwhen sitting on the ball • Prone on the ballProne on the ball – Your baby is getting reallyYour baby is getting really strong now when in prone,strong now when in prone, start to challenge her more bystart to challenge her more by bringing her closer to thebringing her closer to the ground and asking her to pickground and asking her to pick up toys from the groundup toys from the ground
  • 54. Exercises 9-12 monthsExercises 9-12 months • Facilitation of crawling/climbingFacilitation of crawling/climbing – Allow your baby to practice crawling up the stairsAllow your baby to practice crawling up the stairs – Place a bunch of pillows next to the couch and allow him to climb up the pillowsPlace a bunch of pillows next to the couch and allow him to climb up the pillows – Place the ball next to the couch and help him climb up the ball and onto the couchPlace the ball next to the couch and help him climb up the ball and onto the couch • Walking on handsWalking on hands – As your baby wants to get off your lap, gently hold up her pelvis so that she can walk offAs 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 girdleyour lap on her hands. This will strengthen her trunk, gluts and shoulder girdle
  • 55. Exercises 9-12 monthsExercises 9-12 months • ½ kneel to stand at a surface½ kneel to stand at a surface – Facilitate your baby to bring one leg up when holding onto a surfaceFacilitate your baby to bring one leg up when holding onto a surface – As your baby becomes stronger at pulling to stand, she should no longer be pulling up withAs 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 firstarms more than legs, help her up with one leg first – Be sure to switch legsBe sure to switch legs • Squat to stand at a surfaceSquat to stand at a surface – While your baby is holding onto a surface, place a toy on the floor or a stool (which is higherWhile 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 toyand easier) and encourage her to get the toy – Help her bend her knees and support her bottom so that she gradually lowers and comesHelp her bend her knees and support her bottom so that she gradually lowers and comes back up to standingback up to standing • Four point standingFour point standing – Four point standing is when a child is standing with their hands on a lower surface (such asFour point standing is when a child is standing with their hands on a lower surface (such as a stool)a stool) – This position makes her really use her abdominal musclesThis position makes her really use her abdominal muscles • Pushing in four point standingPushing in four point standing – Encourage her to push an object in this position ( a small truck, stool, milk crate, telephoneEncourage her to push an object in this position ( a small truck, stool, milk crate, telephone book, diaper box etc.)book, diaper box etc.) – See blog post – the power of pushingSee blog post – the power of pushing • Pushing weighted objects in standingPushing weighted objects in standing – Placing bags of rice or beans or heavy balls/weights concealed in push toys are a good wayPlacing bags of rice or beans or heavy balls/weights concealed in push toys are a good way to provide increased resistance for pushingto provide increased resistance for pushing – This increased resistance provides increased abdominal strengthening and plantarflexorThis increased resistance provides increased abdominal strengthening and plantarflexor strengthening as well as shoulder girdle strengtheningstrengthening as well as shoulder girdle strengthening – If you are available to help, you resist the object as it is coming forward to provide addedIf you are available to help, you resist the object as it is coming forward to provide added incentive for your babyincentive for your baby
  • 56. Exercises 9-12 monthsExercises 9-12 months • Bench sittingBench sitting – Have your baby sit onHave your baby sit on a small bench or aa small bench or a small playground ballsmall playground ball – Place toys slightly outPlace toys slightly out of your baby’s reachof your baby’s reach so that she has to useso that she has to use her trunk to get theher trunk to get the itemitem
  • 57. Exercises 9-12 monthsExercises 9-12 months • Sit to stand at a benchSit to stand at a bench – When your baby is at the 11-12When your baby is at the 11-12 month developmental level, she ismonth developmental level, she is ready to start working on sit toready to start working on sit to stand from a benchstand from a bench – You can provide a target, such as aYou can provide a target, such as a basketball hoop and a small ball tobasketball hoop and a small ball to help her get to standinghelp her get to standing – You do not have to facilitate at theYou do not have to facilitate at the arms. You may be able to get thearms. You may be able to get the baby to stand by gently tapping atbaby to stand by gently tapping at her belly and her bottom as well asher belly and her bottom as well as providing a good incentive for herproviding a good incentive for her to stand toto stand to – It will be more successful at first ifIt will be more successful at first if you have her stand to a surfaceyou have her stand to a surface such as a couch and later have hersuch as a couch and later have her stand independentlystand independently
  • 58. Exercises 9-12 monthsExercises 9-12 months • Facilitation of cruisingFacilitation of cruising – Your baby is getting very confident now when he is standing at a surface. You now areYour baby is getting very confident now when he is standing at a surface. You now are going to help him move side to sidegoing to help him move side to side – Holding onto the pelvis, lift one hand up and press the opposite downHolding onto the pelvis, lift one hand up and press the opposite down – On the up side, the baby’s leg will lift off the ground and move outOn the up side, the baby’s leg will lift off the ground and move out – Then swich hands the up goes down to weight the leg and the down goes up to bring theThen swich hands the up goes down to weight the leg and the down goes up to bring the opposite leg to the standing legopposite leg to the standing leg – Repeat until you get to your destinationRepeat until you get to your destination • Facilitation of floor to stand via plantargradeFacilitation of floor to stand via plantargrade – The best way to facilitate floor to stand is to pair it with a verbal command such as “1-2-The best way to facilitate floor to stand is to pair it with a verbal command such as “1-2- THRE-eeeee”THRE-eeeee” – Each time you facilitate floor to stand you say 1-2-3 (with an emphasis on the THR- EEEE)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 justso that when you want your baby to stand independently and she is able to do it, you just say 1-2-3 and she standssay 1-2-3 and she stands – In order to faciliate standing, get your baby in hands and knees, her hands must stay on theIn order to faciliate standing, get your baby in hands and knees, her hands must stay on the floorfloor – Bring one leg up and say 1, the other and say 2 then the bring her weight backwards andBring 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!slightly up and say THRE-eeee as she stands up by herself . . . Very proud!
  • 59. Red Flags that shouldRed Flags that should prompt assessmentprompt assessment
  • 60. Red Flags that should prompt assessmentRed Flags that should prompt assessment • Rolling prior to three monthsRolling prior to three months evaluate for hypertoniaevaluate for hypertonia • Head observed to rotate or tilt to one side onlyHead observed to rotate or tilt to one side only  evaluate for Torticollis, visual deficitsevaluate for Torticollis, visual deficits Click here for a link to aClick here for a link to a printout if you suspect preference of tilt or rotation to one side or the other *printout if you suspect preference of tilt or rotation to one side or the other * also recommend that they speak with their pediatrician.also recommend that they speak with their pediatrician. • Persistent fisting by three monthsPersistent fisting by three months  evaluate forevaluate for neuromuscular dysfunctionneuromuscular dysfunction • Failure to alert to environmental stimuliFailure to alert to environmental stimuli  evaluate forevaluate for sensory impairmentsensory impairment
  • 61. Red Flags that should prompt assessmentRed Flags that should prompt assessment • Head lag when pulled to sit after 4 months of ageHead lag when pulled to sit after 4 months of age  evaluate for hypotoniaevaluate for hypotonia • Failure to reach for objects by 5 monthsFailure to reach for objects by 5 months  evaluate forevaluate for motor, visual or cognitive deficitsmotor, visual or cognitive deficits • Inability to prop sit by 6 monthsInability to prop sit by 6 months  evaluate for hypotoniaevaluate for hypotonia • Absent smile by 4-6 monthsAbsent smile by 4-6 months  evaluate for visual loss,evaluate for visual loss, attachment problems, maternal major depressionattachment problems, maternal major depression
  • 62. Red Flags that should prompt assessmentRed Flags that should prompt assessment • Persistence of primitive reflexes after 6 monthsPersistence of primitive reflexes after 6 months  evaluate for neuromuscular disorderevaluate for neuromuscular disorder • Absent babbling by 6 monthsAbsent babbling by 6 months  evaluate for hearingevaluate for hearing deficitdeficit • Absent stranger anxiety by 7 monthsAbsent stranger anxiety by 7 months  may be related tomay be related to multiple care providersmultiple care providers • W sitting and bunny hopping at 7 monthsW sitting and bunny hopping at 7 months  evaluate forevaluate for hypertonia or hypotoniahypertonia or hypotonia
  • 63. Red Flags that should prompt assessmentRed Flags that should prompt assessment • No back and forth sharing of sounds, smiles or other facialNo back and forth sharing of sounds, smiles or other facial expression by age 9 months or thereafterexpression by age 9 months or thereafter  evaluate forevaluate for autism of pervasive developmental disorderautism of pervasive developmental disorder • Lack of tool use (crayon, spoon) by 12 monthsLack of tool use (crayon, spoon) by 12 months  evaluateevaluate for fine motor or cognitive delayfor fine motor or cognitive delay • Lack of imitative play by 18 monthsLack of imitative play by 18 months  evaluate for hearingevaluate for hearing deficit or cognitive/socialization deficit, evaluate for autismdeficit or cognitive/socialization deficit, evaluate for autism • Hand dominance prior to 18 monthsHand dominance prior to 18 months  evaluate forevaluate for hemiplegia or brachial plexus injuryhemiplegia or brachial plexus injury
  • 64. Red Flags that should prompt assessmentRed Flags that should prompt assessment • Lack of prodeclarative pointing by 16 months of ageLack of prodeclarative pointing by 16 months of age  evaluate for autism due to problem in social relatednessevaluate for autism due to problem in social relatedness • No first word, other than mama/dada by 18 monthsNo first word, other than mama/dada by 18 months  evaluate for auditory expressive language delayevaluate for auditory expressive language delay • Does not follow simple 1 step commands by 15 monthsDoes not follow simple 1 step commands by 15 months  evaluate for receptive language delayevaluate for receptive language delay • Persistent poor transitions by 24 monthsPersistent poor transitions by 24 months  evaluate forevaluate for pervasive developmental disorderpervasive developmental disorder
  • 65. Red Flags that should prompt assessmentRed Flags that should prompt assessment • No two word sentences by 2 yearsNo two word sentences by 2 years  evaluate forevaluate for auditory expressive language delayauditory expressive language delay • Advanced non-communicative speech (echolalia) by 24Advanced non-communicative speech (echolalia) by 24 monthsmonths evaluate for autism or pervasiveevaluate for autism or pervasive developmental disorderdevelopmental disorder • Any loss of speechAny loss of speech  babbling or social skills at anybabbling or social skills at any age, evaluate for autism or pervasive developmentalage, evaluate for autism or pervasive developmental disorder.disorder. • (Adapted from Family Practice Notebook,(Adapted from Family Practice Notebook, www.fpnotebook.com)www.fpnotebook.com)
  • 66. Reminders/DisclaimersReminders/Disclaimers • These exercises are only suggestions for how you canThese exercises are only suggestions for how you can help babies progress their developmental skills whetherhelp babies progress their developmental skills whether they are demonstrating delays or are on trackthey are demonstrating delays or are on track developmentallydevelopmentally • Please use caution when doing these exercises as youPlease use caution when doing these exercises as you can harm a baby if you do anything too forcefullycan harm a baby if you do anything too forcefully • If you suspect a baby is delayed in their development,If you suspect a baby is delayed in their development, please let the doctor know so the family can receive aplease let the doctor know so the family can receive a proper evaluation with proper and individualized exerciseproper evaluation with proper and individualized exercise instruction from a qualified pediatric physical therapistinstruction from a qualified pediatric physical therapist • If you have any questions, please do not hesitate toIf you have any questions, please do not hesitate to contact me at jwattenberg@hotmail.comcontact me at jwattenberg@hotmail.com
  • 67. www.babiesfirstfitness.comwww.babiesfirstfitness.com Like Babies First Fitness on Facebook.Like Babies First Fitness on Facebook. Sign up at www.babiesfirstfitness.com to receive newSign up at www.babiesfirstfitness.com to receive new posts to your email.posts to your email.

Editor's Notes

  1. Three months is the period where the infant starts to demonstrate excellent midline control. Notice the chin tuck – this signifies improved flexor control Increased midline orientation of the head Notice the relative symmetry of the upper extremities – this is typical for three months
  2. Three months is the period where the infant starts to demonstrate excellent midline control. Notice the chin tuck – this signifies improved flexor control Increased midline orientation of the head Notice the relative symmetry of the upper extremities – this is typical for three months