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

How to Help Infants Attain Gross Motor Skills: How to Help Infants Attain Gross Motor Skills: Practical Ideas for caregivers of infants 0-12 Practical Ideas for caregivers of infants 0-12

monthsmonths

Julie Wattenberg, PT, MPT, DPTJulie Wattenberg, PT, MPT, DPTBabies First FitnessBabies First Fitness

www.babiesfirstfitness.comwww.babiesfirstfitness.comPediatric 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 You will review the gross motor milestones of infants from 0-12 milestones of infants from 0-12 months of agemonths of age

• You will learn some easy exercises to You will learn some easy exercises to help facilitate gross motor milestone help facilitate gross motor milestone attainment for infants at different attainment for infants at different ages/stages of developmentages/stages of development

Typical Development Typical 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 months are used to detail what an infant should be doing at each month. should be doing at each month.

• However, please think of these as stages in However, please think of these as stages in development. If an infant is not development. If an infant is not demonstrating gross motor skills at the age demonstrating gross motor skills at the age reported, then please adjust accordingly and reported, then please adjust accordingly and use the exercise suggestions for a bit longer use the exercise suggestions for a bit longer than the “age” expectedthan the “age” expected

First MonthFirst MonthFirst MonthFirst Month

Your baby is just learning Your baby is just learning how to lift and turn her how to lift and turn her head when she is on her head when she is on her stomach. She is stomach. She is lengthening out of the lengthening out of the physiologic flexion that she physiologic flexion that she had when she was born. had when she was born. She is unable to hold her She is unable to hold her head in the middle when head in the middle when she is on her back and has she is on her back and has difficulties holding her difficulties holding her head up.head up.

Second MonthSecond MonthTwo Months Two Months

He is starting to feel a bit He is starting to feel a bit floppy. This is because he floppy. This is because he has lost all of the physiologic has lost all of the physiologic flexion tone. When he is on flexion tone. When he is on his back, he is moving his his back, he is moving his head side to side and seems head side to side and seems to be very limp. When on his to be very limp. When on his tummy, he is not able to tummy, he is not able to hold his head in the middle. hold his head in the middle. At this age, he is learning At this age, he is learning how to activate his muscles how to activate his muscles on one side or the other, but on one side or the other, but has trouble activating them has trouble activating them on both sides of a joint at on both sides of a joint at the same time.the same time.

Three MonthsThree MonthsThree MonthsThree Months

Your baby has learned how to Your baby has learned how to activate their muscles and activate their muscles and now is starting to learn how to now is starting to learn how to activate them together, on activate them together, on either side of the joint. This either side of the joint. This means that the baby is more means that the baby is more stable when it comes to head stable when it comes to head control. Your baby really likes control. Your baby really likes to be in the middle. By three to be in the middle. By three months your baby should be months your baby should be able to hold his head in the able to hold his head in the middle when on his back, middle when on his back, show a nice chin tuck when show a nice chin tuck when on his stomach and have on his stomach and have independent head control independent head control when held.when held.

Exercises to facilitate Exercises 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 Prone carry to improve tummy time – this should be used with caution and

should not be used with kids who like to extend all the timeshould not be used with kids who like to extend all the time• Rotation 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

https://babiesfirstfitness.com/2016/05/03/baby-time-is-there-a-best-way-to-pick-up-baby/

Positioning Suggestions 0-3 Positioning Suggestions 0-3 monthsmonths

• Supine (on back) on large Supine (on back) on large boppy pillow or on your lap to boppy pillow or on your lap to facilitate midline orientation facilitate midline orientation of handsof hands– Use rings to bring toys close to baby’s chest to facilitate downward gaze and swatting of toys

• Prone with small boppy or Prone with small boppy or rolled towel under chestrolled towel under chest– This shifts the baby’s weight This shifts the baby’s weight

posterior (toward bottom) so posterior (toward bottom) so that she can more effectively that she can more effectively lift and turn her head. lift and turn her head.

– You can help by placing your You can help by placing your hand on her bottom. This will hand on her bottom. This will also bring the weight also bring the weight backwardbackward

– Babies should start being on Babies should start being on their tummy from DAY 1 for at their tummy from DAY 1 for at least 30 minutes per dayleast 30 minutes per day

https://babiesfirstfitness.com/2016/03/09/baby-time-fun-with-links/




Carrying Suggestions 0-3 Carrying Suggestions 0-3 monthsmonths

• When you carry a baby, you When you carry a baby, you should always be sure that you should always be sure that you are preventing any archingare preventing any arching– Carry the baby in a flexed Carry the baby in a flexed

position, do not allow the head position, do not allow the head to extendto extend

– Flex up and hold one leg so Flex up and hold one leg so that the baby cannot extend. that the baby cannot extend.

– This will prevent abnormal This will prevent abnormal muscle activation and muscle activation and movement patterns that so movement patterns that so many infants are many infants are demonstrating nowdemonstrating now

• You can carry a baby in prone You can carry a baby in prone and when they are little this is and when they are little this is a great position as they can a great position as they can get that feeling of comfort get that feeling of comfort when being in prone. when being in prone. – However, if you have a child However, if you have a child

who likes to arch and extend who likes to arch and extend all the time, this is not a good all the time, this is not a good option for this child as they get option for this child as they get older as they are older as they are demonstrating unbalanced demonstrating unbalanced extensionextension

Pick Up Suggestions 0-3 Pick Up Suggestions 0-3 monthsmonths

• Every 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 This helps to strengthen the muscles on the side of the

body and the rotational muscles that are important for body and the rotational muscles that are important for smooth dissociated movementsmooth dissociated movement



Exercises 0 – 3 monthsExercises 0 – 3 months• Sitting on ball – holding at upper Sitting on ball – holding at upper

trunktrunk– The higher you hold a baby at his/her The 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 Therefore, since a baby from 0-3 months is not very strong in their months is not very strong in their head, you will have to hold them head, you will have to hold them higher on their trunkhigher on their trunk

• Prone on the ball - maintaining Prone on the ball - maintaining elbows under shoulderselbows under shoulders– The ball is a GREAT place to work on The ball is a GREAT place to work on

prone skills for babies who have prone skills for babies who have trouble tolerating prone positioningtrouble tolerating prone positioning

– You can move the ball forward and You can move the ball forward and back to increase or decrease the back to increase or decrease the work. work.

– Be sure you are providing support at Be sure you are providing support at the arms so that the baby learns how the arms so that the baby learns how to push through the surface and is to push through the surface and is not using unbalanced extensionnot using unbalanced extension

– You can use this trick on the floor to You can use this trick on the floor to in facilitate the baby learning to push in facilitate the baby learning to push through the surfacethrough the surface

Exercises 0-3 monthsExercises 0-3 months• Bicycles Bicycles

– Bicycles help with gas Bicycles help with gas as well with improving as well with improving rotation of the pelvisrotation of the pelvis

• Abdominal Massage– Abdominal massage als

o helps with gas. Be sure you are moving the gas from the baby’s right to her left

– Strokes include: I love you, waterfall and knees to chest (click on link for blog (click on link for blog post regarding post regarding abdominal massage)abdominal massage)

https://babiesfirstfitness.com/2014/05/21/my-gassy-baby-tips-for-easing-gas-pain-in-infants-and-babies/









Exercises 0-3 monthsExercises 0-3 months

• Lower trunk stretchLower trunk stretch– This helps to lengthen This helps to lengthen

the muscles of the lower the muscles of the lower back and upper back, back and upper back, especially for babies who especially for babies who are prone to extension are prone to extension posturespostures

– This also helps to This also helps to facilitate activation of the facilitate activation of the abdominals.abdominals.

– Place your hand under Place your hand under the low back and the low back and maintain this position. maintain this position. Place toys on baby’s feet Place toys on baby’s feet to attract attention to her to attract attention to her feetfeet


• Supine on lap with Supine on lap with facilitation of hand to facilitation of hand to hand and hand to hand and hand to mouthmouth– Hand to hand and hand Hand to hand and hand

to mouth are very to mouth are very important skills for a important skills for a baby to havebaby to have

– It helps a baby learn to It helps a baby learn to self calm and is self calm and is foundational for later foundational for later skillsskills

Exercises 0-3 monthsExercises 0-3 months• Side-lying playSide-lying play

– Side-lying play is good for Side-lying play is good for babies who are prone to babies who are prone to extension. extension.

– This position lengthens the This position lengthens the muscles in the back of their muscles in the back of their bodybody

– This position also allows the This position also allows the baby to active their arms baby to active their arms and legs without significant and legs without significant gravity implicationsgravity implications

– You may use massage in You may use massage in this position and bring your this position and bring your hand from the middle of the hand from the middle of the back towards the wrist as back towards the wrist as well as the middle of the well as the middle of the bottom toward the ankle. bottom toward the ankle. This will help to facilitate This will help to facilitate elongation of the posterior elongation of the posterior muscles (back muscles)muscles (back muscles)

Three MonthsThree MonthsThree MonthsThree Months

Your baby has learned how to Your baby has learned how to activate their muscles and activate their muscles and now is starting to learn how to now is starting to learn how to activate them together, on activate them together, on either side of the joint. This either side of the joint. This means that the baby is more means that the baby is more stable when it comes to head stable when it comes to head control. Your baby really likes control. Your baby really likes to be in the middle. By three to be in the middle. By three months your baby should be months your baby should be able to hold his head in the able to hold his head in the middle when on his back, middle when on his back, show a nice chin tuck when show a nice chin tuck when on his stomach and have on his stomach and have independent head control independent head control when held.when held.

Four MonthsFour MonthsFourth MonthFourth Month

Your baby is getting really strong into Your baby is getting really strong into flexion off the surface. This is not flexion off the surface. This is not because they have spent so much because they have spent so much time on their back that they are time on their back that they are getting better at flexor strength, it is getting better at flexor strength, it is because they have spent so much because they have spent so much time on their belly that they gained time on their belly that they gained strength in their flexor muscles by strength in their flexor muscles by pushing through the ground. When pushing through the ground. When your baby is on her back, she is able your baby is on her back, she is able to bring her arms off the surface and to bring her arms off the surface and her feet off the surface and often is her feet off the surface and often is able to tough her knees. Sometimes, able to tough her knees. Sometimes, it is hard for her to stay here, though, it is hard for her to stay here, though, and she falls to her side. When she and she falls to her side. When she falls to her side, she is just learning falls to her side, she is just learning how to activate her muscles on the how to activate her muscles on the side of her neck, so she might lift her side of her neck, so she might lift her head off the surface when on her head off the surface when on her side. Your baby should feel really side. Your baby should feel really confident on her tummy now and confident on her tummy now and should be able to tolerate it without should 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 MonthsFive MonthsFive Months

Your infant is really starting to Your infant is really starting to move. On his back, he has move. On his back, he has gained more strength in his gained more strength in his belly to bring his pelvis off the belly to bring his pelvis off the floor and reach for his feet. floor and reach for his feet. This helps to lengthen the This helps to lengthen the hamstrings and strengthen the hamstrings and strengthen the abdominal muscles to prepare abdominal muscles to prepare him to sit. On his tummy, your him to sit. On his tummy, your baby is doing a great job baby is doing a great job pushing up on his hands and in pushing up on his hands and in sitting, your baby is able to sitting, your baby is able to prop sit. All of this pushing and prop sit. All of this pushing and reaching for his feet, teaches reaching for his feet, teaches your baby how to use his your baby how to use his triceps, the muscle on the back triceps, the muscle on the back of his arm. This means that of his arm. This means that when on his back, your baby is when on his back, your baby is becoming really good at becoming really good at reaching for toys.reaching for toys.

Sixth MonthSixth MonthSix MonthsSix Months

Your baby is starting to Your baby is starting to move around, time to move around, time to be cautious!! Your be cautious!! Your baby is now starting to baby is now starting to roll from his back to his roll from his back to his tummy. He is also tummy. He is also sitting independently. sitting independently. Your baby also really Your baby also really likes his tummy and likes his tummy and likes to play on his likes to play on his tummy for a long time.tummy for a long time.

Exercises to facilitate Exercises to facilitate Development 3-6 monthsDevelopment 3-6 months

Positioning SuggestionsPositioning Suggestions• Supine with large boppy pillow under bottom to facilitate abdominal activaiton and hands to Supine with large boppy pillow under bottom to facilitate abdominal activaiton and hands to

knees/feetknees/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 Supine on a large boppy pillow to facilitate reaching and bringing the arms forward if baby is having

difficulties with this stilldifficulties with 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 Prone carry to improve tummy time – this should be used with caution and should not be used with

kids who like to extend all the timekids who like to extend all the time• Rotation 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 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


https://babiesfirstfitness.com/2016/01/05/baby-and-toddler-time-easty-activity-to-improve-your-childs-core-strength/


• Supine (on back) with large boppy Supine (on back) with large boppy pillow under bottom. pillow under bottom. – Place toys on a play gym on rings to Place toys on a play gym on rings to

bring them close to baby’s feet so bring them close to baby’s feet so that he kicks the toys independentlythat he kicks the toys independently

– This will help to strengthen his belly This will help to strengthen his belly musclesmuscles

• Supine with boppy pillow under Supine with boppy pillow under shouldersshoulders– This will bring arms towards the This will bring arms towards the

toys. toys. – Use rings to bring the toys down closer to the baby so accidental movements will result in batting of the toys– Decrease use of the boppy when Decrease use of the boppy when

baby is able to reach for toys baby is able to reach for toys independently when in supine independently when in supine (usually around 5 months) (usually around 5 months)

• Prone positioning Prone positioning – At least 30 minutes per dayAt least 30 minutes per day– Baby should be able to tolerate Baby should be able to tolerate

prone positioning without the prone positioning without the blanket rollblanket roll

– Baby’s tolerance for prone should Baby’s tolerance for prone should be increasingbe increasing






• When you carry a baby, you When you carry a baby, you should always be sure that you should always be sure that you are preventing any archingare preventing any arching– Carry the baby in a flexed Carry the baby in a flexed

position, do not allow the head position, do not allow the head to extendto extend

– Flex up and hold one leg so Flex up and hold one leg so that the baby cannot extend. that the baby cannot extend.

– This will prevent abnormal This will prevent abnormal muscle activation and muscle activation and movement patterns that so movement patterns that so many infants are many infants are demonstrating nowdemonstrating now

• You can carry a baby in prone You can carry a baby in prone and when they are little this is and when they are little this is a great position as they can a great position as they can get that feeling of comfort get that feeling of comfort when being in prone. when being in prone. – However, if you have a child However, if you have a child

who likes to arch and extend who likes to arch and extend all the time, this is not a good all the time, this is not a good option for this child as they get option for this child as they get older as they are older as they are demonstrating unbalanced demonstrating unbalanced extensionextension


• Every 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 rotational muscles that are important for smooth dissociated movement– By four months, baby should start to lift head laterally By four months, baby should start to lift head laterally

when you pick her upwhen you pick her up







• 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 By four months old your baby is just starting to develop her side to side

control of her trunk and head. You can help facilitate this by moving control of her trunk and head. You can help facilitate this by moving her on the ball.her on the ball.

– Shapes on the ball, move your baby’s bottom in circles, stars, square Shapes on the ball, move your baby’s bottom in circles, stars, square etc.etc.

• Prone on the ball – lateral and anterior/posterior weight shifts Prone on the ball – lateral and anterior/posterior weight shifts

Exercises 3-6 monthsExercises 3-6 months• Prone over legs with Prone over legs with

hands on the floorhands on the floor– To increase activation of To increase activation of

the arms, lift your back the arms, lift your back leg (the leg farthest from leg (the leg farthest from the head of the baby)the head of the baby)

– This will facilitate triceps This will facilitate triceps activation, teaches the activation, teaches the baby how to push baby how to push through their hands and through their hands and works to open up the works to open up the baby’s handsbaby’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 bearing When you are holding a baby after they have been weight bearing

through the ground on their hands, facilitate them up to sitting on your through the ground on their hands, facilitate them up to sitting on your lap. This will strengthen their oblique muscles and lateral neck and lap. 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 babiesfirstfitness.com




Exercises 3-6 monthsExercises 3-6 months• Facilitation of RollingFacilitation of Rolling

– Rolling from back to Rolling from back to front is a really front is a really important skillimportant skill

– It is the first skill It is the first skill where infants where infants become independent become independent with their mobilitywith their mobility

– The important thing The important thing when helping a baby when helping a baby roll is to WAIT for roll is to WAIT for them to activate their them to activate their lateral neck muscleslateral neck muscles

– It is very important to It is very important to facilitate over both facilitate over both sidessides

Exercises 3-6 monthsExercises 3-6 months• Sitting practiceSitting practice

– Tripod sitting (sitting with Tripod sitting (sitting with upper extremity support upper extremity support starts at the same time that starts at the same time that your baby pushes on her your baby pushes on her hands on her tummyhands on her tummy

• Sitting with 1-2 boppy pillowsSitting with 1-2 boppy pillows• Sitting balance on caregivers Sitting balance on caregivers

laplap– When you are sitting with a When you are sitting with a

baby on your lap, feel free to baby on your lap, feel free to move your legs up and down, move your legs up and down, one side at a time, while one side at a time, while holding the baby at her trunk holding the baby at her trunk slowly to let the baby slowly to let the baby practice reacting the balance practice reacting the balance challengeschallenges

Hand to feet in supine – rolling side to Hand to feet in supine – rolling side to sideside

• Facilitate hands to feet Facilitate hands to feet when in supine (on back)when in supine (on back)– This also helps to lengthen This also helps to lengthen

the hamstrings, activate the hamstrings, activate the abdominal muscles, the abdominal muscles, and lengthen the muscles and lengthen the muscles in the back of the bodyin the back of the body

– Place toys on baby’s feet Place toys on baby’s feet to encourage her to get to encourage her to get her feether feet

– Encourage her to eat her Encourage her to eat her toes as this helps to toes as this helps to activate the abdominals activate the abdominals increase the hamstring increase the hamstring the stretchthe stretch

Sixth MonthSixth MonthSix MonthsSix Months

Your baby is starting to Your baby is starting to move around, time to move around, time to be cautious!! Your be cautious!! Your baby is now starting to baby is now starting to roll from his back to his roll from his back to his tummy. He is also tummy. He is also sitting independently. sitting independently. Also, your baby really Also, your baby really likes his tummy and likes his tummy and likes to play on his likes to play on his tummy for a long time.tummy for a long time.

Seventh MonthSeventh MonthSeven MonthsSeven Months

Your baby is starting to explore Your baby is starting to explore positions where her belly is off positions where her belly is off the surface. These positions the surface. These positions include laying on her side while include laying on her side while one hand/arm is supporting and one hand/arm is supporting and the other is playing. She also is the other is playing. She also is starting to enjoy rocking on her starting to enjoy rocking on her hands and knees with her belly hands and knees with her belly off the surface. She may even off the surface. She may even be trying to do a pike position be trying to do a pike position where she straightens her legs where she straightens her legs and brings her bottom toward and brings her bottom toward the ceiling (down dog). What a the ceiling (down dog). What a strong little girl! She loves to strong little girl! She loves to sit and play and is starting to sit and play and is starting to explore the space to the side of explore the space to the side of her where she may be just her where she may be just starting to transition to four starting to transition to four point independently.point independently.

Eighth MonthEighth MonthEight MonthsEight Months

Your baby is getting very strong. Your baby is getting very strong. He prefers to play in prone and He prefers to play in prone and sitting, and rarely plays on his sitting, and rarely plays on his back anymore. Your baby may back anymore. Your baby may be getting well by transitioning be getting well by transitioning from sitting to four point and from sitting to four point and may even be starting to may even be starting to transition from the floor to sitting transition from the floor to sitting on his own. He may be crawling on his own. He may be crawling on his belly to get around. This on his belly to get around. This is ok for a short period of time, is ok for a short period of time, but soon we want to see him get but soon we want to see him get to his hands and knees to crawl. to his hands and knees to crawl. As your baby becomes more As your baby becomes more mobile, he will want to explore mobile, he will want to explore things that are higher than the things that are higher than the floor. This drives him to floor. This drives him to transition from sitting to his transition from sitting to his knees at higher surfaces. knees at higher surfaces.

Ninth MonthNinth MonthNine MonthsNine Months

Your baby should be a pro at Your baby should be a pro at getting around on her hands and getting around on her hands and knees and travels this way for knees and travels this way for long distances. She is loving long distances. She is loving exploring the world, especially exploring the world, especially higher surfaces. This drives her to higher surfaces. This drives her to want to climb higher and higher . . want to climb higher and higher . . . even up the stairs. She may . even up the stairs. She may even be pulling to stand at low even be pulling to stand at low couches, but she prefers to use couches, but she prefers to use her arms more than her legs at her arms more than her legs at this stage. You better get those this stage. You better get those gates! Your baby is not only gates! Your baby is not only sitting in the ring position, but has sitting in the ring position, but has enough trunk strength that she enough trunk strength that she can sit in a variety of sitting can sit in a variety of sitting positions including on her heels, positions including on her heels, side sitting, on a small bench and side sitting, on a small bench and long sitting. long sitting.


Positioning SuggestionsPositioning Suggestions• Sitting independently, place toys laterally (at side) instead of in front of baby to stimulate lateral movement

(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 Prone – your baby should love to be in prone and not like supine (back) much

anymoreanymore• 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 Carry upright – encourage baby to hold onto you more as you carry him if he

tolerates thistolerates this• Rotation 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 Ball – sitting on ball progressing to holding at pelvis due to improved trunk control

and demanding more activationand demanding more activation• Ball – prone on ball – progressing to more demanding positions where your baby has Ball – prone on ball – progressing to more demanding positions where your baby has

to lift her head against gravity as she comes closer to the ground and reaches for a to lift her head against gravity as she comes closer to the ground and reaches for a toytoy

• 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

https://babiesfirstfitness.com/2016/05/03/moving-beyond-sitting-strategies-to-progress-your-baby-to-independent-transitions/

https://babiesfirstfitness.com/2016/05/03/moving-beyond-sitting-strategies-to-progress-your-baby-to-independent-transitions/



• Position toys laterallyPosition toys laterally– This facilitates lateral This facilitates lateral

movement and movement and transitioning from sitting transitioning from sitting to prone and/or sitting to to prone and/or sitting to four point (click on link for four point (click on link for blogpost)blogpost)

• Prone Prone – Your baby should love to Your baby should love to

be in prone now and be in prone now and prefers sitting and prone prefers sitting and prone over supine over supine


• Carry uprightCarry upright• Encourage baby to Encourage baby to

hold onto you more hold onto you more as you carry him if as you carry him if he tolerates this he tolerates this nownow


• Every time you pick a baby up you should rotate Every 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 should really be helping with this transition Your baby should really be helping with this transition

now and will be pushing with her arm as she gets up. now and will be pushing with her arm as she gets up. – You will also start to see her activate the side of her You will also start to see her activate the side of her

trunk muscles and her headtrunk muscles and her head


• Sitting on the ballSitting on the ball– As your baby gets bigger, As your baby gets bigger,

she is getting a lot stronger she is getting a lot stronger in the trunk and the headin the trunk and the head

– Hold your baby at her pelvis Hold your baby at her pelvis to demand more trunk to demand more trunk activation when sitting on activation when sitting on the ballthe ball

• Prone on the ballProne on the ball– Your baby is getting really Your baby is getting really

strong now when in prone, strong now when in prone, start to challenge her more start to challenge her more by bringing her closer to the by bringing her closer to the ground and asking her to ground and asking her to pick up toys from the ground pick up toys from the ground


• Walking on hands off lap or with a Walking on hands off lap or with a foam roller (or a rolled up yoga foam roller (or a rolled up yoga mat)mat)– This exercise will teach your baby This exercise will teach your baby

how to move their arms forward how to move their arms forward which will prepare them for which will prepare them for forward motion as they learn to forward motion as they learn to crawlcrawl

– This exercise also strengthens the This exercise also strengthens the shoulder girdle and trunkshoulder girdle and trunk

• In the first picture, your baby is In the first picture, your baby is learning how to accept weight on learning how to accept weight on her hands when gently moved her hands when gently moved forward at an increased speed forward at an increased speed (protective extension). (protective extension).

• In the second pictures, your baby In the second pictures, your baby is learning how to shift her weight is learning how to shift her weight and reach for a toy, and/or move and reach for a toy, and/or move forward a few steps with her forward a few steps with her handshands

Exercises 6-9 monthsExercises 6-9 months• Transitioning to four pointTransitioning to four point

– Your baby needs to feel Your baby needs to feel comfortable placing weight on comfortable placing weight on one arm and slightly lifting her one arm and slightly lifting her bottom off the floor to reach for bottom off the floor to reach for a toy before she can go all the a toy before she can go all the way to four point, so practice way to four point, so practice this firstthis first

– As your baby becomes more As your baby becomes more confident with this, you can confident with this, you can facilitate her to go all the way facilitate her to go all the way from sitting to four pointfrom sitting to four point

– Place your hand on her belly Place your hand on her belly during the transition to help her during the transition to help her to remember to activate her to remember to activate her bellybelly

– It is absolutely ok to go from It is absolutely ok to go from sitting to prone, in fact sitting to prone, in fact encouraged during this stage, encouraged during this stage, your baby does not have to stop your baby does not have to stop at four pointat four point


• Four point positioningFour point positioning– You may use a foam You may use a foam

roll or your leg to keep roll or your leg to keep your baby in a four your baby in a four point positionpoint position

– When you get her into When you get her into this position, you may this position, you may rock her front to backrock her front to back

– Only do what she Only do what she toleratestolerates

Exercises 6-9 monthsExercises 6-9 months• Transition side sitting Transition side sitting

to tall kneelingto tall kneeling– This is an important This is an important

transition as it allows transition as it allows your baby to gain your baby to gain strength of the side of strength of the side of her hip muscles her hip muscles necessary for necessary for independent crawlingindependent crawling

– You can do this on a roll, You can do this on a roll, your leg or on the side your leg or on the side of a couch or a stairof a couch or a stair

Why creeping is importantWhy creeping is importantHands and knees crawling is the Hands and knees crawling is the preferred way for babies to get preferred way for babies to get around. around. – It takes a lot more strength for It takes a lot more strength for

a baby to creep on his/her a baby to creep on his/her hands and knees than it does hands and knees than it does to crawl on his belly or scoot to crawl on his belly or scoot on her bottom.on her bottom.

– Typically if a baby is scooting Typically if a baby is scooting on her bottom to get around or on her bottom to get around or crawling on her belly there is a crawling on her belly there is a reason that she is reason that she is demonstrating this pattern, demonstrating this pattern, including but not limited to including but not limited to poor core strength, poor poor core strength, poor shoulder girdle strength and shoulder girdle strength and stability, muscle imbalance, stability, muscle imbalance, asymmetrical head position. asymmetrical head position.

Ways to facilitate hands and Ways to facilitate hands and knees crawlingknees crawling

• 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 Place your baby on hands and knees. Shift weight posteriorly (backward) so that her belly is on her knees. This decreases the need for increased strength of the her belly is on her knees. This decreases the need for increased strength of the upper extremities and provides increased support for the lower extremities and upper extremities and provides increased support for the lower extremities and bellybelly

– 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 If your baby likes to extend her legs out, you will need to keep a bit of pressure

back with her bottom on her heels to prevent her from extendingback with her 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 Place 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)get the toys - versus being in front of her (click on link for blog post)

Ninth MonthNinth MonthNine MonthsNine Months

Your baby should be a pro at Your baby should be a pro at getting around on her hands and getting around on her hands and knees and travels this way for knees and travels this way for long distances. She is loving long distances. She is loving exploring the world, especially exploring the world, especially higher surfaces. This drives her to higher surfaces. This drives her to want to climb higher and higher . . want to climb higher and higher . . . even up the stairs. She may . even up the stairs. She may even be pulling to stand at low even be pulling to stand at low couches, but she prefers to use couches, but she prefers to use her arms more than her legs at her arms more than her legs at this stage. You better get those this stage. You better get those gates! Your baby is not only gates! Your baby is not only sitting in the ring position, but has sitting in the ring position, but has enough trunk strength that she enough trunk strength that she can sit in a variety of sitting can sit in a variety of sitting positions including on her heels, positions including on her heels, side sitting, on a small bench and side sitting, on a small bench and long sitting. long sitting.

Tenth MonthTenth MonthTen MonthsTen Months

Your baby is really wanting to Your baby is really wanting to be upright in standing and he be upright in standing and he is transitioning to standing is transitioning to standing using his legs more than his using his legs more than his arms. He often chooses to arms. He often chooses to stand via ½ kneel. Your baby stand via ½ kneel. Your baby now able to lower himself to now able to lower himself to the floor independently from the floor independently from standing, instead of falling to 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 He is even starting to squat down to pick up a toy from the down to pick up a toy from the floor and returning to standing floor and returning to standing on his own. He is doing a lot of on his own. He is doing a lot of playing in standing, often with playing in standing, often with his belly off the surface. He is his belly off the surface. He is doing a lot of looking from side doing a lot of looking from side to side and weight shifting in to side and weight shifting in preparation for cruising next preparation for cruising next month.month.

Eleventh MonthEleventh MonthEleven MonthsEleven Months

Your baby is starting to Your baby is starting to cruise along furniture cruise along furniture (sideways walking). This is (sideways walking). This is getting exciting! She is getting exciting! She is becoming very strong with becoming very strong with her legs and trunk, such her legs and trunk, such that she is able to that she is able to occasionally stand without occasionally stand without her belly on the surface for her belly on the surface for a few seconds. She may a few seconds. She may even start to cruise even start to cruise between objects that are between objects that are really close. really close.

Twelfth MonthTwelfth MonthTwelve MonthsTwelve Months

Your baby is really getting Your baby is really getting big. You are marvel at her big. You are marvel at her progress as she is standing progress as she is standing from the floor from the floor independently from the independently from the middle of the room and middle of the room and starting to take some steps. starting to take some steps. She seems clumsy at first She seems clumsy at first as she tries to take a few as she tries to take a few steps between objects that steps between objects that are a bit further apart, but are a bit further apart, but she is going to very soon she is going to very soon become a proficient walker. become a proficient walker.


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 ball 90/90 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


• Carry uprightCarry upright• Encourage baby to Encourage baby to

hold onto you more hold onto you more as you carry him if as you carry him if he tolerates this he tolerates this nownow


• Every time you pick a baby up you should Every time you pick a baby up you should rotate him to sitting. (click on link for video)rotate him to sitting. (click on link for video)– Your baby is likely able to do this transition on her Your baby is likely able to do this transition on her

own now and will likely do it for you if your just own now and will likely do it for you if your just place your hand on her pelvis or ask her to sit up. place your hand on her pelvis or ask her to sit up.


• Sitting on the ballSitting on the ball– As your baby gets bigger, As your baby gets bigger,

she is getting a lot stronger she is getting a lot stronger in the trunk and the headin the trunk and the head

– Hold your baby at her pelvis Hold your baby at her pelvis to demand more trunk to demand more trunk activation when sitting on activation when sitting on the ballthe ball

• Prone on the ballProne on the ball– Your baby is getting really Your baby is getting really

strong now when in prone, strong now when in prone, start to challenge her more start to challenge her more by bringing her closer to the by bringing her closer to the ground and asking her to ground and asking her to pick up toys from the ground pick up toys from the ground


• 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 Place the ball next to the couch and help him climb up the ball and onto the

couchcouch• Walking on hands Walking on hands

– As your baby wants to get off your lap, gently hold up her pelvis so that she can As your baby wants to get off your lap, gently hold up her pelvis so that she can walk off your lap on her hands. This will strengthen her trunk, gluts and shoulder walk off your lap on her hands. This will strengthen her trunk, gluts and shoulder girdlegirdle

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 As your baby becomes stronger at pulling to stand, she should no longer be pulling

up with arms more than legs, help her up with one leg firstup with arms 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 While your baby is holding onto a surface, place a toy on the floor or a stool (which is

higher and easier) and encourage her to get the toy higher and easier) and encourage her to get the toy – Help her bend her knees and support her bottom so that she gradually lowers and Help her bend her knees and support her bottom so that she gradually lowers and

comes back up to standing comes back up to standing • Four point standingFour point standing

– Four point standing is when a child is standing with their hands on a lower surface Four point standing is when a child is standing with their hands on a lower surface (such as a stool) (such as 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, Encourage her to push an object in this position ( a small truck, stool, milk crate, telephone book, diaper box etc.)telephone 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 Placing bags of rice or beans or heavy balls/weights concealed in push toys are a good way to provide increased resistance for pushinggood way to provide increased resistance for pushing

– This increased resistance provides increased abdominal strengthening and This increased resistance provides increased abdominal strengthening and plantarflexor strengthening as well as shoulder girdle strengtheningplantarflexor strengthening as well as shoulder girdle strengthening

– If you are available to help, you resist the object as it is coming forward to provide If you are available to help, you resist the object as it is coming forward to provide added incentive for your babyadded incentive for your baby


• Bench sittingBench sitting– Have your baby sit Have your baby sit

on a small bench or on a small bench or a small playground a small playground ballball

– Place toys slightly Place toys slightly out of your baby’s out of your baby’s reach so that she reach so that she has to use her trunk has to use her trunk to get the itemto get the item

Exercises 9-12 monthsExercises 9-12 months• Sit to stand at a benchSit to stand at a bench

– When your baby is at the 11-12 When your baby is at the 11-12 month developmental level, she month developmental level, she is ready to start working on sit is ready to start working on sit to stand from a benchto stand from a bench

– You can provide a target, such You can provide a target, such as a basketball hoop and a small as a basketball hoop and a small ball to help her get to standingball to help her get to standing

– You do not have to facilitate at You do not have to facilitate at the arms. You may be able to the arms. You may be able to get the baby to stand by gently get the baby to stand by gently tapping at her belly and her tapping at her belly and her bottom as well as providing a bottom as well as providing a good incentive for her to stand good incentive for her to stand toto

– It will be more successful at first It will be more successful at first if you have her stand to a if you have her stand to a surface such as a couch and surface such as a couch and later have her stand later have her stand independentlyindependently


• Facilitation of cruisingFacilitation of cruising– Your baby is getting very confident now when he is standing at a surface. You Your baby is getting very confident now when he is standing at a surface. You

now are going to help him move side to sidenow are going 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 Then swich hands the up goes down to weight the leg and the down goes up to

bring the opposite leg to the standing legbring the opposite 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 The best way to facilitate floor to stand is to pair it with a verbal command such

as “1-2-THRE-eeeee”as “1-2-THRE-eeeee”– Each time you facilitate floor to stand you say 1-2-3 (with an emphasis on the 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 THR- EEEE) so that when you want your baby to stand independently and she is able to do it, you just say 1-2-3 and she standsable to do it, you just say 1-2-3 and she stands

– In order to faciliate standing, get your baby in hands and knees, her hands must In order to faciliate standing, get your baby in hands and knees, her hands must stay on the floorstay on the floor

– Bring one leg up and say 1, the other and say 2 then the bring her weight Bring one leg up and say 1, the other and say 2 then the bring her weight backwards and slightly up and say THRE-eeee as she stands up by herself . . . backwards and slightly up and say THRE-eeee as she stands up by herself . . . Very proud!Very proud!

Red Flags that should Red Flags that should prompt assessmentprompt assessment

Red Flags that should prompt Red Flags that should prompt assessmentassessment

• Rolling prior to three months Rolling prior to three months evaluate for hypertoniaevaluate for hypertonia

• Head observed to rotate or tilt to one side only Head observed to rotate or tilt to one side only evaluate for Torticollis, visual deficits evaluate for Torticollis, visual deficits Click here for a link to Click here for a link to a printout if you suspect preference of tilt or rotation to one side or the a printout if you suspect preference of tilt or rotation to one side or the other * also recommend that they speak with their pediatrician.other * also recommend that they speak with their pediatrician.

• Persistent fisting by three months Persistent fisting by three months evaluate for evaluate for neuromuscular dysfunctionneuromuscular dysfunction

• Failure to alert to environmental stimuli Failure to alert to environmental stimuli evaluate evaluate for sensory impairmentfor sensory impairment


• Head lag when pulled to sit after 4 months of age Head lag when pulled to sit after 4 months of age evaluate for hypotoniaevaluate for hypotonia

• Failure to reach for objects by 5 months Failure to reach for objects by 5 months evaluate evaluate for motor, visual or cognitive deficitsfor motor, visual or cognitive deficits

• Inability to prop sit by 6 months Inability to prop sit by 6 months evaluate for evaluate for hypotoniahypotonia

• Absent smile by 4-6 months Absent 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 Red Flags that should prompt assessmentassessment• Persistence of primitive reflexes after 6 months Persistence of primitive reflexes after 6 months

evaluate for neuromuscular disorderevaluate for neuromuscular disorder

• Absent babbling by 6 months Absent babbling by 6 months evaluate for hearing evaluate for hearing deficitdeficit

• Absent stranger anxiety by 7 months Absent stranger anxiety by 7 months may be may be related to multiple care providersrelated to multiple care providers

• W sitting and bunny hopping at 7 months W sitting and bunny hopping at 7 months evaluate for hypertonia or hypotoniaevaluate for hypertonia or hypotonia


• No back and forth sharing of sounds, smiles or other facial No back and forth sharing of sounds, smiles or other facial expression by age 9 months or thereafter expression by age 9 months or thereafter evaluate for evaluate for autism of pervasive developmental disorderautism of pervasive developmental disorder

• Lack of tool use (crayon, spoon) by 12 months Lack of tool use (crayon, spoon) by 12 months evaluate evaluate for fine motor or cognitive delayfor fine motor or cognitive delay

• Lack of imitative play by 18 months Lack of imitative play by 18 months evaluate for evaluate for hearing deficit or cognitive/socialization deficit, evaluate hearing deficit or cognitive/socialization deficit, evaluate for autismfor autism

• Hand dominance prior to 18 months Hand dominance prior to 18 months evaluate for evaluate for hemiplegia or brachial plexus injuryhemiplegia or brachial plexus injury


• Lack of prodeclarative pointing by 16 months of age Lack of prodeclarative pointing by 16 months of age evaluate for autism due to problem in social evaluate for autism due to problem in social relatednessrelatedness

• No first word, other than mama/dada by 18 months No 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 Does not follow simple 1 step commands by 15 months months evaluate for receptive language delay evaluate for receptive language delay

• Persistent poor transitions by 24 months Persistent poor transitions by 24 months evaluate evaluate for pervasive developmental disorderfor pervasive developmental disorder


• No two word sentences by 2 years No two word sentences by 2 years evaluate for evaluate for auditory expressive language delayauditory expressive language delay

• Advanced non-communicative speech (echolalia) by 24 Advanced non-communicative speech (echolalia) by 24 monthsmonths evaluate for autism or pervasive evaluate for autism or pervasive developmental disorderdevelopmental disorder

• Any loss of speech Any loss of speech babbling or social skills at any babbling or social skills at any age, evaluate for autism or pervasive developmental age, 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 can These exercises are only suggestions for how you can

help babies progress their developmental skills help babies progress their developmental skills whether they are demonstrating delays or are on whether they are demonstrating delays or are on track developmentallytrack developmentally

• Please use caution when doing these exercises as you Please 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 a please let the doctor know so the family can receive a proper evaluation with proper and individualized proper evaluation with proper and individualized exercise instruction from a qualified pediatric physical exercise instruction from a qualified pediatric physical therapisttherapist

• If you have any questions, please do not hesitate to If you have any questions, please do not hesitate to contact me at [email protected] me at [email protected]

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

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