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How to Help Infants Attain Gross Motor Skills:How to Help Infants Attain Gross Motor Skills:
Practical Ideas for caregiver...
Goals of today’s lectureGoals of today’s lecture
• You will review the gross motor milestonesYou will review the gross mot...
Typical DevelopmentTypical Development
In the First YearIn the First Year
ReminderReminder
• In the following developmental progression,In the following developmental progression,
months are used ...
First MonthFirst Month
First MonthFirst Month
Your baby is just learning howYour baby is just learning how
to lift and tur...
Second MonthSecond Month
Two MonthsTwo Months
He is starting to feel a bitHe is starting to feel a bit
floppy. This is bec...
Three MonthsThree Months
Three MonthsThree Months
Your baby has learned how toYour baby has learned how to
activate their ...
Exercises to facilitateExercises to facilitate
Developmental 0-3 monthsDevelopmental 0-3 months
Positioning SuggestionsPos...
Positioning Suggestions 0-3Positioning Suggestions 0-3
monthsmonths
• Supine (on back) on large boppySupine (on back) on l...
Carrying Suggestions 0-3 monthsCarrying Suggestions 0-3 months
• When you carry a baby, youWhen you carry a baby, you
shou...
Pick Up Suggestions 0-3Pick Up Suggestions 0-3
monthsmonths
• Every time you pick a baby up you should rotate him to sitti...
Exercises 0 – 3 monthsExercises 0 – 3 months
• Sitting on ball – holding at upper trunkSitting on ball – holding at upper ...
Exercises 0-3 monthsExercises 0-3 months
• BicyclesBicycles
– Bicycles help with gas asBicycles help with gas as
well with...
Exercises 0-3 monthsExercises 0-3 months
• Lower trunk stretchLower trunk stretch
– This helps to lengthen theThis helps t...
Exercises 0-3 monthsExercises 0-3 months
• Supine on lap withSupine on lap with
facilitation of hand tofacilitation of han...
Exercises 0-3 monthsExercises 0-3 months
• Side-lying playSide-lying play
– Side-lying play is good forSide-lying play is ...
Three MonthsThree Months
Three MonthsThree Months
Your baby has learned how toYour baby has learned how to
activate their ...
Four MonthsFour Months
Fourth MonthFourth Month
Your baby is getting really strong intoYour baby is getting really strong ...
Five MonthsFive Months
Five MonthsFive Months
Your infant is really starting toYour infant is really starting to
move. On ...
Sixth MonthSixth Month
Six MonthsSix Months
Your baby is starting toYour baby is starting to
move around, time to bemove a...
Exercises to facilitate DevelopmentExercises to facilitate Development
3-6 months3-6 months
Positioning SuggestionsPositio...
Positioning Suggestions 3-6Positioning Suggestions 3-6
monthsmonths
• Supine (on back) with large boppySupine (on back) wi...
Carrying Suggestions 3-6 monthsCarrying Suggestions 3-6 months
• When you carry a baby, youWhen you carry a baby, you
shou...
Pick Up Suggestions 3-6Pick Up Suggestions 3-6
monthsmonths
• Every time you pick a baby up you should rotate him to sitti...
Exercises 3-6 monthsExercises 3-6 months
• Sitting on the ballSitting on the ball
– Progressing to lower on the trunk with...
Exercises 3-6 monthsExercises 3-6 months
• Prone over legs withProne over legs with
hands on the floorhands on the floor
–...
• Rotation to sitting on your lapRotation to sitting on your lap
– This exercise is very similar to rotating the baby up t...
Exercises 3-6 monthsExercises 3-6 months
• Facilitation of RollingFacilitation of Rolling
– Rolling from back toRolling fr...
Exercises 3-6 monthsExercises 3-6 months
• Sitting practiceSitting practice
– Tripod sitting (sitting withTripod sitting (...
Hand to feet in supine – rolling side to sideHand to feet in supine – rolling side to side
• Facilitate hands to feetFacil...
Sixth MonthSixth Month
Six MonthsSix Months
Your baby is starting to moveYour baby is starting to move
around, time to be ...
Seventh MonthSeventh Month
Seven MonthsSeven Months
Your baby is starting to exploreYour baby is starting to explore
posit...
Eighth MonthEighth Month
Eight MonthsEight Months
Your baby is getting very strong.Your baby is getting very strong.
He pr...
Ninth MonthNinth Month
Nine MonthsNine Months
Your baby should be a pro at gettingYour baby should be a pro at getting
aro...
Exercises to facilitate DevelopmentExercises to facilitate Development
6-9 months6-9 months
Positioning SuggestionsPositio...
Positioning Suggestions 6-9Positioning Suggestions 6-9
monthsmonths
• Position toys laterallyPosition toys laterally
– Thi...
Carrying Suggestions 6-9 monthsCarrying Suggestions 6-9 months
• Carry uprightCarry upright
• Encourage baby toEncourage b...
Pick Up Suggestions 6-9Pick Up Suggestions 6-9
monthsmonths
• Every time you pick a baby up you should rotate him toEvery ...
Exercises 6-9 monthsExercises 6-9 months
• Sitting on the ballSitting on the ball
– As your baby gets bigger, sheAs your b...
Exercises 6-9 monthsExercises 6-9 months
• Walking on hands off lap or with aWalking on hands off lap or with a
foam rolle...
Exercises 6-9 monthsExercises 6-9 months
• Transitioning to four pointTransitioning to four point
– Your baby needs to fee...
Exercises 6-9 monthsExercises 6-9 months
• Four point positioningFour point positioning
– You may use a foam rollYou may u...
Exercises 6-9 monthsExercises 6-9 months
• Transition side sitting toTransition side sitting to
tall kneelingtall kneeling...
Why creeping is importantWhy creeping is important
Hands and knees crawling is theHands and knees crawling is the
preferre...
Ways to facilitate hands and kneesWays to facilitate hands and knees
crawlingcrawling
• Pushing a small item – while on kn...
Ninth MonthNinth Month
Nine MonthsNine Months
Your baby should be a pro at gettingYour baby should be a pro at getting
aro...
Tenth MonthTenth Month
Ten MonthsTen Months
Your baby is really wanting to beYour baby is really wanting to be
upright in ...
Eleventh MonthEleventh Month
Eleven MonthsEleven Months
Your baby is starting to cruiseYour baby is starting to cruise
alo...
Twelfth MonthTwelfth Month
Twelve MonthsTwelve Months
Your baby is really getting big.Your baby is really getting big.
You...
Exercises to facilitate DevelopmentExercises to facilitate Development
9-12 months9-12 months
Positioning SuggestionsPosit...
Carrying Suggestions 9-12 monthsCarrying Suggestions 9-12 months
• Carry uprightCarry upright
• Encourage baby toEncourage...
Pick Up Suggestions 9-12 monthsPick Up Suggestions 9-12 months
• Every time you pick a baby up you should rotateEvery time...
Exercises 9-12 monthsExercises 9-12 months
• Sitting on the ballSitting on the ball
– As your baby gets bigger, sheAs your...
Exercises 9-12 monthsExercises 9-12 months
• Facilitation of crawling/climbingFacilitation of crawling/climbing
– Allow yo...
Exercises 9-12 monthsExercises 9-12 months
• ½ kneel to stand at a surface½ kneel to stand at a surface
– Facilitate your ...
Exercises 9-12 monthsExercises 9-12 months
• Bench sittingBench sitting
– Have your baby sit onHave your baby sit on
a sma...
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-...
Exercises 9-12 monthsExercises 9-12 months
• Facilitation of cruisingFacilitation of cruising
– Your baby is getting very ...
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 prio...
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• Head lag when pulled to sit after 4 month...
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• Persistence of primitive reflexes after 6...
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• No back and forth sharing of sounds, smil...
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• Lack of prodeclarative pointing by 16 mon...
Red Flags that should prompt assessmentRed Flags that should prompt assessment
• No two word sentences by 2 yearsNo two wo...
Reminders/DisclaimersReminders/Disclaimers
• These exercises are only suggestions for how you canThese exercises are only ...
www.babiesfirstfitness.comwww.babiesfirstfitness.com
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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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This is an updated version of my lecture that has been viewed over 119,000 times! It has added hyperlinks to videos and blog posts that discuss the activities in this lecture. Enjoy!

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

  1. 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. 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. 3. Typical DevelopmentTypical Development In the First YearIn the First Year
  4. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 59. Red Flags that shouldRed Flags that should prompt assessmentprompt assessment
  60. 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. 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. 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. 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. 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. 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. 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. 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.

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