The starting point is understanding the concept of balance. The body’s balance system works through a constant process of position detection, feedback, and adjustment using communication between the inner ear (vestibular system), eyes, muscles, joints (proprioception system), and the brain. The vestibular system (inner ear balance mechanism) works with the visual system to stop objects from blurring when the head moves. The cerebellum is the small part of the brain positioned at the back of the head, where it meets the spine, which acts as the body’s movement and balance control center.
Babies start off with movements that are preprogrammed into their central nervous system originating in the brain stem. These movements are automatic, requiring no conscious thought. Automatic movements usually occur as a response to a stimulus from the visual, tactile, or vestibular systems. They include righting reactions of the neck and body and equilibrium reactions. At birth, our movements are uncontrolled. We cannot move against gravity, and our primitive reflexes are dominant. Some of these are the Rooting, Moro, ATNR, STNR, and Palmar reflexes.
Most of these reflexes should be integrated by around 6-12 months of age. Equilibrium or balance reactions are also automatic and enable babies to adjust themselves against gravity or readjust when they are shifted off center. These begin with righting reactions of the neck and body at 0-6 months of age and help the child automatically rotate the body when the head is turned and the body following suit to roll when the leg is brought up over to the side. These reactions will help a baby progress from log rolling (everything rolls together) to segmented rolling (when trunk, limbs, head, and neck can roll independently of one another). These automatic reactions progress to balance reactions which will help a baby learn to properly align the limbs. Balance reactions happen in prone, supine, sitting, on hands and knees, in kneeling, and then in standing from 6-7 months of age until 15-18 months.
Back to the inner ear and vestibular system … if a baby has episodes of frequent ear infections with chronic fluid present (they can even have the fluid build up without infections) this not only can affect their hearing and progression with babbling but also their comfort with movements and balance. They may not want to roll or transition in and out of positions. I have worked with many babies and toddlers that have experienced freedom with hearing and floor play movement skills when this issue was addressed and taken care of, typically with tubes placed to drain the fluid and free the space to work as it should again.
Why Is Balance & Coordination Important?
The purpose of these automatic reflex and balance reactions is to help babies learn to develop purposeful movements that become voluntary. Allowing a baby to progress through floor play positions is so important in order to develop these purposeful, independent movements that will isolate out strengthening of the correct muscles they need to improve balance and develop coordinated motor movements.
The typical progression of some of the upright
balance skills will look like this:
Prop sitting: 5-7 months of age
Independent floor sitting with upright trunk: 6-8 months
Protective extension of arms to side and front in sitting: 6-8 months
Sits without hand support for 10 minutes: 8-9 months
Pivots in sitting. twists to pick up objects: 10-11 months
Goes from sitting to tummy (prone): 6-10 months
Demonstrates balance reactions in sitting: 7-8 months
Gets to sitting without assistance: 7-10 months
Gets into hands and knees position from tummy or sitting: 8-9 months
Creeps on hands and knees: 10-12 months
Pulls to stand at furniture: 7-10 months
Cruises or walks holding onto furniture: 9-13 months
Stands a few seconds: 11-13 months
Walks alone 2-3 steps: 12-14 months
As you can see, there is a lot of range for these progressions and each baby is different but the important thing is that they have ample floor play time to work and develop balance reactions and muscle strength to become more independent with each new skill. The previous post talked about how the overuse of “container” toys can inhibit babies from developing these natural progressions and not strengthen needed muscles for improving balance as they become more upright and more mobile.
How Does Pediatric Physical Therapy Help With Balance & Coordination?
Pediatric Physical Therapists are trained to know the normal stages of development and the Central nervous system. If a baby is “stuck” in a stage or a caregiver is having difficulty with helping their baby progress to the next level, therapists can help identify what activities and movements need to be worked on or strengthened. The ultimate goal is to progress to independent walking if possible and then to work on balance and coordination skills to help a child achieve gross motor skills that allow them to move and play at their highest level of independence possible!
