Crawling, walking, running, and jumping are examples of movement and mobility which are typically functional goals a pediatric physical therapist will add to a child’s plan of care based on an initial evaluation and seeking outcomes parents would like for their child. Movement and mobility are the basis for infants and toddlers to learn how to explore and work towards independence within a safe environment. The most important thing parents need to know is that floor play time is what gives babies the opportunity to explore their environment and enhance their cognitive and motor development.
Because of the popularity of exersaucers and walkers (2 million are sold annually and are frequent items to give or receive at a baby shower) babies are spending less time on the floor. Parents may feel that using these are inevitable and normal, but it doesn’t mean it is beneficial to babies. Parents need to evaluate why they are using them. If it is to keep their baby safe when they can’t watch them closely then that can be a valid reason for short periods of time (10-20 minutes). It can become easy though to continue using them out of convenience and may keep a child from vital floor play time which cannot be reclaimed (I’ve seen this at daycares so much!). Walkers have caused a lot of injuries in the past and though they have been made safer, they are probably the reason why exersaucers (which can’t move) were invented. Usually once an infant is placed upright they don’t like to go back down to playing on their tummy or on the floor/blanket. There are a few other reasons why parents use these devices, one being they think they help strengthen their baby’s leg muscles for walking. There was a research study done that determined that infants placed in the walker walked independently later than their twin sibling not placed in the walker and there was less use of the gluteus maximus (hip extensor muscle) and the quadriceps in the walker group. Another reason is that babies due tend to love playing in exersaucers and a lot of parents feel their babies are bored if they are not in it. They are not bored because there are always toys, lights, and visual stimulation place directly in front of them that they don’t have to work too hard to reach and play with. These devices can be part of the reason why babies are missing out on crucial stages of movement and mobility and many babies are placed in these devices before they even know how to sit or stand independently.
Why Is Movement & Mobility Important?
I am going to use the example of crawling here to explain why movement and mobility are important. To clarify the terms of “crawling'“ and “creeping”-most people use the term crawling as being on hands and knees (all fours) but crawling is actually the act of crawling forward on your tummy-commando or army crawling. Creeping however is moving on all fours or in quadruped and that is what I am going to discuss here.
After a baby has learned to sit independently and reach for toys around them with good trunk rotation, they will move forward onto their hands and knees and start to creep. They will first learn to rock back and forth and then start to move backwards or forward in this position. To encourage this, toys will need to be out of reach to motivate them to move towards them. Here are the benefits of creeping and why it is crucial to allow your baby to move through this developmental sequence and not encourage them to be upright in either kneeling or standing too soon before this crucial stage. (Remember they don’t like to go back down usually after being placed in standing).
Creeping:
facilitates left and right sides of the brain working together
assists with sensory processing and cognitive skills
increases strength and coordination especially in the shoulders, wrists, hands, and fingers-needed for later fine motor skills,
creeping puts weight on the pinky side of the hand, which helps prepare the hand for later refined skills, such as writing,
develops the hip joint and strengthens muscles around it needed for cruising and walking.
A parent may say that their child likes to stand more than being on the floor (they usually hated tummy time) and yes, skipping the creeping stage may not keep their baby from walking “on time” but their shoulder, arm, and trunk strength will not be sufficient to help her climb, hop, skip, grasp, and manipulate small objects later on. Putting your baby on the floor to learn to creep is so necessary to build up proximal and distal strength which is critical to your child’s development. There is an important pattern of lengthening one side of the body while the other side is shortening during creeping that the body uses for other higher level motor skills. If they are weak in their trunk, arms, or hips they may have a creeping pattern where their knees stayed tucked under the hips or they may keep their body weight behind the shoulders. One way to strengthen these muscles and encourage them to shift their weight with trunk control is to reach for items with one hand while on their hands and knees. If a baby does not want to creep because of tile or wood floors, they can wear long pants or leggings or put a wrist sweat band over their knees to give them protection. It is also a good idea to have a secure floor rug for babies to have safe and comfortable floor play time.
Creeping is also important because it is from here that a baby learns to pull up to kneeling and standing. It’s important, as mentioned earlier, that a baby learns how to pull up to kneeling and standing on their own and is not rushed to this step by the parents placing them here before they are ready. A baby being placed in kneeling too soon can cause increased lumbar lordosis (arched back) and hip flexor tightness. When babies first learn to pull to stand, they use their arms more to pull themselves up before bringing their legs up under them. As they do this more, they should progress to moving through a half kneel position which requires a lot of spinal and hip mobility, as well as weight shifting abilities and control/stability to support themselves on one leg. They may need help with this transition initially to help them push all the way up to standing.
If a baby is spending a lot of time standing either in an exersaucer, walker, or jumper before they learn how to creep and pull up to standing then they miss out on all this strengthening in the arms, legs, and trunk and weight shifting that can delay their progression with higher motor and fine motor skills.
How Does Pediatric Physical Therapy Help With Movement & Mobility?
Pediatric Physical Therapy can help with teaching parents how to help their child progress through the normal developmental sequence involving creeping or to strengthen the areas that have resulting weakness because a child missed this crucial sequence for whatever reason. Children with neuromuscular involvement or that have a genetic syndrome will have other issues that will need to be addressed and will be talked about in a future article. But for children who have developed weakness or have progressed to walking with missing important motor skills like creeping and pulling up to kneeling and standing is what the discussion here is about.
One example of working with a baby who may position themselves in quadruped keeping their weight behind their shoulders-kind of like a kitten or puppy getting ready to pounce can mean they have some upper body weakness. To improve strength in their arms, you can play games like wheelbarrow-holding their legs up while their hands are on the floor and let them hold their weight here and lifting their head up, you can slowly rock them forward over their hands. Or play “airplane” holding their trunk flying through the air and then land on their hands on the couch or soft surface while you keep supporting their body. Rolling them over a small bolster or a ball and placing their hands on the floor with their hips/legs still over the ball, maybe reach for items or play with a puzzle so they are weight shifting onto one hand. Position different size pillows on the floor to encourage them to crawl on, over, and pull themselves up on. Encourage or help your child with the “bear” position, on hands and feet, which is harder than quadruped and it requires excellent shoulder girdle stability and more control of the lower extremities-knees, ankles, and feet. This position gives a child a great upper body workout and will also elongate her hamstring muscles. Once a child has started to stand, the bear position will also help protect them from falls as they can fall into this position and stop them from hitting the ground.
In summary, I recommend to limit “container” toys for short periods of time and make sure your child has ample floor time play. Allow your child to explore on the floor as much as possible, child proof to prevent potentially dangerous situations, and save the “no” for these situations so that they understand that moving and roaming is a normal part of growing and learning. Babies need to explore. Go with the flow and enjoy each stage of development!
