#MilestoneMonday / Walking Part II
As previously discussed, standing is a critical piece to a baby’s gross motor skill and physical development. Perhaps above all, its an additional means that allows a baby to explore and interact with their environment. This week, we will discuss activities that standing with support and independent standing can be facilitated.
Early on, (i.e. in the first months of life) prone positioning, or ‘tummy time’ is an important strengthening activity to practice. Although at this point, standing is not a short term goal to learn, it is valuable to emphasize the importance for spending some time in prone. This is because laying on the abdomen gives babies a chance to work on the strength of their extensor muscles through their hips, back, and neck. This is so important because these muscle groups are essentially their ‘anti-gravity’ muscles that will provide the necessary strength to achieve and maintain standing. Given this, I realize that tolerance for ‘tummy time’ for some children is limited. In this case, it is important to gradually build their tolerance for this position and present them with activities, toys, and faces they can interact and explore to create a positive experience. Additionally, providing support at around chest level can be used to reduce the strength requirements for prone positioning. This can be done with hands at the chest level and under the arms or a rolled up towel or soft stuffed toy in the same position.
For early standing activities to encourage weight to be taken on the feet, support should be provided at the chest and under the arms. In this position, it should feel as though the child is providing resistance at their legs to remain standing, but cannot quite take their full weight. In this position, you can be facing each other or in the same direction, depending on the baby’s attention and interest. While working on this standing with high support position, you can sustain a stand for longer if they are playing with a toy, or if they enjoy movement, you can work on bouncing on this position with your hands guiding the movement, but allowing them to participate by pushing through their feet. As their strength and balance improve, the goal is to reduce the amount of support that is provided by moving the hands from the chest to the waist, and then to the hips. This way, the amount of weight that they must manage is increased, in addition to balancing their trunk above your hands to maintain standing.
Also, a great way to get more weight bearing on a baby’s legs to play in a kneeling position at a support surface such as a couch. This position gives significant input into the hips, namely, the gluteal muscles that are powerful extensors of the hip. When performing this activity, you may find that the infant may alternate between high kneeling and low kneeling (on the knees, but the buttocks resting on their heels). This is a great activity because they are actively using their hip extensors to bring themselves into an elevated position, thus working on anti-gravity strength at their hips.
As the baby develops their strength and they are looking to become more independent, standing at a support surface may be an activity that would be appropriate. This is significant step, because again, this promotes the independence of the child to allow them to be more explorative. Initially, their positioning will be square to their supportive surface (as previously discussed in the previous post). Here, we want to work on the ability to manage small weight shifts left and right and ultimately master movement in the frontal plane. This can be facilitated by providing support at the hips, and guiding their weight to shift left and right; combine this with toys or objects the child likes just within their reaching range, and they will begin to learn the value to weight shifting to extend their exploration abilities.
As with all activities that involve strengthening, be sure to monitor the infant’s tolerance closely. If you find that new activities require a big effort, then short and frequent bouts of activities may be more tolerable.
For the next post, we will talk about strategies for transitioning into a standing position from the ground.
By: Chris Dahiroc P.T.
