A series of early intervention tutorials from Firefly and Flying Start’s Nick Mant, PT
Part 1. Starting strong - 3 essential early positions
1.1: Back Lying (Supine)
1.2: Tummy Lying (Prone)
1.3: Side Lying
Part 2. Sitting pretty - transitioning from the early positions
2.1: Sitting and Side Sitting
2.2: Lying to Sitting
Part 3. Moving on - kneeling and crawling positions
3.1: Kneeling and 4-point kneeling
3.2: Transition sitting to 4-point kneeling
We often work with children in static positions, telling parents to position their child this way and that. However the movement between the positions is just as useful if we are at the point of being able to achieve it.
Teaching rolling may be a skill your therapist has worked with you on, assisting either from the hips or the top arm.
Lying to sitting is a more complex movement that children complete in a variety of ways. Very bendy children may lie on their tummy and almost reverse over their legs, going into the splits and sitting themselves up.
Some push up to almost crawling position, and sit back into a W-sitting position, where the knees are bent and the feet by the side of the bottom. This is a position to avoid!
As I mentioned in a previous blog it is important to work on movement patterns in order to avoid destructive postures. This section will explain one (but not the only) way to assist your child into sitting from a lying position.
You should be able to try this transition if your child is able to sit with head control and support around the hips only. If you are unsure if your child is ready, you should seek guidance from your therapist. They will be able to guide you if your child is ready to progress to these skills, and the best ways to do it.
Children need to repeat movements many times before they are properly learnt. This is tough for children with any kind of movement difficulty.
It is important, not only that they master the back lying, tummy lying and side lying positions, but also that we work on the transitions between them. I have often seen children who are excellent in static positions but then get very frustrated at not being able to move out of them.
Transitions involve movement through many planes, with the body bending (flexing), straightening (extending), turning (rotating) and moving individual limbs in isolation of each other. The lying to sitting transition involves most of the previously discussed positions, with arms lifted up against gravity in back lying, movement to side lying, weight bearing through one arm pushing up to side sitting, then correcting the body to sitting.
With such a complicated series of movements, no wonder we have to master the individual positions, and consider how children develop leading up to this!
Starting with your child lying on their back, hold one hand and assist them into side lying by taking their hand across their body.
Gently then lead the arm away from the floor, but still slightly in front of their head. They should lift their body slightly and their weight should push through their elbow – it is important you assist and not do all the work for them.
You can tell if your child is pulling back on your hand “bracing” with the arm you are assisting. They should have head control, holding their head up themselves and moving their body to assist. If they are not taking part, it will feel like they are hanging from your hand. As they improve you should be able to help less and less with each part of this transition.
With your assisting hand gently ease it in the direction they need to go to sit themselves up more. Generally this is slightly forward and side.
This will ease them up into a side sitting position so their weight is now pushing through their hand – they should still be pulling against your supporting hand. If they stop actively pulling up at this stage you can place your other hand on the body and ease them into a sitting position.
If they get themselves up to sitting they may still need a little hand to get their balance!
You can hold their other hand as pictured or hold onto their body at this stage until they get their balance.
If you are unsure of any part of this manoeuvre you should ask your therapist for advice. It may be your child is not ready or your handling could be slightly tweaked to ensure your child is active. Again, unless directed by your therapist, this should only be tried when a child has independent head control in sitting and only requires minimal help to maintain sitting balance.
From these early positions we have taught good movement patterns with rolling and moving to sitting. We have hopefully avoided “cheating” & “destructive” patterns of movement and postures early on in a child's journey. If the early building blocks are set well, the later building blocks will fall much more easily into place!
Continue on to Part 3 to learn about kneeling and crawling position.
Nick talked us through his early intervention tutorials live over a series of webinars in March and April 2016.
Part 2: Sitting Pretty - Transitioning from the early positions, is available below.
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