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
In this blog we will be looking at how Playpak can assist with the more challenging positions of 4-point (crawling positions) and kneeling, which require greater anti-gravity control.
The support Playpak offers can allow a child to practice these positions despite being quite a way off being independent in them.
To practice these positions your child should have independent head control in sitting, and only need minimal support to maintain sitting positions. It will allow the child to experience new positions, which is often both challenging and rewarding for them.
Again we will discuss the various problems children face with these positions. At the end I will demonstrate a nice technique to help you practice side sitting and also teach your child how to get themselves from sitting to a crawling position.
As with the sitting blog, you may wish to refer back to my previous guides about earlier positions. Many positions can be tried using the Playpak - if successful they can be repeated and if not, they can be tried at a later date.
It really is hard to go wrong as long as you remember to support the child in a symmetrical way that allows for mid-line play, whether they are looking in front or to the side. And remember your therapist will be able to guide you on positions, especially the more challenging positions found in this Blog.
Hands and knees (4-point kneeling) is a difficult position to master. It requires weight balance over four separate points, and to be able to play in the position, weight must be moved sideways over one arm to then release the other.
This is how babies develop skills to transfer their weight in preparation for crawling. If your child has never enjoyed tummy time, this can sometimes add to the challenge. However the head control and arm stability that being on hands and knees teaches can have far reaching benefits such as improved fine motor skills for later learning, for example to use cutlery or to write.
Children who have low tone may need extra help initially to gain head control and hold up their trunk. Children with high tone may either straighten (extend) away from the support or bend (flex) into it, so it is important to strike a balance between challenge and ability. If unsure about these more challenging positions you may wish to seek advice from your therapist or get in touch with us, we may be able to help.
With the trunk supported by the rolls and horseshoe preventing legs from extending or falling out of position, baby has more chance to push up with their hands and get head control. Try to encourage baby to lift their head to look at you or toys in front.
We are looking for equal weight to be placed through arms and knees. Once in position have a feel of your baby’s arms and legs, slightly lift a hand or a knee to feel if they have any weight going through it. They should still be in a symmetrical position with their back straight or slightly curved, and definitely not arched backward. The body will be working on control to hold itself level and the hips and shoulders will be gaining stability to make play, and eventually crawling, possible. Head control will be improving, lifting and turning both ways. As baby improves in this position, support sections can be gradually taken away, increasing the challenge.
High kneeling is useful as baby can begin to take more weight through their pelvis. They will start to push up from being sat on their feet, to bottom being lifted up and away. This is using muscles we started to develop when lifting our legs away from the floor in back lying (supine). A child needs to be able to kneel to successfully crawl and they will go through high kneeling when they learn to transition from crawling up to standing. Again this is a more challenging position that you may need to get direction from your therapist on before completing. There are reasons your therapist may be avoiding this position, for example mastering the earlier skills first.
Holding the knees together with the whole body weight going through them can be very hard. With postures more up against gravity, children with over-active muscles (high tone) may increase further. Appropriate support needs to be given to prevent W-sitting, which is a position where the child is sat with knees bent in front and their feet by the side of their bottom, toes pointing away from the child. This position is bad for hip development, and can often become habitual. If you see your child adopting this position simply swing their legs around so they are pointing forward, or push their knees and feet together so they are kneeling on top of the legs as opposed to the side. Use Playpak to give support to the side of the legs and to maintain weight through the knees, allowing the child to push up with weight going down through the knees. It will be difficult for them to initially push themselves up to high kneeling and they will need to rest their trunk on the support.
Using both horseshoes the body can be given enough support for baby to lean over. The strap can hold the bottom slightly though we don't want to restrict too much the opportunity for them to push up onto knees.
Toys can be placed in front which may encourage more of a 4-point position. The trunk is nicely rested on the support and there is no over-the-top effort to hold himself up, or arching of the back.
A small roll can be used to help baby keep their bottom off the feet slightly and encourage a more upright kneeling position.
We want to encourage the baby to actively push themselves up onto their knees lifting their trunk away from the support.
Initially your child will only be able to rest their bottom on their feet. We want to encourage them to actively push up onto their knees and hold their trunk upright. We can play with toys such as balls and blocks to encourage weight through the arms with pushing games or weight through one hand whilst stacking with the other. This will simulate more of the activities completed in 4-point and tummy time positions. Some children may not tolerate tummy time or crawling positions, and work in kneeling can help with developing skills missed from those positions. This however can be complicated and if you are unsure, you should seek advice from your therapist.
Nick talked us through Part 1 and Part 2 of his early intervention tutorials live over a series of webinars in March and April. The Part 3 Webinar will take place on Wednesday 4 May at 6pm. To join, please register here.
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