Dr. Anne Zachry

Proprioception is the awareness of joint and body position. It helps us know where our bodies are in space along with the tactile and vestibular systems. There are “receptors” that receive body position information located deep within our muscles, joints, ligaments, tendons, and connective tissues. These receptors transmit information about motion or position in space to the brain by sensing subtle changes in movement, position, tension, and force. When our proprioceptive system is functioning properly, we make consistent, automatic changes in our body position as needed to stay upright and maneuver the environment safely. This system should work in sync with the other sensory systems, but problems with proprioceptive functioning can lead to big problems. Individuals with Poor Proprioceptive Processing sometimes exhibit these signs: 

• Inability to maintain stationary positions (stay seated upright in a chair) 
• Frequently bumps into items/people in the environment  
• Stands to close or far away from others  
• Unable to apply the appropriate amount of pressure when writing, holding utensils, etc.  
• Clumsy- poor motor planning  
• Playing to rough/Over-activity

Proprioceptive Activities: Proprioceptive, or deep pressure input is calming for children and improves muscle/joint awareness. Give your child jobs that involve big muscle groups such as carrying books, laundry, groceries, as well as push-pull activities.

• Pushing or pulling wagons, heavy “wheeled” toys  
• Climbing ropes  
• Jumping- on beanbag chairs, playing on couch cushions/making forts, etc. 
• Wheelbarrow walks  
• Wrestling  
• Tug-of-War  
• Punching bags  
• Pushing others on a swing  
• Swimming  
• Deep pressure given between mats or blankets (“make a sandwich- add lettuce, pickles, cheese)  
• Position your child on the stomach and roll a large therapy ball over him or her, then flip over and do the same (do not put pressure on the stomach)  
• Have your child close their eyes and get into different positions by instructing, “put your finger on your nose, etc.”  
• Sitting in a beanbag chair with heavy blankets or light weights in lap  
• Tossing a weighted ball while sitting on a therapy ball  
• Chair Push-ups  
• Using a hole punch on index cards or file folders  
• Popping packaging bubbles  
• When teaching your little one a new skill that involves motor planning, provide extra proprioceptive input through the use of light wrist or ankle weights.  
• Guide your child through an action, teaching the “motor pattern” providing light resistance to increase the awareness of body position.  
• Gentle but firm massage

Photo by Cole Keister on Unsplash

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I guess it’s because I’m a therapist, but moms frequently ask me, “Is tummy time really that important?”  This is an important question. Tummy time plays a critical role in infant development. It provides a base for motor skills such as head control, rolling over, and pulling up.

     Tummy time is especially important now that that the American Academy of Pediatrics (AAP) recommends that all babies sleep on their backs. Prior to 1992, most babies in the US slept on their stomachs. Then scientific research revealed that infants were approximately 12 times more likely to be found on their stomachs than on their backs when they had died of SIDS. In 1992 the AAP formally recommended that all infants be placed to sleep on their backs or sides to reduce the risk of SIDS. Later, the side position was eliminated because infants could roll from their sides to their stomachs during sleep. Since then, 50% fewer infants have died from SIDS. Putting babies to sleep on their backs turned out to be a simple and effective way to save the lives of infants.

     Eventually, pediatricians and therapists noticed a rise in infants diagnosed with flat spots on the head. They also noticed an increase in the number of infants with mild delays in gross motor skills, such as rolling over and pulling up. Evidently, many parents were not positioning their infants on the tummy for play out of a fear of SIDS. This limited tummy time was having negative consequences. In 1996, the AAP formally recommended that parents provide babies with supervised playtime on the stomach to promote growth and development and prevent flat spots from forming on the head.

     My research has revealed that many infants resist being placed on the tummy. This is probably because they aren’t familiar with tummy time. They also haven’t gained the head control and upper body strength that is necessary to maintain the position comfortably. But rest assured, with time and a few basic and very beneficial techniques, any infant can learn to tolerate tummy time. There are ways to introduce tummy time and increase tolerance without making a parents’ and baby’s life miserable. In fact, it can be the total opposite of miserable. Tummy time provides an opportunity to spend one on one time with baby and create a special bond that can last a lifetime!

     In the beginning, set up a regular schedule for tummy time. Carry it out after naps or after diaper changes. A general guideline should be that half of the time that baby spends for play should be on the tummy. Remember, it is important to vary your baby’s position every 15 to 20 minutes during playtime. Be aware that tummy time is any combination of positions in which your infant is NOT on the back and encourages baby to use the back, shoulder and neck muscles. This includes time spent in your arms and on your lap. Most importantly, don’t look upon tummy time as a chore. Keep in mind that this special time is an important part of baby’s daily routine, which provides an opportunity to bond and develop a close relationship with your infant. For more information on tummy time and some specific tips and suggestions on how to increase infant tolerance to the position, visit my blog @ http://drzachryspedsottips.blogspot.com/.

Also, for more information about tummy time as well as some wonderful brochures and handouts, visit http://www.pathwaysawareness.org/. 

Fine motor skills are the way that we use our fingers and hands to manipulate small objects. They are very important when a child goes to school and it’s time to work with pencils, crayons, and scissors. However, fine motor skills begin to develop long before school age. At around 3 months old, babies begin to use their hands to grasp objects and their arms to swipe. Between 9 and 12 months of age, most infants can pick up a small object with the thumb and index finger, which is called an inferior pincer grasp. When an infant uses the tips of the thumb and index finger to grasp a tiny object, this is called a superior pincer grasp. 

At two years of age, a little one can color with whole arm movement and holds a crayon in a fisted position with the thumb facing upward. By age 4, most children can imitate a cross and trace a diamond and a triangle, and by age 5 they can hold a pencil with 3 fingers, which is called a tripod grasp. This is the optimal grasp to have when writing, although there are others that are acceptable. Hand dominance is typically established by this age as well. 

Reference: Pediatric OT Tips Blog