Training Infant Motor Milestones (English)

Training for infant motor milestones

Our brains are constantly receiving information from their surroundings; light, noise, smells, different sensations from the body. This is called sensory information, it travels up to the brain. In turn it stimulates a response in the body, so information leaves the brain and travels to different organs or muscles. The body responds in some way.

The integration of sensory information (signals into the brain from the surroundings, including light touch, vibration, warmth, cold, sharp pain, deep pressure) and motor training (signals leaving the brain speaking to muscles) is important in activating both hemispheres of the brain. Sensory-motor integration describes how sensory information should equally stimulate both sides of the brain, is important for smooth integrated movements. This is required for balance and coordination. In situations where the infant has some kind of asymmetry (like torticollis, plagiocephaly), the neglected side is not moving in the same way and not turning on the side of the brain it connects to in the same way as the active side.

Basic core training for infants addresses symmetry of movement for the motor milestones, it actually prevents this from becoming a problem. Following the life-saving campaign, “Back to Sleep” there has been a rise in cases of asymmetry due to the pressure on the back of the head. The infant is unable to lie initially with the head on center, so it is easy for the infant to develop a favorite side. This can in turn lead to positional plagiocephaly, where one side of the back of the head becomes flattened with the baby looking predominantly to that side. Motor skills are affected with the dominant side being preferred even with movements which are important for milestones. Many parents are unaware of this subtle change. There are strategies to signal and train the neglected side. It is important to activate both sides of the body so the infants have optimal functioning before sitting up.

Some researchers are exploring the connection between neurodevelopmental conditions and asymmetry in the functioning of the two brain hemispheres. Treatment targets the under stimulated brain hemisphere with a goal of more symmetrical functioning of the hemispheres.

By ensuring symmetrical movements in all the motor milestones, meaning that the baby can perform all motor milestones equally well on the right and the left sides, you also are working simultaneously with stimulating both sides of the brain equally.

Vibration is a tool that stimulates a specific pathway in the brain to alert the body that the part of the body stimulated belongs to them. This is an important tool to use when the infant is not using both sides of the body equally. A simple massage instrument with vibration (or at the very least an electric toothbrush) can be used to stimulate the palm of the hand and the sole of the foot, the joints on the non-dominant side (ankle, knee, thigh, wrist, shoulder, and elbow). Other sensory information can be used like a soft brush, cold, warm, and light tapping, although they stimulate and travel in other pathways. Vibration is the most important tool.

Another aspect of training has to do with synchronizing an inborn reflex which is inactivated in asymmetrical postures, conditions like torticollis and plagiocephaly. The eyes, the balance system and neck movements are coupled. When the infant is old enough to get eye contact, you engage their vision and have them turn their head to the right and to the left. Depending on the age of the infant, they may be most interested at looking and following your face, but eventually they will engage their eyes looking at a toy, particularly one that makes noise and is colorful. They should follow with they eyes and head, turning equally to right and left.

At six weeks the startle reflex starts to diminish as the Fencer reflex becomes more prominent. The infant with asymmetry may have a persistent Startle (Moro) reflex because as they turn the head to the non-dominant side they feel like they are falling. The Fencer reflex is initiated with the head turning to the side, the arm on the same side stretches out straight from the body and the opposite arm bends at elbow with hand near the head. This should be equal on the right and the left. With asymmetry like torticollis you may need to help your infant turn this on on the non-dominant side placing them in the correct position and using vibration on the arms. Tummy time increases with one minute per day.

Fencer reflex

Home care exercises for infants that present with tongue-tie issues can be read here.

At two months the baby should be able to lie on the stomach, balanced on the lower arms at its sides and the pelvis. They should not have a strong arch in their back or lose posture in a shoulder. The should lift the head and look side to side. They should not have a strong arch in the neck and fall over. They should not have an obvious curve in their trunk or neck. On their side they need support but should spend some time on their sides as well as the stomach and back. On the back the baby should rest comfortably feet on surface, no obvious curve in the trunk, no twisting over. They should have ease of movement with the head to the right and the left.

At 3 months, they should bring both the right and the left hands to the mouth, the hands should be playing together and their feet off the ground playing together. From this position you can roll them side to side, engaging vision.

They should lie in a stable position on the stomach and not fall over. They should support themselves well and equally on the left and right lower arms with proud shoulders. They should not lose support of either shoulder. This should be able to look to the right and left. When they look to the right extend the left arm and roll the baby onto its left side, this trains balance and prepares them for the next motor step. always do the exercises on both sides.

When the baby is on the back, you should be able to pull them to sitting, they should tuck their chin and bring the head up on their own. Otherwise, you need to help them with chin tuck and minimal support to achieve this.

Picture. Pull to sit

You should roll the baby from the back to the right and to the left sides. They will have difficulty to the non-dominant side, they usually throw out the arms like they are falling. This inhibits them from turning to that side, it affects balance and motor strength to the one side. Start early with this training. Get their eyes to look to the side you want them to turn and roll them to that side. Do that on both sides. In sidelying, you can hold the baby around the chest, under the arms and start to lift the baby up, you want to see that they engage the neck muscles. You can lift them up from this position. Do this on both sides.

Picture lift from sidelying

It is important through the day to have the baby lie: on both sides, the stomach and back. Lying on the stomach and back they should be able to follow a face or a toy so the head turns fully to the right and the left. While lying on the side, have the baby look at toys to help activate the side that is up. At 3 months the baby should be reaching and holding things, here it is important to make sure the baby reaches with both hands. At three months get them to reach for a toy to the side you want them to turn. At this point, you can train with them on a Pilate’s boll. While on stomach, roll them gently side to side, forward and backward, and even have them on their side so they work with the non-dominant side. Head tilt is most difficult to resolve, so work with the ball and vision to get them to look up to the opposite side.

Picture: training on pilates boll

When lying on the stomach on a firm surface the baby should not tip over. When they have a dominant side, it is common that they develop more strength on one side and do not have stability on the opposite side. The shoulder collapses and they fall over; this is not controlled. If you hold the pelvis stabile or at the knees, they train their core.

Picture, support to sacrum

You can give the weaker shoulder support by pushing from the elbow to the shoulder so they feel the correct position.

Picture, supporting a weak shoulder

Throughout development it is important that the child does everything from the left and the right sides equally well. By working to ensure this, you help to activate the core muscles so you inhibit the effects of an early asymmetry.

At 4.5-5 months the infant has their second motor milestone which is critical to development of the core muscles on the right and left sides of the spine. This is important in the process of  stimulating the right and left halves of the brain equally as well.

Picture 4.5 month motor step

This is difficult for infants with any kind of asymmetry including plagiocephaly. The infant is lying on the stomach, right elbow is held down in front of shoulder. The left knee is bent and held against the floor. Introduce a toy so the baby reaches up with the left hand/arm and shifts its weight to the right side of the body. This activates the core muscles on that side of the body. Practice on both side.

picture

At 4-5 months the baby lying on its back has the hands at the groin and eventually knees. They lay often with bent legs (sitting position) feet together, hands busy playing with a toy. The weight of the legs should enable them to turn to the side. Check they are skilled on both sides. They should be able to switch a toy between the right and the left hands.

Between 5 and 6 months while on stomach, the baby extends the arms and presses the body upwards. At 6 months they may lie on their stomach lifting arms and legs from the floor (superman). On the back they bring the feet to the mouth (holding both feet), they turn easily to the sides.

Between 5 and 6 months the baby may now be working to roll from the back to the stomach. Frustration is evident as they try to free the arm trapped under the body. The 4 month milestone of shifting their weight is important to achieve this step.

At 6 months some babies sit now somewhat steadily. Have them sit between your legs on the floor; tuck in the lower leg on the side they will turn to. Introduce an exciting toy so they pivot over on to their knees using your leg for support as they reach for the toy.  This helps them practice turning the torso in an upright position.

At 7.5 months the infant lying on the stomach should be pivoting in a circle with their body to the both the right and the left sides. You can use a toy to help them. They should reach for a toy with the closest arm. They should be able to lie on the side and play using one foot for balance, eventually up on an elbow.