Development of Eye-Hand Coordination

hand eye coordination

Hand eye coordination plays a powerful role in daily activities. Through the integration of fine motor skills and visual processing, we see intentional and controlled motor skills. But there’s more to catching and throwing a ball at a target than the coordinated use of the hands and eyes. Let’s break down hand eye coordination development skills as well as the other underlying skills needed.

hand eye coordination

We have included affiliate links to resources in this blog post on hand eye coordination milestones. As an Amazon Influencer, I earn from qualifying purchases.

Hand Eye Coordination

Hand eye coordination refers to the coordination, or integration, of visual input and the processing of that visual information for coordinated movement of the hands. These skills impact fine motor dexterity and motor movements in functional tasks for so many tasks while manipulating movements and objects.

Eye-hand coordination is essential in handwriting, scissor use, threading beads, reading, throwing a ball, placing a cup on a shelf, coloring in lines, feeding, self-care, and much, much more.

The phrases “Hand-eye coordination” and “eye-hand coordination” are used interchangeably, however, we tend to use the phrase eye-hand coordination more appropriately, because input comes through the eyes first and the hand responds in motor tasks. However, the general population may primarily use the phrase “hand-eye coordination”.

In this blog post, we will use both phrases interchangeably, in order to reach the populations seeking information on either phrase.

In essence, hand-eye coordination, or eye-hand coordination, are the  Visual motor skills used in motor tasks.

Part of this development is the refined motor skills led by arch development in the hands. Paired with dexterity and precision skills, along with visual motor components, we see hand-eye coordination.

Eye hand coordination develops from a very young age! Here is information about the development of visual motor skills, specifically eye hand coordination in babies, toddlers, and preschoolers.


Eye Hand Coordination Development

Eye-hand coordination development typically occurs through movement, beginning at a very young age. The visual components of oculomotor skills (how the eyes move) include visual fixation, visual tracking (or smooth pursuits), and visual scanning. These beginning stages of child development play a big part down the road in taking in visual information and using it to perform motor tasks. 

These hand-eye coordination developmental guidelines listed below are general guidelines of development based on approximate development of the visual motor skills needed for play, motor skills, and visual motor development.

Holding and talking to baby in the very young ages plays such an important part in the puzzle of visual motor skills. 

Additionally, tummy time and as the baby gains head strength and control, they eyes become stronger in their ability to fixate, track, and scan from the prone position. This is why we place toys around a baby on a baby blanket and encourage reach.

That pivotal stage when baby begins to roll is a social media-worthy time in the parent’s life. But there is more to celebrate than baby’s new rolling skills. Control of the eyes with movement is a big accomplishment and something that baby strengthens with movement. 

Hand Eye Coordination

These skill areas are broken down by months, all the way up through the preschool years. 

Disclaimer: Amazon affiliate links are included in this post.

     Tracking a rattle while lying on back                                    
     Tracking a rattle to the side                
     Infant regards their own hands
     Tracks a ball side to side as it rolls across a table left to right and right to left.
     Tracks a rattle while lying on back side to side
     Extends hands to reach for a rattle/toy while lying on back
     Reaches to midline for a rattle/toy while lying on back
     While lying on back, the infant touches both hands together.

hand Eye coordination and Crawling

Crawling on the hands and knees plays a vital role in hand eye coordination, too. When baby positions themselves up on all fours, they are gaining awesome proprioceptive input, strength in the shoulder girdle, core, and neck.

When crawling, baby is gaining mobility, but also using targeted movement toward a goal they visually process.

Research shows that hands-and-knees and walker-assisted locomotor experience facilitate spatial search performance. Spatial awareness, or visual spatial relations, and visual skill development is needed for coordinated use of the hands in motor tasks.

In fact, crawling improves so many areas needed for refined eye-hand coordination, including the fine motor skills, gross motor skills, gross motor coordination, balance, and strength needed for tasks like precision of in-hand manipulation, positioning in activities, and sustained endurance. We cover more on this topic in our blog post on spatial awareness for baby.

Eye hand coordination develops from infancy! Playing with baby in tummy time is a crucial element to eye hand coordination development.

     Brings hands together to grasp a block/toy while sitting supported on an adult’s lap
     Extends arm to reach up for a toy while laying on back
     Transfers a block/toy from one hand to the other while sitting supported on an adult’s lap.
     Touches a cereal piece with index finger
     Bangs a toy on a table surface while sitting supported on an adult’s lap

     Claps hands together

     Removes loose pegs from a Peg Board (affiliate link) 

     Removes socks
     Releases a cereal bit onto table surface
     Places blocks (affiliate link) into a cup

A lot of eye hand coordination development occurs in the toddler years. Here are developmental milestones for eye hand coordination from 1-3 years.


Development of Eye Hand Coordination for Toddlers

Development of hand eye coordination accelerates during the toddler years because motor skills develop at an increasing pace during the years of 1-3. 

     Turns pages in a board book
     Imitates stirring a spoon (affiliate link) in a cup

     Imitates tapping a spoon on a cup
     Begins to places large puzzle pieces in a beginner puzzle (affiliate link) 

     Scribbles on paper

     Imitates building a tower of 2-3 blocks (affiliate link) 

     Builds a block tower, stacking 4-5 blocks (affiliate link) 

     Imitates copying vertical lines

     Removes a screw top lid on a bottle
     Stacks 8 blocks (affiliate link) 
     Begins to snip with scissors

     Imitates horizontal strokes with a marker
     Strings 2 Beads (affiliate link) 
     Imitates folding a piece of paper (bending the paper and making a crease, not aligning the edges)

     Imitates building a train with blocks
     Strings 3-4 Beads (affiliate link) 
     Stacks 10 blocks (affiliate link) 

     Builds a “bridge” with three blocks (affiliate link) 

     Copies a circle

     Builds a “wall” with four blocks (affiliate link) 

Eye hand development continues in the preschool years. Here are ways that eye hand coordination develops in preschool and how to improve these visual motor skills.


hand Eye Coordination in Preschoolers

During the preschool years, we see even more fine motor and gross motor development. These refined skills, along with more coordinated efforts enable precision and dexterity with hand-eye coordination. Check out some of the preschool activities that we love to use to support this development.

Additional information and resources are covered in our blog post on crossing midline activities for preschoolers, as the eye-hand coordination at this age develops quickly and the sensory motor skills needed for play is an important part of development.

Preschoolers are beginning to use tools such as crayons, scissors, markers, glue sticks, and more. You’ll see greater control in using these materials. 

Preschoolers are also playing with more pretend play, and are able to use different toys with more refinement. While the preschool age may be able to use a pencil to create forms, occupational therapy practitioners prefer that handwriting is not encouraged at this age.

Read about the detrimental impact that handwriting has when pushed before preschoolers build the visual motor experience in this stage.

     Cuts a paper in half with scissors

     Lace 2-3 holes with string on Lacing Shapes (affiliate link) 
     Copies a cross

     Cuts within 1/2 inch of a strait line.
     Traces a horizontal line

     Copies a square
     Cuts a circle within 1/2 inch of the line
     Build “steps” with blocks (affiliate link) 

     Connects two dots to make a horizontal line.
     Cuts a square within 1/2 inch of the line
     Builds a “pyramid” with blocks (affiliate link) 

     Folds a piece of paper in half with the edges parallel
     Colors within lines

There is so much happening through regular play, interaction with babies and toddlers at each stage. What’s important to know is that the development doesn’t stop there! 

Studies have shown that eye-hand coordination impacts learning, communication, social-emotional skills, attention, and focus. Wow! 

Coordination Skills

Here are some ideas to work on eye-hand coordination for preschooler kids and older: 
This Letter Eye Hand Coordination Activity helps with bilateral coordination and the visual processing skills needed for reading and so many other skills. 

Try this scooping and pouring eye-hand coordination activity that can be adjusted to meet the needs of many ages and abilities.

More visual processing activities

For even MORE information on eye-hand coordination and activities to use in your occupational therapy practice, you will want to join our free visual processing lab email series. It’s a 3-day series of emails that covers EVERYthing about visual processing. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs.

In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂

Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!

Click here to learn more about Visual Processing Lab and to sign up.

Free visual processing email lab to learn about visual skills needed in learning and reading.
Work on eye-hand coordination with preschoolers by building with blocks!
Try activities like geoboards, pegboards, and lacing beads to improve eye hand coordination development in kids.

Kermoian, Rosanne & Campos, Joseph. (1988). Locomotor Experience: A Facilitator of Spatial Cognitive Development. Child development. 59. 908-17. 10.2307/1130258. 

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to

Spring hand eye coordination fine motor worksheets

Hand eye coordination activities can be as simple as lacing cards, hole punching activities, and paperclip tasks using printable OT activities. The ones in the image above are found in our Spring Fine Motor Kit, but there are many others in our other Fine Motor and Therapy Kits:

Working on fine motor skills, visual perception, visual motor skills, sensory tolerance, handwriting, or scissor skills? Our Fine Motor Kits cover all of these areas and more.

Check out the seasonal Fine Motor Kits that kids love:

Or, grab one of our themed Fine Motor Kits to target skills with fun themes:

Want access to all of these kits…and more being added each month? Join The OT Toolbox Member’s Club!

Types of Crawling

Types of crawling

Crawling is a babies’ first move toward independence, but did you know there are different types of crawling a baby can use? In this post we will explore: when babies start to crawl, types of crawling (army crawl, cross crawl, bear crawl, asymmetrical crawling), why crawling is important, and how to teach crawling.  Crawling is not just a gross motor activity. Crawling is a motor task component baby play that activates several of the senses, is a social event, and is the beginning of functional play.



Babies start to crawl between six and ten months, however with the various types of crawling, there are things to know about skills that impact a baby’s ability to move from place to place.

Some skip crawling all together, moving straight to cruising furniture and walking.  We will explore later why skipping crawling is not a great idea. 

In order to crawl, babies need a few skills, developmentally. This progression to crawling is a sequence of events.

Before crawling, babies learn to:

  1. Roll over
  2. Push up on their arms during tummy time
  3. Rock back and forth on their knees,
  4. Push backward

When given plenty of opportunity for movement, this stage of development often happens naturally. Crawling gives the baby an excellent sense of power and accomplishment.  It is a huge boost to their self esteem.  

There are several systems at play for these skills and crawling as a result to occur. The underlying skills involved with crawling includes:

  • Cognition
  • Problem solving
  • Balance (motor skills)
  • Sensory system
  • Gross motor skills
  • Coordination
  • Visual Motor skills
  • Spatial Relations

Referring specifically to the motor skills needed to crawl, we can target gross motor coordination and balance, no matter what type of crawling or mobility that a baby is using. The crawling movements utilize strength, mobility, and stabilization of the muscles of shoulders, neck, arms, back, trunk, and head need to be strong enough to support the weight of the baby. 

Binocular vision is needed for babies to switch between distance and close up viewing as they navigate their space.  Crawling offers a great mental workout as well.

Types of crawling

Types of Crawling

Did you know there are different types of crawling? Some of these types of crawling styles are a progression in coordination and balance. The baby will begin with one type of crawling and move onto a different crawling style, developmentally.

Other types of baby crawls are the style that the baby adopts either because one of the underlying skills have not yet developed, or they get into a habit and realize that they can get from A to B efficiently using the particular style. The different ways babies crawl do not necessarily mean a problem. However, there are aspects of each type of baby crawling style which we can look at.

Let’s take a closer look at each style of crawl.

Crawling on Hands and Knees

Crawling on hands and knees, or the classic hands and knees crawling style is a form of cross crawl – in therapy language this is often referred to as creeping. Babies bear weight on their hands and knees, moving one arm with the opposite knee forward at the same time.  This is the classic, traditional, most beneficial type of developmental crawling.

Bear crawl

Related to the classic crawling style on hands and knees, is the bear crawl. The bear crawl style of crawling is one in which babies cruise around on their hands and feet with their bottom up in the air.  This type of crawl provides great proprioceptive input, as well as reciprocal movement.

Army Crawl or Commando crawl

The army crawl, or otherwise known as the commando crawl, is a belly crawl style of crawling. This military style crawl involves babies on their tummies pulling themselves along with their arms and elbows while their stomach drags on the floor.  This type of crawl is excellent for building upper body strength, as well as providing great sensory input.

Scoot Crawling

The bottom scoot crawl, or scoot crawling is another style of crawling. In this type of crawl, babies sit on their bottom, pulling themselves with their arms.  While this is a functional type of movement, it is not the most efficient or beneficial.  While scooting on their bottom, babies do not get the same reciprocal type of movement, or input through their legs and shoulder girdle.

Crab crawl

Crab crawl is a crawling style in which babies move themselves backward or sideways in this type of crawling movement pattern.  They might be prone (belly down) or supine (belly up) as they move.  This might be a functional movement style, but it is not providing the correct input and movement patterns for typical development.

Roll crawl

A roll crawl is another type of crawling which works as a mode of transportation for babies. With roll crawling, babies get where they want to go by rolling. This style of crawling is effective, in that the child gets to where they want in a room, however rolling crawl is not an efficient style of movement, nor is it a means of developing the best movement patterns.

Have you seen any of these types of crawling in action? Let’s move onto why crawling skills are an important part of development for young children.

Why is crawling important

Why is crawling important

There are many reasons why babies need to crawl as a developmental progression. Crawling is so important! Let’s take a look at each of the reasons why babies need to crawl.

  • Gross motor development – babies learn to coordinate both sides of their body as they crawl. They have to balance their body, while an arm and leg is off of the ground at the same time. Joints need to flex and extend, muscles must synchronize, all while each side of the body is doing a completely different movement.  
  • Eye-hand coordination- By crawling, babies develop eye-hand coordination. By moving toward a target, reaching for toys, and engaging in the world around them, coordination between the eyes and body develop.
  • Sensory development proprioception, or input/feedback through the muscles and joints is the primary input developed through crawling.  In addition, vestibular input is engaged through movement of the head and input through the ear.  Vision, tactile, and hearing senses are activated as well during crawling. Babies learn through exploring their environment.  During crawling, most of the senses are alerted, organized, and used to maneuver through space.
  • Mental/cognitive development – problem solving, memory, and processing information are needed for crawling.  The corpus callosum is activated in a balanced way during cross crawling, facilitating both sides of the brain to communicate.  The corpus callosum is not activated the same way during alternate methods of crawling (bottom scooting, crab crawl, commando crawl).
  • Crawling helps joint sockets form – as the baby crawls forward the hip sockets form, the muscles pulling them forward and inward.  This sets the development in motion for future walking.
  • Crossing midline – this is a vital skill for further development.  Cross crawling improves spinal rotation, eye hand coordination, and learning to separate both sides of the body which will be used later on (bike riding, playing the piano, running, climbing stairs).  Here are some cross crawl exercises for older learners to practice and develop this critical skill.
  • Crawling supports reading skills- Crawling on hands and knees helps reading! All this integration of brain halves, reflexes, and hand-eye coordination helps prepare the brain and body for reading. Crawling supports learning, creative problem solving, and brain function in general.
  • Visual Skills- When crawling, a baby is developing the building blocks of visual perception, visual tracking and visual scanning, as well as vision development When crawling a small child moves through space and the eyes develop visual convergence. Visual saccades and tracking is also a component of development. Read more about the development of visual spatial skills happening during the baby years.

NOTE: babies who crawl in alternate methods, while demonstrating creative ways of getting around, may be showing signs of delayed development.  They may have learned to compensate for poor strength, coordination, sensory skills, or cognitive development. Moving babies through the traditional methods of crawling can help with overall development.  Babies who skip crawling should be encouraged to move through this stage of development, as it will develop critical baseline skills to be used later on.

How to teach Crawling

The easiest way to encourage crawling is by setting up an optimal environment for exploration.  

  • Plenty of tummy time on a safe surface may be all that is needed for these skills to develop.  Some families do not have a safe space at home for crawling.  Get creative by suggesting a blanket on the grass, an open space such as the beach, the library floor, or a tarp on the ground covered by a blanket.  
  • Avoid propping the baby up and placing it in containers.  Container baby syndrome is increasing at an alarming rate as caregivers place young babies continually in car seats, carriers, bouncy seats, swings, or being held all of the time.
  • If your baby arches her back a lot, does not want to curl up and snuggle, does not use both arms and legs, uses rolling more often than crawling, or does not seem interested in moving, seek assistance from a functional neurology doctor.
  • Allow your baby to explore their environment freely.  Create safe zones free of wires, choking hazards, and other dangers.  Encourage caregivers not to be afraid to let their baby struggle. Caregivers need to understand that babies will topple over several times before getting it right.  A baby who is too sheltered will learn that movement is scary.
  • Hold a rolled up towel under your babies’ belly while they are in prone to relieve some of the weight off of their extremities, provide extra support, and move the baby through the crawling motions.
  • Help the baby get into a crawling position and gently rock them back and forth to stimulate movement.  Place items just out of reach of the baby to encourage them to reach for it, or move to try and get it.
  • Encourage movement toward a target using novel and innovative items such as these baby shaker toys or our engaging sensory baggie for babies.

Help parents and caregivers understand misconceptions that a baby isn’t “advanced” who skips crawling, “so cute” by bottom scooting instead of cross crawling, or “lazy” because they choose not to move.  While these aren’t always red flags for future difficulties, they can be, and should not be overlooked.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

Tools for a Newborn not Sleeping

newborn not sleeping? these tools will help

Newborn not sleeping? One of the main occupations of infants is sleep but for parents, finding sleep remedies for babies can be the interrupting point in every other occupation of the parents (beyond holding, feeding, and caring for the newborn). Here, we are covering how to support the newborn fighting sleep as well as the parents struggling to get newborns and babies to sleep safely. These strategies support the whole household. Let’s take a look at this important area of occupational performance.

Supporting sleep hygiene, or good sleep habits in parents as well as in babies can be an area that occupational therapy professionals address as a daily occupation for the whole family unit.

Tips for a newborn not sleeping

Sleep remedies for Babies

This sleep remedy information is essential for parents of newborns, but also pediatric occupational therapy practitioners who may be working with parents of newborns.

When a newborn is not sleeping, supporting parents of newborns, babies, and even toddlers is an area of support that OT practitioners can address. Pediatric sleep is an occupation of the whole family!

Let’s break down practical advice for creating an effective bedtime routine for both the baby and the parent.

Strategies for newborn not sleeping

Occupational therapy providers can offer skilled interventions for occupational therapy to support parents of babies fighting sleep so that it impacts the occupational performance of others in the home, including everyday tasks, caring for other children in the home, work, daily self-care, emotions, mental status, and cognitive thought processes.

This occurs through parent education, documenting strategies using a sleep journal, analyzing results, and making suggestions based on the dynamic needs of the family. We cover all of this below, as well as sleep strategies and tools to support newborns and babies in sleep.

Newborn fighting sleep? Create a routine

Parents of newborns have a common problem, all beginning with the newborn fighting sleep.

The issue is that there are several things at play here, occurring in a cycle.

  1. The newborn fights sleep.
  2. The parents try different strategies.
  3. The baby sleeps for a short period but wakes.
  4. The sleep deprived parents try the easiest strategy to get baby back to sleep.

Then the cycle continues. But what really happens is that the baby is on a maladaptive sleep routine, or rather, the fact that the baby fighting sleep has become part of the routine.

Additionally, children with challenges in sleep will likely impact the sleep routines of their caregivers and everyone else in the home. When the baby’s sleep is consistently poor, the parents may adapt strategies such as co-sleeping, which results in insufficient sleep.

The importance of establishing a bedtime routine is enormous. It’s been found that parents instructed to introduce bedtime routines have reported rapid improvements in sleep quality.

Your new baby will not be ready to follow a set sleep schedule during the first couple of weeks, so looking for signs that they might be tired is the best way to tell when you should put them to bed. They might be crying more, wanting to be held, having heavy eyelids, or sucking on their thumb. You can help them to fall asleep by gently rocking or bouncing them, feeding or swaddling them.

The transition from holding the baby to laying them down in their crib is where things can get difficult. 

So often, the young infant or baby is comforted by the warmth and proprioceptive input offered by the arms holding them in close. The baby can even feel the heartbeat of their mother that they were so close to for months in the womb. That comfort is quickly stopped when they are placed into a cool sleep surface. It can be an abrupt change that wakes up baby into a state of startled irritations.

When parents experience this situation over and over again night after night, the sleep quality in the home suffers.

So how to support restful sleep in babies and in the whole household?

One suggestion that is hard for many parents is that you should not let your baby fall completely asleep in your arms. This is because they will get used to this comfortable position and may start wanting to fall asleep this way every time.

Establish a nightly sleep routine to establish rhythm in sleep needs:

  • start with a warm bath
  • Include slow massage with a warm towel
  • Sing nightly lullabies
  • Complete the night time routine in a dimly lit and quiet space
  • Include bedtime stories along with toddler siblings or other family household members

Create another routine for nighttime feeding ritual:

  • Diaper changes often wake up baby in the middle of the night. Be prepared with diaper, wipes, spare clothing, and a bag or place to put dirty diapers right at the changing area
  • After the diaper change, then do the feeding
  • Sit in a rocking chair or lounge chair 
  • Keep the lighting low
  • Softly hum or sing
  • Pat baby’s bottom slowly and with a rhythm

The disruption to sleep can be a source of anxiety for parents, especially as insomnia becomes expected. Having a calm sense can actually support baby more than the worry or anxiety. This can be easier said than done, however, and having a few regulation tools for parents can be a help.

Getting them comfortable with their own bed early on will help with healthier sleep hygiene. Instead, notice when your baby is starting to drift off and put them in their bed before they are completely asleep.

They will wake up many times throughout the night to be fed or changed, so be prepared for them to wake every few hours.

Know that sleep is a fluid area development…meaning that routines will change sometimes nightly as the baby develops.

When to start a sleep routine with newborns

Getting into a routine right away with your baby is important not only for them but also for you. Sleep at night when your baby is asleep and as you need during the day. Make a habit of doing chores during the day like cleaning or showering while your baby naps, or even nap while they do. You can even schedule to have someone watch your child once a week during nap time while you run errands. This will allow you to get things done that you need without having to watch your baby every second.

Start a nighttime routine of changing your baby into their pajamas and then reading them a book (or singing them a song) before putting them to bed. This will set you up for success for when they are older and starting to fight sleeping a little more. Your baby will still wake through the night for a couple of feedings at this age, but it will start to happen less and less. If your child is having trouble falling asleep, it may be because:

  • They are hungry
  • They are spitting up
  • They have had too much or not enough sleep
  • Their swaddle is too tight or too loose
  • They are having a sleep regression (usually around 4 to 6 months old)

Recognize that sleep routines change over time as as development happens. What works at one stage may need to change at other stages.

Newborn Fighting Sleep due to sleep location

During the first weeks and months after birth, learning how to help your baby sleep can be a challenge for many parents.

It is important to pay attention to the place you are letting your baby fall asleep during their first couple of weeks of life.

They will quickly learn to become comfortable in whatever place they are in, so if they learn to fall asleep in your arms, this will be how they will always want to fall asleep. Unfortunately, this is not a practical option for either of you, so get your baby used to falling asleep in their crib from day one.

One thing that new parents consider doing is having their baby fall asleep in bed with them. Doing this has been proven to lead to higher rates of sudden infant death syndrome (SIDS). 

The first step to effective sleep routines is deciding where the baby will sleep whether that be in a crib or bassinet.

The risk of SIDS which could be avoided in this case by simply putting your baby to sleep in their own bed. A bassinet or a crib can be used for your child’s bed which can easily be kept in your room or in your baby’s room, whichever you prefer. Make sure that your baby is falling asleep in a smoke-free area, and that their bed meets safety standards by going to 

This includes leaving out the pillows, sleep positioners, toys, and blankets.

positioning strategies for a newborn not sleeping

One strategy to support the newborn not sleeping is thinking about bed and sleep positioning. Your baby should be put to sleep on their back on a firm but soft surface just as they are falling asleep.

If you put them to bed while they are still slightly awake, they will learn that they can fall asleep on their own, without the need of a parent to rock them to sleep. Do not put them to sleep with a tv in their room, as it can affect their ability to fall asleep. Read more about how electronics effect sleep in your child for more information.

Baby’s Head and Sleep

During the first few months of a baby’s life, they will not yet have strong enough muscles to lift their head or push something off of them like a blanket if they need.

This is why it is important to lay your baby on a firm but soft surface on their back with nothing else around them.

Do this every time you put them to sleep. Keep soft objects, loose bedding, stuffed animals, or anything that could trap your baby away from them.  You will want to make sure that your baby’s face and head are not covered while they sleep.

To help you remember this, the saying “Back to sleep, tummy to play” was created to help your baby sleep. You can find out more about it here.

More tools for the newborn not sleeping

Sleep clothing- For clothing, it is suggested that your baby wears no more than one layer more than what you would wear in that same space. Typically this means that your child will be comfortable in a onesie and swaddle. Do not let the swaddle come high enough that it touches their face.

Room temperature- Make sure that their room is not too hot and not too cold. If their chest is sweaty, they are too hot and you should take off one of their layers. A small fan in the baby’s room can help too, and additionally, the white noise from the sound of the fan can drown out other noises in the home and act as a white noise machine.

Thinking about these considerations, it’s also important to consider development.

Newborn Fighting Sleep? What’s normal?

So, when a newborn is not sleeping through the night, what is typical for the age and the stage? Did you know that newborns fight sleep as a developmental stage?

For the first 3 to 4 months your baby may only stay awake for about 1 hour at a time, but they will then start to get into a routine of sleeping every 2 hours for a longer amount of time.

Up to the time they are three months old, they should be getting about 14 to 17 hours of sleep. Make sure they have no less than 11 hours and no more than 19 hours of sleep.

During the first three months, that hour can go by very quickly and it can seem like the newborn is fighting sleep, when they are actually developmentally on track. After about an hour, the newborn may have something waking them: hunger, diaper changes, and just overall short circadian rhythms.

Between 4 to 6 months old, they will be getting about 12-15 hours of sleep, but should not be getting less than 10 hours and no more than 18 hours of sleep.

When we see problems here is that not all babies easily fall into this sleep regimen. There can be real challenges limiting sleep. Consider the areas stated above:

  • Routines or lack of them
  • Technology use
  • Positioning needs
  • Environment
  • Temperature
  • Clothing
  • Feeding schedule
  • Many other considerations!

Around 4 to 6 months old is when your baby will most likely have what is known as a sleep regression. A sleep regression is when your baby is able to sleep for longer lengths of time at each sleep cycle and will not need to be put down for a nap as many times during the day. 

The baby fighting sleep at this stage is also developmental as this sleep regression happens right when the baby is beginning to develop more mobility and motor control.

It’s important to remember that every child will sleep differently and stay asleep for different lengths of time. Some may prefer to fall asleep on surfaces that are firm while others may love their swaddle. Differences can also come from sensory preferences which impact a baby’s sleep.

Documenting Sleep remedies for babies

Taking all of these developmental stages into consideration, as well as the sleep remedies listed above, there is more to the process.

Occupational therapy practitioners can provide intervention by supporting parents and families with use of a sleep diary. A sleep diary can be used by parents of newborns and babies to document hours slept, and tools used as a support.

When a sleep diary, or sleep journal is used, the family is able to track sleep habits and routines, including successful and unsuccessful tactics. Occupational therapy practitioners can then use information from the sleep journal to identify needs and make recommendations based on the baby’s development, family dynamics, strengths and needs of the family.

This article on AOTA suggests a sleep diary with questions such as:

  • What time did you start trying to put the child to bed?
  • What time did your child go to bed?
  • What time did your child fall asleep?
  • How many times did your child wake during the night?
  • What time did your child wake in the morning?
  • How much awake time did your baby have during the day before?

Other sleep journal questions can include:

  • What did you do before bed to encourage sleep?
  • What sleep strategies were used? (rocking, dark room, sound machine, etc.)
  • How long did the baby sleep?
  • Where did the baby sleep?
  • How long did they sleep before waking?
  • How many times did the baby wake during the night?
  • Reasons for waking during the night? (Example: diaper change, feeding, etc.)
  • What time did the baby wake for the day?

When it comes to sleep remedies for babies, there can be a lot of trial and error. Try to enjoy this time with your young child!

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to

Sensory Activities For 1 Year Olds

sensory activities for 1 year olds

This blog post is one of the oldest posts on the site, but the sensory activities for 1 year olds that we shared way back when are just as fun now! When this post was written, the babies that played with the balls and muffin tins were just 11 months and going on 1 year. Those little ones are now 11 years old! This is such a great brain building activity for babies that I wanted to reshare the idea for the latest crop of babies out there!

If you are looking for more Baby activities, try the fun over on our Baby Play page. You’ll also find some great ideas for different ages on this post on baby sensory play.  We’ve been busy!

sensory activities for 1 year olds

sensory activities for 1 year olds

This sensory activity for 1 year olds is an easy activity to set up. You’ll need just a few items:

  • colorful balls
  • muffin tins

You can add create another sensory activity for the babies with the same colorful balls and a cardboard box or basket. We also used an empty cereal box with hole cut into the sides.

Each sensory activity here supports development of eye-hand coordination, grasp and release, core strength and stability in dynamic sitting, positioning and seated play on the floor (floor play).

Baby and Toddler Brain Building activity using balls and a muffin tin. Perfect for developing fine motor skills, visual perceptual skills in an active activity for sitting and mobile babies.

An important consideration is the use of baby positioners as they can impact powerful movement-based play in babies.

The best for sensory play for 1 year olds is just playing on the floor! There are so many benefits to playing on the floor with a basket of balls and a few muffin tins.

Baby and Toddler Brain Building activity using balls and a muffin tin. Perfect for developing fine motor skills, visual perceptual skills in an active activity for sitting and mobile babies.

What do babies love to do? Take things out and put them back into containers.

We have a bunch of different colored and sized balls that are so fun to play with in so many ways. I had my niece and nephew here one day and we needed something different to do. My nephew and my Baby Girl are both 11 months old and they absolutely loved this play activity! 

I pulled out my muffin tins and they had a blast putting the balls into the tins, taking them out, putting them back into the box, and pulling them out again!

Little Guy (my 3 year old ) loved joining in too. Really, who could resist playing with all of these colorful balls???

Peek a Boo Sensory Activity for 1 year olds

What else do babies love? The peek-a-boo game!

It’s at this age (around one year) that babies often struggle with separation anxiety when being dropped off at a caregiver’s when separated from their parents or caregivers. You will even see signs of separation angst when a parent goes into another room, which can especially happen when the baby is tired.

The next sensory activity for baby was a fun one!

We had an empty cereal box that I cut circles into. They had a ton of fun putting the balls into a hole, and pulling a different one out as the box moved around…there were a lot of little hands in there moving that box around 🙂

The it’s-there-then-it’s not of a great game of peek-a-boo (or peek-a-ball in this case!) is awesome in building neural pathways of the brain. 



More sensory activities for babies

Other sensory activities for 1 year olds and babies include using small baskets or boxes to transfer the balls from one container to the other.

Transferring from box to box…working those hands to pick up different sized/weighted/textured balls.  Dropping the ball to see what happens is so predictable, but it is important in learning for babies. Just like when baby drops the cup from her highchair a million times…

We had a ball!

(couldn’t resist that one…heehee)

Baby and Toddler Brain Building activity using balls and a muffin tin. Perfect for developing fine motor skills, visual perceptual skills in an active activity for sitting and mobile babies.

Need more sensory ideas for 1 year olds? Try these:

  • Sensory tables- put interesting toys, textures, scoops, and containers on a low table like a coffee table. The new cruiser or early walker can stand at the table and explore the textures
  • Messy play on a highchair- Strap baby in and encourage messy food play. Thing about apple sauce, pudding, or mashed potatoes.
  • Textured fabrics- Put a bunch of fabric scraps into a box and invite the one year old to pull them out and put them back in.
  • Play with cups and spoons– with supervision- This is a great activity for eye hand coordination skills.
  • Use a baby gym to encourage reach and play in various positions.

Oral Motor Problems and Feeding

oral motor problems

Many times, OT professionals receive referrals for oral motor problems and feeding. It’s through oral motor occupational therapy interventions that kids can move from challenges biting, chewing, and moving food around inside the mouth, to success with eating and trying new foods. Let’s get started!

Oral motor problems lead to difficulty biting, chewing, and manipulating foods. They can cause difficulties with textures of foods, and can be a cause of extremely picky eating! A good place to start is with understanding the development of oral motor skills.

Oral Motor problems

One thing is for sure; individuals can have a huge spectrum of considerations when it comes to oral motor issues. No two kiddos will be alike. That’s why it’s so important to discuss oral motor issues with a professional.

The process of eating is a complex collection of movements patterns with physical and sensory components.

When feeding is a challenge, many times individual oral structures and sensory-motor patterns are a cause. 

If you are questioning whether an eating issue is sensory or oral motor, be sure to take time to explore each consideration. There can be different interventions and strategies depending on the underlying cause of eating difficulties. For example, there are specifics when it comes to issues with sensory food aversions and sensory food issues.

What are Oral Motor Problems Occupational Therapy Addresses?

The oral motor problems listed below are just some of the issues that can impact function in feeding.  

In a small series of blog posts, I have broken down each oral motor problem that occupational therapists typically address. Each blog post includes information about the specific oral motor concern, the reasoning or underlying influences that relate to each oral motor issue, and feeding issues related to the specific oral motor problem.   

This series of blog posts should be a resource for you to find more information relating to how feeding issues are related to specific oral motor problems and how these feeding issues can be addressed in treatment.   

Click on the links below for more information on each oral motor problem area as they relate to feeding. 

  • Mouth Clamped Shut when eating- Consider the child who clamps their mouth shut during meals.  This is usually the biggest sign to a parent that the child is all done eating, is full, or is refusing to eat.  However, it might be an oral motor problem that is actually the cause of the clamped shut mouth.  The child falls back on this technique because it’s worked for them in the past in some way to provide stability, move out of the difficult oral motor exercises, or has resulted in a response from the parent.   

Other oral motor problems include:

  • Tooth Grinding
  • Tonic Bite
  • Jaw Retraction
  • Tongue Retraction  
  • Tongue Protrusion
  • Tongue Thrust      

Kids can have trouble with picky eating and difficultities in feeding when there are oral motor problems. Different types of oral motor problems.

Occupational Therapy for Oral Motor

Oral motor interventions in occupational therapy can cover a variety of intervention techniques. It is essential to begin with an evaluation and individualized assessment by a feeding professional. Occupational therapists are trained in this area, but some OTs have additional certifications.

The list of occupational therapy oral motor strategies listed below is for educational purposes only and not a replacement for therapy of any kind.

Some occupational therapy oral motor strategies that can be used are:

  1. Oral motor assessment- It is essential to start with the assessment process for safety of the individual. Addressed in more detail below.
  2. Oral motor stimulation- In occupational therapy, strategies include brushing to the lips or cheeks, towel stimulation, feeding swab, tongue mobility exercises, etc. These are explained in greater detail below.
  3. Oral Motor Exercises– We’ve listed a larger list of specific exercises to use in play and in therapy sessions.
  4. Oral motor coordination exercises– Use the oral motor cards in the deep breathing kit to improve oral motor coordination skills. Try mimicking the movements by using a mirror and visual modeling.

Oral Motor Assessment Occupational Therapy

Assessment occurs by a pediatric occupational therapist, but there are many things to be considered.

Feeding is developmental and it’s essential to consider the level, age, and abilities of the individual as this will impact all aspects of feeding and oral motor considerations.

Oral motor assessment and infants-

In infancy, oral motor skills are both a means for self-regulation (nurturing through sucking) and nutritive. Things to consider in an occupational therapy oral motor assessment for infants and babies at this age and stage:

  • Is the infant able to suck in exploration for nipple of bottle or breast?
  • Does the infant suck in bursts and have pauses to allow for breathing while eating?
  • Assessment of the physical mechanics of swallow
  • Timing of sucking and pauses- sucking should occur at a rate of about one suck per second with pausing to swallow the liquid and breathing. This should occur in a coordinated manner.
  • Lip closure
  • Jaw movements to draw liquid into the mouth and to swallow (infants)
  • Anterior tongue movement during the sucking, along with cheek movement and jaw movement as the tongue draws milk or formula to the rear of the mouth to swallow (older babies)
  • Oral reflexes and whole body primitive reflexes (root reflex, a suck reflex, a swallow reflex and then protective reflexes like gag and coughing)
  • Liquid leaking from the mouth during eating
  • Anatomy of the mouth, tongue, lips, neck, etc.
  • Positioning during feeding
  • Family educational needs
  • Sleep and timing considerations

Oral motor assessment in babies

In older babies, you begin to see certain developments. Missing these milestones can indicate oral motor problems. These considerations should be addressed in occupational therapy oral motor assessments as babies grow:

  • Hands in the mouth in exploration and play- this is normal part of exploration and supports development of tongue, lips, cheek mobility
  • Positioning and seating (high chair positioning)
  • Neck, head, and upper body control against gravity
  • Motor coordination at age appropriate levels
  • Bite reflex
  • Mouthing toys, teethers, etc.
  • Making sounds with a variety of oral motor movements
  • Mimic facial expressions (open mouth, tongue out, etc.)
  • Gag reflex present
  • Accepting variety of baby food textures, flavors
  • Accepts foods from a baby spoon
  • Lip closure
  • Tongue mobility (thrusting tongue after initial spoon offerings is normal)
  • Transverse tongue reflex- The baby/child feels stimulation on the side that tongue and the tongue moves in that lateral direction- needed for swiping foods
  • Attempts or tries a variety of flavors, textures, and softer, larger foods

Oral motor assessment in toddlers-

During the toddler years, oral motor issues can present in drinking, feeding, and other areas. Consider these aspects in OT assessments:

  • Drinking from sippy cup/open cup
  • Drinking from a straw
  • Drinking a variety of textures and thicknesses (water, juice, thick or thin smoothies
  • Eating a variety of textures and thicknesses
  • Eating fluids mixed with solids (cereal, soups)
  • Biting foods from a larger piece of food
  • Moving food around within the mouth
  • Swiping the mouth with the tongue to clear the mouth
  • Chewing with rotational movements of the jaw
  • Begins to remove food from the lips with the tongue

Oral motor stimulation

We cover specific oral motor exercises designed to support the oral motor stimulation to move the lips, tongue, and jaw to bite, move, swipe, clear the mouth of food, and swallow food in our resource on oral motor exercises. However, below you will find strategies to provide oral motor stimulation to the mouth, lips, gums, and tongue.

Oral motor stimulation in occupational therapy centers around play in order to enable function. This focuses on independence with feeding with safe ability to bite food, clear food from the mouth with the tongue so that food can be swallowed.

Tongue Stimulation-

  • Use a mouth swab– to touch, swipe, tap and swab the tongue on the sides, at the tip, and along the length, avoiding the back of the tongue to avoid activating a gag reflex.
  • Use a vibrating toothbrush- to stimulate tongue movement on the sides. This can help the tongue with lateral movements.
  • Use a gloved finger- Put on a latex or non-latex glove and use a finger to tap the sides of the tongue. The glove can be worn by either the occupational therapist or the individual themselves.
  • Use a mirror- Move the tongue by mimicking movements and watching them in a mirror. You can even have the individual touch their tongue to a clean mirror surface. Play in front of a mirror alongside the child or in front of the child above the mirror so the child can look at the therapist’s face and check their movements in the mirror at the same time.
  • Tongue movement exercises- Use the tongue and mouth exercises included in our Deep Breathing Exercise pack for ideas.
  • Tongue sounds- Make clicking sounds with the tongue on the roof of the mouth. As the child/individual to copy the sounds.
  • Push the tongue into the cheeks of the mouth to copy motions. This can help with lateral sweep of the tongue to clear foods by increasing tongue range of motion.

Lip and Cheek Stimulation

  • Washcloth oral motor simulation- this occurs with a dry wash cloth and then a wet wash cloth by rubbing the lips and cheeks. Each area can be separated so they are addressed in isolation. Use a dry washcloth or wet washcloth to wipe the face, without food use. Use a warm or cold washcloth to wipe the face.
  • Making faces- Cheeks and lips can obtain heavy work, or proprioception by puffing up the cheeks, making fish lips, sealing the lips and blowing, blowing raspberries, copying facial expressions, etc. Play “Simon Says” with facial expressions. We have oral motor Simon Says Commands to share!
  • Food stimulation- Some foods (sweet, sour) are very alerting. These can be used as a frozen pop in the form of a lemonade pop, smoothie, or popsicle. Or, add fruits and frozen foods to a mesh bag that is sucked on.
  • Ice pops- Freeze an ice cube on a popsicle stick and use it as an alerting and stimulating tool to “wake up” the lips and cheeks.
  • Vibrating tools- Play with vibrating mouth toys and touch the face, mouth, lips, teeth in the way of a vibrating toothbrush (offering input through the jaw).
  • Wilbarger Brushing Protocol– Use prior to eating foods (contact a trained therapy professional)

Jaw Stimulation-

  • Vibrating toys- vibrating toys, chewing tools, or a vibrating toothbrush can offer oral motor stimulation through the jaw. This can be very alerting, so use with caution.
  • Chewing tools- biting on “chew toys” (described as heavy chewing therapy tools) or chewing tools that add heavy work through the teeth and jaws. This offers feedback to “wake up” the jaws.
Oral motor issues related to feeding in kids

    As you can see there is a lot of different areas that need to be assessed and addressed when it comes to oral motor concerns related to eating and drinking.       



Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to

Container Baby Syndrome

container baby syndrome

If you are a new parent, then you have probably heard that tummy time is important for your baby, but it’s so important to process the concept of container baby syndrome. In this blog post, we are covering container syndrome, what this means, and what you can do to support your most precious little one.

container baby syndrome

What is Container syndrome?

Container Syndrome is a term used to describe the lack of skill in infants who are not allowed ample movement opportunities. Container Baby Syndrome is the result of an infant being placed in a container for an excessive amount of time during the day. 

Importantly, this is not to shame use of baby containers…or to say that use of these items is to be omitted at all costs. It’s important for the wellbeing of the caretaker to put the baby down sometimes! Things need done around the home. Parents need a shower, or some time to themselves. Other children need cared for.

The important thing to know here is that we are talking about constant use of baby holders all the time, during the day and night. Moving the baby from one container to another is the issue.

Constant use of positioners, or devices is what leads to the syndrome known as baby container syndrome, not using some of these items sporadically.

This extended time leads to structural, movement, and behavioral challenges as a result. 

Baby containers include baby equipment and items such as:

  • Restrictive playpen that does not allow for movement
  • Crib
  • Car seats
  • Strollers
  • Bumbo seats
  • Bouncy seats and swings
  • Rockers
  • Nursing cushions
  • Vibrating chairs
  • Jumpers
  • Exersaucers
  • positioning pillows
  • Slings
  • Floor seats
  • Infant swings
  • Walkers
  • Jumpers

The other issue is when the devices are used for nighttime and daytime sleep.

It’s easy to fall into that trap of the newborn sleeping in the rocker chair or bouncy seat because the reclined position puts the upper body into a reclined position, which can help with reflux that a baby might have. The warmth and close sides allow the baby to fall asleep easily. But when the newborn is sleeping in this positioner all night and then wakes for a short period and then goes back to sleep in the same device, is when we see the issues with constant pressure on one side of the head and neck positioning that can lead to issues.

For support and help with newborns not sleeping through the night, be sure to check out our blog post on this topic. Occupational therapy professionals can help with sleep during the newborn stage which impacts so many aspects of functional development and family dynamics.

All of the time spent in these baby containers adds up! When in a positioning device such as the ones listed above, little ones are limited in the motor development that results from stretching, wiggling, turning, reaching, and otherwise moving.

Why Worry About Container Syndrome?

As a new parent, you might be wondering “why can’t I just use the wonderful bouncers, baby rockers, and other entertainment devices for infants and toddlers? After all, I got all of these amazing baby chairs, rockers, and positioners for my baby shower…can’t wait to use them!

Why should I put my baby on the floor? The biggest reason has to do with the benefits to development. Putting a baby in a container such as a jumper, positioning seat, bouncy seat lead to something called container baby syndrome.

It’s understandable why the baby seat or jumper seems like a better option than the floor for a baby. Parents and caregivers have shown a great deal of support for baby “containers” like bouncy seats, Bumbo seats, and activity centers. In fact, these baby holders have become so popular over the years, that a term has been coined; “container baby syndrome”. 

When babies are constantly keep in a space where they cannot freely move, how can they be expected to roll, crawl, or walk, when it is the developmentally appropriate timeframe?

Furthermore, babies need experiences where they can learn from their world in a physical way.

They need to discover “what happens when I move my arm and head like this”?’ Babies may fall over, and have some stumbles along the way, but this is how young children learn about gravity and develop postural stability.

Without those learning opportunities, children will only learn that their seat will catch them from falling, no matter how much they wiggle. 

With fewer movement opportunities, a delay may be seen in typical development and reflex integration. More serious issues may occur when we keep babies still, like a flattened head from lying down (positional plagiocephaly) or a tight neck that reduces head movement (torticollis). 

There is the visual component too. When babies are in a positioner such as a bouncy seat, they are positioned on their back with little to no neck movement. The neck, back, spine don’t receive the time (even minutes) to stretch, turn, and move. But the eyes are limited as well.

When placed on the back in a reclined position, the eyes are not strengthened to look and gaze based on head and neck movements. The eyes may stay in one place and are not challenged to focus on different depths and peripheral stimuli.

Neck movements are limited to turning from side to side, and they eyes tend to follow the neck. This limited eye movement can later impact other areas of development.

Where did container syndrome come from?

In 1992 the “back to sleep” campaign was introduced to lessen the likelihood of sudden infant death syndrome (SIDS).  While the rate of SIDS went down 50%, (yay!) container syndrome rose 600%, to one in seven babies! 

This is astounding. 

Parents are so nervous about SIDS, they place their babies in various containers most of the day. While this seems a safe, convenient, and supportive option, the use of too many “containers” can lead to container baby syndrome. 

Babies who have not had enough tummy time may resist this at first, giving the false impression that the container is the best place for them. 

What does container syndrome look like?

  • Head Shape Flatness. The back or the side of the head is abnormally flat
  • Facial asymmetry. The sides of the baby’s face may appear unequal as a result of skull deformity and flatness
  • Torticollis. The baby has difficulty turning the head to one side, or keeping the neck and head straight due to muscle tightness on one side of the neck
  • Decreased movement, strength, and coordination -the baby may not be able to roll, sit up, crawl,  lift the head or reach with their arms while on their tummy. 
  • Delayed milestone achievement
  • Speech, sight, hearing, and cognitive problems – Visual skills can be affected such as following moving objects with the eyes and seeing toys from different distances. Hearing can be disordered, as baby does not hear from all angles. Delayed cognitive skills may arise because the infant is not able to problem solve, explore their environment, or develop language skills
  • Attention deficit hyperactivity disorder (ADHD)
  • Increased weight/obesity

How to prevent container syndrome in babies

Container baby syndrome is 100% preventable.  If you suspect your baby or a client of yours has symptoms of this syndrome, speak with their pediatrician, get a referral to a physical therapist, and begin working on exercises.

  • Allow baby plenty of supervised free time on a blanket on the floor, or in a large play yard. Encourage tummy time, reaching for toys, exploration.  Some caregivers feel unsure about putting their baby on the floor.  A blanket, sheet, or other floor covering can be placed and washed after usage. Or, use toys such as a baby gym to encourage belly play.
  • Limit baby’s exposure to containers. Use only when transporting the baby, or there is truly no other safe option
  • Increase supervised tummy time during the day.  Your baby may cry and resist at first, as this may be difficult or uncomfortable.  Start slowly and persevere. Colleen from the OT Toolbox has a great article on Tummy Time Myths.
  • Hold your infant in your arms, or in a sling for short periods during the day.  This will encourage movement, increased head control, and socialization
  • Rotate baby through various stations and positions during the day. Holding a baby all of the time is not healthy for a growing child either. 
  • Floor Play for Babies is another great resource from your friends at the OT Toolbox
  • Use gates and other borders to secure a safe place for baby to play, away from wandering pets, or siblings who may step on them
  • EDUCATE caregivers and other people about the danger of container baby syndrome. Encourage caregivers to provide opportunities for the baby to explore their environment freely.  Demonstrate tummy time and other appropriate movement experiences

Activities to Prevent Container Syndrome

Now that it is understood that playing on the floor is important, let’s get into the many different ways you can do it! One of the easiest ways to encourage floortime with your baby is to lay a blanket on the floor, preferably with a carpet underneath for comfort, and place a toy or two near the baby.

Depending on their age and abilities, the baby may be totally independent, rolling and playing happily. If the children are younger, or less comfortable playing by themselves, this is a great opportunity for a caregiver to step in. A fair amount of babies do not like being on their tummy for various reasons, including medical or sensory.

Babies who have gastrointestinal issues may be hesitant to engage in tummy time, as it is uncomfortable. Work through these difficulties while encouraging floor play.

How do I keep them safe down there? Prepare a safe and clean environment for movement. This may involve baby gates, barriers, or a large corral to allow freedom of movement, without risking baby falling down the stairs. Lie on the floor yourself and see what is down there at child level. You may be surprised to notice extension cords, small objects, or other unsafe objects while you are down there.

  • 2 months or younger: Talk with your baby, showing them toys, describing them, and giving them to their hand to feel and explore. Sing songs – whatever songs you know! Encourage them to wiggle their arms and kick their legs along with songs, tickles, or kisses. 
  • 3-4 months: Your baby will be able to hold tummy time for a bit longer by now. If they have trouble staying there, lay down with them! Be a part of the team, showing them how fun being on their tummy can be. Babies around this age can reach and bring toys to their mouths, so give them safe opportunities to do so.
  • 5-6 months: Rolling should be part of the baby’s physical development around this time. Encourage this movement by enticing them with something they love. Maybe it’s you, a special toy, the TV remote, or their next bottle. Try singing Five in the Bed. When the song says “Roll over!” show your baby how to roll.  During this time of development, your baby may be moving more than ever. They may even be crawling! Encourage even more floor play with these new skills. As long as the area surrounding them is safe, and you are close by, tons of fun (and important development) can be had! Read here about the types of crawling you might start to see at this age.
  • 7-8 months: Just like rolling, encourage crawling by giving the baby lots of space on the floor (that may mean moving aside some furniture) and placing toys or books in various places. There are so many fun games to be played! Playing “Peek-a-boo” where the baby pulls a blanket or towel off to show what’s underneath, is a classic game and critical to development. This teaches baby object permanence. Scatter toys near and far to encourage looking, stretching, and moving.
  • 9-10 months: Around this age, your baby will really be on the go. Maybe a baby obstacle course is up their alley…crawl over mom’s legs, under the coffee table, around the dog, and up the step into the kitchen! Creative barriers and safety gates will likely come into play around this stage to keep young children safe.
  • 11-12 months: Almost one-year-olds may be walking, which means they will likely not tolerate being in a “container” very well anymore. Now that they are cruising on furniture, squatting to pick up toys, and participating more in play, they may likely lead the way! See what your child’s interests are during floor playtime and follow their lead. 

Need more tummy time information?  The OT Toolbox has several articles on baby play that support the development of balance and coordination through play.

Another great resource to read more on how to promote development through play is DIR Floortime as it covers strategies to support development through interest-based play.

The National Institute for Health also has a great resource on tummy time. 

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

A final note on container syndrome

While the “back to sleep” campaign has certainly been successful, it is not without pitfalls. The rule of thumb for parenting is;  everything in moderation.  Not too much screen time, sweets, or containers.  Parents do not need to be laden with guilt over container baby syndrome.  Most caregivers are doing the best they can with what knowledge they have.  As they learn more, they will do more.

NOTE* The term “they” is used instead of he/she to be inclusive.

Retained Primitive Reflexes & Child Development

Retained primitive reflexes

This post is all about retained primitive reflexes, what retained reflexes look like, and how they impact child development. You’ll find specific strategies to integrate retained primitive reflexes as well. In a recent blog post, we discussed what are primitive infant reflexes, and why they are so important to infant development. Now, it is time to discuss what can happen if these reflexes hang around for too long.

Remember that every case is unique, and if your child matches these characteristics, that does not necessarily mean that they have retained that reflex. If you are concerned about your child’s abilities and how they may relate to retained reflexes, we recommend talking to your pediatrician.

For more information on primitive reflexes and their impact on child development, be sure to check out some of these books on primitive reflexes.

Retained primitive reflexes

retained Primitive Reflexes

The term “retained primitive reflexes” might be a phrase you’ve heard before. But what does that mean and what do retained reflexes look like in children? Well, there is a lot to cover.

Basically, as infants develop into toddlers, their primitive reflexes should do what health care professionals call “integration”. The response that comes with the primitive reflex should integrate into a more mature or voluntary movement. When primitive reflexes are retained, those instinctive actions, movements will remain past the typical age range…they continue to exist. They are retained.

If primitive reflexes are still present long after they should have integrated, the child will display certain characteristics specific to the retained reflex, many of which limit their development and academic skills.

Just to add some background information, when we say that primitive reflexes are integrated, that means that the movements (or reflexes) are absorbed and contributing to characteristics, actions and neurological responses. To put it in other words, a reflex moves along a neurologic arc and when integration of those reflexes occurs, a process where specific stimulus results in a predictable response (or lack of that predictable response) so that movements are more efficient. This occurs so the neurologic system is connected and communicating efficiently. It’s all part of the nervous system.


The palmar reflex is important for the development of purposeful grasping, something that an infant is learning throughout their first year of life. The palmar reflex can be seen when you place your finger in the palm of an infant’s hand and their reflexive response is to hold on to your finger. What an adorable reflex, right?

This is not something we want to see in an older infant or child, though. While the response is necessary for a newborn to learn how to use their hands, it limits an older infant or child to only using their hands and fingers for a strong grip.

retained palmar reflex

Children with a retained palmer reflex may:

  • Get fatigued very easily with handwriting or fine motor tasks, like stringing beads.
  • Have a sensitive or “ticklish” palm
  • Open and close their mouths while using their hands for tasks like writing or cutting with scissors.
  • Have difficulty in speech articulation

The mouth and the hands are connected via neural pathways in infancy, and that connection is still strong in those who have the palmar reflex. This is why the movements of the mouth and speech may be involved in the retained palmar reflex.

How to integrate the Palmar Reflex:

  • Tasks that encourage separate use the fingers
    • Squeeze a ball with one finger and thumb, alternating fingers to squeeze
    • Stringing Beads
    • Playing with small Legos or similar toys


The Moro reflex is also called the startle reflex – it can be seen in a frightened infant up to about 4 to 6 months old. The reflex causes a baby to stretch out their arms and legs, and quickly bring them back in, in jerky movements. This is in response to the feeling of falling, a loud sound, or a drastic change in temperature.

Retained Moro Reflex

Children with retained Moro reflexes are often very sensitive to stimuli – sounds, tags on clothing, lights, etc. They tend to lack emotional and self-regulation skills and have a difficult time paying attention in class. Without an integrated Moro reflex, their fight or flight response can be activated very easily causing them to have deficits in many areas of life.

How to integrate the Moro Reflex:

  • Starfish Exercise
    • While seated, open up into a big “X” shape with straight arms and legs.
    • Cross right ankle over left & Cross right arm over left
    • Open up to big “X”
    • Cross left ankle over right & Cross left arm over right
    • Repeat
  • This is also how you can test for its presence! If a child has a very difficult time completing these actions, without another known cause, they may have a retained Moro reflex.


The tonic labyrinthine reflex (TLR) is used for head and postural control. We know that baby has poor control of their head and neck when they are born, and this reflex is part of what helps them gain control over this part of their body.

Retained Tonic LABYRINTHINE reflex

This reflex typically integrates around 4 months old, but if it persists, the following may occur:

  • Difficulties judging space, speed, depth, and distance.
  • Toe walking
  • Discoordination in simultaneous movements, such as walking or swimming.
  • Avoiding lying on their stomach.

Children with retained TLRs tend to be perceived as clumsy and often have a difficult time sitting upright and still in their chairs. This can decrease their ability to pay attention in the classroom setting. When posture exercises in kids don’t work, sometimes it’s easy for teachers or parents to wonder what is going on, when a look at retained reflexes may be in order. In some cases, integrating the TLR reflex can support posture.


  • Incorporate activities on their stomachs as much as possible, or for as long as they can manage each day.
  • Try reading, watching TV, or playing with a toy while on their tummies
  • Daily practice will strengthen their muscles and correct this response.


This reflex is important to the initiation of crawling, as the arms and legs move as a baby turns their head while on their belly. While infants are on their bellies, and while crawling, they are exposed to a ton of visual stimulation by looking at their arms moving, looking and grabbing toys, etc. Tummy time is so important for this reason and more!

The ATNR should disappear around the time an infant is gearing up for crawling, around 6 months old.


If asymmetrical tonic neck reflex doesn’t integrate, the following may occur:

  • Poor Coordination during movements like skipping or riding a bike
  • Trouble crossing midline
    • Example: Moving right arm to left side of the body to buckle a seat belt.
  • Poor visual tracking = academic issues
    • Difficulty reading and writing

A quick test for a retained ANTR starts with having the child stand with both arms directly out in front of them. Ask the child to slowly turn their head all the way to the left. Their left arm will remain straight and their right arm will bend if the reflex is still present.

How to integrate the ATNR

  • Lizard Crawling Exercise
    • Start on the stomach
    • Look to your left, and bend your left elbow and left knee
    • Look to your right, and bend your right elbow and right knee

There are many more primitive reflexes, as well as postural reflexes, that are important to child development and student success. We have not covered everything here, but we hope to have given you a nice place to start building your understanding of what may happen when primitive reflexes are maintained over time.

Want to learn more about primitive reflexes, what to do when reflexes are retained, and how to know there might be an issue? Check out this primitive reflexes course. (affiliate link)

Assessment And Integration Of Primitive Reflexes For Improved Independence In Daily Activities is a course on primitive reflexes where you’ll learn how to, screen, test and integrate retained primitive reflexes and find tools to help your client or child improve motor, social and daily functioning skills by implementing fun, therapeutic, and functional activities!

In this primitive reflexes course, created by two occupational therapists, you’ll find modules and functional intervention activities for:

  1. Moro reflex
  2. The Tonic Labyrinthine (TLR) & Landau Reflex 
  3. The Rooting Reflex
  4. The Asymmetrical Tonic Neck Reflex (ATNR)
  5. The Spinal Galant Reflex
  6. The Palmar Grasp Reflex
  7. The Symmetric Tonic Neck Reflex (STNR)
  8. Support for kids who push back
  9. Printable handouts, screening tools, and checklists
  10. Information on postural reflexes, yoga, sensory diets, and more
  11. Case studies
  12. Research
  13. AOTA continuing education: 1.05 AOTA CEUs

If your child has retained primitive reflexes, learning to integrate them could lead to improved development in many areas:

  • Social Skills
  • Learning
  • Motor Skills
  • Executive
  • Functioning
  • Coordination
  • Reading & Writing

Find out more and gain insight and tools on retained primitive reflexes and start supporting kids needs with “Assessment And Integration Of Primitive Reflexes For Improved Independence In Daily Activities” today

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

What are Primitive reflexes?

what are primitive reflexes

Have you even heard the term reflexes and wondered what are primitive reflexes? One of the many things that your newborn’s pediatrician will check periodically is their primitive reflexes. The existence of reflexes can be a great marker for neurological health in people of all ages, as they are controlled by the nervous system – the brain, spinal cord, and nerves. Primitive reflexes develop in the womb and are integral to an infant’s survival and future development. Below we will break down each of these reflexes and their purpose. Be sure to read our blog on retained primitive reflexes as well, to discover how to support reflex integration.

what are primitive reflexes

Related: Books About Primitive Reflexes 

What are Primitive Reflexes?

As infants develop into toddlers, these reflexes should do what health care professionals call “integration”. The response that comes with the primitive reflex should integrate into a more mature or voluntary movement.

If they are still present long after they should have integrated, the child will display certain characteristics specific to the retained reflex, many of which hold back their development and academic skills. 

Let’s begin with the most easily noticeable reflex that babies have: the palmar reflex. This is also known as the grasping reflex. You will see this when you place your finger into the palm of an infant’s hand, and they hold on tight. This is an adorable response that can make you feel pretty special, but it is involuntary up until about 6 months of age when the reflex should disappear. 


The palmar reflex is important for the development of purposeful grasping, something that an infant is learning throughout their first year of life. 

Fun Fact: if your baby is holding your hair in a death grip because of this reflex, stroke the back of their hand with your finger – it should initiate a release of the grasp. 


The rooting reflex is one of the main “survival” reflexes. The rooting reflex can be elicited by stroking an infant’s cheek with your finger, or more likely, a bottle or breast nipple. This is because when the cheek is stimulated, the infant will turn his or her head towards that stimulation. 

If you ever need your baby to pay attention to their feeding, try giving their cheek a little stroke or tap so they turn towards the feeding source. This response should be seen in infants up until about 4 months of age. 


Similar to the rooting reflex, the sucking reflex is necessary for an infant’s feeding abilities. To stimulate the sucking response, touch the roof of the infant’s mouth and they will automatically begin sucking. 

Most infants learn this skill very quickly (they do get tons of practice, after all!) and the reflex will disappear by about 2 months old. 


This reflex is the first of three on this list that is a response to a change in body position. Also known as the startle reflex, the Moro reflex can be seen by gently dipping a baby’s head and neck backward, as if they are falling. It can also be elicited by other stimuli like a startling noise or a drastic change in temperature. 

The response that you will see in the baby is that of fear – their arms, legs, and head will reach out and then tuck back in – jerking their body back and forth. They may also open and close their hands and may even cry. The movement that is created by a startling stimulus is to protect your baby and allow them to move away from the stimuli even before they can control their own movements. Pretty cool, huh?

You may notice the startle reflex really kicking in around 1 month old. If your baby is inconsolable and moving around their body in this way, securing supporting their bottom and their head should help them realize that they are safe. By six months old, or as early as two months, this reflex will disappear. 


The tonic labyrinthine reflex (TLR) is used for head and postural control. We know that baby has poor control of their head and neck when they are born, and this reflex is part of what helps them gain control over this part of their body. 

It’s important to know that posture in kids that impact functional performance (sitting at a desk for example) can be a result of a retained reflex and this is an area that is sometimes overlooked.

The TLR can be seen when moving the head and neck forward and backward. When the head moves forward toward the chest, the arms and legs bend and the baby assumes the fetal position. When the head moves back away from the chest, the arms and legs straighten. You can see this really well during tummy time! 

The TLR will disappear by about 4 months old so that more advanced reflexes and movements can begin development. 


Last on the list of movement-based reflexes is the asymmetrical tonic neck reflex (ATNR). As the name suggests, this reflex has to do with the neck. You can see the reflex if you turn a baby’s head to one side while they are laying on their backs. They will reflexively straighten their arm and leg on the side that they are looking, and bend the arm and leg of the other side. That is where the asymmetrical part comes in: their left side and right side of their body are opposite. They look a bit like an archer, about to shoot an arrow. 

This reflex is important in the birthing process, as the motions of the head can control the movement of the rest of the body help the baby through the birth canal. It is also important to the initiation of crawling, as the arms and legs move as a baby turns their heads while on their belly. For this same reason, the ATNR is crucial to the development of hand-eye coordination. 

The ATNR disappears around the time an infant is gearing up for crawling, around 6 months old. 


There are a few more infant reflexes that we did not mention, and you can check them out if you are looking to learn more!

The Spinal Galant Reflex, the Babinski Reflex, the Landau Reflex, and the Symmetrical Tonic Neck Reflex (STNR) are some that we missed in this article. The Landau and the STNR are actually not primitive reflexes, as they develop after the baby is born, but they are developmentally important nonetheless! 

Luckily, we have a resource to share that covers these reflexes and much more…

Check out this primitive reflexes course. (affiliate link)

Assessment And Integration Of Primitive Reflexes For Improved Independence In Daily Activities is a course on primitive reflexes where you’ll learn how to, screen, test and integrate retained primitive reflexes and find tools to help your client or child improve motor, social and daily functioning skills by implementing fun, therapeutic, and functional activities!

In this primitive reflexes course, created by two occupational therapists, you’ll find modules and functional intervention activities for:

  1. Moro reflex
  2. The Tonic Labyrinthine (TLR) & Landau Reflex 
  3. The Rooting Reflex
  4. The Asymmetrical Tonic Neck Reflex (ATNR)
  5. The Spinal Galant Reflex
  6. The Palmar Grasp Reflex
  7. The Symmetric Tonic Neck Reflex (STNR)
  8. Support for kids who push back
  9. Printable handouts, screening tools, and checklists
  10. Information on postural reflexes, yoga, sensory diets, and more
  11. Case studies
  12. Research
  13. AOTA continuing education: 1.05 AOTA CEUs

If your child has retained primitive reflexes, learning to integrate them could lead to improved development in many areas:

  • Social Skills
  • Learning
  • Motor Skills
  • Executive
  • Functioning
  • Coordination
  • Reading & Writing

Find out more and gain insight and tools on retained primitive reflexes and start supporting kids needs with “Assessment And Integration Of Primitive Reflexes For Improved Independence In Daily Activities” today.

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Messy Eating

Benefits of Messy eating for babies and toddlers

Have you ever noticed that small children eat meals with recklessness? Bits of food covers the face, cheeks, hands, lap, floor, belly, and even hair. Part of it is learning to use utensils and manage food on the fork or spoon. But there’s more to messy eating too! Messy eating for a baby or toddler is actually a good thing, and completely normal part of child development. And, letting a small child get messy when they eat, and even playing with their food as they eat is OK!

Messy eating in babies and toddlers has benefits to developing tactile sensory challenges and fine motor skills in young children.

Messy eating

I’m sure that your mother never told you it was okay to play with your food at the dinner table, but I’m here to tell you otherwise. Playing with food is not only okay, it is vital to development of self feeding skills and positive engagement with food. When young children play with their food they are engaging in a rich, exploratory sensory experience that helps them develop knowledge of texture, taste, smell, changing visual presentation of foods and oral motor development.

When play with food is discouraged it can lead to food texture issues, picky eating, oral motor delays and increased hesitancy with trying new foods later on.

Eating with hands- Messy benefits

When solid foods are introduced to baby, it is often a VERY messy ordeal. There is food on the chair, the bib, the floor, you…everywhere but the baby’s mouth. Often times, parents may feel discouraged or don’t like the mess that is the result, but it is OK. In fact, the messier the better.

Exploring food textures with the hands provides tactile experience to the hands, palm, and individual fingers. Are foods sticky, chunky, goopy, or gooey? All of that exposure to the hands is filed away as exposure to textures.

Picking up and manipulating foods offers fine motor benefits, too. Picking up and manipulating bits of food offers repetition in pincer grasp, graded precision, grasp and release, eye-hand coordination, bilateral coordination, crossing midline, and proprioceptive feedback. All of this is likely presented in a baby seat or high chair that offers support and stability through the trunk and core. When that support is offered to babies and toddlers, they can then work on the distal coordination and dexterity. At first, manipulation of food is very messy as those refined skills are developed, but it’s all “on-the-job training” with tasty benefits!

Research shows that a child moves through a series of exploratory steps before successfully eating new foods. This process involves messy play from the hands, up the arms, onto the head and then into the mouth. The steps of this process cannot happen unless the child is encouraged to touch, examine and play with their food. In today’s culture of sterilization and cleanliness, this often counterintuitive to parents and a hard pattern to break.

Promoting Play with Food

Mealtimes can be rushed affairs, making it hard to play with food, but they are not the only times we engage with food throughout the day.

Cooking and meal prep are two of the most common opportunities for play and engagement with food. These activities present perfect opportunities for parents to talk about color, size, shape, texture, smell and taste of the foods that are being prepared. Use of descriptive words,
over exaggeration when talking about and tasting foods, along exploration opportunities develop a positive interest in foods.

Babies can be involved in kitchen prep as they play with appropriate utensils and kitchen items like baby-safe bowls or pots. Toddlers enjoy being involved in the food preparations and can wash, prep, and even chop soft foods with toddler-safe kitchen tools.

Explore these cooking with kids recipes to get small children involved in all the benefits of the kitchen.

Here are more baby play ideas that promote development.

Food Art

Free play with foods like yogurt, jello and applesauce are also great opportunities to promote messy play and creativity. Utilize these foods for finger painting, or painting with other foods as the brushes. This activity challenges tactile and smell regulation, along with constant changes in
the visual presentation of the food.

Creativity with Food

When presented with food for free play, or at the dinner table encourage their creativity–carrot sticks become cars or paint brushes, and raisins become ants on a log.

The sillier the presentation, and more engaged the child becomes, the more likely they are to eat the foods you have presented to them. Especially, if these foods are new, or are non-preferred foods. High levels of over exaggeration also leads to increased positive experiences with foods, which in turn leads to happier eaters, and less stressful mealtimes
down the road.

Ideas like these flower snacks promote healthy eating and can prompt a child to explore new textures or tastes in a fun, themed creative food set-up.

Messy Eating and Oral Motor Development

Not only does play promote increased sensory regulation and positive engagement with foods, it also promotes oral motor skill development.
Oral motor skill development is promoted when a variety of foods are presented and the mastered skills are challenged.

Here is more information on oral motor problems and feeding issues that are often concerns for parents. The question of feeding concerns and picky eating being a sensory issue or oral motor motor concern comes up frequently.

Foods that are long and stick like such as carrots, celery and bell peppers, promote integration of the gag reflex, along with development of the transverse tongue reflex that later supports tongue lateralization for bolus management.

Foods such as peas, or grapes promote oral awareness and regulation for foods that “pop” when bitten, and abilities to manage multiple textures at one time.

Messy Eating and Positive Mealtimes

Whether you have a picky eater, or are just trying to make mealtimes fun, play is the way to go!

Play with food is critical to development of oral motor skills and sensory regulation needed to support positive meal times. Through the use of creative play, exposure, and over exaggeration these milestones can be achieved.

Although the goal is for your child to eat new foods there are many steps we need to conquer before getting there. Don’t worry, these can be fun and stress free! 

Let me ask you a question. If you were presented with a new food, something so new and anxiety provoking that you don’t want it near you and you definitely don’t want to touch it; do you think you would want it anywhere near your mouth? About in your mouth? Even more, how about swallowing it? The answer for most would be NO WAY! 

Well, we can’t expect the same from our kids. If they don’t want to look at or touch a food, they most definitely will not want to eat it! So before getting kids to put new foods near or in their mouth, we need to take several steps back and learn how to interact with it. This is where the fun can come in! 

This week we are going to experiment with various ways of play or interacting with foods. Remember, the goal in not to eat it. The goal is simply to interact with it and hopefully to start getting messy with it! Let’s kid you child comfortable with touching food and have fun doing it. This will not only get them a few steps closer to eating it, but it will also build positive associations with the food and also make them more comfortable with various aspects of it. This can include the color, texture, shape, smell, etc. The more foods we play with, the more of these they are feeling comfortable with. So in short, let’s start our food journey with our hands and our eyes by getting messy!