Simon Says Commands

Simon Says Commands

If you’ve ever run a therapy session with a fun game of Simon Says, than you know the challenge of coming up with effective Simon Says commands on the spot. The beauty of a good game of Simon Says is that you can target any gross motor, fine motor, sensory motor, and visual motor skill area that you need to, making it the perfect gross motor coordination game that supports a variety of skills.

Simon Says commands

Simon Says Commands

Woohoo, it’s Simon Says for OT! Who doesn’t love a good game of Simon Says? It’s a classic game that builds a variety of skills without kiddos knowing it.

Below, you’ll find a great list of therapist-approved Simon Says game commands and, you can grab a Simon Says commands pdf so you can print off these game ideas and use them in any therapy session, or as a brain break in the classroom or home, too.

Let’s cover all of the Simon Says ideas!

How to play Simon Says in occupational therapy, physical therapy, and speech therapy to develop skills.

How to Play Simon Says

If you’ve never heard of Simon Says or don’t have a clue what it is, it’s a fun game that is easy to implement in any location. 

First, you identify one player for the role of Simon and that player will give the other players commands for actions to perform. (There are many targeted goal areas identified with commands listed later in the post.) 

Second, the game has a trick with it, Simon MUST preface the command by saying, “Simon Says”, or the command is NOT to be followed.

If a player follows that direction and completes the movement when “Simon” doesn’t say “Simon Says”, they are out of the game or can lose one of their tally strokes or chips that is given to each player before play.

If they DO NOT follow one of the stated Simon Says commands, they are out or lose a stroke or chip too. 

Third, the last player standing or the player with the last chip or tally stroke is the winner. 

Simon Says Examples:

  • Simon: “Simon Says hop on one foot.”
  • Other players: Correctly follow the direction and hop on one foot.
  • The players that completed the correct action stay in the game or can stay in the game and do not lose a token or tally chip/tally mark.
  • Simon: “Simon Says hop on one foot.”
  • Other players: Incorrectly do not follow the direction.
  • The players that did not complete the correct action are out of the game or can stay in the game and lose a token or tally chip/tally mark.
  • Simon: “Hop on one foot.”
  • Other players: Incorrectly follow the direction and hop on one foot.
  • The players that completed the incorrect action (Simon didn’t say “Simon Says”!) are out of the game or lose a token or tally chip/tally mark.
  • Simon: “Hop on one foot.”
  • Other players: Correctly do not follow the direction and do not hop on one foot.
  • The players that did not complete the incorrect action (Simon didn’t say “Simon Says”!) stay in the game or do not lose a token or tally chip/tally mark.

Easy, right? Not too fast friends! A child’s (and adults’) attention, impulsivity, and patience can play a role in their ability to listen, act, and wait while playing this game. 

Simon Says is actually a really great game for executive functioning skills, and specifically a game to

Think about each child and what kind of commands you may need to give them to help them play successfully.

Younger students or those working to improve the cognitive skill of following sequences can improve these areas with certain adaptations. Give them simple commands that have few words and one step. Think about saying something like, “Simon Says clap your hands” vs. saying, “Simon Says spin around and then clap your hands”, see the difference? This will help a child focus on one skill at a time and then build from there as they age or become better at following multiple directions. 

If a child struggles with verbal or processing skills, consider the use of a visual choice board, like this one by Panda Speech Therapy, that displays someone speaking coupled with a visual that demonstrates the action that Simon Says to do. This is a great modification to help children that need this type of support to be successful during play or even those who are new to learning how to play the game. 

Think about the OT skills that can be facilitated with this game: 

Target whatever area you need to with children based on their goals and you’ve got a fun time with focus!

Think about the social skills that can be targeted while following and giving multiple skill-driven directions – don’t forget to either simply say the direction or add, “Simon Says” to give kiddos the true direction to DO vs. the fake direction to REMAIN STILL. 

Simon Says ideas for therapy

Simon Says Ideas

The list of Simon Says ideas below are separated by area of development. You’ll find specific movement ideas for:

  1. Visual motor skills
  2. Fine motor skills
  3. Gross motor skills
  4. Sensory motor skills
  5. Social skills
  6. Emotional skills
  7. Oral motor skills

Simon Says Commands to Target Visual Motor Skills

  1. Draw a row of circles
  2. Draw a face
  3. Draw a person
  4. Trade drawing tools with your neighbor
  5. Use different colors and write the letters of your first name
  6. Write the ABCs 
  7. Build a block tower
  8. Build block stairs
  9. Build a block pyramid
  10. Write the numbers 1-10
  11. Toss a ball up to self and catch
  12. Walk a ball on the wall

If you need more visual motor command ideas to help, look at these fun resources:

Rainbow Visual Motor Slide Deck at The OT Toolbox

Flower Visual Motor Slide Deck at The OT Toolbox

Simon Says Commands to Target Fine Motor Skills

  1. Do finger taps to the thumb on both hands
  2. Make the okay sign
  3. Make the telephone sign with each hand
  4. Snap your fingers
  5. Push your fingertips together
  6. Clap your hands
  7. Rotate a pencil from writing to erasing
  8. Do pencil push-ups
  9. Do pencil walk up and down the shaft
  10. Wiggle the fingers on both hands
  11. Do finger pull-ups on both hands
  12. Do victory sign
  13. Make the ‘I love you’ sign

If you need more fine motor command ideas to help, look at these fun resources:

Fine Motor Skills Needed for School at The OT Toolbox

Heavy Work for Little Fingers at Your Kids OT

Simon Says Commands to Target Gross Motor Skills

  1. Do 10 wall push-ups
  2. Do 5 sit-ups
  3. Do 5 planks
  4. Do 8 body bridges
  5. Do 5 lunges
  6. Do 8 squats
  7. Do 6 hand presses
  8. Do 8 cross crawls
  9. Walk like a crab
  10. Walk like a bear
  11. Hop like a kangaroo
  12. Walk like a cat

If you need more gross motor command ideas to help, look at these fun resources:

Sports Gross Motor Slide Deck at The OT Toolbox

Superhero Gross Motor Slide Deck at The OT Toolbox

Simon says Commands to Target Sensory Motor Skills

  1. Stretch to the sky and then to the floor
  2. Wiggle your body all around
  3. Give yourself a hug
  4. March in place
  5. Sway your body left to right
  6. Spin around in a circle
  7. Do 5 deep breaths
  8. Do 5 long blows
  9. Do floor push-ups
  10. Sit and rock back and forth
  11. Army crawl in a line
  12. Walk forward and backward 

If you need more sensory motor command ideas to help, look at these fun resources:

Alerting and Calming Sensory Strategy Cards at The OT Toolbox

Heavy Work Movement Cards at The OT Toolbox

Outdoor Sensory Diet Cards at The OT Toolbox

Deep Breathing Exercise Cards at The OT Toolbox

Simon Says Commands to Target Social Skills

  1. Look to your neighbor and say, “Hello.”
  2. Shake your neighbor’s hand
  3. Say a positive affirmation statement to the group
  4. High-five a friend
  5. High ten your therapist
  6. Look at a neighbor and smile
  7. Look at a neighbor and give a thumbs-up 
  8. Look at a neighbor and introduce yourself
  9. Look at a neighbor and say, “Thank you.” 
  10. Give a compliment
  11. Give an apology
  12. Invite someone to play

If you need more social command ideas to help, look at these fun resources:

Self-Awareness Activities Slide Deck at The OT Toolbox

Simon Says Commands to Target Emotions

  1. Make a smiley face
  2. Make a frowning face
  3. Make a scared face
  4. Make an angry face
  5. Make a surprised face
  6. Make a tired face
  7. Show being shy
  8. Show being worried
  9. Show being embarrassed
  10. Show being sick
  11. Show being proud
  12. Show being scared

If you need more emotional command ideas to help, look at these fun resources:

Emotions Cards at Growing Hands-On Kids 

Simon Says Commands to Target Oral Motor Skills

  1. Stick out your tongue
  2. Open and close your mouth
  3. Wiggle your tongue from side to side
  4. Blow a kiss 
  5. Blow bubbles
  6. Smack your lips together
  7. Touch your nose with your tongue
  8. Massage your jaws with your fingertips
  9. Pull the corners of your mouth into a smile
  10. Scrunch up your lips and nose
  11. Push your tongue into your right cheek
  12. Push your tongue into your left cheek

If you need more oral motor command ideas to help, look at these fun resources:

Oral Motor Exercises at The OT Toolbox 

Themed Oral Motor Activities and Exercises at the OT Toolbox:

Simon Says Ideas for the Alphabet

If you are looking for a combination of Simon Says Commands that address multiple areas, you can find a list of these below from A-Z.  Enjoy!

A – Air write your name

B – Blow pretend bubbles

C – Cross crawls or crunches

D – Deep breaths

E – Excited body movements

F – Fingertip taps to thumb

G – Give a compliment 

H – High 5 someone

I – ‘I love you’ hand sign

J – Join hands or arms with someone

K – kangaroo hops

L – Lick your lips all around

M – Make a sad face

N- Number 8’s in the air 

O – One leg stands each leg

P – Print the alphabet 

Q – quick run in place

R – Roll out a playdough square

S – Stick out your tongue

T – Twirl around

U – Up on toes stretch

V – Valentine’s heart hands

W – Wave to someone

X – XO to give self-hug

Y – Yawn for feeling tired

Z – Zig-zag line in air

Lastly, you can also be creative and think about how you can use Simon Says Commands with commercial board games, like Operation, Perfection, Twister, Whac-A-Mole, Spot It, Avalanche, or Kerplunk. Think about just changing it up by using Simon Says commands or NOT, to direct the child in what they should or should not do.  It’s a new approach to some common board games used in pediatric OT and the kids will love it!

Popsicle stick labels Simon Says Commands
Free printable Simon Says Commands for craft stick labels.

Free Alphabet Simon Says Popsicle Stick Labels

I am so excited to share this newest resource. All you need is a printable page with the popsicle stick Simon Says commands and craft sticks. We used the larger-size popsicle sticks to make the popsicle stick commands.

Kids can pull a craft stick out of a cup and use the command to create actions based on movements for each letter of the Alphabet. This set goes with our Alphabet Exercises blog post where each letter of the alphabet has a corresponding exercise or motor action.

Want a copy of these popsicle stick exercise labels? Enter your email address into the form below. OT Toolbox members can also find this printable inside the Member’s Club (along with the full list of Simon Says cards listed above in printable card form AND in popsicle stick label format).

Free Simon Says Popsicle Stick Labels

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    Regina Allen

    Regina Parsons-Allen is a school-based certified occupational therapy assistant. She has a pediatrics practice area of emphasis from the NBCOT. She graduated from the OTA program at Caldwell Community College and Technical Institute in Hudson, North Carolina with an A.A.S degree in occupational therapy assistant. She has been practicing occupational therapy in the same school district for 20 years. She loves her children, husband, OT, working with children and teaching Sunday school. She is passionate about engaging, empowering, and enabling children to reach their maximum potential in ALL of their occupations as well assuring them that God loves them!

    What is Motor Planning

    motor planning

    You may have heard the term motor planning but wondered what this means and what does it look like to utilize motor planning skills in everyday activities. Here, we are breaking down this important motor skills topic. Occupational therapists are skilled at analyzing movements and underlying skills needed to perform the things we do each day, or the tasks that occupy our time, and establishing an efficient and coordinated motor plan is one of the main aspects of this assessment. 

    Motor planning

    Motor Planning

    When we perform an action, there are movements of our bones, joints, and muscles that enable our bodies to move. It’s through this movement that the body and brain receives feedback, or a motor concept that tells the brain and body that we have moved in a certain way in order to accomplish a specific action. This is the motor plan for that particular task at work!

    Let’s look at a child’s motor skills in a specific action to really explore this concept. 

    Ok, so you’re walking along a hallway with an armful of bags and see a ball in your path. You walk around it and continue walking. But, hold on. That was a pretty cool ball. It was all red and shiny. It looked like a really fun ball to bounce. You stop, turn around, walk back to the ball, stoop down, put down your bags, and pick it up. Woah. It’s not only red and shiny, but it’s a little heavy too. 

    It takes a bit more muscle oomph than you were expecting. You hold your arm up high, with the ball up over your head. Totally not a baseball player’s pose, but all awkward and kid-like. You know. Pure fun throwing. 

    You toss that red, shiny, heavy ball as hard as you can towards a big old blank wall on one of the hallway walls. Now watch out! That red, shiny, heavy ball is bouncing around like crazy! 

    It’s bouncing off of the wall and right back at you! You jump to the side and then to the left and right as it bounces back and forth between the walls of that hallway. You have to skip to the side to avoid your bags. 

    The ball stops bouncing and rolls to the side of the hall. 

    Well, that was fun. You pick up the ball and hold it while you gather your bags. Now, you see a boy coming down the hall who sees that red, shiny, heavy ball in your hand and says, “Hey! There’s my ball!” You smile and toss the ball as he reaches out his hand and catches. “Thanks!!” he says as you wave and start walking down the hall again.

    What is Motor Planning? Tips and Tools in this post with a fun fine motor motor planning (dyspraxia) activity for kids and adults from an Occupational Therapist

    What is Motor Planning?

    Motor Planning happens with everything we do! From walking around objects in our path, to picking up items, to aiming and throwing, drawing, writing, getting dressed, and even dodging red bouncy balls…

    Motor Planning is defined as the problem solving and moving over, under, and around requires fine motor and gross motor skills and planning to plan out, organize, and carry out an action. We must organize incoming information, including sensory input, and integrate that information into our plan. We need to determine if a ball is heavy or light to pick up and hold it without dropping it.

    You might hear of motor planning referred to as praxis. 

    Praxis (generally also known as Motor Planning, but also it’s more than simply motor planning…) requires observing and understanding the task (ideation), planning out an action in response to the task (organization), and the act of carrying out the task (execution). A difficulty with any of these areas will lead to dyspraxia in many skill areas. 

    Praxis includes motor planning, but also involved is ideation, execution, and feedback, with adjustment to that feedback. You can see the similarities in motor planning, which refers to the conscious and subconscious (ingrained) motor actions or plans.

    Motor Planning is needed for everyday tasks. Think about the everyday activities that you complete day in and day out. Each of these actions requires a movement, or a series of movements to complete. There are both gross motor movements, fine motor movements, and posture all working together in a coordinated manner.

    There is a motor plan for actions such as:

    • using a toothbrush to brush one’s teeth
    • brushing hair
    • getting dressed
    • putting on a backpack
    • walking down a hallway
    • walking up steps
    • walking down steps
    • holding a pencil
    • writing with a pencil (motor planning and handwriting is discussed here.)
    • riding a bike
    • maintaining posture
    • putting on a coat or jacket (on top of other clothing such as a shirt so that in this case, there isn’t the tactile feedback available of the fabric directly on the skin’s surface)
    • performing sports actions such as swinging a baseball bat or tennis racket, running, or gymnastics like doing a cartwheel

    The interesting thing is that a movement plan, or the physical action that is completed whether the action has been performed in the past or if it is a new movement. A motor plan for a new task can be completed without thinking through how to move the body because it is just inherently completed.

    When we complete unfamiliar tasks and need to stop and think through how the body needs to move, is when we see inefficient movement, or motor planning issues.

    Motor Planning Difficulties

    Above, we talked about praxis as another term or way to name the motor plan concept. When there are difficulties with motor planning, we are referring to the opposite of praxis, or dyspraxia. 

     Dyspraxia can be a result of poor sensory integration, visual difficulties, fine motor and gross motor coordination and ability, neural processing, and many other areas.

    Motor planning difficulties can look like several things:

    • Difficult ability to complete physical tasks
    • Small steps
    • Slow speed
    • Pausing to think through actions
    • Clumsiness
    • Poor coordination
    • Weakness

    These challenges with motor function can exist with either new motor tasks or familiar actions. Deficits are apparent when speed is reduced so that the functional task isn’t efficient, when the motor task is unsafe, or poor completion of the task at hand.

    There are diagnoses that have poor motor planning as a component of the diagnosis. Some of these disorders can include:

    When motor planning difficulties exist, this can be a cause for other considerations related to movements, and demonstration of difficulties when participating in movement-based activities:

    • challenges in social interactions
    • anxiety
    • behaviors
    • social skills issues

    Today, I’ve got a quick and easy fine motor activity to work on motor planning with kids. This activity is part of our 31 Days of Occupational Therapy series where we’re sharing fun and frugal ideas for treatment of many OT skill areas with items you might already have in your house.

    motor planning activity

    Motor Planning Activity

    Affiliate links are included in this post. 

    Motor planning activity

    To make this motor planning activity, you’ll need just a few items: 

    • a clear plastic baggie
    • white crafting pom poms
    • one red pom pom. These are items we had in our crafting supplies, but you could modify this activity to use items you have. Other ideas might be beads, pin pong balls, ice cubes, or any small item.
    1. Fill the baggie with the pom poms and squeeze out the air. 
    2. Seal the baggie.
    3. Use a permanent marker to draw on a maze from one side of the baggie to the other. You can make this as complex as you like. 
    4. Add additional mazes, or two different pom pom colors for the maze. Work the red pom pom from one end of the maze to the other.
    Apraxia activity

    Squeezing the pom pom is a fine motor work out for the hands. You’ll need to open up the thumb web space (the part of your hand between the thumb and fingers, and use those intrinsic small muscles of the hand. Both of these areas are important for fine motor tasks like coloring and writing.

    Use this motor planning exercise as a warm-up activity before writing, coloring, and scissor activities. This is a great activity to have on hand in your therapy treatment bag or to pull out while waiting at the doctor’s office.

    Motor planning toys and games

    Motor Planning Activities

    Looking for more ways to work on dyspraxia with your kids? These are some fun fine and gross motor activities that are fun and creative. 

    The best thing about all of them is that they are open-ended. Use them in obstacle courses or in movement tasks to incorporate many skill areas. These are some fun ideas to save for gift ideas. Now which to get first…

    Work on fine motor dexterity and bilateral coordination while encouraging motor planning as the child matches colors of the nuts and bolts in this Jumbo Nuts and Bolts Set with Backpack set. The large size is perfect for preschoolers or children with a weak hand grasp.

    Practice motor planning and eye-hand coordination. This Button Mosaic Transperent Pegboard is a powerhouse of motor planning play. Kids can copy and match big and bright cards to the pegs in this large pegboard. I love that the toy is propped up on an incline plane, allowing for an extended wrist and a tripod grasp. Matching the colors and placing the pegs into the appropriate holes of the pegboard allow for motor planning practice.

    Develop refined precision of fine motor skills with eye-hand coordination. A big and bright puzzle like this Puzzle-shaped Block Set  allows kids to work on hand-eye coordination and motor planning as they scan for pieces, match the appropriate parts of the puzzle pieces, and attempt to work the pieces into place. Building a puzzle such as this one can be a workout for kids with hand and upper extremity weakness.

    Strengthen small motor skills. Kids of all ages can work on motor planning and fine motor skills with this Grimm’s Rainbow Bowls Shape & Color Sorting Activity. Use the colored fish to place into the matching cups, as children work on eye-hand coordination. Using the tongs requires a greater level of motor planning.

    You can modify this activity by placing the cups around a room for a gross motor visual scanning and motor planning activity. Children can then follow multi-level instructions as they climb over, around, under, and through obstacles to return the fish to their matching bowls.

    Encourage more gross motor planning with hopping, jumping, and skipping, or other gross motor tasks. This Crocodile Hop A Floor Mat Game does just that. It is a great way to encourage whole body motor planning and multiple-step direction following.

    Address balance and coordination. These Gonge Riverstones Gross Motor Course challenge balance skills as children step from stone to stone. These would make a great part of many imagination play activities as children plan out motor sequences to step, cross, hop, and jump…without even realizing they are working on motor planning tasks.

    Introduce multiple-step direction following and motor planning. These colored footprints like these Gonge Feet Markers support direction following skills. Plan out a combination of fine and gross motor obstacle courses for kids to work on motor planning skills.

    Make hand-eye coordination fun with challenges. For more fine motor coordination and motor planning, kids will love this Chickyboom Balance Game as they practice fine motor skills, hand-eye coordination, and about balance and mathematics.

    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

    Bone Names Activity for Kids

    bone identification activity

    As occupational therapy students, we had to learn bone names and all about anatomy and physiology. Naming bones comes in very handy as an occupational therapist! But, if you are working in pediatrics, kids need to learn names of bones, too! For one thing, kids learn bone names in school. But did you consider the interoception aspect to teaching bone names? When it comes to internal feelings or anatomical states that impact sensory processing and internal body actions, learning names of bones supports this awareness of self. Add this fun way to learn names of bones to your anatomy and physiology games!

    Use labels to teach bone names with a fun way to learn the names of bones.

    Bone Names Activity

    Learning human anatomy has a special place in my heart. I mean, those semesters in Human Anatomy, Anatomy lab, and clinical kinesiology bring back fond memories.  

    So, when my kids ask questions like how their arm can pick up a sandwich, I have a little fun telling them about bones, joints, and muscles. This bone naming activity is just one fun way to teach bone names and teach kids about anatomy.

    (Moving a sandwich is a big deal in our house!)

    We’ve done a body part identification activity before, using band-aides, but these labels were a big hit with my kids.  We used them to practice for a test for my big kids.  

    My Kindergartner and Second grader had a bones theme in their gym class, we had fun talking about the bones in our body, and made this Bone Identification and movement activity. (It would be great as a skeleton activities for preschoolers, too.

    Bones Activity

    This bone activity for kids is one they won’t forget…and when teaching human anatomy to kids, it’s one that will stick! The fun stickers help! 🙂

    This post contains affiliate links.

    I threw this activity together really quickly.  We had a few sheets of blank address labels, and I grabbed a red permanent marker (affiliate link).  I made a quick strip across the top and bottom of the address labels and then wrote in black marker (affiliate link), “Hello my name is” with the bone names below.  

    If your kids are like mine, they get a kick out of those Hello My Name Is Stickers.  You could use store bought stickers, or just make your own like we did.  (Amazon affiliate links)

    bone identification

    While we used this bone identification activity with kids, it would be a great way to learn bones as part of an anatomy and physiology lesson for OT or PT students, too!

    This bones anatomy movement and learning activity is perfect for kids or anyone learning human anatomy and bones or musculature. Add this to a health or gym curriculum to learn body parts with kids.

    list of bones in human body

    After I wrote out the names of the bones, I tested my kids on what they knew. They recalled most of the bones from gym class lessons, but we had a few that needed practicing.  

    For the second grade and kindergarten physical education curriculum, they had to know this list of bones in the human body

    • skull
    • humerus
    • radius
    • ulna
    • carpals
    • phalanges
    • clavicle
    • sternum
    • ribs
    • pelvis
    • femur
    • tibia
    • fibula
    • tarsals

    Complete List of Bone Names

    Above is just a simplified list of bone names, which can be used for teaching kids about the skeletal system. A more complete list is as follows. The bone identification activity shown below can definitely be used for this complete list of bone names and bone types. Classifying and naming the entire skeletal system requires much practice, and as occupational therapists we know the power of multi-sensory learning!

    Bones in the skull (includes bones in the head and face):

    • Cranial bones:
      • frontal bones
      • Parietal bone
      • temporal bones
      • occipital bone
      • sphenoid bone
      • ethmoid bone
    • Facial bones:
      • mandible
      • maxilla
      • palatine bone
      • zygomatic bone
      • nasal bone
      • lacrimal bone
      • vomer bone
      • inferior nasal conchae

    Bones in the thorax:

    • sternum
    • ribs

    Bones in the throat:

    • hyoid bone

    Bones in the vertebral column, or spine:

    • cervical vertebrae
    • thoracic vertebrae
    • lumbar vertebrae

    Bones in the pelvis:

    • coccyx
    • sacrum
    • ossa coxae (hip bones)

    Bones in the legs :

    • femur
    • patella
    • tibia
    • fibula

    Bones in the feet:

    • Ankle (tarsal) bones:
      • calcaneus (heel bone)
      • talus 
      • navicular bone
      • medial cuneiform bone 
      • intermediate cuneiform bone 
      • lateral cuneiform bone
      • cuboid bone 
    • Instep bones:
      • metatarsal bone
    • Toe bones:
      • proximal phalanges
      • intermediate phalanges 
      • distal phalanges 

    Bones in the middle ears:

    • malleus
    • incus
    • stapes

    Bones in the shoulder girdle:

    • scapula or shoulder blade
    • clavicle or collarbone

    Bones in the arms:

    • humerus
    • radius
    • ulna

    Bones in the hands:

    • Wrist (carpal) bones:
      • scaphoid bone
      • lunate bone
      • triquetral bone
      • pisiform bone
      • trapezium
      • trapezoid bone 
      • capitate bone
      • hamate bone 
    • Palm or metacarpal bones:
      • metacarpal bones
    • Finger bones or phalanges:
      • proximal phalanges
      • intermediate phalanges
      • distal phalanges

    Teach kids the names of bones with a bone identification activity.

    We had a blast sticking the labels all over ourselves while saying “Hello my name is humerus!” in funny voices.  

    While we had the labels on our body parts, we practiced the motions of that bone.  We talked about how that bone could move and what it could do.  

    Yes, your humerus has a job in picking up a sandwich! (This is a very important fact when teaching bone names to preschoolers!)

    Learn bone names by using this Bone identification activity and sticking bone name stickers onto a doll.
    Bone identification activity with a doll.

    Even the baby doll got in on the bone labeling action.

    Use stickers to learn bone names

    How cute are those tarsals??

    This bones anatomy movement and learning activity is perfect for kids or anyone learning human anatomy and bones or musculature. Add this to a health or gym curriculum to learn body parts with kids.

    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

    Bedtime Relaxation Stretches for Kids

    Relaxation stretches for bedtime

    In this post, you will find calming bedtime relaxation stretches for kids and families, based on the popular children’s book, Time for Bed. These activities are perfect for helping kids calm down before bed. We know the power of sleep hygiene in child development, but let’s consider the powerful impact of stretches before bed have on children.

    Relaxation Stretches for Kids Sleep

    An important thing to cover when it comes to helping children fall asleep and stay asleep at night is the concept of pre-bedtime yoga. When kids participate in bedtime stretches as part of their bedtime routine, it’s a sensory diet that supports sleep.

    relaxation stretches for bed time
    Use animal theme yoga poses to support relaxation at bedtime.

    One thing that we’ll cover here is the impact that the interoception sensory system has on sleep.

    Related is our resource on the role occupational therapy professionals can play in sleep for the whole family, when it comes to supporting a baby or newborn not sleeping.

    Relaxation Stretches for Kids Sleep

    An important thing to cover when it comes to helping children fall asleep and stay asleep at night is the concept of pre-bedtime yoga. When kids participate in bedtime stretches as part of their bedtime routine, it’s a sensory diet that supports sleep.

    I love to bring this concept together for kids by first talking about how everyone needs sleep. Kids, adults, and even pets and animals. Sleep supports growth, learning, and allows our brains to rest. You can even use a few of our hibernation activities to take this concept further with kids, depending on the interest level.

    Use these relaxation stretches for bedtime to incorporate calming sensory input.

    One thing that we’ll cover here is the impact of the interoception sensory system has on sleep.

    Children can get a little wound up before bed.  All it takes is one rouge energy burst and you’ve got giggling kids bouncing from every surface imaginable.  

    Couch cushions? check. They are jumping up and down.  

    Running from room to room? Check. There’s two of them chasing one another back and forth will the occasional knee slide across the hardwoods.  

    Practicing the living room tumbling skills? Yep and check. There’s one more doing somersaults across the room.

    Why must they gang up on me with their endless energy during those exhausting pre-bedtime hours?

    Having a set of bedtime relaxation stretches in the nightly routine can support sensory needs and promote a sense of calm before bedtime, just when children are wound up and excitable.

    benefits of stretching before bed

    We know that sleep is a necessary occupation for all of us, but for children sleep patterns and healthy sleep cycles support so many aspects of development.

    • Cognition
    • Learning
    • Behavior
    • Nutrition
    • Emotional development
    • Social development

    When children don’t get enough hours of sleep, or if they don’t get quality sleep on a consistent basis, there are several things that can occur:

    • Poor focus
    • Trouble concentrating
    • Attention and behavior problems
    • Poor academic performance in school
    • Excess weight or increased food intake
    • Problems paying attention
    • Health problems: obesity, type 2 diabetes, poor mental health, and injuries
    • Decreased physical activity
    • Poor mental health
    • Unhealthy risky behaviors related to decision-making
    • Risk-taking behaviors, bullying, school violence-related behaviors, and physical fighting
    • Higher risk of unintentional injury

    There are several studies describing the benefits of stretching before bed. Kids can benefit from a pre-bedtime stretching sessions to integrate sensory processing systems and the calming benefits of slow movement, heavy work as a regulation tool. This calms the body and helps with relaxation before bed.

    Stretching before bed supports sleep quality. One review of multiple studies found that mindfulness meditation practices that incorporate gentle stretching, such as yoga and tai chi, generally improve sleep quality.

    Another study found that older adults reported improved sleep quality after performing low level physical and cognitive activity. The researchers found that gentle stretching resulted in better sleep than when the participants performed more strenuous exercises, such as aerobics.

    Bedtime stretches help kids stay asleep. A study into resistance exercise training and stretching found that exercises could improve symptoms of insomnia. In the study, the participants performed stretching in 60-minute sessions three times per week for a period of 4 months. The results showed improved sleep quality when stretching in the evening.

    Better sleep supports learning and executive functioning skills. Other studies tell us that better sleep hygiene in children support development of executive functioning skills.

    yoga poses for stress relief

    Today, I’m sharing a great way to calm kids down before bed so that quality sleep is possible. These yoga poses for stress relief and bedtime relaxation promote organizing heavy work through the proprioceptive sensory system and gentle movement through the vestibular sensory system.

    Another contributing factor is the interoceptive system which connects our internal systems such as digestion, heart rate, circadian rhythms, and muscle tension. All of these factors play a vital role in impacting sleep, with both the ability to fall asleep, and the ability to stay asleep throughout the night. This study shares more on the interoceptive system’s role in sleep.

    These organizing and calming yoga poses stretch the muscles and joints to offer feedback to regulate an overactive system.

    If you’ve ever participated in a yoga session, you know the benefits of certain yoga poses in reducing stress and anxiety.

    It’s important to make the connection between stress responses, anxiety, over-active thoughts, and a hyper-response to stimulation and emotional responses. The difficulty in identifying and describing emotions in self (a huge part of social emotional learning and development) is referred to as Alexithymia.

    This ability develop social emotional skills occurs with age, and social skills interventions.

    Specifically, alexithymia is defined as difficulty identifying and describing emotions in self. We know that noticing and understanding internal body signals (aka interoception) is crucial to a bodily systems, so it makes sense that if interoception is affected, using or showing emotions, and identifying emotions in self will be affected.

    Interoception influences emotions by it’s control and underlying influence on internal processes of the body: toileting, hunger, thirst, and sleep!

    When interoception impacts sleep, it then further impacts emotions:

    • stress
    • getting angry or frustrated easily
    • anxiety
    • fear
    • worry
    • overly emotional responses
    • sadness
    • over-excitability
    • hyperactive responses

    All of these emotional responses are normal and good feelings to experience. However, when sleep is reduced, they can move into an area of impacting other functional tasks or everyday occupations.

    You’ll also find information and resources in this article on the limbic system including the stress response. You can see how all of these concepts fit together to impact daily functioning.

    How to use yoga poses for stress relief with children

    Using yoga to support relaxation at bedtime is not a new concept. Yoga naturally supports relaxation through the heavy work input of the proprioceptive sense.

    However, yoga also adds the benefit of deep breathing exercises to calm and center the body as an organization tool.

    When it comes to bedtime, adding anything to the nightly routine can mean a delayed bedtime, so making the relaxation stretches part of the routine that is already in place is important. If you read a book together each night, incorporate stretches into that. If brushing teeth and going to the bathroom are the only tasks that happen each night, use the time just after those jobs to do a few stretches.

    Adding bedtime stretches for the purpose of relaxation doesn’t need to be difficult. The most important thing here is to make it work for your situation and home. down the somersaults and hardwood floor stunts into relaxing bedtime.  

    Here are some tips to support relaxation at bedtime:

    • Use bedtime relaxation stretches in a nightly routine. A visual schedule can be helpful with some kids.
    • Dim the lights and turn on soothing music
    • Read a book before bed
    • Drink a warm drink as a calming food/sensory tool.
    • Set the mood for sleep with a calming bedroom or sleep space: snuggly blankets, cozy pillows, or cool temperature, depending on the individual’s preferences.
    • Use the relaxation stretches listed below.

    One way that helps to get kids relaxed before bed is reading a great book.  When kids can listen to an engaging story that is read aloud, their bodies can’t help but slow down.  

    Bedtime Relaxation Stretches for Kids

    These bedtime relaxation stretches are a combination of relaxing yoga moves and heavy work that helps to ground the body through proprioceptive input to the body’s sensory receptors in the muscles. 

    Performing these relaxing stretches can help transition kids to a calmed state that allows for a better sleep.

    Below are forms of yoga poses for children.

    We decided to use one of our favorite going to bed books, (Amazon affiliate link) Mem Fox’s Time for Bed

    In the book, we hear a rhyming verse about each animal’s transition to sleep.  It’s such a beautiful book to snuggle up with kids during night time routines.  In fact, Time for Bed can easily become one of those books that you read over and over again.

    We loved looking at the watercolor pictures in Time for Bed and picturing each animal as it got ready for sleep.  

    To go along with the book, we tried some of these bedtime relaxation stretches. 

    Grab your copy of the free printable below by entering your email address into the form, or going to The OT Toolbox Member’s Club and heading to the Mindfulness Toolbox.

    Time for Bed book by Mem Fox and relaxation stretches for bedtime

    To do these exercises, simply cut out the printable on the lines, and create a small stack of stretches.  Kids can do one or more of these relaxation stretches to calm down before settling in with the Time for Bed book. (affiliate link)

    Simply pull out a couple of the stretches and join your child on the floor to perform each stretch.  The stretches are designed based on the animals in the book.  

    When doing the stretches, hold the stretch for 2-3 minutes while maintaining deep breathing. 

    Bedtime relaxation stretches
    Print off these relaxation stretches for a bedtime calm down session for kids.

    As we all know, kids will be kids.  If your child is getting too wound up from the stretches (because sometimes the sleepy sillies take over and make concentrating on stretches and relaxing deep breaths nearly impossible!) simply put the stretches away and try them another day.

    Bedtime stretches with an animal theme
    Relaxation stretch for kids, incorporating yoga poses for stress, anxiety, or to calm down before bed.

    Your child will love doing these bedtime relaxation stretches with you and the whole family!

    Bedtime stretches to do before bed

    Little Goose Stretch– Lie on the floor on your back, with your feet raised up on the wall.  Keep your knees straight.  Spread your arms out on the floor like a goose.  Bend and point your toes slowly.

    Little Cat Stretch– Snuggle in tight!  Sit criss cross applesauce on the floor.  Bend forward at the hips and place your head on the ground.  Stretch your arms out on the floor over your head.

    Little Calf Stretch– Grasp both hands together behind your back.  Bend forward at the hips and raise your arms up behind you.

    Little Foal Stretch– Lie on your back and pull your knees in with your arms.  Hold the position and whisper about your day.

    Little Fish Stretch–  Take a deep breath. Hold your breath in your cheeks and puff out those cheeks.  Slowly let out your breath with pursed lips.

    Little Sheep Stretch–  Stand facing a wall and place your feet shoulder width apart.  Place your hands flat on the wall, shoulder width apart.  Push against the wall by bending and straightening your elbows.

    Little Bird Stretch–  Close your eyes.  Think about your day and take deep breaths.  Breathe in through your nose and out through your mouth.  Add a “wing” component by raising your arms up high as you breathe in and lowering them as you slowly breathe out.

    Little Snake Stretch–  Lie on your back on the floor.  Keep your legs straight and cross them at the ankles.  Place your arms over your head on the floor.  Cross them at the wrists.  

    Little Pup Stretch–  Get into a downward dog yoga position.  

    Little Deer Stretch– Sit on the floor with your legs straight. Spread them far apart and bend at the hips to touch one foot.  Hold it and then stretch to touch the other foot.

    Try this tonight!  Do a few stretches and then snuggle up while reading Time for Bed! (affiliate link)

    Calming bedtime books for kids

    MORE relaxing bedtime books for kids

    These relaxing bedtime books for kids are other ideas to use to support calming sensory input in a relaxation bedtime routine:

    Amazon affiliate links are included below:

    Free Printable set of relaxation stretches for bedtime

    Use the Time For Bed book and relaxation stretches we used above in a bedtime routine of your own. Get a printable PDF of these stretches by entering your email address into the form below. Or, members in The OT Toolbox membership club can grab this PDF by logging in and heading to Brain Break Tools.

    Free Time For Bed Relaxation Stretches

      We respect your privacy. Unsubscribe at anytime.

      One more thing! If you are into creative ways to extend and learn based on books, you will LOVE this resource! 50 activities based on books that address friendship, acceptance, emotions…This ebook is amazing for covering all things emotional development through play!

      Get yours!  

      Read more about the book here.

      Exploring Books through Play helps kids develop fine motor skills and gross motor skills while learning about empathy and compassion.

      Bilateral Integration

      bilateral integration

      Bilateral Integration is an area that kids need for so many tasks…but it’s not a developmental milestone that stands out unless a problem is necessarily noticed unless there is a problem. What we do notice in as our kids grow and develop are the motor skills that impact functioning. We notice use of both hands, fluid and efficient movements in tasks like playing, getting dressed, and interacting with peers. Let’s take a look at bilateral integration and dissect how to support this essential sensory motor skill.

      Another resource that supports this information is our blog post on bilateral coordination. You’ll find many bilateral integration activities in that blog post.

      Bilateral integration resources and information

      Bilateral Integration

      From writing and holding the paper, to holding a art project and cutting with scissors, to zippering a jacket, coordinating both sides of the body in an efficient manner is a skill that is necessary for almost everything we do.

      Bilateral coordination develops from a very young age. When babies begin to bring both hands together at their mouth, you are seeing coordinated efforts begin. When the infant pushes up on both arms while lying in a tummy time position, the integrated movements of both hands and legs occurs along with strength and control.

      Research tells us that motor tasks like jumping, jumping jacks, riding a bike, hopping, etc. become easier and more fluid with age as children develop. It’s through play, sensory input, motor skill experience, and activities that these skills are developed.

      Below, you will find bilateral integration activities that can be incorporated at various ages. Use these bilateral coordination activities to promote coordinated and efficient movements in meaningful activities.

      What is Bilateral integration?

      Bilateral integration refers to the ability of both sides of the brain to work together in a coordinated manner. We see this ability when the skills associated with the left side of the brain are done in conjunction with skills associated with the right side of the brain.

      Skills associated with the left side of the brain:

      • Speech and language- Understanding using language (listening, reading, speaking and writing)
      • Comprehension
      • Math problems and facts
      • Handwriting
      • Linear thinking
      • Memory for spoken and written messages
      • Logic
      • Verbal language
      • Sequencing

      Skills associated with the right side of the brain:

      • Creativity and imagination
      • Creative thinking
      • Spatial skills
      • Intuition
      • Art, drawing, and creative artistic skills
      • Musical skills

      Then, when other aspects of functional performance are added to the mix and the individual is still able to complete the task, this is bilateral integration in action.

      Those other considerations include:

      • Attention and focus
      • Proprioceptive input
      • Vestibular input
      • Visual information
      • Motor targets achieved, or motor control shown by fluid movements
      • Praxis- movements thought about and completed in coordinated manner

      When both sides of the body work together in a coordinated manner so that the individual can manipulate objects such as cutlery with various amounts of force modulation, taking in sensory stimuli such as sights, sounds, tastes, and proprioceptive and vestibular input, and managing posture, coordination, and body awareness, bilateral integration is visible.

      When bilateral coordination or bilateral integration is intact and progressing appropriately through development, it is an indicator that both sides of the brain are communicating effectively and sharing information during functional tasks. 

      Tasks that require bilateral integration

      Knowing what we covered above, it is easy to see how some daily tasks are impacted by coordinated and integrated motor skills requiring both sides of the body. Each of these skills requires and has input from other sensory systems and cognitive systems as well, such as proprioceptive input, executive functioning, attention, and even creative thinking and problem solving.

      • Writing and holding the paper in a stable position
      • Cutting and holding the paper steady and at an appropriate height
      • Putting on a coat while holding a backpack (or other item)
      • Tying shoes
      • Pulling up pants and not losing balance
      • Putting socks on
      • Jumping jacks with coordinated movements
      • Turning a page and writing or copying work
      • Typing
      • Squeezing toothpaste and brushing teeth
      • Flossing teeth
      • Playing an instrument
      • Using a knife and fork
      • Pouring water from a pitcher into a cup
      • Cooking skills: chopping, cutting, slicing, peeling, taking food out of packages, putting food into the microwave or stove, taking food out of the fridge
      • Reaching for objects
      • Stabilizing an object with one hand while manipulating another object with the other
      • Jumping rope
      • Catching a ball
      • Riding a bike
      • Swimming
      • Many more tasks!
      These bilateral integration activities are creative ways to help kids with bilateral integration needed for fine motor tasks like handwriting, scissor use, and other functional skills.

      Bilateral Integration Activities 

      Amazon affiliate links are included in this post.

      First, let’s talk about some ways that coordinated use of the arms and legs are needed for coordinated movements. These are skills and tasks that can easily be performed by some children. Others, who struggle with motor planning, core strength, posture needs, left-right discrimination, visual motor skills, or many other areas can struggle. It’s easy to see that simply addressing some areas won’t fix the issue when an underlying concern is present.

      To promote the skills needed for these tasks, try some of the activities listed below to promote bilateral integration:

      Related Read: Here are are some additional bilateral coordination activities with a winter theme.

      Bilateral Integration Activities for Babies

      Bilateral movements are part of everyday life for baby! From turning, creeping on the floor, rolling, sitting, crawling, cruising on furniture, and taking first steps, babies are developing bilateral integration skills from birth.

      Read here about the types of crawling, all of which integrate bilateral coordination and motor planning.

      Encourage these bilateral integration activities with babies:

      There are ways to support child development at this stage through age-appropriate play that will support the child’s progression at later stages, too.

      • Provide various toys and objects appropriate for young babies. Include bold colored objects including black, white, and red items or contrasting colors, toys, or pictures on a blanket or play mat during tummy time. This black and white board book (affiliate link) can be propped up or used while on an adult’s lap.
      • Provide gentle infant massage during and after bath time, and on all extremities. Here is a resource book on infant massage. (affiliate link)
      • Provide toys and age-appropriate objects for reach and grasp. This banana toothbrush teether (affiliate link) has molded handles that make it a great teething item for little ones.
      • Provide teething toys as baby brings hands together at their mouth.
      • Provide toys that are appropriate for mouthing that can be held in both hands.
      • Provide hand-held toys while the child is seated in a high chair. This one (affiliate link) has a suction cup base to keep it stable, but has a black and white ring at the base that babies can grasp with one hand while manipulating with the other hand.
      • Provide toys of various weights when seated upright to provide resistance against gravity and to promote strengthening of the upper extremities. Blocks, rings, sorting toys, or something like this quality teething toy (affiliate link) made of heavier materials can be useful to provide variances in weight, while still allowing the baby to manipulate the item.
      • Provide toys available on a high chair or table surface at various distances to provide opportunities for depth of perception when reaching for toys and bringing them to the mouth.
      • Continue tummy time while playing in prone to promote strength and stability in upper extremities.
      • Use the ideas in our baby play library for more ideas.

      Bilateral Integration Activities for Toddlers

      Provide toys requiring one hand to stabilize a base while the other hands manipulates an object. Shape sorters are great for this.

      Other toys include:

      • Peg Boards (affiliate link)
      • Blocks- These press and stay sensory blocks are perfect for encouraging one hand to use as a stabilizer and one hand as a
      • Play Dough
      • Drawing/coloring- Here is more information on the benefits of coloring.
      • Use these crayons for toddlers to support bilateral coordination skills during coloring.

      Bilateral Integration Activities for Preschool

      Preschool is a time for building hand strength, coordination, eye-hand coordination, and improving motor skills needed for the upcoming years. You can find many preschool activities here on our website, but some specific ways to support bilateral integration include:

      • Encourage kids to participate in cooking activities.
      • Use play dough to cut with scissors and roll out play dough snakes or balls of play dough.
      • Age-appropriate crafts and craft sets are great for this age.
      • Play with stickers of various sizes.
      • Make “snow angels” on a carpet or fluffy blanket
      • Simon Says is a great game for encouraging novel and varied motor combinations. Use these Simon Says Commands to get started.
      • Play various song and movement games such as the Hokey Pokey, Farmer in the Dell, etc. Here are movement and song activities that can be used in circle time, warm-ups, centers, or in group activities. All of these move and dance songs promote core strength and stability.
      • Climb on outdoor play areas at playgrounds and in low trees.
      • Add sensory! Try this table top bilateral coordination activity to draw shapes.
      • Draw with both hands! This four leaf clover activity is a powerful one as it covers a variety of skills.

      Bilateral Coordination Activities for School-Aged Kids

      In schools, development of bilateral integration is important for tasks like putting on a coat or jacket and backpack, holding a paper with the supporting hand and writing, and using scissors. There are many other bilateral integration tasks that happen throughout the day.

      Some ways you can support development of these skills include:

      Try these bilateral integration activities and coordination ideas to promote use of both hands together in activities such as handwriting, cutting with scissors and so many other tasks!

      Last thoughts on encouraging bilateral integration

      The best way to encourage and promote integration of both sides of the body? Movement and play! Get the kids active, moving, and experiencing various planes against resistance and with exposure to all types of sensory experiences.

      The combination of proprioceptive input into a play experience that promotes strengthening in a fun way provides all of the benefits kids need to improve bilateral coordination skills. Add personal interests as the child grows. And finally, have fun!

      Use these bilateral coordination activities to promote bilateral integration needed for skills like writing and holding the paper and any activity that uses one hand to manipulate an object while stabilizing with the other hand.

      Matching Uppercase and LowerCase Letters

      uppercase and lowercase letter matching

      This interactive and hands on game to teach matching uppercase and lowercase letters is a fun gross motor game for preschool and kindergarten. Use this interactive letter activity along as an alphabet matching with objects and a sensory-motor learning activity!

      Matching uppercase letters to lowercase letters is a literacy task that supports reading skills, but also challenges visual discrimination skills, form constancy, and visual scanning, all of which are visual processing skills needed for handwriting and reading comprehension. What’s fun about this activity is that it builds these skills in a fun way!

      Be sure to grab our color by letter worksheet to work on letter matching, visual discrimination skills.

      Uppercase and lowercase letter match activity

      Matching Uppercase and Lowercase Letters

      Learning letters and matching upper and lower case letters is a Kindergarten skill that can be tricky for some kids.  We made this easy prep letter identification activity using items you probably already have in the house.  If you’ve seen our blog posts over the last few days, you’ve noticed we’re on a learning theme using free (or mostly free) items you probably already have.  

      We’re sharing 31 days of learning at home with free materials this month along with 25 other bloggers in the 31 days of homeschooling tips series.  

      Today’s easy letter learning activity can use any letters you have around the house or magnetic letters and coffee filters.

      Matching upper and lower case letters and alphabet letter identification can be difficult for kindergarteners.  Use this letter matching game to prepare for kindergarten skills and gross motor play along with visual scanning. Uses magnetic letters and coffee filters for easy prep and set-up.  Great letter matching ideas and activities here!

      While this activity is almost free if you’ve got the items at home already, we’re sharing the affiliate links for the items in this post.

      Matching upper and lower case letters and alphabet letter identification can be difficult for kindergarteners.  Use this letter matching game to prepare for kindergarten skills and gross motor play along with visual scanning. Uses magnetic letters and coffee filters for easy prep and set-up.  Great letter matching ideas and activities here!

      How to play this interactive letter matching activity

      You’ll need just a few items for this letter matching activity:

      • Magnetic letters
      • marker
      • coffee filters (but paper towels or recycled paper would work as well.

      To set up the activity, there are just a few steps:

      (Amazon affiliate links included below.)

      1. Grab the magnetic letters from the fridge and 26 coffee filters.
      2. Use a permanent marker to write one lower case letter of the alphabet on each coffee filter.
      3. With your child, match the magnetic letters to the lowercase letters on the coffee filters.
      4. Ask the child to help you crumble each letter inside the coffee filter that has its matching lowercase letter.
      5. Continue the play!
      Matching upper and lower case letters and alphabet letter identification can be difficult for kindergarteners.  Use this letter matching game to prepare for kindergarten skills and gross motor play along with visual scanning. Uses magnetic letters and coffee filters for easy prep and set-up.  Great letter matching ideas and activities here!

      More ways to match uppercase and lowercase letters

      By matching the magnetic uppercase letter to the lowercase letter on the coffee filter, kids get a chance to incorporate whole body movements and gross motor activity while looking for matching letters.

      With your child, first match up each lower case coffee filter letter to the upper case magnetic letter.  

      You can spread the filters out to encourage visual scanning and involve movement in the activity, OR you can stack the coffee filters in a pile and one by one match up the letters.  This technique requires the child to visually scan for the upper case magnet letters.  

      Try both ways for more upper/lower case letter practice!

      We then wrapped the coffee filters around the magnets in a little bundle.  There are so many games you can play with these upper and lower case letters:

      • Match the same letter– match uppercase letters to uppercase letters and lowercase letters to lowercase letters.
      • Alphabet matching with objects– Match an object that starts with the letter of the alphabet. Use small objects inside the coffee filter and match it to lowercase letters written in the coffee filter with uppercase magnet letters.
      • Match the picture with the letter– Print off pictures of words that start with each letter of the alphabet. Then match the picture with letters of the alphabet using lowercase letters written on the filter and uppercase letters in magnetic letter form.
      • Play a letter memory game– Hide letters around the room and challenge kids to find the letters in order to match the uppercase letter to the lowercase letters.
      • Letter sound matching– Make a letter sound and challenge kids to find the letter that makes that sound.
      • Letter Hide and Seek- Hide the bundled up letters around the room while your child hides his eyes.  Send him off to find the letters and ask him to open the bundle and identify the letter.
      • Letter Toss Activity- Toss the coffee filter bundles into a bucket or bin.  Any letters that make it into the bin are winners!
      • Name the letters- Unwrap the bundles and name the letters.  Spread the coffee filters out around the room.  Toss magnetic letters onto the matching lower case letter.  
      • Letter toss game- Toss a bean bag onto the coffee filters.  The child can identify the lower case letter, then go to the pile of magnetic letters and find the matching upper case letter.  
      Matching upper and lower case letters and alphabet letter identification can be difficult for kindergarteners.  Use this letter matching game to prepare for kindergarten skills and gross motor play along with visual scanning. Uses magnetic letters and coffee filters for easy prep and set-up.  Great letter matching ideas and activities here!

      Can you think of any more ways to work on upper and lower case letter matching with coffee filters and magnetic letters? 

      Matching Big and Small Letters

      The nice thing about this activity is that you can teach the concepts of big and small letters. When we say “big letters” and “small letters”, we are showing the concept of letters that touch the top and bottom lines, or the upper case letters.

      And teaching children the difference between those big letters and the small letters which touch just the middle point are part of the visual discrimination process that is needed for handwriting on the lines, or line awareness skills.

      You will enjoy more alphabet posts from our archives:

      Looking for more interactive letter activities to match uppercase and lowercase letters? The Letters! Fine Motor Kit is for you!

      Letters Fine Motor Kit
      Letter Kit for fine motor, visual motor, and sensory motor play.

      This 100 page printable packet includes everything you need for hands-on letter learning and multisensory handwriting!

      This digital and printable packet includes these multisensory handwriting and letter formation materials:

      • A-Z Multisensory Writing Pages
      • Alphabet Fine Motor Clip Cards
      • Cut and place Fine Motor Mazes
      • A-Z Cotton Swab Cards
      • A-Z Pattern Block Cards
      • Fine Motor Letter Geo-Cards
      • A-Z Color and Cut Letter Memory Cards
      • Color By Size Sheets
      • A-Z Building Block Cards
      • A-Z Play Dough Letter Formation Cards
      • Graded Lines Box Writing Sheets
      • Alphabet Roll and Write Sheets
      • Pencil Control Letter Scan
      • Color and Cut Puzzles

      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.

      Crossing Midline Activities

      Crossing midline activities

      In this blog post, we are covering all things crossing midline activities…but what is crossing midline?? We’ll get into that too, as well as some fun ways to develop midline crossing skills and specific exercises that kids (and all ages) can do to support development of this motor skills task that is huge in the way of gross motor coordination.

      Crossing midline is one of those motor skills we do constantly throughout the day, but never really give a second thought. And that automaticity of motor movements is a good thing, too! Imagine processing the action to use one hand to pull a door open. Imagine the time it would take to shower, dress, put on and tie your shoes if you had to process through the action to move your hands fluidly across the middle line of your body.

      As therapists, we hear “crossing the midline” all the time.  Have you ever wondered what the big deal is?  Why is crossing the midline so important?  In this post we will delve into what crossing the midline is, what causes issues, and how it impacts daily function, especially schoolwork.

      Before we get started, if you are doubting the validity of crossing the midline, tie one hand behind your back and go about your day.  How much did you reach across your body to get something?  You reached across, diagonal, up and down to interact with your environment.  While a two-handed person does not do this much crossing the midline, there is still a fair amount.

      Crossing midline activities and exercises for crossing the midline.

      What is Crossing Midline?

      Crossing midline refers to moving the body (hand/arm/foot/leg across an imaginary line that runs vertically down the center of the body to the other side (and vise versa). Additionally, crossing midline also refers to twisting the body in rotation around this imaginary line, as well as leaning the upper or body across the middle of the body.

      Let’s break it down further:

      Midline of the body is an imaginary line that drops from the middle of the head, straight down over the nose, to the belly button and divides the body into left and right sides.  Imagine a line that starts at the middle part of your hair and runs straight down your forehead and ends at the core of your abdomen. This imaginary line effectively divides your body into a symmetrical (mostly) left side and a right side.

      Crossing the midline” is a simplified way to indicate that part of the body moves over that imaginary line. This can look like 3 different aspects of movement:

      1. Reaching an arm/hand or foot/leg across the middle of the body to the other side of the body (Example: Reaching the right arm across the body for an object placed on a table to the left side)
      2. Rotating the body around the midline in a rotary motion in order to twist at the hips. This can look like putting your hands on your hips and rotating your upper body around at the abdomen (Example: reaching for a seatbelt involves reaching the hand and arm across the midline but it also involves twisting at the hips)
      3. Leaning the upper body over the middle line as in doing a side crunch. The head and shoulders move over the middle of the body (Example: Bending sideways at the waist while getting dressed or reaching while sitting for an object that’s fallen to the floor)
      What is crossing midline and why is it important to a child's development?

      Crossing the midline is a motor skill that requires using both hands together in a coordinated manner (bilateral hand coordination) allows kids to cross midline during tasks. This bilateral coordination ability is deeply connected to crossing midline.

      Why is Crossing Midline Important?

      Midline crossing is a developmental ability that is important for so many fine motor and gross motor tasks. This relates to functional skills in a major way. When a child has difficulty with crossing midline, they will demonstrate challenges in practically every functional task.

      When a child does efficiently cross the midline, they can use their dominant hand in skilled tasks.  They develop a dominant hand and the other extremity becomes the assisting hand.  They can manipulate objects in the world around them through all planes. They can demonstrate sensory integration by motor skills with vestibular, proprioceptive, and visual input.

      In particular, crossing the midline offers vestibular input. Moving the head from center plane shifts position of the inner ears. When bending, twisting, and moving from center, the vestibular system is at work.

      When the child does not cross the midline, they tend to use both hands equally in tasks like handwriting, coloring, and cutting with scissors. They may demonstrate awkward movements by moving the body to position itself so they don’t need to cross the middle line.

      Challenges with this motor skill impact learning, social skills, play, and self-care.

      In particular, we might notice sensory motor challenges at different age levels. For example, for children aged 3-5, we might see specific midline red flags that impact learning and play. We cover this specific age group in our blog post on Crossing Midline Activities for Preschoolers.

      Child crossing midline to place one hand on opposite knee

      Crossing Midline Occupational Therapy Asessments

      Occupational therapists perform individualized evaluations and assessments of underlying skills as they impact functional performance in every day tasks. Because of this, crossing midline is an essential skill that will be observed and looked for in every OT evaluation.

      Occupational therapists can complete a standardized evaluation, but most often, their skilled abilities will enable them to identify when crossing midline is a problem through play and interaction during the evaluation process.

      When you are watching for midline crossing, you should observe kids playing in normal situations.  A child will demonstrate a tendency to avoid crossing midline in activities or tasks, but if “set up” to cross the midline (i.e. setting items to the left of the body and asking them to reach over the midline with their right hand), they will typically be able to complete the requested movement pattern, but not carry over the action in a normal situation.

      If they have difficulty with crossing midline, a child will switch hands during handwriting because both hands get practice with pencil manipulation.  

      The child might rotate their whole body instead of twisting at the trunk or shift their weight in a task rather than leaning the upper body over the midline.  

      You can often times observe a tendency to avoid midline crossing in activities such as kicking a ball, throwing beanbags, switching hands in coloring, difficulty with putting on pants and shoes independently, and difficulty with visual tracking and reading.

      Crossing the midline exercise for child

      Crossing Midline Activities

      So, what do you do when crossing the midline is an issue? There are many ways to support the development of this skill.

      The ideas listed below are fun ways to play and develop motor skills by crossing midline, however they have a sensory component too.

      We mentioned above the aspect of vestibular input and proprioceptive input that occurs in crossing the midline. These midline activities have those sensory motor considerations through play.

      • Rotate the body in a twisting motion.
      • Bend the upper body side to side.
      • Play Simon Says. Use these therapy Simon Says commands to get you started.
      • Play hand clapping games
      • Thread lids on a long string – Position string and beads or lids at different placements to encourage crossing the midline.
      • Wash a large wall with big swooping arm motions.
      • Erase a large chalkboard.
      • Scoop balloons in a water bin.
      • Wash a car.  Encourage the child to use large circular motions with the sponge.
      • Kick a ball.
      • Yoga
      • Dinosaur Gross Motor Game
      • Brain Gym Bilateral Coordination activities
      • Toss bean bags -Encourage upper body movement! Bend through the legs, turn sideways, reach back behind you, rotate side to side…encourage vestibular input by bending and rotating.
      • Squirt gun activities at targets.
      • Play with magnets on the garage door.
      • Play Twister.
      • Slow motion cartwheels- Place both hands on the floor to the side, kick legs over. By doing the cartwheel in slow motion, the body is forced to move sequentially, adding midline crossing at the trunk.
      • Hit a ball with a bat.
      • Use pool noodles to hit a ball- think hockey and hitting the ball into a target on the floor
      • Play catch with rolled socks- Use a bucket or bin to catch the rolled socks. They will fly high, low, left, and right!
      • Play flashlight tag.
      • Catch lighting bugs or butterflies.
      • Show the child how to write their name in the air with large arm movements.
      • Bend over at the waist and swing the arm side to side, in large circles, and in figure 8 motions.
      • Play with scarves to music.
      • Move a ribbon wand to music.
      Midline march. Crossing midline gross motor activity to help with handwriting, and bilateral hand coordination skill.

      Crossing the Midline Exercises

      I love this crossing midline exercise below, because it has a ton of different movement options with one fun activity.

      We had fun one winter day with a few crossing the midline exercises, including marching, crossing arms over, and stomping out some wiggles.

      Our midline march activity was a marching parade with “Stop Stations”.  We marched along to music and when I turned off the sound, the kids had to do a midline exercise.    

      The midline exercises included:

      • Place left hand on right knee
      • Place right hand on left knee
      • Stand and bend to touch the opposite foot
      • Standing and place right elbow on left knee
      • Standing and place left elbow on right knee
      • Crunches with touching right elbow to left knee
      • Crunches with touching left elbow to right knee
      • Cherry picker crunches- lay on the back slightly bent forward at the hips so the upper body is off the ground. Move a ball or small toy from the right side to the left side.

      Because we were doing these midline exercises to music that quickly stopped and started, the thought process was quick. The kids had to quickly complete the exercise without much forethought.

      This quick start and stop activity allowed them to practice crossing midline without over-thinking about the action.

      Child crossing the midline with hand on knee
      Child crossing midline with hand on opposite knee

      Fine Motor Crossing Midline Exercises

      Crossing the midline can be done on a small scale, too. This activity is similar to the midline marching activity described above, but it uses paper, pencil, and small colored dots such as stickers or a small circle drawn with markers.

      1. Draw dots on the left margin of a paper using colored markers or colored stickers. There should be one of each color going down the left margin.
      2. Draw dots using the same colors going down the right margin. Use each color only once.
      3. Turn on music. The student can draw to music on the center of the page using their pencil or markers.
      4. Turn off the music. When the music stops, call out a direction: “Left hand, yellow!” The student should put down their marker and touch the yellow dot on the right margin using their left hand.
      5. Turn on the music to draw again and repeat.

      This activity is similar to the gross motor midline exercise because it requires the child to think on the spot. They have to listen to several instructions, but also process the motor skills and cross the midline automatically.

      You can adjust this activity by numbering the dots, using less colors, or less dots, and reducing the amount of instructions. This activity can be used with any level by grading the activity.

      Child bending to touch hand to opposite foot to cross the midline.

      This post is part of the Gross Motor A-Z series hosted by Still Playing School. You can see all of the gross motor activities here.

      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