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 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.
  • Provide toys and age-appropriate objects for reach and grasp. This banana toothbrush teether 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 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 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
  • 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:

  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
  • 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

Victoria Wood, OTR/L 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.

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.

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

Apple Brain Breaks

apple brain breaks for kids

These Apple Brain breaks are a resource that has been popular on the site for many years. During the fall months, all things apple theme is the way to go, so when it comes to adding themed resources into a Fall, harvest, farm, or back-to-school theme, apple themed exercises and movement activities are the way to go!

Apple brain Breaks

Many of you have used the brain break activities that we have here on the OT Toolbox help kids focus and pay attention in the classroom environment. Movement in the classroom is helpful for learning and helping kids with movement needs such as fidgeting or attention. The brain break activities listed below can go along really nicely with an apple theme. Try adding the Apple themed brain breaks in between activities, lessons, and other classroom tasks.

Apple themed brain breaks can be a great way for kids to extend on an Apple theme activity while adding movement into the classroom.

Other brain breaks you might enjoy include:

Apple Theme Brain Breaks

apple brain breaks for kids

Looking for brain break videos for the classroom or home? Here are the best brain break videos on YouTube.

Related read: These visual perception apple theme shape stamps are a perfect way to work on visual perceptual skills and fine motor skills with DIY stampers.

Apple themed brain breaks for kids to use in the classroom or as part of an apple theme in learning and play.

How to Use Apple Brain Breaks

Get this list of apple theme activities as a printable sheet to use in the classroom. Print them off, glue them to cardstock or index cards and laminate for durability. Kids can complete apple brain breaks as a group or individually.      

In the PDF below, you’ll find printable cards that you can cut out and use over and over again as a movement break for kids. Other ways to use these fall brain breaks?

  • Incorporate into an apple tree life cycle curriculum or any apple lesson plan
  • Use with talking about Johnny Appleseed during the Fall months
  • Use as a Johnny Appleseed game
  • Add to a harvest theme or visiting the Farm during the Fall
  • Use as a transition activity between classroom activities
  • Use along with our Fall sensory stations kit (another great Fall brain break!)
  • Indoor recess activities during the Fall months
  • Great for waiting activities or transitions in an apple themed classroom!
  • Use when waiting periods during classroom breaks
  • Add as sensory motor activities to promote attention, focus, re-direction, or needed heavy work input

These apple theme exercises can be added to a weekly therapy theme when planning occupational therapy lesson plans, and then individualized based on the child’s needs and interests.

Apple Exercises

The brain break cards include activities like these ones. These apple theme exercises can be adapted or modified as needed to meet specific needs.

Here are some apple think brain break activities that can be used at movement into the classroom using an Apple theme:  

1.) Reach and climb- Ask students to stand up beside their desks and pretend to climb a ladder. Students can reach up high with alternating arms as they climb in place. Imagine climbing up a ladder to reach the top of an apple tree.

2.) Pick apples- Ask students to imagine reaching up to grab an apple from an apple tree’s branch, and  then bend down to drop it into a basket. Ask students to repeat this motion repetitively reaching up high and then bending down low to the ground.

3.) Peel and toss apples- Ask students to imagine peeling an apple as they roll their arms over and over again at the elbows. Then ask them to toss an imaginary apple into a bucket. They can imagine the buckets are at different levels and distances as they pretend tossing apples. Continue this exercise for one minute.

4.) Apple dash – Ask students to run in place and imagine running at an apple farm. Students can pretend they are delivering bushels of apple from a tree to a barn as they run in place while carrying an imaginary bucket. Ask them to imagine hopping over logs or running faster or slower.

5.) Make a pie- Ask students to imagine picking an apple and buffing it with their sleeve. Ask them to buff an apple on their left sleeve and then their right sleeve. Doing this activity encourages crossing of the midline. They can then pretend to slice the apple, roll out dough, pour the apple slices into the pie pan, and putting the pie into an oven.

6.) Apple spell- Ask students to form the letters used to spell the word “apple” using their arms and legs. To make an “A”, the student can reach up over their head putting their hands in the middle and stretching their legs wide next. Next, make a “P” by standing with feet together and arms curved toward the side to create the bump of the letter. Complete the same movement again for the second P in the word apple. Next, form a letter L using by sitting on the floor and bending at the waist stretching legs out straight. Finally, create a letter E by sitting on the floor bent at the waist with leg s extended straight and feet together. Put one arm out at the waist and reach the other arm out overhead bent at the elbow.

7.) Spell and clap- To the tune of “BINGO”, spell the word apple. After singing a round, replace one letter with a clap of the hands. Each round adds another clap in place of a letter. Try adding other movements in place of clapping such as hopping in place or stomping a foot.

8.) I’m a Little Apple- Use the song “I’m a little teapot” only pretend you are an apple. Kids can sing  “I’m a little apple small and round. Here is my stem and here is my leaf. When I get so red, I fall from the tree. Reach down low and pick me up.” Add movements to go along with the words.

Can you think of any other apple themed brain breaks?

Squirrel Themed Brain Breaks may be another fun movement idea that you are looking to pair with a book.  

Apple themed brain breaks for kids to use in the classroom or as part of an apple theme in learning and play.

Free Apple Brain Break Cards

Want a copy of these apple brain break cards to add to your toolbox? Enter your email address into the form below to access these printable tools.

This freebie is also available inside our Members Club! Members have easy access to all downloads on the site, in one place, without the need to enter your email address for each item.

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This resource is just one of the many tools available in The OT Toolbox Member’s Club. Each month, members get instant access to downloadable activities, handouts, worksheets, and printable tools to support development. Members can log into their dashboard and access all of our free downloads in one place. Plus, you’ll find exclusive materials and premium level materials.

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    More Apple Theme Activities for Kids:

    You will love these apple activities to go along with an apple theme.
    Ten Apples Up on Top pre-writing activity
    Apple fine motor strengthening activity and fall math with hands-on learning.
    Gross Motor Apple Tree activity for learning red and apples with toddlers and preschool children. Kids love this in the Fall!

    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

    Tag Games To Develop Motor SKills

    Tag games for kids

    The thing about playing tag games is that you can take a classic lawn game and make rules to change the game a thousand different ways and never play the same game twice! Chase games are a fun way to get kids moving and outside with movement, balance challenges, development of the visual system, and heavy work. Best of all? Tag activities can support developmental needs on all levels and abilities. Add these tag games to our massive list of outdoor lawn games to get kids moving, running, jumping, and building motor skills!

    These tag games are powerful ways to help kids develop skills. Use the creative tag games in therapy or in summer camp activities.

    Tag games

    There are so many reasons why tag games are a must for summer time fun. Let’s break it down:

    • Tag games are great ways to add motor movement to kids, to get them off the screens, and outside. Running and playing tag supports gross motor coordination.
    • Tag also is a powerful way to play together as a family, adding a chance for connection and creating memories. What better way to spend some time together as a family than playing a game of tag that offers heavy work, sensory input, in the great outdoors?
    • Tag games are also great running games for physical education.
    • Tag is a fun way to support therapy goals with a small group. Use the tag games in a group therapy setting, in PE planning, or in summer camp activities.
    • Playing tag at summer camp offers a break between activities, adds heavy work, and can get kids moving and building skills. Best of all- you can modify the tag game to meet any theme or topic!

    The options are limitless! Here are more summer camp ideas that tag can fit well into with therapeutic and team-building benefits.

    There are many therapeutic benefits of playing tag. Use these tag games in therapy or summer camps to help kids with child development and have fun too!

    Therapeutics benefits of playing tag

    When kids are running, stopping, turning course, running around obstacles, there are many developmental benefits.

    Let’s break down games of tags for their therapeutic benefits:

    Running- running in short bursts offers cardio input that gets the blood pumping. When kids run and stop in short bursts, they are gaining heavy work input through their legs and core.

    The short intervals involved in tag games build muscle strength, and allow for running at various speeds. As opposed to longer distance running, kids can be successful in running in short bursts.

    This is also a great way to “reset” after being indoors for a while, on a long car ride, in the classroom all day, or on screen devices for a long period of time. We talked here about the benefits of treadmills and wellbeing, but for shorter bursts of running, the mindfulness benefits definitely exist!

    Stopping and Starting- When we run and then stop abruptly or stop and turn, there are so many motor components occurring at one time.

    The muscles that are actively engaged need to stop abruptly, adding heavy work input through those muscles and joints. Then the opposing muscles and core need to activate to maintain posture. The whole body is engaged in this action. Kids often play tag in a yard or park where there are trees or other stationary structures.

    These provide a need to move around targets and slow running speed. This requires the visual processing system to interact with the motor tasks. When kids are running around other tag players, they are running around moving targets, which further engages muscles and visual processing system.

    Stopping and starting motor skills are a challenge for:

    • Proprioception
    • Vestibular input
    • Motor planning
    • Body awareness
    • Depth perception
    • Balance
    • Coordination
    • Postural control

    Tagging others- Tag is such a great way to interact with others in an appropriate way. You may have had a school yard experience where you were pushed down in a game of tag. When others tag you and it occurs unexpectedly or with too much force, a fall can happen!

    However, by playing tag, kids get that experience with proprioceptive input, vestibular input, and visual motor skills.

    • How much force must they exert to tag without pushing over a playmate?
    • How far do they need to reach out to tag a friend without hitting their face?

    All of this experience in movement is powerful! It helps kids learn about how their body moves in space, body awareness skills, visual perceptual skills, spatial awareness, and eye-hand coordination skills.

    Spatial awareness- Expanding further on the spatial awareness skills, or spatial relations, body awareness, and position in space, all of these body concepts are able to be carried over to other functional tasks.

    This experience allows kids to use this knowledge when walking in crowded hallways without bumping into others, spatial awareness in handwriting on a page, moving while carrying plates or heavy items. All of these experiences can be integrated for functional movement.

    Executive functioning skills- Playing a simple game of tag can build executive functioning skills, too! Think about it: when you play tag, there is working memory to recall movements that allowed you to escape in a previous game or trial.

    If you’re playing a fun tag game version, you need to recall specific words or phrases that were already used. Other executive functioning skills that are used in tag include planning, prioritization of movements, impulse control, task completion, initiation, processing speed, self-monitoring, foresight, mindset, and cognitive shift. What a powerful game tag is in building cognitive skills!

    Motor planning- Moving, making motor plans, running around obstacles and other children…what a great game tag is to build motor planning skills.

    There’s more: tag is a fast-paced game. So those motor planning sequences and movements need to happen quickly. The good news is that a game of tag offers many trials and repetitions to build motor plans and muscle memory.

    Visual Processing Skills- Visual processing skills is an umbrella of visual skills and tag addresses many of these areas through play. And playing tag requires many visual processing skills under that umbrella!

    Take a look at all of the visual skills needed for tag:

    What a powerful game tag is!

    So, now that we know the massive therapeutic benefits of tag, let’s take a look at some fun tag games for kids.

    Play these creative tag games to add a twist to the classic tag game.

    Fun Tag Games

    Classic tag

    Someone is it and chases the others in the group. When they touch someone else, that person is now “it”. The game continues.

    TV Tag

    One person is “it”. When they approach another person, the player yells the name of a TV show and drops to the ground. They are then safe and the person that is “it” needs to run and tag another person. This type of tag can be adjusted to call out music, songs, YouTube shows, games, sports, favorite foods, animals, etc.

    Flashlight Tag

    Play tag in the early evening hours with flashlights. When you shine your flashlight on a fellow tag player, that player is tagged and they are now “it”. This is a great activity for challenging visual scanning skills, visual discrimination, visual figure ground, and visual tracking skills.

    Sharks and Minnows Tag

    One person is the shark and the others are the minnows. When the shark touches another player, that person then turns into a shark. Now there are two sharks. Play until all of the minnows turn into sharks.

    Freeze Tag-

    When a person is tagged, they need to freeze in place until another player touches them to “unfreeze” them.

    Cops and Robbers Tag-

    A group splits into either “cops” or “robbers”. The cops chase the robbers and once tagged, they need to sit in “jail” until another robber tags them and releases them.

    Pizza Tag-

    One person is “it” and chases the others.  Players run from “it” and can stay safe from being tagged by naming pizza toppings and touching the ground.

    Animal Walk Tag-

    Players can assume an animal walk (crab walks, hop like a bunny, waddle like a penguin, sway like an elephant, etc.) and play tag!

    Social Distance Tag Games

    No-Touch Tag Games-

    Tag games can be modified to any theme which is great for social distancing. One person is “it”. When they near another child, that person yells out a word or phrase, or completes an action like hopping, squatting, acting like an animal, touching the ground, dabbing, or completing any physical action. Tag could take any action or theme in this way.

    Shadow Tag-

    Play classic tag but tag one another by stepping on the shadow of others. This is a great social distancing version of tag, as well.

    Social Distancing Tag-

    This tag game is another way to play with others, gain the benefits of tag, and play in a socially distanced form. Simply play tag in the classic version (or use any of the fun tag versions described here) and when “it” is within 6 feet of another person, they have tagged the other player. This is a nice way to work on spatial awareness and scanning at a distance, too.

    Tag Games for Different Themes

    The cool thing about a classic game of tag…or any of the versions listed above, is that you can adjust the theme to fit a weekly therapy theme, a summer camp theme, or a learning theme at school. Different types of tag games can be played using all one theme to add different movement opportunities and motor planning challenges.

    • Have an ocean summer camp? Play ocean animals tag (kids call out ocean animals and drop to the ground to stay safe.)
    • Planning a space camp? Play space tag. Kids can call out planets when the “it” person is near and stay safe.
    • Creating a Pirates theme summer camp? Modify sharks and minnows tag to meet your theme.
    • Coming up with a handwriting camp to work on handwriting skills? Encourage heavy work through the arms by adding crawling, hopping, or heavy work animal walks.

    What do you think? Have you played any of these tag games before? Let’s get those kids moving!

    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

    The Development of Balance

    Development of balance

    Balance development is a pivotal part of child development. Gross motor coordination, balance and motor planning are all part of the processes of acquiring these skills. Here, we cover balance development, strategies to support this skill, and specific balance activities.

    Development of balance from infancy through preschoolers.

    Balance Development

    Acquiring or practicing balance can be seen in a toddler swaying step by step, a child pretending the sidewalk curb is an Olympic balance beam, or a teenager managing their new crutches.

    Strong standing and walking balance equal safe mobility, which opens the door to so many wonderful new things; running, jumping, cartwheels, backflips…you get the picture.

    Achieving physical balance plays an important role in the development of many different skills, some of which may surprise you!


    Before officially diving into the development of balance, we first need to define and understand it. 

    • Balance – According to the Harvard Medical School, balance is the ability to distribute your weight in a way that lets you stand or move without falling, or recover if you trip. Good balance requires the coordination of several parts of the body: the central nervous system, inner ear, eyes, muscles, bones (Check out this list of bone names), and joints
    • Static Balance – maintaining body position during an unmoving task, such as sitting or standing
    • Dynamic Balance – the ability to remain standing and stable while performing movements or actions that require displacing or moving oneself

    The various muscles of the body contract or relax in order to maintain the proper balance for our daily activities, as controlled by our balance center in the brain; the cerebellum

    In addition to the cerebellum, the inner ear also sends signals to the brain, to give a status report on the environmental changes that affect balance. The inner ear is where the vestibular system is located.

    Its’ fluid picks up on the motion and position of the head, constantly sending information back to the brain via the eighth cranial nerve. When there is a medical issue within the ear, such as an ear infection or torticollis, it may affect balance. This is generally in the form of dizziness or unsteadiness. 

    The primary source of information for the following list of balance developmental milestones was primarily sourced here.

    Information from different sources may vary slightly, largely due to the fact that developmental patterns fall into different ranges. For a general list of developmental milestones, refer to the CDC resource here.

    Balance Development in the first year


    • The vestibular system is developed at five months pregnancy

    0-3 MONTHS

    • Primitive reflexes (uncontrolled movement) lay the groundwork for future motor development
    • Tummy time develops vision and postural control required for optimal balance later on 

    4-6 MONTHS

    • Rolling prone to supine (front to back), then supine to prone (back to front)
    • Supported sitting, then unsupported sitting

    7-9 MONTHS

    • Picks up a dropped toy, may fall while reaching
    • Begins to army crawl, cruise crawl, or scoot
    • Holds majority of their own weight while standing supported
    • May squat up and down while standing 

    10-12 MONTHS 

    • Pulls self up to stand, then stands unsupported
    • Manipulation of toys/ movement of arms while sitting unsupported 
    • Moves in and out of laying and seated positions with control
    • Cruises along furniture or walks supported

    Development of Balance in Toddlers 

    13-16 MONTHS

    • Walking unsupported, but may tumble easily
    • Crawls up and down furniture and stairs with support for safety
    • Begins to learn how to walk faster/run 

    17-19 MONTHS

    • Is able to get onto small chairs without help
    • Walks up stairs while holding on with one hand
    • Runs stiffly and falls often
    • Can pick up objects while standing, without losing balance

    2 YEARS

    • Pulls off socks without losing balance
    • Runs with improved coordination
    • Can kick a ball without losing balance

    Development of Balance in PReschoolers

    3 YEARS

    • Can briefly balance and hop on one foot
    • May walk upstairs with alternating feet (without holding the rail)
    • Able to pedal a tricycle

    4 YEARS 

    • Hops on one foot without losing balance
    • Throws a ball overhand with coordination

    5 YEARS:

    • Skips, jumps, gallops, and hops with good balance 
    • Stays balanced while standing on one foot with eyes closed 

    The majority of our balance skills have developed by age 5, but will continue to fine-tune up until around age 12. Remember to keep in mind, these are averages for the typically developing child. 

    Balance is required to do just about anything in daily life. 

    Balance is needed to stand at the mirror while brushing teeth, get out of the car, and put on socks, to name just a few. Without the development of this balance skill, support aids (walkers, crutches, braces) may be necessary for safety and function.

    Static Balance

    Did you know that balance is also related to non-physical, or static tasks?

    Research suggests that when balance is improved, so are attention and learning skills. Good balance helps children develop better reading, writing, and language skills, as well as improved concentration. 

    One way balance is theorized to improve academic skills, is through increased body control, and knowing where the body is in space (proprioception). Having better body control and knowing how to coordinate movement in various environments is important.

    Correct body awareness makes it easier to have a comfortable seated posture. Good balance also makes activities such as sitting still while moving the head to look up at the chalkboard, and then back down to write easier. 

    Check out these Body Awareness Activities from the OT Toolbox.

    Without proper body control, it is just that much more difficult to perform the tasks of a student: copying from the board, holding and reading long textbooks, carrying materials from space to space, and supporting an upright seated posture for many hours a day.  

    How to Support Balance Development

    Knowing the huge impact that balance has on the body, what can you do to improve it?

    Check out this blog post on balance activities.

    The OT Toolbox has great articles on gross motor skills, that will suit the needs of your children. Check these out and let us know your favorites!

    If you love all of the great resources found above, consider becoming a member.

    Want to add this resource to your therapy toolbox so you can help kids thrive? Enter your email into the form below to access this printable tool.

    This resource is just one of the many tools available in The OT Toolbox Member’s Club. Each month, members get instant access to downloadable activities, handouts, worksheets, and printable tools to support development. Members can log into their dashboard and access all of our free downloads in one place. Plus, you’ll find exclusive materials and premium level materials.

    Level 1 members gain instant access to all of the downloads available on the site, without enter your email each time PLUS exclusive new resources each month.

    Level 2 members get access to all of our downloads, exclusive new resources each month, PLUS additional, premium content each month: therapy kits, screening tools, games, therapy packets, and much more. AND, level 2 members get ad-free content across the entire OT Toolbox website.

    Join the Member’s Club today!

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

    Dinosaur Game Kids Love

    dinosaur game

    This dinosaur game is a huge hit among kids. It’s a movement-based dinosaur activity that kids of all ages love. If you are looking for creative dinosaur games to use in therapy, at home, or in the classroom, then be sure to add this dinosaur game for kids to your list!

    Use the dinosaur game below along with these dinosaur exercises and other dinosaur themed activities in therapy sessions. You can even incorporate handwriting and visual motor skills into dinosaur games with this printable dinosaur visual perception worksheet.

    This dinosaur game is great for kids who love dinosaurs!

    Dinosaur Game for Kids

    This dinosaur game is an older blog post here on the website, but it’s a gross motor activity that is well-loved for many reasons.

    There is just something about the stomping and roaring of a dinosaur game that takes me back to my own kids at their preschool ages! This is an older post here on The OT Toolbox, but one that is one of my absolute favorites.

    We read the dinosaur book, Dinosaurumpus by Tony Mitton…and created a fun dino game that the kids loved! Our dinosaur movement game inspired tons of giggles and wiggles as we moved our way through this book with a gross motor activity!  

    The gross motor coordination tasks and motor planning skills make this dinosaur game the perfect addition to dinosaur physical therapy and dinosaur occupational therapy themes.

    When kids play this dinosaur movement game, they build skills in areas such as:

    • Eye-hand coordination
    • Balance
    • Whole body coordination
    • Crossing midline
    • Position changes
    • Heavy work input
    • Proprioceptive input
    • Vestibular input
    • Visual scanning and visual processing skills

    The specific activities in the game allow kids to develop skills such as hopping, jumping, twisting, stomping, and other gross motor tasks.

    How to Play the Dinosaur Game:

    We’ve included affiliate links in this post for the book and items you’ll need to create the DIY Dinosaur game.    

    Have you read the book, Dinosaurumpus!?  This is a book that is sure to get the kids moving with it’s loud and active rhymes as the dinosaurs dance an irresistible romp. 

    Using this book and the game you’ll find here together is a great dinosaur game for toddlers and preschoolers to address listening skills, comprehension, and regulation through movement and play.

    My kids couldn’t help but move and groove as I read them the story.  We had to make a movement gross motor game to go along with the book!  We talked about the fact that dinosaurs have big feet and big bodies that sometimes move too fast in the space around them.

    This is a great lesson on body awareness that kids can relate to.


    Dinosaur movement game for kids. This gross motor game is based on Dinosaurumpus the book and is a great activity for auditory and visual recall in kids.

     Make this game easily using our free printable for the game board.  We listed out the dinosaurs in the book and the actions they did.    

    These went onto a game spinner that I made on  card stock.  We used dinosaur figures for part of our movement game.  These ones are a great deal!  

    Free dinosaur game printable

    Dinosaur Game Printable

    To play the dinosaur movement game:

    This is a dinosaur movement activity for preschool and older aged kids. Use in in the classroom or home as part of a story and reading activity, or use it as a dinosaur brain break in the classroom. 

    First print out the free printable.  You’ll also want the game rules for easy play and the spinner piece.  

    1. Print your printable on card stock OR you can use regular printer paper for the game board, but the arrow won’t spin as well. You may want to print the game spinner on paper and then glue to cardboard for more sturdiness during (active) play. Make your game board and ensure the arrow spins using a brass fastener.
    2. One player hides the dinosaur figures around the room or outdoor play area.  
    3. The first player spins the arrow and reads the action.  He or she then races off to find one of the hidden dinosaurs.  
    4. When she finds a dinosaur, she races back and performs the action.  

    Hide dinosaur figurines and use them in the dinosaur game for preschoolers and toddlers to develop motor skills.

    There will be shakes, stomps, jumps, and TONS of giggles with this gross motor activity!   

    We loved this game activity for it’s gross motor action.  It would be a great activity for rainy day fun or indoor play when the kids need to get the wiggles out.  Racing off and remembering the action they must perform requires a child to recall auditory and visual information necessary for so many functional skills.  

    Dinosaur game rules for kids
    Kids can spin the wheel on the dinosaur game to build gross motor skills.

      We hid the dinosaurs in all sorts of fun spaces in the house.  

    Spin the wheel on the dinosaur game to support fine motor skills.
    Spin the wheel on the dinosaur game to support fine motor skill development, too.

    The dinosaurs in the book, Dinosaurumpus! move a lot!  Get ready for stomping, shaking, diving, dancing, running, jumping, twisting, and spinning!  

    Move like a dinosaur with this dinosaur game for kids

    My kids love any kind of scavenger hunt game and this one, with its movement portion, was a HUGE hit!

    Dinosaur gross motor movement game based on the book, Dinosaurumpus!

     Gross motor skills are important to develop through play.  It’s essential for attention and focus to build core body strength.    

    More Gross Motor Games

    Looking for more ways to work on gross motor skills like core strength and proximal stability for improved attention and distal mobility?

    Some more of our favorite gross motor activities that you will love:  


    If you are looking for more dinosaur activities for kids, be sure to check out our Dinosaur Jacks activity to promote more motor skills, and our Dinosaur visual perception worksheet to work on visual perceptual skills.

    Dinosaur game for kids that is a great preschool dinosaur activity for gross motor skills.

    Free Dinosaur Game Printable

    Want to play this dino game with kids you work with in therapy or in the classroom? Print off the game pieces using the free printable. Simply enter your email address into the form below to access.

    Want to add this resource to your therapy toolbox so you can help kids thrive? Enter your email into the form below to access this printable tool.

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    Free Dinosaur Game

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      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