Author: Stephanie Adam, OTD, OTR/L
During the first year and beyond, those little hands will be busy. While it’s very important to keep working on tummy time to develop the skills for independent sitting and improved core stability and strength, it is also important to give your baby opportunities to use her hands together for play by providing the necessary support for her body. It’s great for babies to be given the opportunity for seated exploration right away. They won’t be able to do much, and will require a lot of support in the beginning with an inclined chair or leaning against your tummy or knees. Even though they’re tiny and you will be doing most of the work, these are great early opportunities to start reaching and lifting those little arms and turning that sweet little head to see what’s going on around her.
There are many seating options available that provide varying degrees of support. Choose the one that provides the least amount of support necessary to maintain the desired position. For example, a newborn will require total support in a bouncer, Boppy pillow, or on your lap to begin reaching and lifting her arms. However, as your baby gets bigger and stronger she will be able to tolerate being more upright in her bouncer, and then as her head control improves she can move to an infant seat, and eventually just a Boppy pillow. You want to provide enough support to be safe and secure and enough freedom to work on emerging skills and to get a little exercise. If your baby is not yet able to hold her head up, you will need to support her entire trunk and head for her to use her hands for exploration and play (a high back feeding chair). If she is able to sit with support and hold her head up, maybe you will just need a positioning tool to support her at her hips (a Boppy pillow).
There are a wide variety of options available, and you may transition through a few of them based on your baby’s skill level.
Graco 4-in-1 Seating System with Recline
Megaseat Infant Floor Seat with Safety Belt
Fisher Price Sit-Me-Up Floor Seat with Tray
Sassy Sensory Seat
You’ll know you’ve found the best seat with the appropriate support when your baby is able to use her hands easily. It’s important to provide opportunities to explore and play with her hands in a variety of positions such as while lying flat on her back – reaching for and manipulating toys in this position requires working against gravity. The extra challenge of working against gravity provides great opportunities to improve strength, stability, and coordination in the shoulder and upper arm. This also provides great practice for coordinating and controlling the small muscles of the hands to work together to reach for, grasp, and pass a toy between hands. There are many options for baby activity mats that allow for toys to be suspended above your baby to complete these activities. This activity can also easily be accomplished with any visually appealing object or toy held within reaching distance by a parent or caregiver, or even by playing games or singing songs that require actions or bringing their hands together. These activities can also be completed in side-lying (rotate between sides) and in a semi-reclined position such as in a car seat or reclined high-chair. Each of these positions requires your baby to work against varying degrees of gravity, to utilize different muscles in their shoulders, arms, and hands, and requires they coordinate their vision and motor skills in a variety of ways.
Now, back to the seat. The more opportunities your baby is provided to play and explore objects in a supported seated position, the more quickly she will develop more control for grasp and release of objects and become more successful in functional and play activities. Provide toys for play that can easily be picked up, that make noise and/or are interesting to look at and feel. As your baby becomes more coordinated with her movements you can provide activities for putting in and taking out of a container, you can begin to provide toys of varying sizes and weights – larger and heavier toys will require using hands together to lift and manipulate, smaller toys or objects will require more coordinated movement and increased stability from the shoulder and big muscles of the arm. Be sure to provide time for these activities each day.
Playing in a supported seated position will quickly become a favorite for both you and your baby – they can play and learn in a safe position, and you can have a few minutes with your hands free for other activities! However, it’s important to continue to work on independent sitting. This skill is still very necessary for the functional development of grasp and fine motor coordination. Babies typically begin to prop themselves up with their arms when they are learning to sit, however, babies with Down Syndrome can sometimes have proportionally shorter arms making this task very difficult when combined with low tone. Trying to sit without the proper positioning support can start some bad habits such as letting their heads fall back to be supported by their upper back. This can be a hard habit to break if allowed to continue, and it delays the development of good head and neck control against gravity. To prevent this posture you may need to provide additional supports to encourage the correct seated position. This may include a small box or book to support their arms on in front, which will require that their head move forward and be held up over their arms. They may also require additional support behind their back with a cushion or pillow. Your baby may need a lot of support in the beginning, but you’ll see that they will require less and less as they are allowed opportunities to practice.
I know this is supposed to be a focus on fine motor development and grasp – and it is! These skills are imperative in the development of functional fine motor skills and grasping patterns. It may be hard to see this when watching your baby as she begins to use her hands to reach, touch, and play, but if you think about what she’ll be doing one year, three years, five years from now…if she isn’t able to sit independently she won’t be able to take her socks off and put them on, she won’t be able to lift a cup to her mouth or feed herself independently, or learn to write her name or cut out shapes. If the big muscles aren’t strong and stable, the little muscles can’t learn all of the important skills they need to.
Now, for those little muscles…your baby will get right to work trying to use their hands. She’ll hold on to your finger and before you know it she will be reaching for toys and objects in front of her. Every child progresses through a series of grasping patterns leading to a well coordinated and controlled pincer grasp. For children with Down syndrome they may move through this series more slowly, they may require more support and practice, and they may hold their hands or use their fingers a little differently, but the goal is the same:
- All children start with a grasp that is completed by using the bigger muscles of the hand and is called a palmar grasp. The fingers do very little in manipulating an object – just opening and closing to hold onto it.
- Next, the fingers will begin to get more involved. You may notice that they are beginning to move more independently when picking up and holding onto an object, rather than together as a unit. Objects will still be held within the palm, but will be up higher in the hand and will beginning to move into the fingers.
- The next grasping pattern is called a mature grasp. You’ll recognize this because objects are picked up and held by the fingers. There is a space evident between the object and the palm and your baby will be using his hands more efficiently and in a much more coordinated way.
- Those little fingers are getting stronger all the time and preparing for the pincer grasp. This skill will start with a raking motion. The fingers will “rake” items to bring them into the palm and scoop them up. As the general coordination of the hand improves, so to does the ability to isolate the fingers and then…it happens. They can finally pinch that Cheerio between their little fingers and bring it to their mouth,and just like that a whole new world begins!
This simple little skill paves the way for so many exciting things…learning to hold a crayon, writing letters, feeding themselves with utensils, managing snaps and buttons…lots to learn!
Will you remember all of that practice laid back in a high chair or propped up on the floor in the Boppy, or teaching her to hold her head up? How about all of that practice picking up rattles and blocks, and dropping them into a box or learning to pass it between her hands or to you? Maybe you’ll remember all that it took to get those two little fingers to pick up that little Cheerio, but all the work will be worth it…for both of you.