by Robert J. Doman Jr. and Ellen R. Doman
National Association for Child Development
One of the areas of parental concern for the development of any baby is the area of mobility. Watching a baby learn to crawl, creep, stand and walk are thrilling to all parents. As a parent we can see our child learn to better explore their world and move from dependence to independence sometimes in the time span of the first year.
As a parent of a DS child, you may have a special concern about your child’s development of mobility. Cardiac conditions can slow down the emergence and development of mobility. The potential or reality of low muscle tone and poor tactility can also slow down development in this area drastically. Parents are often tempted to skip mobility developmental stages in an effort to reach the coveted skill of walking more rapidly. The consequences of this strategy can be very long lasting and impact other developmental areas as well.
Why stomach crawl? Crawling on your stomach on the floor in a cross pattern is hard work. Aside from people training in the military, few of us have spent any time past our first year of life utilizing this movement. What is to be gained by doing it, and why does your baby need this essential first form of locomotion? There are several reasons. Your child’s eyes begin the work of learning to focus and converge together on near-point objects, a skill which is needed for everything from reading to depth perception. The tactile feedback given by the entire body moving against the friction of the floor teaches your child the location of the entire torso, arms and legs, and feet and hands. Proprioception, knowing where your body is in space, is based on these early messages of tactile input on the floor and feeling every movement through the feedback of this contact. The child is learning that they have two legs, two arms, two feet and two hands because they can feel these parts moving against the floor. Crawling engages virtually all of the muscles of the body, from the arches of your feet to your abdominal and neck muscles, all of which are used in the process of moving your body forward across the floor. Arm, chest and back muscles are utilized in pulling the arms forward and then pulling the body forward. Quads, hips and hamstrings are worked during the leg movement. This is a workout!
Learning coordinated movement starts here with crawling on the floor. Whether the child picks up the cross pattern movement on their own or they learn it through parent assistance, this is the beginning of that very fundamental movement of a right arm and left leg, left arm and right leg– the movement we use to walk and run, climb stairs and climb hills. When the child learns this by working on the belly crawl, they get all of that helpful tactile information through the limbs and through the torso, laying a strong foundation for more advanced forms of mobility. They also develop a very critical physical piece through crawling– muscle balance. The crawling movement is one of flexion and extension of the arms and legs, pushing and pulling using the flexor muscles, then the extensor muscles. One of the issues confronting many parents of children with Down Syndrome is that they are often advised that the child needs to begin developing trunk strength and tone through sitting because it is this lack of trunk strength and tone that creates the problem with crawling and walking. If sitting were the best thing for the development of the trunk, every adult would have strong backs and great abs. Sitting is not what develops the trunk; crawling and creeping is. The child should not sit independently until they can get themselves into that position independently, which is typically after they have learned to crawl on their tummy and creep on their hands and knees.
Another very significant aspect of crawling involves the integration of sensory input. Crawling provides the brain with what is quite possibly the best integrated sensory input that a child ever receives. This act of crawling sends simultaneous information to the brain from all of the tactile and proprioceptive receptors, the surface receptors, the deep receptors and the proprioceptive receptors in the joints. And not only is the brain receiving all of this input, it is receiving it through the simultaneous input from the movement of the right arm and left leg, and the left arm and right leg. This is very powerful sensory-integrating input. Many children, when they start to move forward on the belly, have to learn where their pieces are before they can really start coordinating their movement. Many start by just pulling with both arms together or both legs together. These children are learning where their arm and legs are. Then with a little time and help they begin to alternate arms or legs, and sometimes they get the arm and leg moving on one side of the body, or leave out one leg. As children go through these phases, they are getting more and more input, developing tactility, strength, tone, muscle balance, vestibular balance function, and proprioception. Furthermore the brain is learning to integrate all of this critical information. Given some time and some help, their brains and bodies can learn all of these critical developmental pieces and establish the foundation they need for all future physical and neurological function. It is also important to note that those children who find it the hardest to crawl need it the most, for they are the ones who really need to put all these pieces together properly.
Some children move through this stage very quickly and move on to creeping on hands and knees. Some children take longer to learn this stage and may need a great deal of extra input to locate their limbs in order to be able to control those movements. This may take longer than parents expect, but is time well spent. Children moving from a good cross belly crawl to a good cross pattern creep on hands and knees are in good shape to move on to developing proper walking. Children moving from rolling to scooting to sitting to walking have not had the opportunity to learn where they are in space and how to move their limbs in an organized fashion, nor have they developed the proper muscle balance or strength. They potentially have not even learned how to focus on close objects or to use their eyes together for depth perception.
Short cuts and quick fixes will lead to later repercussions. Don’t take the chance. Try to do it correctly the first time and avoid thousands of hours of time in the future in physical and occupational therapy trying to overcome the problems that are often created by skipping this critical developmental activity.