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Stage 3

Have you moved on to the third stage, having mastered the program of the second stage, i.e. have you learned to army crawl, to crawl over obstacles? Welcome! The child is already standing up on all fours, but can NOT do army crawl? It is worth returning to the second stage and mastering this skill.

Tasks of the third stage

  1. Sequential formation of standing up, turns, and crawling on all fours.
  2. Correct crouching from a position on all fours.
  3. Correct sitting.
  4. Standing at support on high knees and feet.

Problems of the third stage

  1. W-shaped sitting.
  2. «Round» back.
  3. Surrogate movement in the stalls, crawling while sitting.

The value of crawling on all fours is difficult to overestimate. In this position, the child develops the skills of relying on straight arms, strengthens the waist muscles of the upper and lower limbs, and develops the ability to alternate movements of hands and feet. As a result, there is an active preparation for standing and walking.
Some might argue that there are children who have learned to walk without being able to crawl. This is true, but according to our observations, this is only possible in relatively healthy children. The process of learning to walk in these babies lasts longer, the percentage of orthopedic problems associated with improper development of the feet, hip joints, and the formation of curvature of the spine is higher. In the end, nature still takes its course: these babies learn to crawl independently, already knowing how to walk. Also, children who «missed» the stage of all fours are more likely to have impaired speech development and fine motor skills.
It should be noted that in most cases, the stage of crawling on all fours «falls out» due to the actions of parents themselves. This is facilitated by early untimely start of sitting (in pillows or with support on back), standing (at support) and walking (in a walker, armpits, both handles), frequent position on the hands («tame» child), rare presence on the floor. A positive test for traction (when a child tries to sit down and then stand up from a lying position on back while pulling on the handles) is considered by many parents (not without the help of doctors) as a signal to start training standing and walking.


After some (relatively short) time, the child gets used to the vertical position with support on the legs that the position with the load on the hands begins to perceive negatively. A frequent result of this scenario is the formation of increased tone in the legs, which is expressed in the setting the foot «on tiptoe», the valgus position of the feet (support for mainly internal surfaces of the feet), excessive straightening of the legs in the knee joints. When you try to put such a child on all fours, the child will immediately jump out to belly, trying to straighten legs.

Often parents motivate the refusal to let the child on the floor by the fact that the floor is cold, the apartment is close, there are pets. In this situation, a child's mobility is limited and the habit of independent actions does not develop.

So, according to the ideal development algorithm (IDA), the next skill after the ability to crawl over obstacles in the prone position and stand up on all fours is turns on all fours. Making steps with the hands to the sides, the child learns to turn their body. This can be facilitated by an attractive object located on the side. A wall in front of their face or standing on all fours with their face in a corner (a «boring» corner) can also encourage you to turn to the side.
The ability to turn the body using steps with the hands to the side opens the opportunity to develop forward movement (crawling on all fours) and transition to a sitting position.


Formed crawling on all fours is normally always reciprocal: left hand – right leg, right hand – left leg. The child goes gradually to crawl on all fours fully. A few steps on all fours and then on their bellies. Gradually the movement on belly is completely stopped, and the hands and knees alternating with seated.


Properly developing a child in the position on all fours has the feet that always located below the knees. This important feature is a consequence of a physiologically balanced tone of the hip muscles. It is always easier to move to the sitting position from all fours, pushing with your hands, moving the body and pelvis to one side. This position is called the «snake». Normally, the child sits in the «snake» in the direction opposite to the turn of the head. The process must be symmetrical. Crouching in the right «snake» (right leg in front), the child acts with the left hand (on the right rests). As the friendly actions of the hands, body, and thighs improve, it becomes necessary and possible to act simultaneously with both hands. In the «snake» it is not very convenient to do this, and the child turns the second hip out (the « Buddha» position).


For a child who develops in accordance to IDA, it is comfortable to sit on the floor ONLY in the «SNAKE», acting with one hand, and ONLY in the «BUDDHA», using both hands for manipulation.


Sitting with straight legs at the knees and, especially, in a W-shaped position indicates a deviation from IDA, disorders of muscle tone; it is always a reason to look for problems. The sitting position with straight legs is usually accompanied by a rounded lumbar-thoracic section and a re-bent neck. In most cases, this position is typical for children, who began to put on their feet in the absence of the ability to army crawl. Their muscular corsets have not matured, and their shoulder girdle has not been formed by crawling.


The direct cause of the formation of the W-shaped seat is the internal rotation of the hips. In a position on all fours, the lower legs are parallel to each other or the feet are wider than the knees (often with the toes looking out). This pathological position is extremely stable: the area of support is large, the hands do not need to rely on.


The ability to sit on the floor alone ONLY in a W-SHAPED POSITION is one of the basic signs of CEREBRAL PALSY and a number of severe neurological disorders. Fighting the W-shaped position is an important element of the technique. In addition to the exercises performed, it is necessary to create conditions that make it impossible to sit down in this pathological position. «CATERPILLAR» allows you to sit in the «snake», but makes it impossible to rest lying down. The «TUBE» does not allow you to sit down, but it does not prevent you from resting on one’s belly. Both devices stimulate the supporting function of the hands, significantly improving their functionality.


In this section, it is also necessary to mention such surrogate methods of movement as crawling with simultaneous steps with two hands and (or) legs (squirrel jumps) and crawling in a sitting position on the bottom. The first variant is a component of mainly spastic forms of cerebral palsy, and the second is inherent in the hemiparetic form of cerebral palsy.


For the correct development of crawling skills on all fours, you need to prepare hands, body, and hips (the division is conditional for easier perception). Sufficient degree of development of movements coordination, balance, and psychological readiness for an elevated (relative to the position on belly) position are provided by the implementation of the tasks of the previous stage.

The hands should hold the weight of the body with straight elbows and grip on the adult’s fingers or clothes (grip function) and keep the body weight and head in support of the open hands also with straight elbows (support function). To develop grip functions, we perform all types of «monkeys». To develop the support function, we perform the «snake» and «seal».

The corps should hold the body in a sitting position without the participation of hands, ensure the transition of a child from a position on all fours to a sitting position in the «snake» and «Buddha», from a position on all fours to high knees. Extensor capabilities of the body (straight back) are formed by performing «rider», «seal», «swan», «Buddha»; flexor – «monkey», and lateral stabilization is achieved by «snake», oblique versions of «monkey» and «buddha».

The hips are involved in providing actions on all fours, sitting, standing up on high knees, standing up on the feet with one leg. The balance of their flexion and extension activity is formed by the exercises «snake», «spider», «Buddha», «low start».

EXERCISES OF THE THIRD STAGE

3.1 «Snake».
3.2 «Monkey».
3.3 «Spider».
3.4 «Rider».
3.5 «Swan».
3.6 «Buddha».
3.7 «Seal».
3.8 «Low start».
3.9 Transition from fours to «Buddha».

3.1 «Snake»
Performed on a non-slip surface. From the position of half-sitting on the side, one leg is brought out with the foot forward, the other with the foot back. The body leans forward, forming support on the hands. Attempts to change the position are prevented by fixing the pelvis and tilting the body. Gradually, the position is fixed independently. We distract the child from the front, increasing the fixation time. We offer interesting items for manipulations with the foot facing back. Alternate sides. The ability to raise both hands while still sitting means completing the tasks of the exercise and moving to other sitting positions.


3.2 «Monkey»
In the third stage, all the variants of the «monkey» are united by the control of the straight elbow. The child learns to focus on the fingers of the hand without involving the flexor muscles of the forearm. The angle of the body is 45 degrees or more, the hand is turned with the palm to the face.

3.2.1
Wearing with a tilt towards the child, stimulating self-retention by grasping the clothes.


3.2.2
«Monkey» without the support of the back and pelvis with alternate grip for one index finger and control of the arm straightened at the elbow.


3.2.3
Oblique «monkey» with insurance for the hip.


3.3 «Spider»
It is performed on a non-slip cushioning surface. Exercise is relevant when the muscle tone of the femur anterior surface is increased. This is manifested by the need to straighten (often with force) the legs in different positions, crawling on belly without legs (crawling «like a mermaid»), jumps from belly to the position on all fours. In most cases, this behavior is observed in children who are accustomed to premature verticalization with the support of their feet.

The child's feet are parallel to each other, if necessary, fixed with the pinkies of the hands. The heels are pressed to the surface. The knees are wider than feet. With your thumbs or chest and belly, hold the child's body in a forward-leaning position with the support of your hands. Exercise is contraindicated in severe hallux valgus deformation of the feet.


3.4 «Rider»
The exercise is performed astride with the thrust to feet and fixing on the hips and pelvis. In parallel, we offer the child interesting items for manipulation.

3.5 «Swan»
The exercise forms the correct setting in the sitting position (hips turned outwards, lumbar lordosis). It consists of two consecutive phases. In the first phase, from the initial position, sitting in the «Buddha», we tilt the child's body forward, holding the hands with the hands back and palms down. In the second phase, we allow (force) the child to begin to straighten, fixing the lumbar region in a state of 30-degree tilt. The impossibility of rectifying means unwillingness of the child to sit without the hands' participation and lack of army crawling practice.


3.6 «Buddha»
This is the normal position that the child takes when sitting independently. The back is straight, the lumbar lordosis is pronounced, the knees are bent and look out. If the child is inclined to sit with straight legs, round back, in the W-position, only with the support of the hands, then we create a physiological position with the help of the « Buddha» exercise. In the sitting position on the hip, we hold the child's feet with the soles directed to each other, while simultaneously turning their socks to themselves. The angle in the child's knees is 45-90 degrees, the back is tilted forward. Possible attempts to recline the body are prevented by tilting your own body forward.


3.7 «Seal»
The exercise provides the formation of the hands supporting function. It is performed in different versions. The goal is to teach the child to alternately move their hands, straightening them at the elbows (to stamp).


3.8 «Low start»
The exercise helps to form the skill of crawling on all fours with alternating steps of feet (fighting with crawling like squirrel jumps) and the skill of getting up at the support with one foot. From the initial position of standing on all fours forward to the position of support on the foot, the legs are taken out in turn and fixed. By frequent repetitions with a change of legs, we achieve independent standing in this position.


3.9 Transition from fours to «Buddha»
As the third stage of the exercise is mastered, the child in most cases independently learns the transition from a position on all fours to a sitting position in the «Buddha». If the development of this skill is delayed, we encourage it. Slowly pulling the child's hands behind the pelvis and to the side, we sit him on the hip. We help to expand the second hip outwards.


EVERYDAY ROUTINE. EVERYDAY ROUTINE COMPONENTS OF THE THIRD STAGE

  1. Independent activity.
  2. Position in the arms of an adult.
  3. Sitting: on the floor, on a chair, in a stroller, on an adult's lap, on a potty.
  4. Position for feeding.
  5. Position for bathing.

Independent activity

Independent activity is advisable only on the floor. It is necessary to take care of child’s safety, eliminating drafts, removing small objects, and everything that can fall, and that can be dumped, silencing sharp corners and sockets. Wet cleaning is required daily. The larger the area, the better. Restriction of mobility is harmful. Not useful and often harmful are any structures that make it easier to get up: Swedish stairs and everything that you can cling to. There should be fewer toys on the floor and more obstacles for crawling over.

Position in the hands of an adult

For wearing we use: «monkey» with an independent grip on adult’s clothing, «crane» front and side, oblique position, SLING, Ergo child.


Sitting

Any sitting position should not be too comfortable - it should force the child to change position more often. It is highly undesirable to use comfortable backrests and everything that replaces them when sitting. It is important to use the right chair, the right stroller, and the right potty. Relevant positions: «Buddha» on the floor, «Buddha» on the knees, «rider».

Position for feeding

Feeding in any of the sitting positions

Position for bathing

Bathing in a bath with a gradual increase of depth, stimulating standing up on all fours, and moving to a sitting position.