Crossing Midline “Red Flags” in Preschoolers
It has been awhile since I’ve posted a blog. Insert excuses here…So as I was thinking of a topic to write about, I saw an article by The OT Toolbox (which is an excellent resource) talking about ‘red flags’ for crossing midline in preschoolers. You can find a similar article here: https://www.theottoolbox.com/crossing-midline-march-gross-motor/
So, as always, each ‘red flag’ on its own may not be a concern. The best way to assess this is to seek out an OT or PT evaluation to rule out any delays. The earlier that we can get children/babies into therapy, the better the outcomes. This has been studied and proven time and again, here is one example of a long-term study of children with ASD https://www.sciencedirect.com/science/article/abs/pii/S0890856715002567.
We are seeing a shift from the “wait and see” mentality because it takes time away from potential therapies and potential progress. As a parent, if you feel your child is have issues in any of these areas and your pediatrician is not hearing your concerns, advocate for your child, or switch pediatricians. If you get a referral and find that your child is on-target, great, that’s excellent news. In that scenario, it would be an evaluation only, and you would not need additional services. If there is an area of concern, your therapist may recommend additional services.
Crossing midline is a fundamental part of human movement that involves the ability to reach across the body's invisible line dividing it into left and right halves. This skill is crucial in performing various everyday tasks such as dressing, reaching for objects, and participating in activities that require coordination between both sides of the body. Children typically develop this skill during early childhood, and challenges in crossing midline can impact their motor skills, coordination, and cognitive development. When a child struggles with crossing midline, it can hinder their performance in school. This skill plays a crucial role in various activities, such as reading, writing, and physical education.
For instance, difficulties in crossing midline may affect their ability to track words from left to right while reading, leading to slower reading speed and comprehension issues. Writing tasks also become challenging, as the child may have trouble coordinating hand movements to write across a page. Crossing midline is essential for activities that require coordination and bilateral movement, such as throwing a ball, catching, or kicking.
Children with poor midline crossing skills may struggle to participate in physical education classes and team sports, impacting their overall physical health and social interaction. Children who have trouble crossing midline may find it hard to stay focused on tasks that require them to switch between the left and right sides of their body. This can lead to frustration, decreased attention span, and difficulty completing assignments that involve crossing midline movements.
Ok, so potential ‘red flags’ that may present at the preschool age that could indicate issues with integrating motor patterns include the following:
Atypical crawling patterns: Atypical crawling patterns can impact a child's development, including their ability to successfully cross midline. When a child crawls inefficiently or skips the crawling stage altogether, it can affect their bilateral coordination and strength.
Not developing a dominant hand: At the preschool age, a dominant hand should be established. It is common to switch hands on occasion, but you should not see the child using their right/left hand because the item was placed on their right/left side. They should be able to reach across the midline to retrieve the item with their dominant hand.
Rotating their body to retrieve an item: Along the same lines as above, if the child is right-hand dominant and needs something on their left side, they should be able to reach across the midline to retrieve the item. They should not need to rotate their trunk to avoid crossing that invisible midline, or pass the item from one hand to the other at midline.
Atypical skipping and/or jumping jacks: This could manifest as challenges with coordinating the arm and leg movements simultaneously, struggling with the rhythm of the exercise, or displaying discomfort with the jumping motion.. These atypical jumping jacks may indicate underlying issues with motor coordination, sensory processing, muscle strength, or body awareness.
Trouble visually tracking an object: Visual tracking across midline is an important skill that involves smoothly following an object or target as it moves from one side of the body to the other. This ability requires coordination between the eyes and the brain to efficiently process information. Ask your child to follow an item with just their eyes. They should have a smooth gaze across that midline area.
Trouble making a horizontal line: This simple yet crucial task helps strengthen neural connections between the two brain hemispheres and fosters better coordination. Warning signs include switching hands at midline or stopping the line completely at midline.
Difficulty with age-appropriate self-care: We cross our midline multiple times during our self-care tasks. Children should be able to brush their teeth without switching hands or turning their heads to avoid crossing midline. Other warning signs could be having difficulty putting on socks/shoes, or front-opening garments such as a jacket.
If any of these ‘red flags’ resonate with you and your child, I would recommend speaking with your pediatrician about an OT or PT referral. Here are some activities that can help!
I think everything is pretty self explanatory, except the stickers. Stickers are an easy way to work on midline integration. You can ask your child to place stickers in specific spots, or peel them off something. Keeping their bodies still, you can encourage them to reach across their bodies to place or peel them!
