Thursday, October 11, 2012

Therapy Thursday: All About the Crawl

Like any other parents, we are excited when our children reach their milestones.  Our son Wyatt, who has Down syndrome, is no exception.  However, with his cardiac issues and his prematurity, he has some added challenges that even his peers with Trisomy 21 do not.  At this time, at almost 20 months of age, he can expertly commando crawl, sit up on his own and has begun grasping the edge of things and attempting to peep over.  He is not pulling himself up, standing or creeping.  At times it can become frustrating and it begs the question:  is there something that we can do to "speed up" this process?  Right along side this comes the parental guilt:  are we doing the right things for our son?

There is a lot of literature out there about treadmill walking;  I will not deny that the research looks promising, especially with getting kids who are creeping (on their hands and knees) to the walking stage weeks earlier. As it turns out however, commando crawling is an extremely important stage of development that helps map and incorporate all the senses and should therefore be given as much attention as possible. 

When a child learns to crawl on their stomach, they:
  • learn to focus their eyes on near objects
  • discover the placement of their torso, legs and arms through tactile stimulation with the floor (develop proprioception - the awareness we have of our limbs as we move them)
  • Use almost all of the major muscle groups
  • Learn co-ordinated movement (especially 'cross pattern movement' of right leg, left arm then left leg, right arm)
  • Learn muscle balance (the ability to steady one's self using their muscles, primarily those in the 'core')

Co-ordinated movement is very important as it is a skill that we use all our lives.  Developing 'cross pattern movement', that is the ability of simultaneously moving the right foot and left arm, then the left foot and right arm, is used in all forms of human movement, including walking.  During belly crawling, the arms, legs and torso receive sensory (tactile) information that helps the child improve their development of such movement.  Almost all the muscle groups are used and it is only by learning to alternate the flexion and extension of their joints that the child will crawl.  The more the muscles are used, the stronger they become and in turn, the stronger the crawling becomes.  It is in this way, the child develops their arms, legs and trunk;  in conditions such as Down syndrome where there is lower muscle tone and looser ligaments, this is a very important stage.

As mentioned previously, crawling utilizes tactile and proprioceptive receptors throughout the body.  The information received by these receptors during crawling comes simultaneously from both the right and left side of the body.  As the child becomes more adept at crawling and integrating this sensory information, they further the development their tactile senses and in turn continue to develop their muscle tone even further. As well, they develop muscle balance, learn to use utilize vestibular balance (balance that is monitored by the sensory system in the inner ear) and continue to develop their proprioception.  The more all of this is developed, the stronger the muscles and sensory connections become. 

Some children with Down syndrome may take even longer than their peers to progress from a commando crawl to a creep as they may require more input and time to make the necessary connections.  However, continued practice has shown to provide a strong foundation for future movement.  Wyatt is one of those children.  Allowing him to continue practicing his crawling and encouraging him to creep (along with his other exercises, such as weight bearing) will only strengthen his motor and sensory skills and give him the best possible practice for when he does begin to walk. 

Abdel Rahman, Samia A., and Afaf A M Shaheen. "Efficacy of Weight Bearing Exercises on Balance in Children with Down Syndrome." Egyptian Journal of Neurology, Psychiatry and Neurosurgery 41.1 (2010): 37-46. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. Web. <>.

Bruni, Maryanne. "Occupational Therapy and the Child with Down Syndrome." Down Syndrome: Health Issues. News and Information for Parents and Professionals. , 2001. Web. <>.

Doman, Robert J., Jr., and Ellen R. Doman. "Down Syndrome: The Importance of Crawling on the Stomach." The NACD Foundation 22.12 (2009): n. pag. The National Association for Child Development. Web. <>

Winders, Patricia C. "Physical Therapy & Down Syndrome." National Down Syndrome Society. National Down Syndrome Society, Web. <>

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  1. Thanks Bubblez! I anxiously await your questions!

  2. I read/heard somewhere that crawling is not as important a milestone in some other cultures places, and that babies in other parts of the world tend to skip it in favour of walking. It makes sense if you think your kid is going to be in a less safe/hygenic environment (say, the floor of a mud hut or something). Still, I'm on the same page as you.. crawl before you walk, walk before you run. BTW, the Lightning Kid started crawling too! The progress was *ahem* lightning fast, from nothing to commando, to hands and knees. Go Wyatt!

  3. As a retired Occupational Therapist, who worked in early intervention, I love your blog (and I voted for you in the circle of 25 every time it would let me). You say what many parents I have known (not only those with children with Down Syndrome)should say. As to Crawling, all of what you said is true but one thing you left out that is also very important is that a crawler (in any style) is able to move around his environment independently. If he is efficient in one style he will be reluctant to move on to a less efficient (read fast) style because he is not sure that he will still be as independent. He does what is easiest to meet his needs.

    1. Thank you, for your kind words. It is true, kids with DS don't want to move on to new things as easily; Wyatt gets lazy/stubborn when we try to show him creeping. Thanks for pointing it out!


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