Developing Independence

Your child’s body grows better when you give the child good food. Your Child’s brain grows better when you do five simple things that feed the growing brain. 

• Respond - You notice your baby’s needs and feelings.
  • This switches on your brain and body to connect to your baby.
• Cuddle and Engage - Your baby picks up signals from your body when you are close together.
  • This switches on the baby’s brain and body to connect to you.
• Relax - Settling and calming yourself settles your baby.
  • The brain works best when we are calm and alert.
• Play - Your face, your movements, and your tone of voice all stimulate your baby’s brain.
  • Playfulness promotes healthy development at all levels of the brain.
• Talk - Human brains need language in order to work properly.
  • All the words, sounds, signs, symbols, or objects that you use to communicate build patterns in your baby’s brain that will help them to make sense of their life.

Tummy time is a great way to help build your baby's upper body strength. You can start doing tummy time from birth by lying your baby on your chest (but only do this when you are wide awake and unlikely to fall asleep). Gradually increase the amount of time you do this day by day. Then when your baby is ready, try doing tummy time on the floor.

Tummy time helps strengthen the back, neck and shoulders, as well as giving them a different view of the world!

My baby doesn't really enjoy tummy time!

Don't worry, this is very normal for lots of babies. If you've been trying to do tummy time on the floor and your baby isn't really that keen you could try:

• lying your baby on your chest, or lap
• putting some toys out within easy reach
• talking, singing, interacting with your baby
• propping your baby up a bit by putting a small, rolled-up towel under their arms

Try doing this every day, for a short amount of time, you'll gradually build tummy time until your baby is used to it.

Only do tummy time when your baby is awake and alert, and you're there to keep an eye on them.

Aim for around 20 to 30 minutes a day of tummy time by the time your baby is 3 or 4 months old, until they are able to roll over on their own.

Babies learn to roll so they can explore their environment and learn to move to toys outside their reach. 

Rolling develops the muscles in your baby’s tummy and back and this will help them gain the strength they need to sit and move between positions. It allows them to explore and gain new experiences, which helps with other areas of development.

How can I encourage my baby to roll?

It’s important for your baby to spend lots of time every day on the floor playing in different positions. Placing toys just out of your child’s reach around them on the floor will encourage them to try to roll.

Ensure your child isn’t always placed under a baby gym when they’re on the floor, where toys are in easy reach above them. Avoid placing them in any type of seat – including bouncy chairs, push chairs, car seats, door bouncers and baby walkers – for long periods, as this may prevent them from learning how to roll.

How often should I practice rolling with my baby?

Encourage your baby to roll throughout the day. If you’re moving them from their front to their back, or from their back to their front, help them to roll rather than picking them up and placing them.

Rolling from tummy to back

Babies usually first learn to roll from their tummy to their back by pushing up unevenly on their hands and rolling to one side. It’s really important to place your baby on their tummy to play frequently throughout the day so they have the chance to practice this skill.

Rolling from back to tummy

• With your baby lying on their back, gain their interest in a toy and then place it to the side of their head
• Hold the leg on the opposite side of the toy at the knee, and slowly bring it across their body so they roll onto their side and then onto their tummy towards the toy
• Do this slowly so your baby can join in with the movement and do some of it for themselves
• They might need some help to bring their arms out in front if they get trapped underneath them as they roll

How can I encourage my baby to sit?

Sit with your baby on the floor, supporting them around their body

• Put toys in front of them for them to play with. Babies need to prop themselves up on their hands as they learn to sit. You can help them learn this by placing sturdy toys in front of them to lean on
• Give them as little support as they need so they use their tummy and back muscles
• As they improve, you can move your hands from their body to their shoulders or their hips. You might like to sit your baby in a play ring to give them some support. Place toys in or on the ring so they can play

How can I help my baby learn to get from lying to sitting?

• Start with your child lying on their back. Grasp one hand and bring their arm up towards you across their body
• They should start to push off the floor with their other hand and help get themselves into a sitting position
• You can do this throughout the day whenever you want to help your baby move from lying to sitting, so they get regular practice and start to understand how to move position by themselves
• Avoid holding both their hands to pull them up as this means that they can’t push up for themselves

When to ask for help

If they can't roll to either side by around six months, or they can't temporarily hold a sitting position by around nine months, and you’ve tried all of these techniques but you’re still not seeing any improvement after a few months, please speak to your health visitor or GP.

If they can’t get from a lying to a sitting position by twelve months, please speak to your health visitor or GP.

Self-help and other support

NHS guidance video: What can I do to encourage my baby to sit and crawl?

Take a look at the Association of Paediatric Chartered Physiotherapist's leaflet Promoting Physical Development: Lying to Sitting.

Crawling

Your baby will probably start crawling (although not all babies crawl – some shuffle around on their bottoms) at around 7 to 10 months. These are exciting times for you and your baby – plus it gives them a bit of independence and a chance to explore their surroundings. Can you create a space in your house where your baby can explore safely? 

During a baby’s first year, they will gradually gain coordination and muscle strength, and learn to sit, roll over and crawl. The next phase is to pull him or herself up to standing, initially with support and then it's a matter of gaining confidence and balance in order to prepare for walking. Babies who bottom-shuffle tend to walk later than babies who crawl.

Take a look at the 5 ways to encourage crawling tips from Pathways.org

If you're worried that your baby isn't showing any signs of moving by 12 months, ask your health visitor for advice.

How can I help my child to stand?

You can hold your child supported in a standing position from an early age. This allows them to experience the feeling of their body weight through their feet. They may bounce up and down, which develops the strength in their leg muscles.

You can stand your child in many different ways, for example on your lap when you’re sitting in a chair, in front of a coffee table or sofa, or on the sofa cushion next to you with their back against the back cushions.

As they get stronger, they’ll need less support from you and start to use their hands on the furniture to support themselves more. When they can stand briefly without holding on, they’re ready to learn to step along the furniture or ‘cruise’.

How can I help my child to learn to pull to stand?

Babies pull themselves to standing at furniture to prepare for standing without holding on and eventually walking.

A child may start to pull to stand as early as nine months of age or as late as 18 months. Children who bottom shuffle rather than crawl are often later in pulling to stand. At first, they’ll be unable to get back down to sitting in a controlled way, and will ‘plop’ back onto their bottom.

• Kneel-sit on the floor in front of a sturdy coffee table or low sofa. Place toys on the furniture
• Sit your child on your knee with their feet on the floor
• Encourage your child to reach forward and hold onto the furniture
• Put your hands around their hips and help them into a standing position by moving their hips forwards as they straighten their legs
• You could also start by placing your child in a kneeling position

What can delay my child’s walking

It’s important for your child to spend lots of time every day on the floor playing in different positions.

The Association of Paediatric Chartered Physiotherapists doesn’t recommend the use of baby walkers and door bouncers. Baby bouncers and baby walkers can actually delay a child’s ability to learn to pull to stand and to stand without help. This is because they support the child in a position they’re not developmentally ready for and don’t allow the child the opportunity to develop strength in the right muscles. Because you have to lift them in and out of the equipment they can’t learn how to move in and out of standing for themselves.

How can I help my child to take their first steps?

Once your child is confident in standing, they’ll be keen to explore by taking steps. They will usually side step along furniture first.

As they stand at a coffee table or sofa, place a toy just out of their reach. This will encourage them to try and step sideways along the furniture towards it.

Walking along furniture helps them develop strength and balance.

As their confidence increases, they’ll hold on with one hand only and eventually let go. You can walk along with your child holding their hands until they’re ready to let go.

Push-along toys can be fun as a child moves from cruising to walking independently. Heavier wooden trolley style toys give them more stability than lighter plastic ones.

Walking patterns vary from one child to another. It’s easy to feel concerned about the following things, but they’re all normal variations that don’t need checking by a physiotherapist:

• Flat feet: All children are born with flat feet; the arch of the foot develops gradually over the first 10 years of life, and 20% of six year olds still have flat feet. There’s no evidence that insoles will help an arch to develop, but they may be useful if a child is experiencing foot and ankle pain when they walk.
• Intoeing: This is where the knee and foot turn inwards when a child stands. It’s common, and happens to girls more than boys. Often children who intoe sit in a W kneeling position to play. Intoeing tends to improve gradually up to the age of around eight, and in many cases will resolve completely without treatment. The child doesn’t need to be seen by a physiotherapist unless they’re having difficulty walking or running. Encourage them to sit cross legged rather than in a W, and to take part in sports. Don’t ask them to try and correct the way they walk
• Bow legs: This is when there’s a larger gap between the knees than the ankles when the child stands. This usually corrects naturally by the time the child is three. They don’t need to be assessed by a physiotherapist unless one leg appears bowed while the other one is straight
• Knock knees: This is when there’s a larger gap between the ankles than the knees when the child stands, and it’s common in children between the ages of three and eight. This usually improves over time without treatment. They don’t need to be assessed by a physiotherapist unless one leg appears more bent than the other, or if the gap is very large
• Curled toes: This is when the toes are not straight and is common in young children and often runs in families. No treatment is needed unless there’s pain, or a change in the skin or nail
• Toe walking: This is when a child walks on their tiptoes. There are many different reasons why this might happen, and it often runs in families. If it interferes with the child’s daily activities please ask our Health Visitors for advice 

You can find lots of information and advice on the Association of Paediatric Chartered Physiotherapist's website including advice on:

• Baby walkers
• Footwear
• Flat feet in children
• Intoeing gait
• What parents should know about flat feet, intoeing, bent legs and shoes for children

When to get further help

If at around six months when lying or standing they either hold their legs in a stiff position or in a very relaxed ‘froglike’ position, or by nine months they lift their legs up when you place them in a standing position, please speak to your health visitor.

If by twelve months of age if they find it difficult to pull up into a standing position because their legs are stiff or they walk on tiptoes, please speak to your health visitor.

If they can’t stand from the floor without using furniture for support by two years old, please speak to your health visitor or GP.

Using a potty is a new skill for your child to learn. It's best to take it slowly and go at your child's pace. Being patient with them will help them get it right, even if you sometimes feel frustrated.

Children are able to control their bladder and bowels when they're physically ready and when they want to be dry and clean. Every child is different, so it's best not to compare your child with others.

Bear in mind that most children can control their bowels before their bladder.

• by age 1, most babies have stopped doing poos at night
• by age 2, some children will be dry during the day, but this is still quite early
• by age 3, 9 out of 10 children are dry most days – even then, all children have the odd accident, especially when they're excited, upset or absorbed in something else
• by age 4, most children are reliably dry during the day

It usually takes a little longer for children to learn to stay dry throughout the night. Although most learn this between the ages of 3 and 5, up to 1 in 5 children aged 5 sometimes wet the bed.

Further advise is available on our potty training page

As soon as your baby starts solid foods, encourage them to be involved in mealtimes and have fun touching, holding and exploring food.

Let them feed themselves with their fingers when they want to. This helps develop fine motor skills and hand-eye co-ordination.

Your baby can show you how much they want to eat, and it gets them familiar with different types and textures of food.

Offering your baby finger foods at each meal is a good way to help them learn to self-feed.

As they get older your child will watch and learn from you how to use their spoon, then forks and knifes. Using a knife and fork will help their hand eye co-ordination develop. They need this for skills like handwriting too, so it is important they get plenty of practice.

Learning to sit still at mealtimes is an important skill. It is good for building concentration and social skills.

You can make this a family habit by all eating together as often as you can. It is great if you have a table to sit at together. If you don’t have a table you can still have mealtime rules – where everyone sits together and the TV and all screens are off. 

Eating together as a family is a great way to model good eating habits to fussy eaters. This also gives you all the space to talk and listen making mealtimes more enjoyable and social.

Developing cutlery skills:

• Eat at the same time as them so they can copy you
• Use the right sized cutlery, e.g. child-sized cutlery or chunky cutlery for a better grip
• Make sure they’re sat high enough that they can comfortably prop their elbows on the table, their feet are supported and their bowl or plate is on a non-slip mat
• Introduce a child sized spoon between nine and 12 months old and letting them play with it and get used to the motions of eating by feeding their toys. When they’re confident, let them use the spoon during meal times and use your hands to support their elbows and guide their hands
• Introduce a child sized fork once they’re confident using a spoon. Start by loading the fork for them and using your hands to guide them
• Give them foods that will stick to the spoon, e.g. porridge, mashed potato and puddings, or are easy to stab with a fork, e.g. fruit or cooked vegetables
• Give them a fork and a spoon to practice with a piece of cutlery in both hands

Drinking from an open cup

• Start with a cup with two handles to help them hold it. Once they’re confident with this, introduce a cup with handle and eventually a beaker they need to hold with both hands
• Fill the cup half way with thick drinks, e.g. smoothies, milkshakes and yoghurt drinks, to give them more time to practice their lip seal around the cup
• Slowly help them lift the cup to drink from. Once they’re confident, start giving them less and less help
• Giving them a see through or tilted cup so they don’t have to tip their heads back as far

Independent dressing is a complex activity and a skill that takes us years to learn and refine. Before learning to undress, dress and use clothes fastenings, such as zips and buttons, a child needs to develop the following skills: 

• Understanding and controlling the body’s movements. 
• Understanding where the body is in space and how to coordinate each part of the body in turn
• How to plan, remember and sequence a series of instructions and movements. 
• How to make use of the intricate movements of the hands and use a variety of grasps and finger movements.
• How the body (and particularly the hands) can effectively feel and discriminate one touch or piece of clothing from another. 
• How to process the information received from the eyes and coordinate this with the body movements to successfully manage the task.

Pre-Dressing Activities 

• Using a large shirt or smock, let your child get ready for wet play, painting or cooking. 
• Matching sock game = place a variety of socks in a pile, then take turns in finding pairs and putting them on Package wrapping = make parcels and tie them up with different sorts of ties.
• Play ‘Simon Says’ and get your child to identify various body parts and do the ‘hokey cokey’ to learn left from right. 
• Complete threading activities = get your child make their own pattern and then step it up by asking them to copy a pattern of various sized beads on thread. 
• Posting coins = using a pincer (finger and thumb) grip to post coins into a money box will help develop pre-button skills.
• Completing jigsaws and inset puzzles will help with visual skills. 
• Foot massage = this will give your child awareness of their feet. This can also be achieved by walking on various surfaces barefooted, grass, concrete, etc. Do these as a preparation for putting on shoes and socks, tying shoelaces.
• Clothes pictures = make a picture of different items of clothing to talk about with your child; these pictures can then be used as a reference point for future dressing sessions.

What can help develop?

• Take your time to practise these skills. 
• Start practising with undressing first, as it is easier to take clothes off than to put them on. 
• Show and talk to your child about what you are practising. 
• With older children, encourage self-monitoring, for example “tell me why that went wrong?” or “what worked?” 
• Encourage your child to check in the mirror that clothes are put on correctly. 
• Organise drawers and put picture labels on them to help your child choose their own clothes.
• Encourage your child to try independently first before helping.
• Avoid difficult or tight clothing or many layers of clothes. 
• Help your child by guiding their hands. Initially, help your child and then withdraw the support as they become more independent. 
• Minimise distractions. Practise somewhere dry, light, warm and relatively quiet to maximise the opportunity for your child to concentrate fully on the task. 
• Consider using a sticker reward chart to help with motivation.  
• Take the struggle out of dressing by using larger zips or attaching a rubber band or a piece of string through the zip pulley to give your child a better grip. 
• Give your child jogging bottoms with elastic waistbands instead of jeans with zips and buttons.
• Use no-tie lacing systems (e.g. Hickies or Greeper) instead of traditional shoe laces to make shoes ‘slip on’ or loosening and fastening the laces easier.

Problem Solving: 

• Your child cannot find the arm/head holes in the clothes – put out the clothes, in front of your child and show how to put the arms in first and to then pull it over the head.  
• Clothes are put on inside out – try and use clothes with contrasting colours or textures on the in and outside. Put labels/name tags on the inside of clothes and teach your child to find the label.
• Clothes are put on back to front – lay out the garment face down. Add small labels to clothes to indicate front/back and left/right. Choose clothes that have pictures/logos on the front.
• Socks are twisted with the heel over the top of the foot – avoid very tight socks. Use socks with contrasting colours for the toe and heel. Use tubular socks if the difficulty persists. 
• Putting clothes/shoes on the wrong feet/parts of the body – make sure that your child has an understanding of the body parts and the directions left/right. If this is an issue speak to your Occupational Therapist for advice if needed. 
• Teach your child to dress in the same sequence every day. Encourage the child to tell you what an item feels like when it is on. Is it comfortable? Is it lumpy? Enable the child to feel for clues that an item is correct and encourage them to adjust it themselves until it ‘feels right’. 
• Tying shoe laces – start by teaching your child how to tie a knot. You can do this using a lace board or an actual shoe. Using the “bunny ear” method is easier to start with, where you make a loop with each shoelace and then tie these together in a knot