If you haven’t caught Part 1 if this two part series, check it out here.  This list consists of more upper body, hand skills, and fine motor suggestions that target bilateral coordination. The list below will provide you with full body, gross motor activities that incorporate bilateral coordination and midline crossing. When we cross our midline (imagine a line that separates the left and right sides of our body), we engage both sides of our brain to communicate and to coordinate movement. Crossing midline is a critical skill for strengthening bilateral coordination and for all of those activities that were mentioned in Part 1 (dressing, reading, writing, walking). When kids do not cross their midline to complete tasks, their movements are static, limited in quality, and they likely have difficulty with general coordination.

If a child has difficulty crossing her middle, you may see the following signs:
–Switching hands frequently to do all things on the right side of her body with Right hand and all things on the left side of her body with Left hand
-rotating her body to approach items on one side or the other
-difficulty visually scanning an object or situation, such as when reading a sentence across a page
-general coordination challenges with the following exercises or activities

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So let’s get on with it. Here are some [more!] bilateral coordination activities that you can do with your kiddos!

0-3 months

As an infant, babies remain in a flexed pattern. That’s why you see those cute little newborn photos with their hands scrunched by their face or their little bum up in the air when they are strategically placed in a basket. Gradually, over the next 3 months, Baby will begin breaking out of that scrunched position. As you might recall, a baby’s motor patterns are largely directed by reflexes that are designed for survival. Notice how each extremity is moving in comparison to the other. Is baby lifting both arms and legs against gravity at some point? Is he showing the movements similarly on both sides?

• cross arms to opposite knee for them
• bicycle legs (watch out for poo!) and legs up to chest and down
• bring their hands together at their middle to “clap” with them
• go ahead and start tummy time!

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3-6 months

I love this age! The cooing. The mouthing. A little less crying. A little more sleep. The exploration! This can also get challenging in that babies want to do more than they are physically capable of. So they can get fussy when trying to “play”.

• supported sitting is so nice as a parent. However, early on, this requires close supervision. There will be spills. Sitting gives an excellent way to encourage core strengthening, body awareness, and spatial awareness, all important for bilateral coordination. Here are a few ways to set up supported sitting:
  –use your body. Sit your babe in between your legs. Make your legs as close together as your baby needs. More support? Legs snug to baby. Less support? Wide legs and your hands can be there to catch any stumbles.
  –use a Bumbo. Warning: these are not for every body or every baby. This set up will require extra towel rolls to help your baby fit or a tray in front to keep her from slouching forward. Also chubby thighs aren’t ideal for this. I’ve not seen many babies that can sit in this safely for a long time without close supervision. You may want to consider an Upseat. Full disclosure, I have not tried these personally, but it is designed by a physical therapist. I looked into them a little more out of curiosity. The Upseat offers an improved position of the pelvis and hips that allows for free movement. If your child has any motor impairments, extreme core weakness, or tone differences, this might be the way to go.
  –try your boppy or nursing pillow. This requires supervision as well because it is a low surface and Baby likely will fall backward
  –consider a large pillow like a Sit Me Up
• tummy time!!! This helps give symmetric weight bearing opportunities through elbows and hands as they push up. When you help Baby get into this position, roll him there and roll him out of it. Be sure to alternate going both ways. Baby will begin rolling himself, and notice to make sure he is going both ways.
• Happy Baby: encourage Baby to touch feet with hands. Help him do this if he is not doing so. This gives excellent body awareness of top and bottom halves and right and left sides.
• Bouncers: ok. I know. There is controversy here. The concerns of bouncers and baby walkers are that they place Baby’s hips into a poor position. Also, it promotes mobility and ambulation before a baby may be developmentally ready, impacting the process. Another concern is that the baby cannot visualize their mobility, which impacts the sensorimotor relationship. A serious issue is safety and that babies can walk into objects or worse, down the stairs! And lastly, if a baby is placed in a walker or bouncer for much of their waking hours, they are missing out on other developmental positions. The benefits of them? Gosh, it’s nice to put Baby in there and go to the bathroom. Or maybe have them in the kitchen in a walker while you brew your coffee. Also have you seen a baby bounce away in a bouncer? It is the cutest!
  The research says: “Evidence against baby walkers is not enough regarding its negative effect on child development.” –Badihian, Adihian, Yaghini 2017
  So my opinion: Use these sparingly. Bouncers can offer the bilateral use of his legs that gives nice input to his muscles and joints. Use allllll of the other positions that we talk about on a daily basis (tummy, back, supported sitting, sidlying) and limit time to 10 minutes at a time and infrequently. If your child has varying muscle tone and is at risk for hypermobility or loose joints, consult your doctor about the choice in using this piece of equipment.
  

6-9 months

Baby can sit up independently or will soon. Hallelujah! There is a sweet spot of time that Baby can sit and is not mobile. It’s glorious. And then crawling happens. Crawling is a HUGE bilateral coordination activity (think: hand, knee, hand knee). 

• for supporting the act of crawling, sit with Baby between your legs as mentioned above. Use your leg as a support under his chest as you help him put his hands on the outside of your leg. Hang out there with hands on one side of your leg and knees on the other side. Gently rock him back and forth for movement and weight shifting. If your leg doesn’t work, consider a foam roller, a rolled up blanket or yoga mat, or a lumbar pillow. (You know, those long, thin decorative pillows that no one knows what they’re for? Those ones.)

9-12 months

Ohhhh get ready. Baby is on the move. Nothing is safe and mobility is the name of the game. If the baby in your life is not mobile at this time, continue to work on the supported sitting and transitions in and out of crawling through the over-the-leg trick mentioned above!

• roll/throw balls– again, make them big and squishy so they are easy to grasp and he uses both hands 
• standing at a surface, try water mats or paint in large zip bags. Place these on top of an ottoman or couch or large chair to encourage standing play. Encourage reaching all parts of the surface to incorporate both sides of her body. Another great place to set her up in standing is at an open cupboard door with plastic containers and kitchen items she can get into!
• push walkers are great for use of both hands and beginning the coordination of shifting weight and preparing to walk
• vertical surface play: you might start realizing that I love this set up for all ages. It is such a great visual tool. For littles at this age, they love being up. You’ll want to use a large surface like a sliding glass door, refrigerator, or a wall. Use foam letters, shapes, or pictures with a little water that then stick on the window and encourage reaching for this. Or use magnets for reaching and grabbing at the refrigerator. Have Baby sit on your bent knees so it looks like she is sitting on a bench. Then she can easily go from sit to stand and go for all of the targets (placed on both her right and left sides on the surface)!

12-18 months

Ok, I REALLY love this phase because they are exploring so much and not acting like a toddler…. yet. At this time, the young toddler is beginning to walk or is mastering walking. Give them grace. There will be lots of spills.

• walking– hold one hand at a time to decrease the amount of support you give. Try push shopping carts or small baby strollers to incorporate pushing, steering, and pretend play!
• swim and water play
• climbing– she may begin climbing stairs in all fours. Encourage alternating legs and hands up the stairs. Down is harder. Feel free to encourage down on her bottom or on her tummy.

18-24 months

Baby suddenly becomes a toddler, seemingly over night. He is more advanced in his skills and is attempting new skills every day. Also he is wanting to be more independent which is so challeng…err, great! With that, there are opportunities to work both sides of the body left and right! (See what I did there?)

• point out and perfect body parts, include specifics like knees, elbows, hands, shoulders, belly button, neck, etc. Start games and songs such as “Head, Shoulders, Knees and Toes”
• On that note, also include Itsy Bitsy Spider, Wheels on the Bus, Little Bunny Foo Foo- All songs that engage both arms and hands.
• Follow the Leader… loosely. A toddler can be pretty terrible at Follow the Leader since her attention is still poor and she is fairly bad at copying motor actions. It’s cute, really. But, start the concept! Practice with “easy” movements. Sometimes, I’ll stretch or do simple yoga and my little one will do her “stretches” next to me. Watching her try to figure out how to make her body look like mine is hilarious and beautiful. Hold easy positions that the child in your life can follow; wide legged stance, one leg in front of the other, jumping jack position, hands on knees, touch toes, etc.
• tub paint! Fingers and feet allowed and welcome! Get messy. This is an excellent way to incorporate both sides of the body, crossing the middle, sensory play, all while you sit back and just let him go for it! If you want to get really crazy, add a little shaving cream. The child will go bonkers. If the child you are playing with likes to eat things or mouth items, maybe wait on this activity…
• stairs practice- up and down, down and up. Likely he is wanting to do this much of the day. Provide close assistance and let him practice, it’s best to do on hands and knees. See below for more details.

2 years

Oh 2. We love you. Right? Right?!?! Two year olds are so fun though because they start being funny! They start finding their niches and interests in play. They’re able to physically do more with [slightly] better balance and stability. Going to the park can be a little less anxiety-producing!

• jumping practice– This is the cutest. She will thrust her body upward, believing she is clearing her feet, acting like she is Michael Jordan. Encourage it. She is coordinating a LOT of her body movements doing this.
• climbing– try small slides, slides at the park, and slanted rock walls. Have him use both hands to hold onto a railing.
• stairs… Guys. I’m not a stairs expert. If my PT friends have edits, please let me know! 😉 This is the age that kids can start using a hand rail and going up and down bringing a foot to meet the other. She may play around with reciprocal stepping (one foot on one step, other foot on the next step), but also her little leg can’t quite successfully make that span just yet. But she may play around. You’ll want to see this improve over this next year to assure equal strength in legs. If she always leads with the right leg, She might have some strength imbalances.
• ball throwing… not yet catching, but encourage having him turn his hands up toward the ceiling and together to give it a go!
• downward dog position. Check out the visual below. (Also, inversion can be a very calming position!) Model this for him and do it together… believe me, it feels amazing.

3 years

This is the time that a child will demonstrate the use of two hands in simultaneous and coordinated actions. You likely will see a dominant hand and leg forming or established at this time, but if you don’t yet, that is just fine! Imitation and body awareness are really coming together nicely at this time, so you can capitalize on this by using lots of new games and tools! This is also a time that they love being like “big kids” so use peers and siblings to your advantage.

• simple yoga. Use this visual printable!! And do yourself a favor, go ahead and do a few of these poses yourself. Your body will thank you.
• riding a tricycle or no-pedal, balance bike
• playing catch– start with large balls or balloons, they’re way easier
• use animal walks to get some movement in your kids’ life. Take turns on choosing the animal and join in. My favorites: Bear (hands and feet), duck (squat walk and flap arms), cat/lion/tiger/cow/dog (hands and knees and make the appropriate noise!), seal (hands and belly and legs drag behind), kangaroo/frog/rabbit (jump far out in front of you), crab (hands and feet with belly toward the ceiling). All of this incorporates both sides of the body and upper and lower portions!
• when cleaning up her toys, encourage to complete in a crab walk position or dog position (mentioned above) and grasp the objects all around and put them in their bins. Encourage crossing his body.

4 years

At this phase, kids are really becoming quite good at tasks. Their skills are becoming more coordinated and they are starting to begin to separate sides of their body to do separate tasks, as seen in skipping.

• introduce ball skills such as bounce-catch, catch, dribble and throw
• bike with training wheels
• zoom ball or a summer version: hydro zoom ball!
• rock climbing, hop scotch, climbing ladders
• swinging and pumping legs
• yoga–Check out Cosmic Kids. He might be ready for more stimulation and direction-following.

5-6 years

By this age a child should establish a dominant hand and leg. And if he has not, encourage this with these tips. Maybe the child in your life wants to do all of the things. Maybe he is timid and observes first. Maybe he has not been exposed to some of the above activities, so these are too challenging. Don’t fret. Meet him where he is at!

• catch with a baseball/softball glove or velcro pads
• encourage jumping jacks, yoga poses with sidedness, ski jumps (two feet jumping over a rope at the same time)
• twister… don’t have Twister? No problem. Just set up targets (paint tape, paper plates taped to the ground, draw circles with chalk, use colored dots, etc) and give directions: “Right hand on the placemat! Left hand on the bubble wrap!”
• wheelbarrow walks, 3-legged, burlap sack races! great for a group of kids that can pair off. You don’t need a burlap sack, just use a tote bag!

Elementary School

These kids are reading, writing, climbing, playing sports and board games, learning independence. Your kid is amazing and awesome. If the child in your life is not yet doing these things, do not worry. Go back to where she is at and work on those skills. Remember to use age ranges only as a way to categorize similar activities. Some kids will never do this stuff, and that’s ok! At this stage, focus on his interests and abilities and go from there.

• batting, tennis, hockey, lacrosse, table tennis, air hockey
• obstacle courses! These can be personalized to what the child is able to do.
• monkey bars
• activities like tumbling, swimming, karate or tae kwon do- these are excellent organized activities that naturally encourage motor actions with both sides of his body
• skipping, Skip-It, hop scotch, jump rope, roller skating or roller blading. I remember one day when I was a kid, I Skipped-It all the way to school. It was only a block, but still! I was so proud of myself.
• hand games with friends! Anyone remember the classics: Miss Mary Mack, Down by the Banks, you know them.

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So there we have it. Holy smokes, lots of stuff (do you see why I split it up into two posts?). Again, I hope you find a tidbit or two between this list and the list in Part 1 to help the kid in your life coordinate both sides of his body, cross midline, and begin to integrate dynamic movements to increase independence in kid-related tasks!

What are some of your favorite bilateral coordination activities?

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The Effect of Baby Walker on Child Development: A Systematic Review
Bilateral Integration: Stages of Bilateral Integration for Reading, Tracking, Writing and Crossing the Midline
Case-Smith, J., & O’Brien, J. C. (2014). Occupational therapy for children. Place of publication not identified: Mosby.
Chandler, B. E. (2010). Early childhood: Occupational therapy services for children birth to five. Bethesda, MD: AOTA Press.
Development of hand–arm bimanual intensive training (HABIT) for improving bimanual coordination in children with hemiplegic cerebral palsy
Early deprivation impairs the development of balance and bilateral coordination