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Early Activity System User Manual
Clinical reasons for side lying
Hands and knees is a position which
enables children to move into and
out of other positions. They can begin
to move onto hands and knees from
tummy lying, and then in to a sitting
position. Depending on each child’s
capabilities, some will learn to use
hands and knees as a building block for
movement – they may go on to be able
to tall kneel (hands off the floor), or
even begin to crawl.
Physical goals
In the four-point position, baby is
supporting her body weight against
gravity using her extended arms and
bent legs. This strengthens her hips
and shoulders, which will improve her
ability to sit well, and use her hands to
play. It will also be useful if she later
crawls. This position encourages both
sides of the body to work together – in
doing so, the brain is helped to make
connections between the left and right
sides – the wiring is improved, so to
speak. And when baby weight bears
through open hands, her thumbs are
helped into the right position for using
with the forefinger for a pincer grasp.
Cognitive goals
Weight bearing against gravity, as we
have seen in all positions, helps baby
to understand where her body is in
HANDS AND KNEES
(FOUR POINT KNEELING)
relation to her environment, and also
where each of her body parts are in
relation to the other parts. Therefore,
baby’s spatial awareness, body
awareness and coordination continue
to develop. Some research has also
shown that children who experience
hands and knees activities have a
better sense of object permanence –
the understanding that something is
still there, even if it cannot be seen17.
Sensory goals
The palms of the hands are naturally
sensitive, but some children seem to be
over-sensitive and don’t like to touch
things. While it is normal to avoid
touching things that don’t feel nice
to us, children who are over-sensitive
to touch limit their opportunities for
exploring and learning. Weight bearing
through extended arms and open
palms exposes baby to numerous
sensations and can help to improve
tolerance for touch. Therapists call
this “sensory integration” – speak to
your occupational therapist for further
advice if you have worries about your
child’s sensory tolerance.
