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The Importance of Crossing the Midline + 9 Activities to Try

Apr 10th, 2024 | by Jocelyn Lee, OTD, OTR/L

Jocelyn Lee, OTD, OTR/L

April 10th, 2024

What is “Crossing the Midline”?

Imagine an invisible line running down the middle of your body, dividing it into left and right halves. This is what we refer to as the “midline”. Therefore, crossing the midline is simply moving your arms, legs, or eyes from one side of your body to the other.

Imagine a line drawn from the top of your head, in the middle of your brain, down the center of your eyes, between your arms, down the middle of your belly and separating your two legs; this is your imaginary midline.

What Are Examples of Crossing Midline?

For most of us, we cross midline without a second thought. Throwing or kicking a ball, tying shoes, and opening a door are just a few examples of daily activities that require the ability to seamlessly cross the midline. Crossing midline can present in various ways, here are a few more examples:

  • Reaching for something on the right side of the body utilizing the left hand
  • Rotating your belly to reach behind you and grab something
  • Reading a book from left to right
  • Bending sideways to grasp pants as you pull them up
  • Biking
  • Participating in bilateral fine motor play (stringing beads, connecting legos, squigz, etc.).

Why is Crossing Midline Important?

Did you know that crossing the midline is not just a physical action? It’s a powerful tool that shows both sides of your child’s brain and body are working together. Crossing midline is an important gross motor, fine motor, cognitive, and sensory-based skill and is important to an individual’s overall holistic functional health.

On a physiological and neurological level, for an individual to participate in the above examples, the brain needs to efficiently communicate on both sides of its hemisphere to then pass along motor information to the body to complete activities as desired. If the skill of crossing midline is absent, most kids will have difficulties in their functional activities.

What Does Difficulty Crossing the Midline Look Like?

Children who have difficulty crossing midline may generally look uncoordinated and effortful. They tend to switch hands frequently during tasks rather than reaching across their body. For instance, while painting with their right hand, a child might need to dip their paintbrush into a water bowl placed on the left side. Rather than reaching over, they may opt to switch the paintbrush to their left hand. Furthermore, these children may struggle to establish hand dominance and encounter difficulties with visual tracking.

Here are a few examples that may indicate a disconnection between the left and right sides of the body:

  • While coloring, the child often demonstrates only vertical lines (up and down) and lacks horizontal (left and right) scribbling. Often, children will utilize both hands to color to avoid crossing midline to scribble on both sides of the paper. Further, there is a difficulty with determining the dominant hand, often utilizing both hands equally because the dominant hand is not moving across midline to support in all activities.
  • A child demonstrates difficulty with gross motor movements that require rotation, disassociation of upper extremities and lower extremities, and head orientation to support navigation. An example of this is crawling or walking.
  • If an item is placed on the left side of the body and the child is asked to retrieve it with the right hand, the child will move their full body inefficiently to reach the item with the right hand versus crossing in the middle to grasp items. This can also look like a lot of movement while completing seated tasks to avoid midline crossing.
  • Increased difficulty with dressing, buttoning/zipping clothing due to lack of both hand participation.
  • No interest or participation with clapping hands or playing in the middle with bimanual toys.

Occupational Therapists Are Here to Help

If you are noticing difficulties in your child’s functional participation with approaching the midline, have no fear, your occupational therapist is here! Occupational therapists utilize their expanse knowledge of motor functioning, sensory processing and activities of daily living (ADL)-based approaches to support the connection of brain to body. Contact your occupational therapist with your concerns and begin to develop a plan of care to support your child’s growth. 

9 Crossing the Midline Activities to Try At Home

In the meantime, there are plenty of easy and fun crossing midline activities to incorporate at home right now! 

1. Rainbow Figure 8

Draw a large infinity sign on a vertical surface for your child. Have them stand in the middle and trace it with a different color marker each time for each color of the rainbow. Bonus: Create figure 8’s using arms and trunk or the whole body.

2. Cross Crawls

Have your child bring their elbow to the opposite side knee and repeat! You can do this sitting, standing, or lying down on the ground.

3. Reach for Stickers

Place stickers on your child’s arms so they must use the opposite hand to peel them off. You can also sub the stickers out for clothespins on their shirt sleeves for an added fine motor challenge. Alternatively, place stickers on various parts of the body and identify only 1 hand to retrieve them all. This works the gross and fine motor skills equally as it develops visual motor skills.

4. Simon Says and Twister

Find crossing midline activities in this blog post by an occupational therapist!

Play Simon Says, with adult modeling and specific cueing, such as “Simon Says, touch your right knee with your left hand.” This is a fun game that can involve the entire family. Another great game to consider is “Twister.”

5. Back-to-Back Ball Pass

Sit back-to-back with your child and have them use both hands to hold the ball and rotate their body to pass it to you.

6. Hand Clapping Games

Miss Mary Mack is just one example of a hand clapping game that requires you to cross midline.

7. Yoga!

Yoga is a fun and mindful way to move the body throughout various planes to not only support sensory processing but also create increased body awareness. Yoga poses often include trunk rotation, disassociation of various parts of the body, and the incorporation of deep breathing, which helps the body regulate while in novel movement patterns.

8. Mazes

Find crossing the midline activities in this blog post by a pediatric therapist!

Mazes are a great way to practice the coordination of visual motor and fine motor skills to support the connection of the brain’s processing and the motor skills that occur. 

9. Sorting Games

Sorting games where a child must utilize one hand only in order to sort items into appropriate bins which can be located on both sides of the body or in a semi or full circle.

To wrap this up, imagine completing your day-to-day activities with just one arm. How much can you functionally complete and how efficient would this be for you? This thought reminds us of how important crossing midline is for an individual to fully experience their environments and feel successful in the activities that bring their life meaning. If you have any further questions, comments, or concerns, never hesitate to reach out to your therapy team for greater support and guidance.

About the Authors

In this blog, pediatric therapist shares crossing midline activities to try at home!

Jocelyn Lee, OTD, OTR/L
Jocelyn is an occupational therapist at NAPA Center LA. Outside of NAPA she loves to go on nature walks and get coffee with friends.

In this blog, pediatric therapist shares crossing midline activities to try at home!Sydney Borys, OTD, OTR/L
Sydney is an occupational therapist at NAPA Center Denver. She always knew that working with kids and helping facilitate function and fun was exactly what she wanted to do every day!

About NAPA Center

NAPA Center is a leading pediatric therapy clinic with multiple locations worldwide. At NAPA, we take an individualized approach to therapy because we understand that each child is unique with very specific needs. For this reason, no two therapeutic programs are alike. If your child needs our services, we will work closely with you to select the best therapies for them, creating a customized program specific to your child’s needs and your family’s goals.

TAGS: Blogs, OT
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