Creeping: A Vital Developmental Stage

We have covered crawling, which is flat on the floor on your tummy. Now we are going to go over the very important stage of creeping on hands and knees. For the great majority of children with brain injuries, it is easier to learn to creep than crawl. This is not to lessen the importance of crawling. Crawling is the preparation for creeping. The more the child crawls, the more likely it is to be easier for the child to learn to creep. 

Like crawling, it is essential the child continues to be patterned. Cross pattern movement is a function of the midbrain. Creeping is a function of the midbrain. Patterning in a cross pattern is saying to the child’s brain, “This is how to creep on your hands and knees. This is how to creep on your hands and knees.” 

To be able to creep, it is neurologically necessary for the child to have some balance. When the child is crawling, it is impossible to fall because the child is already flat on the floor. But when the child pushes up in the quad position (on hands and knees), the child is in a three-dimensional situation. It is possible for the child to fall. Well babies will fall and sometimes be startled and begin to cry. For the child with brain injury, we want to provide them with a Balance Development Program. 

The why’s of the Balance Development Program are explained in the book, Fit Baby, Smart Baby, Your Baby, On our Institute's Developmental Profile, creeping is Level 3 in mobility. In the chapter about creeping there is information about the Passive Balance Development Program.This program in the book is easy to do and the great majority of children love it. Follow the program as laid out in the book. As always, begin with very brief sessions, perhaps only 15 seconds and do these throughout the day as an award. The children love the activities. For example, if the child crawls to you, you can then pick her up and spin her around as an award for her effort. Your well children will love these activities as well. Do them throughout the day so the brain feels how it feels to orient itself and the body in time and space. 

These activities are designed for small children. For larger brain-injured children they may be hard to do. In a situation such as this  it is possible to do passive rolls.These are very effective in terms of improving balance as well. This program is explained in the Fit Baby book as well. In the chapter about Level 5 in Mobility it describes how to do the passive rolls. We do log rolls and forward rolls. We begin passively, which means that parents do all the work and move the child through the rolls. This is always done on a good quality gymnastics mat. Then parents go on to move the child through forward rolls. For larger children two adults may be required. The results can be very much worth the time and effort. 

These passive rolls not only help to develop balance but all vision and overall spatial awareness. After many months of doing the passive rolls many times spread throughout the day, as explained in the book, we begin to transition to active rolls. This means the child learns how to do the log rolls independently. At the same time the child is learning to do the forward rolls independently. This usually takes longer. The child is on his hands and feet looking down. Encourage the child to “walk” his feet towards his hands. As he steps forward his weight shifts forward. With a little push by mom or dad he will flip over having done his first forward roll, or somersault. 

To help the child transition from crawling to creeping, we give the child the opportunity to crawl over obstacles. When the child crawls for transportation around the house and crawls well on a carpet, he is ready to crawl over obstacles. The obstacles are very low and easy. Start with an obstacle that is 1 inch (2.5 cm) high, covered with a thick pile carpeting. Cotton carpet such as ones used in bathrooms work well. Ideally, you would like the pile to be 1 to 2 inches long. The reason for this is so the child can grab the thick carpet with their hands and pull themselves forward. The obstacle should be about a yard long (1 meter). The width should be measured from the top of the child’s shoulders to the top of the child’s hips. You want to have at least three of these obstacles. Place the obstacles around the house so your child has to crawl over them. A hallway is perfect because the child will not be able to crawl around them. 

Start with 3 obstacles a day and gradually build up to 30 times the child crawls over the obstacles. When this is happening easily and quickly increase the obstacles to 2 inches high (5 cm). Once the child is crawling at least 30 times easily over the 2 inch obstacles, add another inch (7.5 cm). As the weeks and months go by, continue to raise the obstacles by an inch at a time until the obstacle is so high that when the child crawls over the obstacle and straddles the obstacle on their tummies they are actually in the Quad Position. This is the height from their armpits to their hands on the floor and from their tummy to their knees on the floor.

In addition, it is excellent to permit the child to crawl up and down steps. Ideally, we would start with just one step at a time, such as a step from one room to another. Have the child crawl both up and over the step and down the step as well. Then, if available, two steps up and two steps down. Steps are an excellent environment , because it is almost impossible to do them without moving in a cross pattern. 

All of the above activities are designed to prepare the child to balance themselves in the third dimension, and move in a cross pattern. Function determines structure, the more they function using the above activities the more they will have strength to push up on their hands and knees. Many brain injured children, like well babies, will experiment by pushing up and straightening their arms with the top half of their bodies off the floor. Or they will pull up with their legs with their knees on the floor and their bottoms pushed up toward the ceiling. They will do this many times throughout the day. When they do this show great enthusiasm and appreciation. Cover the child with hugs and kisses. Let them know what they are doing is a wonderful thing. Eventually, they will push up on their hands and knees. They will hold the Quad Position for 2 to 3 seconds then they collapse. This is the reason why we want them to be on a thick pile carpet. If they fall they will not get hurt and they will feel comfortable about getting back up on their hands and knees. 

Some brain-injured children even when they are crawling well, crawling over obstacles and experiencing the Balance Development activities may not independently get up on their hands and knees. Instead, parents can show children the Quad Position and help them to get into the position. This is best done if mom is on the floor on her knees and is sitting back on the floor. Open your knees and create a ‘V’ between your legs. Then place your child’s legs inside your ‘V’ and have them sit back like you on their bottom. Then straighten their arms and encourage them to keep them straight. Let them do this independently even if only for a second or two. If your child does this then make a huge party of it. Do it two or three times spread throughout the day. Gradually increase 5, 10, and eventually 20 times a day. The child’s time will improve from 2 seconds to 4 seconds to 10 seconds. As the child improves encourage them to start to push their bottoms up so they are in a true Quad Position. 

The objective is to make the child into an expert in holding the Quad Position. Some children will be able to do this in a few months. Others will need many months. Like well babies, some hurt children will begin to swing their torso back and forth. They will also shift their weight from their left hand and knees to their right hand and knee. They are experimenting in this position and shifting their balance. These are all great signs and cover your child with kisses every time they do so. At some point they may begin to move their hands and knees. Once they have slid their hands and their knees 1 inch (2.5 cm) or so forward they have crept their first inch. Excellent! Now gradually increase this to 5 times a day, to 10 times and then more than 20. The one inch will become 2 inches, then 4, and beyond. 

Once the child is creeping the objective is to increase the distance each day a little bit. It will get easier and easier and the child will get faster and faster. Playing games by pushing a ball around the house and playing with it a small child can rack up hundreds of yards (meters) a day. Our first big objective is 400 yards, which is a quarter of a mile. At this point the child is a very fine creeper and can get anywhere that they want. Give them the opportunity to creep outside. At first they may not like the grass then you may choose to put an old carpet on top of the grass. Or if you live near a beach creeping on the sand when the sand is hard and solid can be a challenge but fun. Do not try to creep on very soft sand it will be difficult for your child. 

When children are easily and consistently creeping 400 yards a day some will begin to climb on a sofa or a chair and start to stand. This of course is exactly what we want. This is what well babies do. Encourage this as much as possible. Next, the children will begin to take steps holding on to the furniture. This is the beginning of what we call cruising. Many well babies cruise before they begin to walk. It is wonderful when brain-injured children do this.

There is one important exception. The midbrain is responsible for the control of the elbows and knees. For children injured in the midbrain (sometimes called cerebral palsy) their elbows and knees may be tight and or they may lack control of their elbows and knees. In this case when they cruise they may keep their knees bent. At first when children begin to cruise their knees may be a little bent. As they improve they will “lock” their knees. When they do this they are aligning their bones so the bones take the great majority of their body weight. This is the way you and I walk. It is essential that brain-injured children learn to stand, take steps and eventually walk with their knees straight. For you and I there is a brief second when we straighten our legs. Then we bend them slightly to step forward. 

Those children who cruise but keep their knees bent are learning to stand and step incorrectly. Such children should not cruise. If they do so their brain is learning how it feels to walk with bent knees. Once the brain is programmed in this way it takes considerable time and effort to reprogram the brain once the child’s knees are loose and can be controlled. Do not worry. We encountered this problem more than 60 years ago with brain-injured children. It led to a very significant breakthrough. In 1968, Glenn Doman developed the Overhead Ladder. This will be the subject of our next blog. It is the ideal environment to teach brain-injured children to walk. 

For children who do cruise and lock their knees encourage them to do this with high frequency, short and easy distances spread throughout the day. Ideally, they will cruise 50, 100, or 200 yards or more. Some will begin to walk independently. This is excellent. Some will not. They need to continue to creep longer distances. As was the case with crawling. The more the child creeps the stronger his arms and legs will become. This strength will help them to walk underneath the Overhead Ladder. We will want them to “sprint” creep for fun in order to make their respiration deep and fast. We want them to build their non-stop creeping distances from 20 meters to 40 meters and beyond. This develops their physical endurance and their respiratory endurance. The huge goal to achieve is to build to 1,600 yards (or meters) a day consistently and easily. We have never seen a child accomplish this distance who has not been able to start to stand and move underneath the Overhead Ladder. 

For the parents of brain-injured children we know there is nothing more important than getting their child walking independently. For more than 60 years my father and now the Physical Staff of the Doman International Institute have concentrated their efforts into finding as many ways as possible to get our brain-injured children walking independently. That is the subject of our next blog.