This is a topic that probably arouses the most emotions after the topic of sitting – not only among parents, but also among physical therapists and doctors.
Some say that “all fours” are simply A MUST without which a child absolutely cannot develop any further. Others say that some children skip this phase and it does not affect their development at all.
It can make you crazy. 😉 I myself, as a pediatric physical therapist and, above all, a mother (one of my children did all fours only briefly and lazily), have wondered about this topic many times. I was looking for information both in books, scientific publications, on the internet… And you know what? When it comes to scientific research, you can find information that confirms… both views!!! Aaaargh!!!
Who is the wiser?
Of course, after entering the phrase “all fours” in the search engine, we will be inundated with information about the beneficial impact of this activity on almost every sphere of life. But if we search deeper, it will turn out that there are also voices assuring us that all fours are not that important, and children who have not gone through this phase, in terms of motor development, do not develop worse than their peers…
Meeting a lot of people every day, I get the impression that there is some kind of pressure when it comes to all fours… First we can’t wait for our toddler to start to move, and when he or she masters it, we check if they are doing it correctly.
And rightly so! Of course, the quality of movement is very important, but we must not forget that a little person above all wants to get around, so the technical side of it is not THAT important. Babies wants to move efficiently, quickly, and using the least energy possible, which is why they often develop their own methods which are sometimes completely different from our ideas and ideals.
So then what do you do?
It is best, for your own peace of mind, to consult a specialist of course, but it is not the case that a toddler who does not get up on all fours will need rehabilitation. It only should cause alarm when you see that your toddler has difficulties with other motor skills – like turning, pivoting; or if you have the impression that he or she stiffens, does not smoothly transfer the weight of the body from one side to the other, or clearly favors one side.
In my practice, I meet a lot of little patients who show signs of a problem early, but there are others who really have no issues and yet, at the time when they “should be” getting up on all fours, they choose… to stand upright.
Then the question arises – should you let them or not???
Theoretically, it is easy to say “stop them”… but if we look at it from the parent’s perspective… it seems a little more complicated and a cause for frustration. Honestly, I cannot imagine running after a child and leveling him or her to the ground just to make them get on all fours, when the toddler is simply fascinated by climbing, for example, on a coffee table in order to reach some fascinating and, most often, forbidden item. 😉
The more so because very often these children return to the all fours position after they learn to walk. And for various reasons – sometimes it is faster, more efficient, or simply more stable. In fact, taking into account healthy developing children, I do not know any two- or three-year-olds who would not be able to play, for example, in imitating a cat and marching on all fours throughout the house, even if they had skipped this phase completely before.
The time period in which a toddler “should” master this skill is 5.5 to 13.5 months (WHO: „Windows of achievment of gross motor milestones”)
Personally, I think that all fours is a fantastic thing and just like every new skill it brings a whole new quality to a little person’s life. It is impossible to overestimate this skill when it comes to perceiving the world, for children to learn about their own independence, because now they can get where they want when they want.
On the other hand, I am cautious in issuing extreme opinions (I have heard these as well) that without the “all fours” phase, the cerebral hemispheres will not connect. There are other activities that strongly support cooperation between the hemispheres. Of course, when children go through the all fours phase, they improve and reinforce their skills, but children who do not certainly also have “connected” hemispheres. 😉
What are the benefits of “all fours”? They are endless!
- While on all fours, toddlers work hard on stability, strengthening the muscles of the torso, shoulders and hips, which has a positive effect on later control in the deeper parts of the body.
- They perfect cooperation between individual muscle groups, which contributes to the improvement of posture control and allows further development to run smoothly.
- Getting on all fours also affects the integration of primary reflexes – especially ATOS (asymmetrical tonic neck reflex) and STOS (symmetrical tonic neck reflex), and improves the sense of rhythm or cooperation of both sides of the body, which is important for activities that require coordination of the right and left sides (e.g. clapping, manual activities, cycling, walking, running, dressing, writing, reading, etc.).
- By putting weight on the hands, the toddler prepares them for a precise grip – the finger muscles are elongated, the arches of the hands are shaped, etc.
- The all fours position also affects sensory integration, visual perception, “body mapping” and motor planning. Phew, that’s just for starters. 🙂
Of course, when you drill down, you can list even more advantages, but it is worth remembering that in fact, each new skill acquired by a child also brings a lot of benefits and it is never the case that only thanks to all fours will a child develop smoothly.
Can you help a baby with the all fours position?
Getting to the all fours phase actually starts much earlier than we notice. 😉 As I always say, child development is a PROCESS and new skills always appear based on previous experiences.
Therefore, if your child is not getting to all fours, it is worth considering why and to look for reasons that sometimes turn out to be trivial. Perhaps the floor is too slippery and the child’s legs split to the sides, which makes it difficult to keep the center of gravity of the body above the ground; perhaps the toddler does not have many opportunities to train and test these abilities on a mat, because he or she spends a lot of time in a bouncer, walker, or other such contraption?
I once had a patient, a fantastic little girl who was already sitting at five months. And so she sat… almost until the age of one, when a stressed mother came with her for rehabilitation. The recommendation was to prevent her from sitting and to get her on the mat. 😉 And what turned out? After several days of hard work for the parents, the girl began to discover the various possibilities offered by tummy time. She quickly went on all fours, stood upright, and began to walk. She was a completely healthy child, only made to sit too early. 😉
Therefore, before we search for pathologies, it is really worth taking a look at the simplest things. 😉
- Make sure your baby spends lots of time on the tummy
- Make sure your baby has plenty of opportunities to practice on a firm enough surface
- Take care that the surface is not slippery
From personal experience – my own child who barely hit the phase is now a healthy, normal eight-year-old. 😉
INTERESTING FACT: the “all fours” phase is so engaging that toddlers who master this skill often have trouble sleeping.
You may also be interested in:
How to use playtime to enhance your baby’s skills? Check out my e-book for ideas for playtime from birth to first steps – and have fun!!!
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- The Treatment of Neurologically Impaired Children Using Patterning; Pediatrics, November 1999, VOLUME 104 / ISSUE 5, AMERICAN ACADEMY OF PEDIATRICS
- Hadders-Algra, M. (2005). “Development of postural control during the first 18 months of life.” Neural Plasticity, 12(2-3), 99-108
- Ayres, A.J. (2005). Sensory integration and the child: Understanding hidden sensory challenges, 25th anniversary edition (p. 21, 57). Los Angeles, CA: Western Psychological Services.
- Franzsen, D. and Visser, M. (2010). “The Association of an Omitted Crawling Milestone with Pencil Grasp and Control in Five- and Six-Year-Old Children.” South African Journal of Occupational Therapy 40(2), 19-23
- Nichols, D. (2005). “Development of postural control.” In Jane Case-Smith (Ed.), Occupational therapy for children, 5th edition (p. 279). St. Louis, MO: Elsevier Mosby
- Tracer D. research: https://www.scientificamerican.com/article/crawling-may-be-unnecessary/