Proper positioning of your baby is important to prevent asymmetry of the body structure, leading to dislocation of joints or tightness of joints and muscles. It is also utilised to optimise respiratory function.

The following exercises serve as a guide to the various developmental positions your child can be in.  If your child is unable to move independently, your child should be repositioned every 2 to 4 hours to prevent pressure sores.

Safety precautions when exercising

  • Ensure that you have been taught the recommended exercises by a physiotherapist before carrying them out.

  • Position your child comfortably using ample blankets and pillows for sleep positioning if required.

  • Observe for signs of pain or discomfort – if pain occurs, stop, and check in with your therapist before continuing further.

  • Avoid prone activities immediately after feeding to prevent regurgitation.

Positioning exercises for your baby

Lying on back, propped with towels

Aim: To stimulate the child to make eye contact with you, enable hands to reach and touch each other, develop stomach muscles, and reduce arching.

Instruction: Lay the child face up with a small-folded towel supporting the child’s head. Roll two medium-sized towels lengthwise and place them under the child’s shoulders, tucking the towels snugly along each side of the child’s body. Fold a large towel, and tuck it under the child’s legs to keep hips and knees bent. Bring the child’s shoulders down, arms forward and down, and hands together.

Play ideas: Suspend a toy from a baby gym or hold it within easy reach for the child to touch and explore. Make faces with your child.

Side-lying, propped by towels with supervision

Aim: To develop eye contact with hands and toys, keeping the body relaxed and reduce arching.

Instruction: Place the child in side-lying, using a large, rolled up towel longer than child snugly against the child’s back. Put a small pillow, or a folded towel under the child’s head, and a medium-sized rolled towel along the child’s chest, stomach, and bottom leg. Keeping the bottom leg straight and the upper leg bent, rest the upper leg on top of the towel. Bring the child’s arms forward in front of the body.

Play ideas: Prop up a book or colourful pictures as you talk about them. Encourage child to play with textured toys and items.

Child on hands, supported on your legs

Aim: To develop head control, strengthen back and shoulder girdle muscles

Instruction: Sit on the floor with your legs straightened. Put toys on the floor by the side of your legs and lay the child face-down on your legs. Place your hands on the child’s back to encourage the child to do push up on straight arms and reach for the toys.

Precaution: Ensure that the toys are not hard objects in the event if the child fatigues and loses control of pushing on their straight arms. You can place your hands under the child’s body and support the child’s stomach and hips, giving the child tactile cues to push upwards on their elbows.

Sitting between your thighs, reaching out for toys

Aim: To develop head control, strengthen trunk and back muscles, and improve sitting ability.

Instruction: Sit on the floor with your legs straightened with the child supported between your legs. One leg can act as an anchor for the child’s legs while another acts as a cushion behind. Place toys in front of the child to encourage forward reaching.

Long-sitting with your support

Aim: To develop head control, balance, strengthen trunk and back muscles, free arms for play, and lengthen hamstring muscles.

Instruction: Sit on the floor with your legs straightened and support your back against the couch. Seat the child on the floor in front of you, between your legs. Bring the child’s hips and back against your body as close as possible. This enables the child to sit up straight and ensure the hips are bent at 90 degrees. Ensure that the child’s legs are straight and forward. If necessary, support the child’s hips with your hands to help keep the knees forward.

Play ideas: Put toys or a colourful book on the child’s lap, read a story to the child and touch the pictures. Rock the child gently to left and right dancing to songs or playing with balls.

Side sitting with an arm propped on your leg

Aim: To develop trunk and back muscles, strengthen shoulder muscles of the arm that supports the body, free one arm to play, allow the child to accept body weight to one side.

Instruction: Sit on the floor with your legs slightly wide opened and support your back against the couch. Side-sit the child on the floor in front of you, between your legs. Bend the knees of the child and turn both the legs to the opposite side of your leg. Place child’s hands on your lap to prop up the child. Support the child at the lower trunk and opposite shoulder to shift child’s body weight to the hip near your leg.
Repeat the same on the opposite side to encourage sitting on the opposite hip.

Play ideas: Use stacking toys, blocks or cars to play. Read a story book placed on the floor at the side.

Child on hands and knees over your leg

Aim: To strengthen trunk and back muscles, develop coordination, and allow the child to experience weight onto hands and knees.

Instruction: Sit on the floor with your legs slightly wide opened and support your back against the couch. Place the child on hands-and-knees position, support child’s knees with your other hand. Have the child put hands on the floor and push up on straight arms while your leg supports the child’s body.

Play ideas: Place a toy outside your leg to encourage the child to move over your leg onto hands and knees. You can also use stacking toys, cars, balls or blocks to play.

Kneeling

Aim: To develop trunk, pelvis, and back muscles.

Instruction: Kneel the child in front of a coffee table, chair, or a couch. Bring the child’s arms forward and place the hands on the table. This will encourage the child to go into high kneeling and strengthen their hip and trunk muscles.

Play ideas: Put toys or snacks on the table, or have the child pick up toys on the floor and stack up on the higher surface by going into high kneeling.

Standing while holding onto furniture

Aim: To develop trunk, pelvis, and back muscles, to develop balance control of the body and legs, to allow the child to experience body weight on feet and to develop independent standing

Instruction: Place the child standing in front of a coffee table, chair, or a couch. Support the child’s body by holding the child’s hips if necessary.

Ref: K21