Cross the Midline

If you have a disabled child or toddler, chances are you’ve heard the term “cross the midline.” We’re told that it’s important and we’re told to encourage our child to do this. Now, I wish my child wouldn’t cross his midline in some situations, but more on that in a bit.

While many parents have heard the term crossing midline, they may be unaware of how developmentally significant this skill is. Crossing midline is important to develop because it helps in a child’s brain development to get both sides of the brain and body working together.

teens in a pillow fight

When children lack this skill, in can be indicative of other struggles. The inability to cross midline naturally can lead to poor body and spatial awareness, motor coordination for both fine motor and gross motor activities, dressing independently, participation in sports, and more.

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What is Crossing the Midline?

Pretend that we drew an imaginary line down the middle of your body. Crossing the midline means when kids reach with an arm or a leg on one side of the body over that imaginary line. For those of us who have this skill and don’t need to consciously work on it, we cross the midline all the time and don’t even think about it.

Crossing the midline requires that the left and right sides of the brain work together to signal the body to use both sides at the same time. Otherwise the brain has to think about movements that would otherwise come naturally to complete tasks.

A precursor to crossing midline is appropriate core strength and stability. As an infant and toddler, K’s core strength was so poor (hypotonia) that he often clasped his hands in front of himself to keep himself centered and stable.

It is not something I noticed as a new mom, until it was pointed out to me. Below is a picture of him in a swimming pool, and that posture is one that is evident in many of his baby pictures.

A baby sitting upright with his hands clasped may not look unusual to most parents. However, it can be an indicator of poor core strength.

His core was not strong enough to keep him upright, in the event that one of his arms would cross midline. If he did, he often toppled over. In order to stay upright, he would clasp his hands or hold something directly in front of himself, right at the midline.

Core Strength and Crossing Midline

There is a connection between core strength and crossing midline, as I pointed out with my own child above.

If you are working on this skill (crossing midline) with your child, make sure that there core strength needs are supported.

This can be accomplished with solid, supportive seating. We saw a tremendous improvement in K’s seat work skills once he got a Rifton chair for home. The Rifton chair allowed him more back and side support than regular seating.

A child/teen may need foot support too. If you lack core strength, it is best to not have your feet dangling. Put them on a stepstool, footrest or Rifton chair platform so that the child’s core feels stable.

Otherwise, the brain expends all its energy thinking about being stable, and may not have much left to think about crossing midline.

Is crossing the midline important? Why?

Crossing the midline is important to the development of gross and fine motor skills, cognitive skills, and even plays a role in social-emotional development. Balance and coordination (i.e. crawling, skipping, and kicking a ball) strengthen gross motor skills.

Hand dominance and bilateral integration skills are needed to complete tasks such as writing, cutting, and dressing oneself for good fine motor skills.

Additionally, cognition develops because both sides of the brain are engaged and must work together during learning tasks.

When a child cannot complete a task or skill, they don’t know why. Their heads don’t say “Gee, I really need to work on my crossing midline skills and then I’ll be a phenomenal tennis player!”

They just know that they cannot do what their age peers can do. All this to say that developing midline crossing skills is just as important to social and emotional wellbeing as it is to developing fine motor and ADL skills.

When should a child be able to cross midline?

Crossing the midline is not just for hands and arms.

  • 0-3 Months Old: Should be crossing midline with eyes and vision
  • 6 Months Old: Begin crossing midline purposely to reach for toys or objects with hands
  • Toddler and Preschooler: Should be crossing midline with arms and legs in any age appropriate activity
  • School Age Children: Skills should develop and improve with age. For example, reaching for a crayon across midline as a toddler is age appropriate. An older child should be able to reach across midline (like to a peer’s school desk) and write on a sheet of paper. Like if you were playing tic-tac-toe with a peer and they had the paper on their desk.

But, even if your “child” is now a teen or adult, you should still work on these skills if they do not have them.

Crossing Midline Examples

As always, you have to meet your child where they are at. For many of our disabled kids, no matter what age, they have to be direct taught everything.

Skills do not magically appear, and crossing midline is no different.

Great way to cool off and practice crossing midline--pool volleyball! And, in shallow water it doesn't require swimming skills.

Babies and Toddlers Crossing Midline Examples

If your infant has a mobile overhead or is doing tummy time, you want to put desirable toys across midline to encourage them to reach in all directions.

Toddlers cross their midline when they are reaching for food or putting on a jacket.

One indicator of a child struggling with crossing midline at this age is frequently switching hands while completely age appropriate tasks.

If an older child is crossing midline to do some things, like at the dinner table, but struggles with other things like sports or riding a bike, investigate the crossing midline skills further. At any age or level of skill development, progress can stall.

Indicators that a Child Does not Cross Midline

In addition to actually not ever seeing your child’s arms or legs cross midline, there are other indicators that this is a task that your child struggles with.

It can also be an indicator of poor core strength, or both.

  • Never observed crossing midline
  • Switches hands with objects to complete a task, rather than crossing midline to complete the task
  • Hands frequently clasped in front for balance and stability
  • Delayed crawling or skipping the crawling phase entirely
  • Very little trunk rotation observed

If your child is age 0-3, then they may be eligible for an IFSP or IDEA Part C. Ask your pediatrician about this.

Crossing Midline for Social Emotional Wellness

When a person lacks crossing midline skills, then other activities and tasks are more challenging.

Frustration at the inability to do what their peers are doing can lead to many other issues–feelings of inadequacy, feeling “dumb,” feeling left out of activities and so on.

It has been my experience that once kids get to that older preschool age, teachers and clinicians kinda ‘forget’ about crossing midline activities.

For example, when a child cannot tie their shoes at ages 8, 9 or even older, it is treated as a fine motor skill deficit. Which is true!

But what about crossing midline? A child must have crossing midline skills to tie shoes too. And that piece often gets ignored.

And, once a child leaves the primary grades, maybe somewhere around grade 4, I find that IEP teams stop talking about crossing midline entirely.

When I Don’t Want my Son to Cross Midline

At the beginning of this article, I stated that I didn’t want my son to cross midline. Sometimes.

Let me clarify.

K is tube fed. And if you know anything about tube feeding, you know that you have to sit pretty close to the person to assist them with feeding. Which I do.

K has always struggled to cross midline. The only time he does it regularly, with ease? When we’re doing his tube feeds. And, as he regularly reaches across midline to look at a tablet or book to pass the time, his opposite arm frequently bangs into the tube. And, pulls it out of the port.

A mess ensues….and the entire time I’m cleaning it up, I’m thinking “If he would not have crossed midline, he wouldn’t have knocked the tube out.”

Yay for progress?

Crossing Midline Activities for Adults and Older Kids

I don’t know why so many IEP teams and clinicians just stop working on crossing midline skills after a certain age, but they do.

I’m a firm believer that if you don’t have the foundational skills, you can’t acquire the new skills. If I’m still working on this stuff with K when he’s 30 or 40, so be it.

  1. Art activities such as coloring, painting, writing with chalk on pavement.
  2. ADLs (activities of daily living) such as dressing, undressing, toileting, shoes and managing your lunchbox or backpack (to hang in a locker).
  3. Consider outdoor games like horseshoes, ring toss and bean bags (cornhole)
  4. Line dancing!
  5. A pillow fight is a great way to encourage teens to get those arms across that midline.
  6. Other at home crossing midline requirements are reaching for food or a napkin across the table, bathing oneself in the tub or shower and recreational activities.
  7. Most sports require a person to cross midline. A person who lacks the skill and has poor core strength will not be successful at sports and will be frustrated. If the person likes sports, offer them the opportunity in a low risk environment.
  8. Riding a bike or scooter requires crossing midline skills and can be done independently.
  9. Consider ribbon dancing or ribbon gymnastics, or using a bubble wand to get the same effect and encourage the person to move their arms and legs across midline. Play music that they love to encourage movement
  10. Exercise or calisthenics to practice crossing midline include side bends, lunges, twists, bicycle crunches, and windmills.
  11. Do you paint your nails? That’s an activity that requires crossing midline! If a male is not comfortable with nail polish, clipping fingernails or even filing them requires one hand to work on the other.
  12. Throwing, catching, and kicking a ball–consider a game of kickball, or a soccer shoot out.
  13. Placing items on the other side of the body (i.e. a brush on their right side if they prefer to use their left hand) when assisting with ADLs.
Foosball requires many skill sets. Crossing midline is just one of them.

Just because a child is older does not mean that skills magically appear, or that we should stop working on them.

Crossing the midline is a foundational skill that affects so many other things and should be practiced at all ages, if needed.

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