‘In the bliss of perfect health he is striking out with his little arms and kicking about with his chubby feet. Your instinct tells you that he is seeking an object against which he may measure his strength, and by measuring increase and enjoy it. To the need indicated by his lively movements your motherly love promptly responds, and you hold your hands so that the little feet may alternately strike against them.’
Friedrich Froebel, Mother Play, 1895.9
Even though rolling is one of the first things your baby learns to do, it comes at the end of a long learning journey. Along the way to rolling your baby:
straightens out of his lovely newborn curled-up posture
learns to resist gravity
develops sensitivity in his neck muscle receptors
integrates primitive reflexes and develops adult reflexes
discovers that he can move his whole body where he wants to go.
That ‘newborn curl’ reflects the fact that it is the flexor or ‘curling-up’ muscles that are strongest at birth. In other words, there isn’t an equal balance between the muscles on the front and the back of baby’s body — the muscles on the front are much stronger.
So how does a baby ‘straighten out’? Not by you helping him — you’ll find that to comfort your newborn you ‘curl him up’ again. The straightening role is actually taken by one of the primitive neck reflexes, in this case it is the tonic labyrinthine reflex. And yes, all the names of the reflexes are just as discouraging but if we unpack each word the meaning becomes relatively clear. ‘Tonic’ means that it alters the tone of muscles by tightening them up or loosening them. ‘Labyrinthine’ means that it is the labyrinths of the ear that are the sensors involved here, in this case detecting a changed head position. In fact, in response to a changed head position, either when it is bent forward or backwards, your baby’s body is swept by a wave of muscle contraction that changes muscle tone throughout.
If your baby’s head tips forward then the muscles on the front of his body tighten and he curls up. If your baby’s head tips backwards then the muscles on the back of his body tighten and he straightens out.
I first noticed this reflex in action when Tim was two weeks old. He had discovered that by tipping his head forward and backwards he could flip fish-like across the bed, and I would find him reattached to the breast shortly after I’d placed him some distance away. You might like to try it: head back, straighten out — head forwards, curl up — head back, straighten out. When you are lying on your side it does allow some movement.
Over time your baby loses that lovely curled-up posture because the muscle tone on the back of his body is now sufficient to balance that on the front.
Gravity in the womb is greatly softened. There’s enough of an effect to train the labyrinths of the ears to respond to up and down, but that is about all. So when your baby comes out of the womb, your loving arms will be what cushion him from gravity early on. He experiences anti-gravity movement first of all by being carried around by you, feeling your body shift against his as you move. This is a multi-sensory treat for your baby: touch sensation and movement sensation while his balance sense absorbs the feeling of resisting gravity, accompanied by lovely mummy smell, comforting body warmth, quick visual shifts and the string of interesting sounds in his favourite voice in the whole world; alerting, comforting and teaching him.
Setting the scene for good movement skills
I remember being stunned when a friend procured the Choice list of the best baby equipment and systematically proceeded to ensure she had every item: the best pram, the best backpack carrier, the best cot, the best rocker. While something may be regarded as the best of its kind, it doesn’t mean that you need to have it. Indeed, for good movement skills, less stuff is better.
To grow good movement skills your baby needs to spend time on his tummy on a flat surface and on his back, and he needs to have you there with him to make it fun. He also needs to be carried as much as possible, so a sling where he is cradled against your chest and turned in towards your face is useful.
Such things as prams and baby carriers, like the plastic slot-in-and-out of the car seat things, rob a baby of some of these important movement experiences. Apart from missing the warmth and smell sensations that create the feeling of safety in which a baby learns best, in a carrier he can’t learn from the steady repositioning of your body about how you move against gravity. Nor can he hear your heartbeat changing, or yoke together his eyes by watching your face as he is carried in your arms.
Rolling is led by the head so, as well as a sign that your baby is engaging with the world, head turning is a very important step on the pathway to rolling. Babies don’t turn their heads initially to roll or even to look, but to find the nipple. This is another of the primitive reflexes in action — the rooting reflex. Simply, baby responds to a touch on the cheek by turning his head in search of the nipple. As he grows, a touch to the cheek also encourages a baby to open his mouth in a smile. (A surprising number of politicians know this.) Of course, in turning his head your baby will be moving against gravity.
So baby is straightening out. He’s turning his head but he also needs his neck muscles to be quite a lot stronger and working together more cooperatively to convert a head turn into a roll. How does this happen?
There are three compounding processes happening here. The first is simply a conditioning process: baby fights gravity and in doing so he gets stronger. A lovely game to play to help this process along is ‘flying’ baby through the air and this is a good game from around two months old. ‘Up, down, flying around’: babies who are flown through the air will arch their little backs and lift their heads, defying gravity just as bravely as the marvellous men in their flying machines. This activity also inhibits the tonic labyrinthine reflex, allowing your baby to develop more advanced movement patterns.
Second, your baby is developing an adult reflex, and it should be in place by four months of age. It was the one I had you feel on yourself in the last chapter when wrapping your hands around your neck, thumbs to the front, and leaning from the waist. This is the oculo-headrighting reflex in action. This reflex lets you fix on and follow a ball in flight, it lets you fix on a line of text and follow it to the end, and it is something you definitely want your baby to develop.
Third, your baby’s neck receptors are becoming increasingly sensitive as the startle reflex integrates.
The neck muscles have more nerve receptors than any other muscles in the body. One researcher conducted a very simple experiment to see just how important the information provided by these nerves is. He anaesthetised one side of a man’s neck and watched what happened. The man toppled over on the opposite side of his body and couldn’t right himself.10 As you might imagine, the more sensitive the neck receptors are, the better coordinated our whole body movements will be. So how do you increase the sensitivity and accuracy of the nerves in your child’s neck?
Give him opportunities for movement by carrying him in your arms or a sling, lying him on his back and tummy, and lying down and putting him on your tummy. In this way he will be able to curl and uncurl his body (the tonic labyrinthine reflex in action) and in doing so link movement to sensation. As your baby experiences over and over the feeling of head going forward and body curling up, head going backwards and body straightening out, he links the balance information from his neck to the positional information coming in from the labyrinths of his ears.
Every parent is told that tummy time is important, but many babies absolutely loathe being placed on their tummies. Before the connection between stomach sleeping and SIDS was made, most babies slept on their stomachs. And all that sleeping on the stomach must have conditioned them to the sensation, because Mum tells me that the large numbers of babies who hate being placed on their ‘tummy for play’ is a very recent phenomenon.
This is not to suggest that you sleep your baby on his stomach. The incidence of cot death has dropped by more than 50 per cent since the ‘back for sleep, tummy for play’ recommendations were made.
Instead, slowly build up the time your baby spends on his tummy, starting on the very first day of his life. Every day he will lift his head higher, building up his anti-gravity muscles and the sensitivity in the nerves of his neck.
If lying down on the floor on your tummy with him is painful for you, lie him on a table on his tummy and talk to him. Or lie him on your tummy. If you are constructed to allow it, breastfeed your baby with him lying on your tummy and ‘sucking uphill’. Roll a towel into a crescent shape and place it under his chest, and put something interesting for him to look at that he’ll be able to see if he lifts his head.
Basically, remember that tummy time means that he is on his tummy. It does not mean that he is left lying on the floor by himself, on his tummy. Come up with ways to make it enjoyable for both of you.
So your baby has developed the sensitive strong neck muscles that are required to get up the velocity to roll, but this is still not everything. We need to look more closely at the reflexes that are involved.
We’ve already met several of the primitive reflexes that are part of this journey: the rooting, palmar and tonic labyrinthine reflexes, and one of the mature reflexes, the oculo-headrighting reflex. Just two more reflexes for you to meet: one primitive and one mature.
Have you noticed how when a very new baby is lying on their side and their head is turned that their whole body follows in a ‘log roll’? This lasts until baby is around six months old, at which point you can help your baby roll by simply pushing one leg to the front of her body when she is lying on her side. Straightaway, she rolls.
This is, of course, yet more reflexive behaviour. Both of these early rolling behaviours are called ‘reactions’ and lead straight to the development of a reflex called the ‘segmental rolling reflex’, which develops at around six months of age and should remain active throughout life. This reflex simply ensures that the body smoothly follows the lead given by the head or the feet. Once the shoulders or hips become involved, the rest of the body just flows in the right direction. The occasional adult you see with ‘blocky’ movements as they dance or run has not properly developed this reflex. It gives grace to our dancers and fluidity to our athletes: lots of rolling in childhood is vital to grace in adulthood.
Strong neck muscles, a body that he can uncurl at will, a developed segmental rolling reflex, the desire to turn over fed by lots of rolling play … and there is one more thing required for baby to be able to roll when he feels like it. He needs to have integrated another of the reflexes: the asymmetrical tonic neck reflex or ATNR.
This reflex makes the sides of the body asymmetric: shortening the muscles on one side of the body and lengthening them on the other. When baby turns his head to the side it activates the reflex. On the ‘face side’ the muscles lengthen, leading to the straightening out of the arm and leg. On the ‘back of head side’, the arm and leg bend.
A funny roll is a warning sign
The ability to roll or not roll is a strong indicator of a baby’s development. Research indicating that a baby who rolls late and who rolls ‘despite’ a still active asymmetrical tonic neck reflex (by arching his back and flipping in the opposite direction to the way he is looking) is at risk for a number of disorders, including autism.11 If you see that flip in the opposite direction’ roll, remember that it may well be a very early marker for later difficulties, so consider taking your baby to a paediatrician.
So what will happen if baby tries to roll with an active asymmetrical tonic neck reflex? As baby turns his head his hand will shoot out straight in front of him, becoming a barrier to rolling in that direction. So this reflex must be integrated for the baby to roll successfully. When it is gone, baby can turn his head, twist his shoulders and, by George! He’s rolled.
When Tim was born I did everything I could to get him to grasp. I encouraged him to grab my hair, spectacles and nose. I wasn’t so reckless with Sam. I had learned by then that a baby can grasp and hold long before he can voluntarily release!
Learning to grasp requires baby to see, to want, to judge how far away the object is, to reach and to open the fingers at the right moment and close them at the right moment and finally to let go. It sounds complicated, and it is even more complicated than it sounds. As well as being the journey to grasp it also:
integrates primitive reflexes
links balance and vision
expands the journey to understanding
builds eye-muscle skills
is a critical step in your baby connecting to the world.
When teaching a sporting technique often the teacher will take the pupil’s arm and move it for her. In this way she ‘knows it from the inside’. The primitive reflexes perform this teaching also. The first ‘feel’ of grasp is provided by the Palmar reflex.
You see this reflex in action when you touch a newborn’s palm with your finger: her tiny fingers will close tightly around your finger. You will notice that her thumb, which is so critical for the grasp later on, barely participates in this early grasp. From the first day baby enjoys the gentlest of tug of wars, pitting her tiny strength against yours. To release your finger you can gently stroke the back of her hand, and her grip will loosen (this does not always work, however).
What helps the Palmar reflex integrate into your baby’s growing brain? It is the same movements that activate the neck muscle receptors: round and round the garden and pull-to-sit.
Baby first of all grasps reflexively, and then slowly begins to grasp deliberately by around three months of age. Being able to ‘release’ when she wants to comes a little later, and most babies will resort to the trick of flicking their hand backwards to pull open their fingers to drop an object. Once they’ve ‘got the feel’ of release, they can make the movement voluntary.
Why you should avoid ‘prop-feeding’
but consider using a dummy
The Palmar reflex is also integrated through the hand-foot-mouth link. Babies have a ‘suck’ reflex at birth that teaches them how to suck, and the reflex is integrated by lots and lots of sucking. But all that sucking doesn’t just integrate the suck reflex. Because of that hand-foot-mouth link, sucking also assists in making grasp voluntary rather than reflexive. The work of sucking improves strength and voluntary control of the muscles of the head and neck, and also of muscles in the hand.
Babies who are breastfed are at an advantage here because breastfeeding is harder work, but care and attention to how baby is bottle-fed does help. At all costs, avoid ‘prop-feeding’: when the milk simply runs out of a teat a baby barely has to suck. Mum and I, among other therapists, frequently find that babies who are ‘prop-fed’ by bottle become children with both a sucking reflex and Palmar reflex. These children are characterised in schoolrooms by ‘sucking’ on their hair, or clothes or a pencil, poor fine motor skills and unclear speech.
But this is just one sort of child who needs to suck well past infancy. In my experience there are actually two sorts.
Whereas the first group, who didn’t have enough sucking in infancy, keep both the Palmar and sucking reflexes, the second group did have sufficient sucking. What sets them apart is a very high level of interest in fine motor tasks. This places constant pressure on their fine motor skills, which they then ratchet up to more and more precision by activating the hand-mouth feedback loop, which is called the Babkin response. So, like the artist who purses his mouth (the beginning of a sucking movement) when adding a very fine final touch with his brush, these children increase sensitivity and precision of their hands through that hand-mouth loop.
The first group of children need extra assistance in all fine motor tasks, and my recommendation is to let them suck as it will help them develop fine motor precision. The second group of children will only be sucking when they are challenging themselves in more difficult fine motor tasks.
If your child fits into either group of children, and if you’ve chosen to give her a dummy which she is now using past a ‘socially acceptable’ age, think very carefully before weaning her off her dummy You don’t have to keep the dummy available in public, but why not continue to allow her private use?
At the same time as baby is learning to grasp and release, she is learning to rely more and more on her vision. The development of vision is far more complex than we might think. To begin with, it needs to be linked to other sensory information to be really useful. Imagine that you can see a dog. It doesn’t look friendly. How big is it? This is critical information: a very small unfriendly dog is not the same degree of threat as a very large unfriendly dog. So how do you judge its size?
The tonic labyrinthine reflex, where if a newborn nods her head forward her whole body curls up and if she tips her head back it straightens out, also trains the baby’s vision. Both parts of this reflex work together to fine-tune the baby’s sight to her balance. The baby begins to link what up and down look like with what up and down feel like. In other words, the activity of this reflex joins together the existing internal balance information with the brand new visual external information. It also links positional information coming in from the neck muscle receptors with the balance information coming in from the ears.
Baby is learning to recognise that her head has moved partly due to changes in her neck muscles and partly because of the change to what she sees. Balance becomes the foundation for vision, and shortly afterwards, vision begins to affect balance. This feedback loop becomes the basis for decoding visual information: we know how big the growling dog is because we know where the dog is in relation to us. It also becomes the basis for eye movement: we know how much to move our eyes because we know where we are in relation to the place we want to look. This is the beginning of depth perception. Of course, this skill will become a lot more refined when baby is able to crawl and find out how ‘deep’ a space is for herself.
But for the time being, through the early action of the tonic labyrinthine reflex, baby is able to begin linking together what she can see with how far away something is. And now another reflex comes into play: the asymmetric tonic neck reflex. This is the one that stops a child rolling and we very briefly mentioned it in the previous chapter. This reflex is also the one, however, that trains in the link between hand and eyes.
If we unpack the name, ‘asymmetrical’ tells us that the two sides of the body take up different positions. ‘Tonic’ tells us it works by altering the tone in muscles, and ‘neck’ tells us that it is triggered by head movement. In fact, when your baby turns her head to the side this reflex causes the muscles throughout her body to respond. The muscles on the side of the body the baby is looking toward lengthen, causing the arm and leg on that side to straighten. On the other side of the body the muscles shorten and contract, pulling the arm and leg into a bent position.
This reflex has a number of critical roles. It helps baby wriggle down the birth canal and it ensures a good supply of air, moving the potential hazard of the baby’s own hand away from mouth and nose. There is also good evidence that it helps baby turn her head to help her breathe if she’s face down on a soft surface. And, as mentioned, it is crucial in the development of both vision and grasp.
The reflex gives the baby something to look at: her own hand, at just the right distance for baby to see. This is the beginning of intentional reach and grasp and, of course, of hand-eye coordination. And often it is a sound that has caused baby to turn her head, so this reflex also links the ability of the baby to look and touch in response to sound, ‘tuning’ those senses to each other. To begin with, of course, they need to be linked, but being tethered together permanently is very limiting. For one thing, it will stop her being able to close her hand around the object she is looking at. For another, it will stop her being able to look at an object held in the hand at the end of a bent arm, such as a pencil, and block the development of attention and concentration skills. (More on this later, in Chapter 16.)
The importance of ‘back’ time
Your baby needs to spend hours ‘playing’ with her asymmetrical tonic neck reflex to lose it. And to do this she needs to spend some awake time lying on her back. If you have a colicky baby, don’t put her on a flat surface, but in a ‘bouncinette’ or on a wedge cushion. Not, perhaps, as a newborn (though mine had tummy and back time from day one), but certainly once she is a month old. This is not something babies can do in a ‘sit-up’ pram, so try to limit the use of the pram to sleeping only.
This reflex should be gone by the time a baby is six months old, but occupational therapists frequently find it in older children who haven’t had enough floor time as babies, where it wreaks great destruction on their attention and fine-motor skills.
What do I mean by playing with the reflex? I mean that a baby will deliberately attempt movements that the reflex prevents. She’ll go to the very limits of what she can do, and just keep stretching that envelope. Bear in mind that what this reflex does is cause a change in the arm and leg position based on the head position. So what your baby does is set up a confrontation between the action of the reflex and what she wants to happen.
For example, she’ll lie on her back with her head in ‘middle position’, turned neither to the right nor left. Her attention is fixed on an outstretched hand that she turns into a fist and steadily brings down towards her face. Making a fist is significant as the action of the reflex is to open it up. Then her head turns a little and she loses control of the fist. Depending on the direction in which she turns her head, it will shoot off into space or hit her face above the eye.
She’ll start bringing her hands together and keeping them there, despite turning her head from side to side. She’ll grab her foot and watch it as she passes it from hand to hand. She’ll pass a rattle from hand to hand. She loves clapping games (bringing both hands together) and ‘boo’ games where Mum suddenly pops up in a new place, taking her focus away from her outstretched hand.
Back time also builds visual skills
She is not just integrating this reflex and practising reach, but working towards adult visual skills. Watching her hand is teaching her to ‘converge’ (focus both eyes on a single near point, which is vital for reading) and ‘accommodate’ (switch focus between near and far) and generally yoking both eyes together to allow ‘binocular vision’. Binocular vision means that the brain takes the slightly different images from each eye and uses them to judge distance and movement and speed. She needs that information to be able to grasp an object.
Soon, playing with the ATNR and reaching to grasp are indistinguishable from one another. At four to five months babies become dedicated graspers, or maybe ‘grabbers’ is a better word. Hair, noses, glasses, chest hair, nipples; and the more parents yell ‘Ow!’ the more dedicated they become. The more she can look at what she is grabbing, and watch it go into her mouth to ‘taste’, the more confident you can become that she has integrated her asymmetric tonic neck reflex. Being able to roll, of course, is another sign that it has been integrated.
Finally, all that time lying on the back and grabbing things integrates another reflex called the spinal galant, which should be gone by the time baby is nine months old. If you have a baby you might like to experiment and see if it still there. When baby is lying on her tummy, stroke down her back near her spine on one side. Does she arch her back away to that side? If she does, the spinal galant is still active. More time playing on her back and kicking her legs is required: it will make a big difference down the track for such things as walking, sitting still in class and toilet training.
It is such an emotional moment when our newborn grasps our finger. The thing to remember is that this is a much more emotional moment for us than it is for our baby. For her, that grasp is a reflexive response. Just a few months (three to six) later, your baby hears your voice, turns her head to look, and reaches out a hand to grasp yours. When that happens your baby is saying, ‘I know you are here with me and that I am here with you and we are together’. This moment is a shared one.