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Chapter 3 Stage 3: Pivoting, Sitting, and Preparation for Standing

Sitting on the Floor You may notice that your baby wants to sit up when you are holding her in your lap. She will lift her head up and try to move upward to sitting. Or, when she is in the infant seat, she may lean forward and try to sit up. This is the time to help her sit up and play.

Your child has learned to sit with her middle trunk supported. During this stage, the goal is for her to learn to sit without support. To achieve this goal, she needs to learn to sit with her trunk up straight and learn to balance herself in sitting so she can maintain the position without falling out of it. To do this, she needs to develop strength and control in the middle and lower sections of her trunk and strength in her arms.

To develop trunk control, she first needs to gain the strength in her back muscles to lift her trunk up straight and maintain that position. When she can hold her trunk up straight, then she needs to gain strength in the stomach muscles to balance herself in the middle and prevent falling back. Later, she will learn to use her back and stomach muscles simultaneously to help her balance when she leans in any direction.

As your child is developing the trunk control needed for sitting, she will also learn to use her arms to help her sit. She will learn to prop on her hands or hold on to your thumbs to maintain the position. Later, she will learn to "catch" herself with her hands when she begins to fall out of the position.

Children with Down syndrome usually have shorter arms than other children. This makes sitting harder to develop, since propping on arms is necessary in developing the skill. To develop sitting, a typical child props forward on her hands when learning to use the position and then learns to prop to the side to maintain her balance if she falls. When your child is supported properly in sitting, her hands will not touch the floor. If your child learns to sit by propping forward with her hands on the floor, she will learn an abnormal way to sit. Another difficulty is that when your child falls to the side, she has to fall farther before her hand can touch to prop. This makes it harder to develop balance in sitting. You will need to support your child to compensate for her shorter arms. For example, rather than prop her hands on the floor in front of her, you can place an activity center (Busy Box) across her lap and have her prop on it. (See figure 3.4)

Your child will learn to sit following this sequence:
1. with middle trunk control with support at her waist,
2. with low trunk control with support at her hips,
3. with support to balance herself,
4. without support

Activity #3: Supported Sitting, Propping on an Activity Center
1. Sitting on your heels, place your child sitting on the floor in front of you.
2. Place an activity center (Busy Box) over her legs. Put a large book under the front edge of the activity center to keep it level and at waist height.
3. Place your hands on each side of your child's trunk at waist level and hold the activity center. Pull it so the edge is against the front of her trunk and she is sitting tall.
4. Prop her hands on the activity center with her hands shoulder width apart. Entertain her by playing with the various activities.
5. Encourage her to prop, play, and sit tall for as long as tolerated.
6. When she uses this position well, the activity center can be lowered to rest on her thighs. Use a smaller book to support the front edge. Place your hands on each side of your child's trunk at hip level and pull back and downward. Encourage her to prop, play, and sit tall.