Hey everyone! My name is Sarah Johnson and I'm a pediatric occupational therapist and part of the infant development team here at Emerge Pediatric Therapy. I'm here today to talk to you about arm strengthening in infants over three months of age. When we're looking at initial arm strengthening in infants, for that birth to three months of age range, what we typically see is infants working on time and time in a plank position. Once infants start to hit three or four months of age, we look for them to transition from that plank position to extended arms, which is actually a precursor skill for rolling and sitting. For rolling, we look for extended arms because it creates more space between the arms and the torso and it allows for the infant to tuck their shoulder under when they're rolling from their belly to their back. In sitting, infants develop the ability to prop sit first, which is to sit with their hands on the floor or surface and hold their body upright as they're working on the posture of control needed for sitting. If an infant is not able to push up on extended arms after three months of age, it might be because they don't have the arms straight to do so and that could impact both rolling and sitting. I am going to go through a couple different ways that you can work on arm strengthening and these are great for infants three months of age up. As infants get older, especially if they had difficulties with tummy time earlier, it can become harder and harder to keep them in traditional tummy time and that's when these strategies come into play. The first thing we're going to look at is a little bit of a wheelbarrow. What I like to do for this activity, you can either do it on your leg or your boppy. I'll show you both, but what you're working on is you have the infants hips on your leg and their arms are forward so they're pushing up on straight arms. It's really important that their body is forward and just their pelvis and their hips are on your leg and not their arms because if their arms and you're right at the bottom of their arm, if that's where your leg is, they're not going to be able to push up all the way. You're going to push them forward. This actually makes them a little bit more top heavy so it makes them more likely to push up and be able to hold that position. You can try that one either on your leg or you can do it on a boppy. Typically when we start working on tummy time with a boppy, we have the torso supported by the boppy. For this exercise, since we're just trying to isolate the arm strengthening, you're going to have their pelvis on the boppy and their arms are going to be out in front of them so they can push up straight. This activity is also a great activity to have some toys and specifically when we're talking about tummy time, you want the toy to be at eye level or where you want their head to be. For this one, I'm actually going to choose a toy that stays on the ground because I don't want them to arch their head all the way up and activate their back inswers instead of the muscles that we're targeting in this exercise. When you're picking a toy, look at where the infant's head should be, which in here is just slightly lifted and then put the toy at eye level for that. Another way you can work on arm strengthening is on the ball. This can be great for older infants or for infants who really don't tolerate being on the floor. For this, what I'm going to do is I'm going to put them on the ball and then I'm going to roll them forward and I'm going to hold their hips up a little bit. This will allow them to push up on those extended arms. Sometimes I'll bring my body a little bit more forward, set it closer to them, depending on their size and how much they move. This is the same idea as on the floor where I'm pushing up on extended arms, but sometimes infants tolerate a better when we have the movement out the ball. I'm going to go side to side or forwards and backwards and give them some engagement through movement. This is also a great one to have some beads so they can start to reach out for these and engage more as well. Another way we can work on arm strengthening, and I find that this is especially helpful in infants between four to six months of age when we're starting to work on sitting skills. We can actually target our arm strengthening while working on sitting. The important thing to note about one more work on sitting, especially initially, is that we always want to have a slight bend in the leg. If an infant is sitting with their legs straight out, they're actually using their hips instead of their core. Even if it's just a slight bend in the knee, we want to make sure there's some bend so that infants are having to use their core to keep their body upright. When we're working on sitting, one way I like to work on it is at a vertical surface. This one's a little bit slated. This walker is a great option for both sitting and crawling because it provides this surface that infants can push up on. So for this, I'll have them sitting in front of it, a little bit of a ringset, and then their arms would be out on the toy, which would look like this. So they would be pushing up and depending on how tall they are, it could be lower or higher. But the idea is that they're pushing through extended arms to engage with the toy. Another way you can work on this is on a shorter surface on the floor so you can have your infant here and they're reaching forward to have their arms up on the surface, which would look kind of like this. You can add a toy on top so they're holding and also engaging. What I typically tell parents for this is this is a great time to go around your house and see what boxes or containers you have kind of lying around. Sometimes it does take some trial and error of seeing what is the correct size, but ideally you want your infant's arms to be bent at a 90-degree angle. That's about how high you want the surface because that's going to work on them pushing a little bit to get that surface. If it's higher than a 90-degree angle, they're not going to be able to push fully. So look at either 90-degree angle or slightly lower so they can push up on that object. The next thing you can do once you've started working on these skills and you feel like your infant is getting good at keeping their arms straight out, you can actually work on them reaching for objects and activating objects when they're in that position. So once I have an infant in that position, especially if I'm working with a toy like a piano, I will shift them to one side and have them activate it and then shift to the other side and activate it with the other hand. You can also do this when they're in sitting practice, especially if you're using a toy like this, you can have them sitting here and you can have them reaching for a dynamic toy like beads with one hand and then switching and reaching with the other hand. That is the next step up for this skill because that's working on the weight shift that is needed for rolling. If you have any questions regarding your infant's development, please reach out and maybe more than happy to answer them. Thanks so much!