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Midline crossing and why is it important?

Crossing the midline is a term that we as occupational therapists and other professionals use to refer to an imaginary line running from head to toe, separating the body into the left and right hand side. By having the ability to move your body (arms and legs) across the midline it allows your child to:

  • Draw a horizontal line across a page without shifting their entire body

  • Pick up toys and objects without switching hands

  • Fluidly move their eyes when reading

  • Hold a bat with both hands and hit a ball

  • Reach across with both hands to put socks and shoes on


When your child reaches across the midline, it helps to establish dominance while giving their dominant hand the time to practice fine motor movements. If they are not crossing the midline, they are using both hands equally, which can delay the establishment of dominance and cause left/right confusion. When they start school, tasks such as learning to write can be more difficult if they do not know which hand is more skilled to hold the pencil. If they are not crossing the midline you might notice your child using their left hand when activities are placed at their left side and using their right hand when activities are placed at their right side. You may even notice them swapping their hands in the middle of a writing or colouring in task.


To adequately cross the midline, your child needs to have:

  1. Bilateral integration: the ability to coordinate both sides of the body

  2. Body awareness: internal awareness of our body’s position at all times

  3. Hand dominance: the consistent use of one preferred hand or foot

  4. Trunk stability and rotation: keeping the body in a stable position while the trunk moves to allow the arm to cross over the midline

If your child cannot cross the midline, it might impact on their ability to engage in tabletop activities (writing, painting and colouring in) or it might impact their ability to coordinate their body to engage in gross motor play. Children who experience difficulty with crossing the midline also find ways to avoid doing it. Look at how the rainbow in picture A is painted (only on one half of the page) instead of taking up the whole page as in picture b.


Picture A:





Picture B:




Need ideas of how to develop the skill?


Here are some activities to help improve your child’s ability to cross over the midline. These activities are easy to set up, requires little to no preparation and it gives you a sneak peak of what we do in our therapy sessions!

  1. Side sitting while drawing against a wall: this encourages trunk rotation and gives the added benefit of improving shoulder stability as well

  2. Playing Simon Says: incorporate instructions where your child has to touch their left foot with their right hand

  3. Rainbow art ( see pictures above)

  4. Playing tug of war

  5. Waving a parachute up and down, instead of the parachute parents could use a sheeT

  6. Playing hot potato: the ball must be held with both hands when passed on


Above is a picture of the parachute game and below is a picture playing hot potato.




Next week, we will be tackling number and letter reversals!


Have a great week😊


written by,

Zareen Abrahams

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