Babies are born entirely dependent on the care of others for their survival, both physically and emotionally, and this underpins the vulnerability of the child’s experience. With consistent, loving care the potential of the developing child seems infinite while conversely the consequences of abuse and neglect can seem catastrophic. The emphasis of a lot of work with children with developmental trauma is currently on their emotional and psychological wellbeing; harnessing relationships to lay down new experiences alongside their early ones.
Whilst Sarah was working in Fife CAMHS (2005 – 2013) she was part of a team developing a therapeutic service for local children who were looked after. The team were offering traditional psychological therapies and became aware of a significant group of children who weren’t able to make use of these, who were seemingly as dysregulated on a bodily level as on an emotional / relational level. Wanting to understand more about how children grow into themselves on a bodily level and why this process halted for children who had experienced early adversity, Sarah turned to sensory integration. Sensory integration theory helpfully mapped out how the brain and central nervous system develop in response to movement, but there was very little mention of the relationships and conditions necessary for babies to thrive. Similarly, in the attachment and trauma literature there was a relative dearth of information about the process by which children grow into themselves on a bodily level.
A solution seemed to be to build a model that could bring together an understanding of the body and motor development with our psychological understanding of the impact of trauma on the developing child. The result is the BUSS (Building Underdeveloped Sensorimotor Systems) model which brings together an understanding of how a baby and young child’s sense of themselves on a bodily level develops through experiences of being touched, held and of moving, all within the context of nurturing relationships. Sitting alongside a neurodevelopmental understanding of the impact of trauma on the developing brain, attachment theory, child development theory and drawing on sensory integration theory, the model focuses on the development of the vestibular, proprioceptive and tactile systems.
It takes as its starting point the understanding that without nurturing relationships babies don’t progress through the stages of movement that are needed to feed the brain and central nervous system with enough information to build an internal map of the body and lay the foundation for well coordinated movement. Clinical experience suggests that these systems aren’t broken in the way that might be seen in children with sensory processing disorders, rather they are underdeveloped because of a lack of adequate movement experiences at critical stages of development. The BUSS model explores the potential for rebuilding the gaps in these systems left by early adversity, using games and activities within relationships that offer the child a loving, attuned base to grow from.
Playing games and doing activities designed to fill in gaps in essential patterns of movement, missed in infancy and early childhood, within these loving relationships has a significant effect on a child’s bodily regulation. It allows children to feel confident in their movements and the messages their body gives them about their physiological state, providing a solid foundation for the development of social and emotional skills and learning.
Improved bodily regulation has a significant impact on children’s emotional wellbeing and regulation, and parents talk about how much better their relationship with their child becomes as they help their child to feel more comfortable in themselves on a bodily level. Other parents talk about how much less angry their children become and it’s interesting to think how frustrating it must be for children who have to fight against their bodies to move around and do things. Click here to read some quotes from parents, and here for some longer testimonials. The amount of energy and effort that this takes is phenomenal, and what’s lovely to hear, as children grow into themselves on a bodily level, is how much more energy and capacity they have. The fact that babies are born entirely dependent on the care of others for their survival, both physically and emotionally, underpins the vulnerability of the child’s experience. With consistent, loving care the potential of the developing child seems infinite while conversely the consequences of abuse and neglect can seem catastrophic. The emphasis of a lot of work with children with developmental trauma is currently on their emotional and psychological wellbeing; harnessing relationships to lay down new experiences alongside their early ones.
This is different to work with children who have a sensory processing disorder. Although a child with an underdeveloped system may move in a similar way to a child with a sensory processing disorder, they’re actually completely different. For a child who has experienced abuse and neglect, it’s usually the case that the system isn’t broken, it just hasn’t been built yet.
The human body is amazing and babies come equipped with all sorts of reflexes and reactions designed to move their body through the stages of development that it needs to go through, from gaining head control to moving from lying down to a crawling position. Unlike other animals, the brain and central nervous system of the human baby is still at an early stage of development at birth and babies need an attuned adult and lots of nurture and movement experiences to allow them to grow into their bodies on a physical and an emotional level.
When abuse or neglect mean that children have missed out on those early stages, it can be helpful to take them back through those patterns of movements so that their brain and central nervous system has enough information to allow their bodies to work in a smooth, well coordinated way. This is obviously more challenging because there’s not that natural push that the newborn has to move through the critical stages of development in the intended way, and so it’s really important to first make a good assessment of each individual child or young person and then to tailor a programme of therapy to suit them and their family.
Not being able to follow that blueprint of typical development means that we need to work together with families to make up games and activities to make children think that being on their tummies, commando crawling and crawling are the best fun they could be having!
We all find it easier to do things if we understand why, and I wanted to talk you through the reasons for some of the things we’re asking you to do, like tummy time, commando crawling and crawling. If you’re interested in finding out more, I have collated some of my favourite resources, which you can have a look at in the “Other Useful Resources” section here. I’ve also written a couple of books about underdeveloped sensorimotor systems – the first one, Improving Sensory Processing in Traumatised Children (2015) is written for parents and carers, while the second one, Building Sensorimotor Systems in Children with Developmental Trauma (2020), is a bit more detailed and talks more about development as well as ways to rebuild the systems. Books are all available on Amazon, and there is more information about them in the resources section too, which you can find here.
The spine of a new born baby is shaped like a giant C, and I’m sure you’ll know that way that new born babies tend to be quite curled in on themselves in those early days. It’s this flexed position that is most efficient, as a new-born, for utilising oxygen, feeding and digestion (Kranswoitz, C., Lopiccol, A., 2017)
However, over the first year of the baby’s life it needs to develop from that curved position to an inverted S to give the body the best distribution of weight during movement as well as balancing mechanical stress at rest. Once babies are up on their feet and moving around, it’s this inverted S shape that is most efficient for breathing and digestion as well as movement.
To move from the C to the inverted S shape is a process that starts in the early days and weeks of the baby’s life. As the baby spends time of her tummy and her back as well as being carried around, the baby’s neck muscles develop so that the spine can take its first curve; the one at the top of our spine, the cervical spine curve. This combination of skeletal changes and growing muscle tone is crucial for the beginning of the development of core strength, starting with the baby’s head. If you visualise a baby on their tummy, their head is usually at an angle of about 90 degrees to their body, as they look around and take in the world. As they begin to commando crawl, moving forward from this position on their tummies, they’re usually looking around and trying to see as much as they can and all of these early movements really boost the development of the spine and of muscle tone.
If baby’s have missed out on lots of movement experiences in their early days, weeks and months, we need to work hard to try and rebuild both the skeletal and muscular changes that the body needs to give a child a stable base for movement. While it is a very simple thing to do, spending time on their tummies is probably the single biggest thing that we can do towards filling in those crucial gaps.
I always find it helpful to have a picture in my head of what the stages of development look like, and if we think again about typical development, babies follow a fairly well established sequence of events here – they move from lying on their tummies to beginning to get themselves into a better position for moving.
So we can see that progression from the baby being on their tummy and needing their forearm to support them, then being able to manage with just their hands, and then, by about 7 months, they’re getting enough stability from their head, neck and trunk, to be able to just have one hand on the floor while they’re busy doing something else.
As the baby learns to sit, crawl and then walk , their lumbar spine develops. This process takes between 12 – 18 months, until the baby is walking independently.
Another thing that you’ll notice about the model, is that we spend a lot of time talking about crawling…
Being up in the crawling position is an especially important part of the process of the baby’s spine development– it’s like a turbo boost for the development of the lumbar spine – but it is also beneficial in so many ways!
Let’s start (as always!) with the blueprint of typical development. If we think about all of this pre-crawling preparation, we can see that by 8 – 9 months the baby can independently support their weight on their hands and knees. They can rock back / front, side / side, and diagonally. This is important in preparing the wrist to move in all directions and stimulating the finger extension. By this time, they can often scoot forward a few feet by moving their arms and legs and are generally delighted with themselves that they can do this!
So, by 9 months the typically developing baby is now able to be on their hands and knees and shift their weight from one hand to the other while reaching out, without dropping their tummy to the floor. They’re only a tiny way from actually crawling – and if we look for a moment at a baby in this position we can see great head strength and control, strong shoulders, lovely straight arms, flat hands with fingers facing forward they’re ready for the off!
And then they crawl! Moving at speed and, for most babies, this is the stage before walking. But don’t let’s rush forward, if we just think about the advances a child makes through crawling for a moment, we can see many good reasons why it would be useful to go back and fill in gaps in development if children have missed this (and earlier) stages.
Crawling really demands that the baby uses both sides of their body together (bilateral integration and sequencing); as the right hand goes forward, the left leg moves then as the left hand goes forward, the right leg moves. This massively strengthens the connections between the left and right sides of the brain and is so important in our bodies being able to work as one unit, in an integrated way.
Crawling is also hugely beneficial for developing what’s called proximal joint stability – so strengthening the joints close to our core, our shoulders and hips. As children get older they develop competence in fine motor skills, nearly all of which involve our hands, which are the furthest point from that stable core. So to develop good control of things that are far away from their bodies, children need good head, neck, shoulder girdle and trunk control. Crawling plays a really important part in building that core stability.
Crawling also helps the baby to develop what’s called postural control. We need to be able to hold our bodies in a good upright and stable position for just about everything, from sitting to standing, walking to skipping. A really important building block towards postural control is what’s called co-contraction, where different parts of the body work helpfully together with other parts so that body can do increasingly complex tasks. To be able to crawl, the baby needs to contract all the muscles around their trunk so that stays nice and still while their arms and legs are moving their body forward. Again, crawling is the perfect chance to do this!
Crawling gives the infant one of their first chances to hold their body off the floor and to have their hand flat on the floor, with their fingers facing forward. This hand position helps with lengthening the long finger muscles that are so important in fine motor tasks, like handwriting. When I’m watching older children crawl, where their early lives have meant that they haven’t gone through this lovely sequential process of development, I often notice that their hands are clenched as they crawl. It’s really helpful to know that typically developing babies don’t crawl like that, except perhaps in the early days. Where we’re taking children back through stages of development that have been missed, and wanting to get the maximum benefits from crawling, we need their hands to be in the right position; flat hands, fingers facing forwards.
Crawling with hands in this position develops the arches of the hand. The arches help the hand to mould itself around objects when we grasp at something. Think about catching a ball – your hand moulds itself around the ball as you catch it so that you can hold onto it. Or think of picking up a really delicate object – you don’t want to hold it so tightly that you crush it, but neither do you want to use so little force that you drop it. Your hand needs to know just how much pressure or or force to use, and to position itself appropriately. All of these skills have their origin at this stage of development! It’s phenomenal that crawling has such long term benefits.
Think of how important it is that a child has progressed through this stage of development before they’re trying to do things like hold cutlery or beginning to draw with a crayon.
The baby’s hand being in this position (flat hands, fingers facing forward) is really helpful in the process of specialisation. Specialisation is a massive topic (Ayres, 2005 talks very helpfully about this) but for just now, it’s enough to know that we don’t need our whole hands to be able to do the same things, and even at this early stage of development, our brain and central nervous system are constantly refining things so that our bodies become more efficient and effective. For the developing child, the fingers near their little finger, the ulnar side of the hand, becomes the stabilising part of the hand and the thumb and forefinger, the radial side, the working side. You can see how this works if you just try writing something – your whole hand isn’t involved in the movement – the ulnar side of your hand provides a really nice stable platform for your thumb, index finger and middle finger to do the work! Again – crawling paves the way for this to happen.
Although we’re focusing on motor development, lots of other changes are happening in the brain, including the whole visual system. When the baby is crawling, they’re doing lots of different things with their eyes – looking from hand to hand as they move forward, tracking where they’re going. This ability to visually track from left to right and right to left is really important not only at the crawling stage, but all through our lives. Without this, children can only read one half of a page of text.
As well as tracking their movement from side to side, the baby is also constantly negotiating their environment. They’re looking at where they are and where they might be wanting to go. It’s amazing that you rarely see a newly crawling baby bump into things – the brain is just phenomenal in the timing of the development of these motor programmes that are just waiting for the right environment to come into being.
The process of crawling helps to develop what’s called binocular vision and depth and space perception. Again, these are skills that we need all through our lives – not just as children sitting in classrooms needing to look up at the board and then back down at our paper, but they’re also crucial in things like also planning whether to overtake when we’re driving.
As the baby gets better at crawling, they spend more and more time in this position. This means that the muscles around the baby’s trunk are getting stronger. This is so important because it helps to develop the muscles that are vital for breathing and the development of speech as well as eating. Such important life skills start right back at this stage.
When I’m training, the question that I’m most often asked (usually by people in the audience who are parents of typically developing children) is
‘What happens if a child doesn’t crawl – does it really matter?’
I think we probably all know children who went from sitting on their bottom to walking without seeming to have done much in between. And for a typically developing child, growing up in an environment where there’s lots of warmth, happiness, stimulation and opportunities for play, there’s a much bigger margin for error. For these children, not doing much crawling takes on a different value. They’ve probably done all the stages that preceded it – rolling, spending time on their tummies, pushing up, reaching up for toys, spending time in their high chair banging spoons … and will go on to be children spend lots of time climbing, playing in play parks, building dens and playing games that involve them being on their hands and knees (any game involving animals inevitably involves a bit of crawling!). So you can see this this becomes one small gap in an otherwise rich early life.
For babies growing up with abuse and/or neglect, they will spend a lot of time in a state of frozen watchfulness, missing out not only on crawling but all the stages that precede and come after it. This leaves them without the building blocks their bodies need to develop core stability and fine motor skills – and I’m always keen to go back and fill in these gaps so that we can allow these children to function to the best of their ability.
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