Crossing the midline: what it means and 6 activities

What crossing the midline looks like in daily life

Picture a line that runs from your child’s nose to their belly button and splits the body into a left half and a right half. Every time an arm or a leg moves across that line to the other side, your child is crossing the midline (Growing Hands-On Kids).

It happens all the time, and usually nobody notices. A few moments from an ordinary day:

• Getting dressed: the right hand pulls up the left sock or zips a jacket from bottom to top.
• At the table: the hand holding the pencil moves across a whole line of writing without passing the pencil to the other hand.
• At mealtimes: your child reaches with the right hand for the cup that sits to the left of the plate.
• Playing ball: a ball comes in from the side, and your child catches or hits it across the front of the body.

The eyes cross the middle too, when they follow a line of text in a book. That is why occupational therapy sites list reading and writing next to dressing, biking and ball games as everyday tasks that call for crossing the midline (Growing Hands-On Kids).

How occupational therapists use the term

“Crossing the midline” is occupational therapy language. It belongs to a bigger topic: how well the two sides of the body work together. Therapists call this bilateral coordination.

An Australian pediatric occupational therapy practice describes three ways the two sides can work together (Occupational Therapy Helping Children):

• Both sides do the same thing, as in clapping.
• The sides take turns, as in crawling or walking.
• Each side has its own job, as when one hand holds the paper and the other one writes.

Crossing the midline is one piece of that picture. When a child tends to avoid the middle, therapists usually also look at how the two hands work together, how steady the child is when sitting, and whether a preferred hand has shown up yet (Occupational Therapy Helping Children).

Keep in mind that the term describes a movement. It is not a diagnosis, and whether a child needs support never depends on a single sign.

What you might notice at home

You don’t need a test to get a sense of this. Watch for a while when your child draws, gets dressed or plays catch with you. Occupational therapy sites describe a few things they see in children who would rather not reach across the middle (Growing Hands-On Kids):

• The pencil or the scissors switch hands in the middle of the page.
• Instead of reaching across with the arm, your child turns the whole upper body.
• Things on the left always get picked up with the left hand, things on the right with the right hand.
• Buttons, zippers and socks take a lot of effort.

None of these means much on its own. Young children often switch hands because they haven’t settled on a preferred hand yet. In a study of children aged four to eleven, the four and five year olds showed a weaker preference for one hand than the eight to eleven year olds (Hill & Khanem 2009).

Rather than hunting for signs, jot down the situations where something stands out. Those notes come in handy later if you talk to your child’s pediatrician.

What research says about cross-body movements

There is surprisingly little research on crossing the midline. Most collections of exercises online come from occupational therapy practice and don’t cite studies on their effects, including the ones linked here (Your Therapy Source).

Some studies look at how reaching across the middle changes with age. In Hill and Khanem’s study, whether children reached across with their preferred hand depended on the task as well as on age (Hill & Khanem 2009). Occupational therapy sites give a rough timeline: crossing starts in the first year of life and is usually solid by around age eight or nine (Growing Hands-On Kids). Treat it as a rule of thumb from practice rather than a fixed norm.

Whether cross-body movements as a standalone workout change anything in daily life has barely been studied. International recommendations on motor coordination problems in children are clear on one point: the best evidence supports practicing the actual activity a child finds hard (Blank et al. 2019). Programs that claim to improve learning through specific movements are described there as not systematically evaluated. An older review of one well-known commercial program of this kind found no solid support for its claims (Hyatt 2007).

In practice, the games below are good movement time and let your child practice using both hands in sequence. If one specific task keeps getting stuck, like the zipper on a jacket, practice that task in small steps alongside the games.

6 crossing the midline activities for kids

All six games need very little material and take only a few minutes. The first three use big movements, the last three work with hands and fingers.

Cross Crawl March: your child marches in place and brings the right elbow to the left knee, then the left elbow to the right knee. A calm beat works better than a fast one. It’s a classic cross-body movement for kids and needs no material at all.

Big Loop: a large open loop hangs on the wall, and your child traces it with a finger in one slow movement. Standing in front of the center, the hand travels from one side of the body to the other.

Big Air Shapes: your child draws large shapes in the air with a straight arm while the eyes follow the hand. A sideways figure eight in front of the body is a good start, since it crosses the middle twice.

Wavy Line Trace: a colored wavy line runs across the page, and your child slowly follows it with one finger. Put the sheet right in front of your child, so the path from one edge to the other passes across the body.

Ball Figure Eight: your child passes a small ball around the knees in a figure eight, from one hand to the other. Both hands have to coordinate closely, or the ball rolls away.

Two-Hand Path: on the sheet, green pieces belong to the left hand and blue ones to the right. Your child has to think for a moment about which hand is up next, and when a piece sits on the other side, the hand reaches across.

You’ll find more movement games for both sides of the body among the body and coordination activities.

How to set up the games: slow, big, then smaller

These games can feel strange at first, and some kids get frustrated when their arms and legs don’t cooperate right away. Here is one way to go about it:

1. Start slow: show the movement once, then do it together, slowly enough that your child can think along. Speed comes later on its own.
2. Move big: begin with the whole body, like the cross crawl or air shapes with a straight arm. Big movements are easier to control and easy to see.
3. Then go smaller: once the big shapes work, move to the wall or the table and trace with a finger. Use a pencil only after that.
4. Change one thing at a time: each round, change just one thing, such as faster, smaller or with the other hand.
5. Stop while it’s still fun: two or three games of a few minutes each are plenty. There’s always another round tomorrow.

At the table, pay attention to where your child sits. If your child sits in front of the middle of the page and the crayons or pieces lie sometimes on the left, sometimes on the right, they’ll reach across more often without being told. If your child keeps switching hands anyway, don’t comment on it. Next time, put things a little closer to the middle.

And join in. Kids would rather copy a movement than follow instructions. If you get tangled up yourself during the cross crawl, you’ll laugh together, and that counts as time together too.

When to get help

The games in this article are movement time for home. They don’t replace occupational therapy or a medical evaluation. Talk to your pediatrician if movement has been clearly harder for your child than for other kids the same age for a while, with dressing, eating, drawing or play, and your child is unhappy about it. A regular checkup is a good time to bring it up.

Your pediatrician can refer your child to an occupational therapist or another specialist for an assessment. The NHS describes how coordination difficulties in children are assessed and who is involved (NHS).

Coordination difficulties often show up together with other conditions, ADHD among them (Blank et al. 2019). If that applies to your family, CHADD offers information and support for parents.

You won’t find a checklist of warning signs here, and that is on purpose. Whether a child needs support depends on how they manage in daily life, and that is something a professional should assess together with you.

Frequently asked questions

Further reading

• Occupational therapy activities at home: what parents can do