Balancing Act: All About Postural Control

“Stand tall. Sit upright. Shoulders back, tuck your bottom…”

While your grandparents might want you to be prim and proper, posture is much more involved than just how you look. How we sit, stand, or maintain any upright position without support requires postural control. We do this daily without much thought or effort so that we can use our energy and focus on more complicated tasks. But for some, especially kids, just sitting in a chair without falling is a challenge. It may not seem like a big deal, but almost activity we do requires sustaining an upright position against gravity.

Let’s Start at the Beginning

Postural development starts when babies arrive home and start tummy time. While on their belly, your newborn’s first goal is to gain head/neck control and muscle tone (tension). Once they do this, they can begin to build muscle strength and coordination for voluntary movement, like rolling over or sitting up.

As your baby develops and refines their head control, between 2-4 months, their visual and vestibular (movement) systems help them recognize and ensure that their head is upright and at midline, the beginning of upright posture.

I’m Melting!

Postural control is influenced by the information provided by our senses, but the one that plays a major role is proprioception. We’ve talked about this sensory system before, but to recap: This system is responsible for understanding where and what the body is doing. It receives information from receptors in our muscles, skin, joints, ligaments, tendons, and connective tissue. When our muscles stretch, bend, or contract, these receptors notify the brain on where and how the movement occurs. However, if the receptor signals are weak, it can result in low muscle tone. Children with low tone look floppy in their movements, frequently preferring the floor to lie down or are seen “melting” off their chair.

Sorry. Reflexes.

Another factor that could be affecting your child’s posture is the presence of primitive reflexes. These reflexes are involuntary, stereotyped movements that provide a fundamental foundation for conscious actions later. You can see primitive reflexes at work when a baby immediately curls up in a fetal position or bends backward like The Exorcist, or has a very rigid body extension. However, these actions should only have a limited lifespan and eventually integrate as more neural connections in the brain develop.

If they don’t integrate within the first year of your child’s life, they can impact how they participate in functional activities as they get older. It may seem like they don’t have complete control over their own body. Things to look for:

Difficulties sitting in a chair appropriately, sometimes turning/shifting their body to one side to complete a task
Fear of excessive movement or falling (known as gravitational insecurity)
Getting tired from standing for any length of time or constantly fidgeting to remain upright
“Bowing” of the body, standing with their head jutted forward
Toe walking and rigid motions, affecting balance and coordination
Slouching or slumping in a chair while sitting or lying on the desk to write or arms are on the table while eating

Methods of Compensation

Children with poor postural control will try very hard to compensate. They use their attention and energy to stay still or in their seat, leaving little left to learn new skills, focus on tasks, retain information, or listen to instructions.

If they have to stand for a long period of time, they may try to lock their joints or fidget.
If they must sit in a chair, they’ll try to shift their body in their seat or try to put their legs up on their desk.
They might wrap their feet behind the legs of their chair to ensure they won’t fall out.
They may prefer to lie on the floor when reading or writing.
They may prefer to W-sit, providing a wide base of support and requires little postural control to sit upright.

How to Help Your Child Build Postural Control

Stabilize and Hold – To help your child gain the core strength needed to maintain an appropriate posture, try exercises that stabilize their trunk muscles. These can be plank holds, hollow holds, bird-dogs, or cat-cows.
Integrate those Reflexes – One of the main ways to integrate primitive reflexes is crawling/creeping on hands and knees. Crawling through tunnels or over and under pillows can be both fun and challenging. You can get creative and play a game of “head soccer” where you push an inflated ball into a goal with only your head while crawling on the floor.
Got your back – If your family is going somewhere that requires being seated for an extended period (like at a restaurant), make sure they have something they can lean on for support. It may be sitting in a chair that has arm rests, sitting at the far end of the booth up against the wall, or sitting between two adults.
Chair alternatives – To get those wiggles out while working on postural control, try seats that provide movement. These are stability balls, dynamic wedges/discs, or T-stools. Be sure to go over the expectations of these items before using them.
Switching positions – Instead of sitting to do homework, let them do it while standing or lying on their belly. You can also tape their assignments on the wall or under to table to help. This will allow them to move around more or lessen the amount of energy and control needed to remain still.