FREE RESOURCE: Crossing Midline

06.02.21 05:19 AM Comment(s) By Christie

Adult and child holding a blue paper cutout of a house.

By Krupa Kuruvilla, MA, OTR/L

Product Specialist at Verge Learning

XceptionalED Leader at XceptionalED

Owner at Total Report

What is crossing midline?
Crossing the Midline refers to the ability to reach across the middle of the body with the arms and legs crossing over to the opposite side. 

Ideally, this should happen spontaneously in daily activities but some children need to be encouraged to develop this skill. 

When a child is not able to cross their midline, it means that the two sides of a child’s brain are not communicating with each other.


Why is crossing the midline an important skill to develop?

A lot of our daily activities such as reading, writing, dressing, and tying shoelaces, require us to combine movement patterns that involve us reaching across the middle of our bodies. In order for our body to be able to perform bilateral movements, which are tasks requiring the use of both hands, we need to have developed crossing the midline.

When a child spontaneously crosses the midline with the dominant hand, the dominant hand gets the practice needed to develop good fine motor skills by repeated consistent hand dominance. If a child avoids crossing the midline, then both hands tend to be used in performing tasks and the child’s development of hand dominance may be delayed. 

Even a skill as simple as drawing a horizontal line from one end of the page to the other, requires crossing midline. 

Young girl writing in notebook with a pencil.
When children do not develop this skill properly, what does it look like?
A child who is unable to cross the midline usually presents with delayed developmental milestones and the quality of his/her motor movements and learning are affected. Difficulty crossing the midline will affect visual tracking which leads to problems with activities such as reading and delayed hand dominance and fine motor skills, which will lead to difficulties with handwriting.  Other ways it may manifest will be reduced Independence in self-care tasks such as putting on shoes and socks, and difficulty with sports and other motor coordination because poor midline crossing also makes it difficult to visually track a moving object from one side to the other. Children who have not developed this fully will have difficulty and may sometimes get stuck mid-way while performing an activity, and have to switch hands. They may compensate by turning their trunk to reach toward the opposite side. 
What are the Building blocks necessary to develop the ability to cross the body’s midline?
  • Bilateral integration skills (using both sides of the body at the same time)
  • Core stability
  • Trunk rotation 
  • Hand dominance 
  • Planning and sequencing 
  • Body awareness
Signs that a child is not crossing the midline
  • Delayed crawling or skipping the crawling stage entirely 
  • Have difficulty coordinating gross motor patterns (crawling, skipping, jumping jacks)
  • Switches objects between hands
  • Switches hands midway through a task such as writing, drawing, or coloring, 
  • Uses their left hand for things on the left side of their body and right hand for things on the right 
  • Moves his/her body to face an object versus using trunk rotation and moving their hand across their body 
  • Difficulty making a horizontal line across a piece of paper (may stop in the middle and switch hands, or pause visually) 
  • Difficulty using two hands in play 
  • Poor handwriting/coloring skills
  • Skips words when reading
  • Have difficulty visually tracking an object from one side of the body to the other, such as following text when reading.
  • Use different feet to kick a ball (mixed feet dominance)
  • Behavior – a child may become angry or frustrated when engaging in fine motor activities due to less refined hand skills.  Performing self-care tasks independently (age influenced).

What happens if crossing midline is not addressed?
School aged children are expected to be independent with most self care skills and classroom tasks. If they continue to have difficulty with crossing midline, this could lead to increased pressure and anxiety if they feel the need to continually ask for help and find it difficult to keep up in class due to poor handwriting skills. Difficulties can also be manifested in participation in sports that require good coordination (e.g. basketball, baseball, netball, tennis).
Activities That Encourage Midline Crossing

Stamping with Ink-stamps 
  • Materials needed: Large sheet of paper, stamps, stamp pad.
  • Activity: Have the child use the stamp with the dominant hand and hold the paper with the non-dominant hand while enjoying this activity. 

Pick-up Games   
  • Materials needed: Anything! Toys, ordinary household objects.
  • Activity: Place objects to the child’s right and a container on their left side, so that they must reach across the midline to drop objects into the container. Switch sides.  Make sure the child’s non-dominant hand is resting on the floor.  Other Manipulatives that can be used are: pompoms, pennies, paper clips, marbles and chips from games. A variation of this is to have the child hold the container in their non-dominant hand and drop the objects in with their dominant hand. Another variation is having the child pick up objects using tongs, incorporating fine motor skills in the activity as well.
  • For younger children: Have them sit in front of you on the floor, and place all toys on one side. Hold the hand on that side down on the floor, so they are encouraged to use the opposite hand to reach out for the toys and materials. 

Puzzles on the Floor
  • Materials needed: Puzzles
  • Activity: Have the child lie on their tummy and reach for the puzzle pieces, spread out in different directions on both sides.

 Toddlers on their stomachs putting a puzzle together.

  • Materials needed: Stickers
  • Activity: Put stickers on the child’s left hand, arm and leg and have them remove the stickers with the right hand. Then switch to the right side of the body and use the left hand to remove stickers. 

Young child stamping on paper.

Figure of 8 
  • Materials needed: Paper/chalkboard/tray filled with sand/shaving cream
  • Activity: Have the child draw or trace over a figure of 8 vertically or horizontally (looking like the infinity symbol ∞) in the air, on paper, in a tray filled with sand, shaving cream and other textures. Get creative!

Body Awareness Games
  • Materials needed: Mirror (optional)
  • Activity: Playing body awareness games like Hokey Pokey or Simon Says increases awareness and encourages children to cross the midline. Having a mirror in front of them may increase engagement and awareness. Another game idea is Twister.

Popping Bubbles
  • Materials needed: Bubble liquid and a wand
  • Activity: Have the child pop bubbles with any ONE hand only at a time. Switch hands later.

Toddler popping bubbles in the air.

Ball Passing
  • Materials needed:  One large ball
  • Activity: Sit back to back with the child and pass the ball to each other sideways, by maintaining that position and only using the trunk to turn around and twist. 
  • BONUS: Also works on core stability and trunk rotation, both good precursors to crossing midline. 

  • Materials needed: OPTIONAL - Tunnel. Otherwise, none. 
  • Activity: Crawling! Incorporate crawling in fun and different ways during play time. Crawling will encourage reciprocal movement. 

Gross Motor Movement (IMAGE - BOY KICKING BALL)
  • Materials needed: Could be swings, trampolines, bounce houses (As deemed appropriate and safe by adults). 
  • Activity: Encourage the child to participate in swinging, bouncing and rough housing. These activities will increase body awareness and help in the development of midline crossing. 

Toddler kicking soccer ball with his parents.

Have the children participate in any activity that works on bilateral coordination skills, using both sides of the body together. These activities will automatically develop crossing midline as well. 

Examples are:
  • Jump rope
  • Riding a bicycle
  • Playing catch with a ball
  • Playing the drums
  • Tying shoelaces
  • Cutting with scissors
  • Threading beads
  • Manipulating buttons


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