Tummy time, re-positioning important for kids' development

Kelly Kisling, Licensed Physical Therapist Assistant
MedCentral Pediatric Therapy  

Many people know about the "Back to Sleep" campaign - in fact most parents had "Back to Sleep" drilled into their heads long before their babies were born. Since the early 90s, when the campaign began, there has been a decline in deaths from Sudden Infant Death Syndrome (SIDS). But there also has been an increase in comparatively minor conditions - yet ones parents should know about - related to babies spending more time on their backs.

Plagiocephaly is an asymmetric condition of the head. Simply, it means flattening of a baby's head. It may be across the back or on one side. At times, plagiocephaly is present with another condition called torticollis, a tightening of muscles on the side of the neck. This causes a baby to tilt her head to one side and prefer to turn toward one side.

We place our babies on their backs to sleep, which for a newborn is the majority of the day, then we proceed to place them on their backs in car seats, swings, bouncy seats, carriers, etc. No wonder their little heads get flat! Parents must remember that babies need to be in various positions throughout the day. The most important of these is tummy time!

Recent ads have replaced the earlier "Back to Sleep" message with "Back for sleep, tummy to play" - a much clearer message for parents. The earlier in life a baby is placed on his tummy, the more likely he is to tolerate it. Many babies will not like this position at first, so they will need toys to look at and someone to lie with them and encourage them as they try to look around. A rolled up towel or Boppy Pillow under the chest might make this position more tolerable.

In addition to tummy time, re-positioning can help improve mild to moderate cases of plagiocephaly or torticollis. Some of these include:

• Placing the baby on the opposite end of the crib so she is encouraged to turn her head to the un-preferred side to see the door or her favorite toy.
• Feeding and carrying the baby on the opposite side he is facing.
• Using a small towel rolled up under the baby's shoulder on the flattened side to encourage the head to roll the opposite direction.
• Using a small Boppy under the base of the baby's head when she is lying flat to prevent pressure on the flattened parts of her skull.

Moderate to severe cases cannot be treated by these techniques alone, so it is important that the baby is seen by a pediatrician who can diagnose the condition and refer her for treatment, usually with a physical therapist. The therapist will perform simple stretching exercises for the tightened neck muscles, strengthening exercises for the weak muscles, developmental activities such as working on tummy time and positioning techniques. The physical therapist will also teach parents or caregivers how to perform these exercises at home for best results.

In severe cases of plagiocephaly, the baby might need a positioning helmet. An orthotist (a specialist who makes orthotic devices) will make a custom helmet that uses constant gentle pressure to round out the skull as it develops. It is important that plagiocephaly and torticollis are treated early, as the baby's head can no longer be re-shaped when the skull's "soft spots" close between 18 and 24 months. If you have concerns regarding your baby's head shape, speak with your child's pediatrician.

Last updated January 14, 2009