Originally published August 25 2008
Physical Therapists Strongly Recommend 'Tummy Time' for Improving Infant Development
by Dr. Samuel Mielcarski
(NaturalNews) In 1992, the "Back to Sleep" campaign led by the American Academy of Pediatrics was aimed at preventing Sudden Infant Death Syndrome (SIDS). According to their statistics, the program seems to have been successful. However, what appears to have been ignored until recently is a new epidemic of developmentally delayed children -- including those with plagiocephaly (a flattening or deformation of the head). Although the "Back to Sleep" program convinced parents of the importance of putting newborns and infants to sleep on their backs, this recommendation may have been misunderstood. As the American Physical Therapy Association points out, the back-lying position is for when kids are sleeping and unsupervised, not all the time.
Some health authorities have questioned whether stomach-lying is the true cause of SIDS. An alternative explanation is that babies may be really dying because they are inhaling toxic chemicals from their sleeping environment (mattresses). When on their stomachs, they are inhaling these chemicals directly, as opposed to being on their backs and breathing the air above them. Dr. Jim Sprott has done some extensive research on this proposed cause of SIDS and has published a book about it (http://thecauseofsids.org/). He notes that SIDS is very rare and even unheard of in other countries that do not use mattresses for their babies (e.g., hammocks). He notes also that SIDS was not really heard of until mattresses started being filled with toxic chemicals as well. Other potential suspected causes of SIDS include nutritional deficiencies, vaccines, pesticides, and second-hand smoke.
No matter the cause of SIDS, one thing is for sure: Without ample "tummy time," kids will not develop properly. A national survey of 400 pediatric physical and occupational therapists by the non-profit children's health advocacy group "Pathways Awareness" found that two-thirds of therapists reported increases in motor delays in infants who spend too much time on their backs. These delays can be: developmental (muscle and bone disorders), cognitive and organizational skills delays, eye-tracking problems, and behavioral issues to name some of complications that can arise.
One of the biggest problems is that it's not just when they're asleep that babies are being kept on their backs. It appears to be occurring all the time. New parents are now using car seats often that also serve as infant carriers, many of which fasten directly into strollers and swings without having to remove the baby from the seat. In other words, the new generation of babies is spending way too much time strapped into things that keep them on their backs. Little ones love to explore their environment. Without ample tummy time, this exploration process is becoming severely hindered, and so is their development as well.
As mentioned previously, a misshapen head (plagiocephaly) can be a common result of too much time spent on the backside of the body. However, it should be noted that many newborns can have some degree of head shape irregularity. In most cases, the head will resume a symmetrical shape by 6 weeks of age. Abnormal head shape beyond this period may indicate a condition that requires repositioning and orthotic treatment. Premature infants are at higher risk for plagiocephaly, as they tend to spend extended periods of time in neonatal intensive care units (NICU) on a respirator with their heads maintained in fixed positions.
Although many new parents are concerned often with just the basics, such as sleeping, eating, changing, and nurturing, babies need simple movements and changes of position too. Just holding and soothing a baby in different positions can help them get used to tummy time. Pathways Awareness has developed "Five Moves for Baby's First Workout," a guide that includes photos, tips and suggestions for integrating tummy time into an infant's day. They recommend babies start with tummy time for just a few minutes (or even just a few seconds) per day, eventually building up to an hour a day, in spurts throughout the day, by three months. Parents can visit (www.pathwaysawareness.org) for more information.
Children's Healthcare of Atlanta has also put out a brochure called; "Tummy Time Tools" (http://tinyurl.com/6eknkj) , which offers parents with ideas and activities to make sure a baby gets enough time on the tummy throughout the day, while awake and supervised. These activities include handling, carrying, diapering, positioning, feeding and playing with their baby.
Deformational plagiocephaly is typically diagnosed during a regular physical exam by a pediatrician or craniofacial physician. Measurement techniques and a visual exam of a baby's head can determine the asymmetry of the skull and facial features. Physical therapy may be recommended for infants with moderate deformational plagiocephaly or torticollis (wryneck). A typical treatment plan may involve repositioning the infant's head away from the asymmetry and tilted position, gentle stretching and massage. Physical therapists develop at-home therapy programs that instruct parents in proper positioning techniques, along with exercises to facilitate symmetrical movements and developments.
A common recommendation is to reposition the child's head during sleeping (such as rotating the head away from the flattened or asymmetrical side). Also, periodic changes in the orientation of the baby to the room are suggested. For example, the baby's body or crib can be periodically turned to face the door at a different angle. This will require the baby to look away from the flattened side when they want to see parents or others in the room. Supervised tummy time is also used to prevent unwanted pressure on the back of a baby's head and helps a child to develop proper head and neck control.
A cranial remolding orthosis (also called a "cranial helmet" or "band") may be recommended. Remolding helmets usually have a hard outer shell and a foam inner lining. The theory of how they work is that they apply gentle, yet persistent, pressure to the infant's head, inhibiting growth in the prominent areas and allowing for growth in the flat regions. Cranial remolding orthoses are believed to be most effective with infants 4-18 months of age. During this time, an infant's skull is more malleable to allow for rapid brain growth. The average helmet treatment usually lasts 3-6 months, depending on the age of the infant and severity of the condition. Frequent monitoring is required with this intervention. Parents should remember that using such a device is a personal choice. If parents do decide to use a cranial helmet, they should be sure to check the chemical toxicity or allergy potential of these devices. Gentle manual therapy (hands-on) techniques, such as craniosacral therapy and myofascial release, may be beneficial in a child's treatment as well.
Developmental delay, including plagiocephaly can be a confusing and fearful obstacle for many new parents. The good news is that it's often a treatable as well as preventable condition.
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Influence of supine sleep positioning on early motor milestone acquisition. Dev Med Child Neurol. 2005; 47(6):370-6; discussion 364 (ISSN: 0012-1622)
Richardson BA. Sudden infant death syndrome: A possible primary cause. Jour Forensic Science Society 1994;34:199-204.
Sprott TJ. The Cot Death Cover-up? Auckland: Penguin Environmental-NZ, 1996.
About the authorDr. SAM (Samuel Arthur Mielcarski), DPT, is an expert in the field of rehabilitation. He is currently licensed as a physical therapist in Georgia and Florida. He has over 13 years of clinical rehabilitation and health-coaching experience, combined with additional training, education, and practical experience in integrative bodywork, nutrition, natural hygiene, exercise/fitness, mind-body integration, performance enhancement, and personal training. He is the author of the recently released: "Revolutionary Rehab Manual: A Common Sense Approach to Health and Healing." Details can be found at: RevolutionaryRehab.com. He can be contacted via email at [email protected] or through his main website: www.DrSamPT.com.
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