Once upon a time, people had their babies. They lived in multi-generational homes with lots of support. Life was simpler.
Now we are surrounded by gadgets and high tech contraptions. Many of us have less family around. There seem to be more rules. Some of the new rules are science based, including the very important ones about safe sleeping.
In 1992, the American Academy of Pediatrics initiated the "back to sleep" program in order to try to combat Sudden Infant Death Syndrome. Since this program began, the rate of SIDS has decreased by over 40%. An unintended consequence though was the number of babies who have flat heads from spending so much time on their backs. Nice round heads are becoming a real rarity.
This flat head condition is called plagiocephaly. Statistics claim that It occurs about once every 300 births, but I think more babies than that have at least mild cases. Interestingly, little boys are twice as likely to have issues with this, and right side flattening is more common than left. Many babies with plagiocephaly were predisposed to it because of their position in utero.
Newborns' skulls have a lot of plasticity, so they are pretty susceptible to external pressure. Up until about six months of life, the skull is naturally thin and flexible. It can easily change shape. It turns out that if you drop a cell phone on your baby’s head it will actually leave a little dent! Yes that is a real call that I got from a frantic mom. (Don’t worry his little head is fine.)
Positional plagiocephaly does NOT affect brain growth or development, and by ages 4-6 months, most heads have developed a normal shape. But early intervention and recognition can speed up the rounding process and hopefully keep things from getting worse.
Babies don’t have a lot of motor control during their early months, so they can’t always easily re position themselves. Babies who do tummy time will have an advantage.
Tummy time should be started early and often. It doesn’t need to be hazing. Even one minute at a time can count.
The first tummy time can be within their first couple of days. Start by having your baby simply lay on you. Don’t worry about the cord (you most likely aren’t that firm of a surface.) Tummy time is an excellent way for them to develop muscles and work on their head control. It is also great for their digestion!
Even though Infants lack head control, they should be able to turn their heads to either side at rest. Some babies, particularly those with shortened neck muscles may develop a more serious kind of flattening. You may hear this condition referred to as torticollis. If you find that they don’t easily move their head from side to side easily I would suggest a visit to a Physical Therapist or Chiropractor. It is never too early for an evaluation.
There are little steps that you can do right from the beginning that minimize your baby having one favorite side. You would be surprised how many parents don’t recognize the fact that their babies heads are a bit tilted.
Try to give each side equal attention:
Jennifer Maeder, a local lactation consultant and Tummy Time Method provider adds:
Parenting today includes the use of a lot of ‘containers’ - equipment such as swings, bouncy seats, car seats, and other infant containers to help hold babies in our modern world. Another influence is ‘containment,’ or the over reliance on excessive swaddling with products like the SNOO and restrictive swaddling blankets. Too much of this can have a negative effect on hip development and inhibit movements vital for optimal breastfeeding and maybe even neurodevelopment. I’m all for making parenting more manageable, but consistent, daily tummy time is essential to counter these practices that decrease natural floor time that is key to supporting motor and sensory development.
If your baby struggles to enjoy tummy time, has plagiocephaly, torticollis or other asymmetries, or you just want to optimize postural development and a healthy nervous system function (including digestion) - daily, consistent tummy time (3-5 sessions per day, 4-5 waves per session) can help. Remember, we frequently expect babies to learn to self regulate quickly. Babies need practice to succeed. The interaction between parent and baby in tummy time provides the chance for connection, interaction and play. Check out this video for a step by step how to on “tummy time waves” from neonatal occupational therapist and founder of the Tummy Time Method!, Michelle Emanuel:
For anyone interested in finding out more, or having a little coaching, Jen holds her Tummy Time Method classes at www.noevalleylactation.com check them out!
As Jen mentioned, pay attention to places where their little head is up against a hard surface. The crib is the main culprit, but anywhere you put them down for a bit counts. Anytime that the baby doesn’t have their heads in contact with a firm surface is a bonus!
Sandra Roddy-Adams, a San Francisco based chiropractor who does cranio-sacral works on a lot of babies, weighed in on the importance of tummy time.
Supervised tummy time is important because babies begin developing their cervical lordosis (neck curve) around 3-6 months. This curve is formed as the baby begins to lift his/her head. This helps train the surrounding postural muscles and enhances visual awareness. A noticeable flattening of the base of the skull (occiput) or a spine out of line, can also interfere with tummy time and development.
If the birth was challenging or if you begin to notice some things like the base of the skull not changing/rounding, difficulties nursing on one side, or a continued head tilt on one side in the car seat or stroller, bringing them sooner than 3 months to see if a gentle adjustment is needed to align their spine can help create symmetry and ease in their bodies and brains. I actually recommend that babies get their nervous system/spine checked as newborns. (I am also a huge advocate of wearing your babies in slings.)
It is not recommended that babies have a pillow for night sleeping, but I am fine with one of the memory foam infant pillows for changing tables. There are quite a few options for this available on Amazon. Janet Green Babb, a SF PT,
says that one product that her clients have found helpful is a pillow called Mimos Baby Pillow.
She suggests to parents that they should feel their baby's neck, shoulders, arms with gentle massage. This can give information about symmetry. She agrees that if there are any concerns, it is important to begin therapy early to develop a home program of stretches and exercises.
She has a list of gentle exercises that she shows parents how to do at home.
If all of your tummy time and intervention have not been as successful as we like, the next referral will be to the craniofacial or neurosurgery team for an evaluation. Either of those specialists might end up sending you along to the pediatric orthotist team. The orthotists do some scanning (no radiation) and become part of the team that is monitoring your child’s head shape. In some cases, the kids may end up with helmets. Insurance companies vary greatly with their coverage of helmet therapy. The orthotist team at UCSF is top notch.
Although helmet therapy is usually not started prior to 5 months of age, there is little downside to having a referral sooner. For those of you interested in further details about the cranial helmet remolding process, see the information in my old post; the link is at the bottom. Although we sure do see a lot of kids with flat heads, very few of them end up needing a helmet.
Annie, one of my mom’s whose son ended up requiring a helmet, shared her story and wisdom. Her little guy is a second child with a mellow temperament so she wonders if that led to a bit more time hanging out in his infant seat.
Her doctor repeated the need for tummy time at each visit, but Annie thinks that with a bit of hindsight, if she had seen a helmet in her future she would have been more aggressive with it. At 2 months she did end up at the chiropractor who loosened up the neck muscles. These treatments made a big difference in his favoring one side over the other, but this little guys head was seriously flat and keeping him off of it did not seem to be helping as much as we needed it to. Annie adds a healthy dose of perspective: “There are worse things, We are fortunate to live in a place where this can be fixed.”
For more information about Helmets or local resources check out my old post on this topic:
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There are so many different factors to consider when facing most of the common parenting issues. The Nurse Judy approach is a combination of many years of medical experience, a desire to treat things as naturally as possible, a large dollop of common sense. email nursejudysf@gmail.com to be added to my weekly email list
Friday, January 17, 2020
Flat Heads/The Importance of Tummy Time
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