Tag Archives: tummy time

How to Prevent or Treat Infant Flat Head Syndrome

Happy laughing funny baby boy wearing a colorful shirt learning to crawl playing on his tummy, on white background
Many parents are understandably worried when their baby is referred to a doctor for an evaluation for plagiocephaly, also known as flat head syndrome—but there is no cause for alarm.

As an infant’s growing brain pushes the skull’s thin, moldable bones apart, new bone forms at expansion joints, or sutures. When pediatricians see an irregularly shaped skull, they often refer patients to a neurosurgeon or other specialist to rule out craniosynostosis, a rare condition in which a baby is born with a premature closure of one or more of these sutures.

Much more common is an easily treatable condition called positional molding or deformational plagiocephaly. This occurs when babies get into the habit of lying on one side of the head, resulting in repeated pressure that flattens that side and back of the skull.

Deformational plagiocephaly is not a brain problem, does not cause neurologic or developmental issues, and does not require surgery. It is usually a minor cosmetic issue noticeable primarily from behind. For the very small percentage of children who have a significant asymmetric frontal appearance, unaddressed plagiocephaly could affect how people treat them later in life, potentially leading to psychosocial issues.

The key to plagiocephaly is prevention. You can prevent it the same way it is corrected: by encouraging tummy time and changing your baby’s sleeping position.

Tummy Time
Unfortunately, many parents confuse the recommendation of placing babies on their backs for safe sleeping with avoiding time on their bellies altogether. Engaging in tummy time while awake is both good for babies developmentally and the best way to prevent plagiocephaly. For babies with signs of the condition, tummy time will keep them off of the flattened portions of their heads as much as possible.

When babies are awake and under supervision, position them on their bellies for as long as they can tolerate. Infants who are used to lying on their backs most of the time may fuss when put on their bellies, so it’s best to start early—within the first month or two from birth.

Early Repositioning
Early repositioning is important if your baby’s head is starting to flatten on one side or you notice that your baby sleeps with his/her head always turned to the same side—a condition called behavioral torticollis. You can change the sleeping position by propping your baby up to prevent putting pressure on the side he or she prefers.

A variety of commercial devices are promoted to counteract torticollis, but the simplest way to lift a child off the flattened or preferred side is to simply prop up that half of the body about 30 to 45 degrees. The cheapest method involves rolling a dishtowel into a cylinder, wrapping it with some tape to make sure it stays firm, and placing it vertically under your baby from the shoulder to the buttock.

Mildly abnormal face-on skull deformities can almost always be corrected with repositioning, as long as they are caught by age four or five months.

A Word About Helmets
Treating plagiocephaly with a helmet works by applying pressure to the skull in the reverse direction of the pressure that caused the initial molding. Helmets work; however, for the vast majority of children, they are not any more effective than simple repositioning and are much more expensive. That’s why it’s best if helmets are considered only for the small group of kids whose skulls are still severely misshapen at four or five months old.

At the end of the day, plagiocephaly is an aesthetic issue, particularly if it is only noticeable at the back of the head. If you are concerned about it, talk to your pediatrician—but the key thing to remember is the importance of tummy time and repositioning.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Jeffrey H. Wisoff, M.D. is the director of the Division of Pediatric Neurosurgery at NYU Langone Medical Center and professor of neurosurgery and pediatrics. Over the past 30 years, he has made innovative contributions to the surgical treatment of neurological disorders in children—particularly brain tumors, Chiari malformations, hydrocephalus, and craniosynostosis. A renowned expert in the treatment of craniopharyngioma and other brain tumors, Dr. Wisoff has published more than 160 scientific articles and book chapters, and has been an invited speaker and visiting professor at numerous international sites. Dr. Wisoff received his medical degree from George Washington University School of Medicine, and completed a neurosurgical residency and a fellowship in pediatric neurosurgery at NYU.

 

5 Tips for Tummy Time Success

Happy laughing funny baby boy wearing a colorful shirt learning to crawl playing on his tummy, on white background
In part one of our series on tummy time, we discussed the importance of tummy time and why parents should make sure their infants engage in tummy time daily. Now, part two, we have five tips to ensure that the tummy time experience is successful—tips we tell our patients at the pediatric program at Rusk Rehabilitation.

Safety first. It is important that your baby is supervised at all times. Your baby may need a little help adjusting his arms and body, and it is not uncommon for babies to get themselves into positions they can’t get out of. In the first few months when head control is developing, it is best to use soft toys so that your baby doesn’t get hurt.

Location. The best part about tummy time is that it can happen anywhere and you don’t have to fit it in your baby bag! All you need is a firm, soft surface that is clean and clutter-free. To make tummy time a little easier in the first months, use a soft towel roll or feeding pillow under the upper chest to make it a little easier for your baby to hold up her head. In the early months your baby will also enjoy tummy time on your chest since it allows parental contact and face-to-face interaction. Tummy time can also happen horizontally over your lap when a surface is not available. Placing your baby on her favorite blanket can also provide additional comfort.

Timing. The best time for tummy time is when your child is awake and alert. Pick a time to engage him before feeding, or wait 30 to 45 minutes after eating. Some babies also do well soon after waking up from a nap. Try to engage your baby in tummy time about three times per day and gradually increase the length of time in this position. Even a few minutes at a time is a great start. You know your baby best, so you’ll be able to tell how much tummy time he can handle. Once your baby is comfortable, he will be happy to spend more time engaging with you or toys in this position.

Make it fun. There are endless amounts of toys that can keep your baby entertained during tummy time, or he or she may connect well with a familiar face. Many babies respond positively to toys that are cause and effect, light up, make musical sounds, or have a mirror attached. Keep in mind the placement of the toy. Place the toy within or just beyond your child’s reach so that it encourages movement and problem solving. As your baby begins to move his or her head and body during tummy time, varying the placement of the toy will encourage your baby to turn her head right and left and shift her body to both sides to grasp the toy.

Anyone can do it. Parents, grandparents, relatives and nannies are all caregivers who can help and maximize tummy time. Let your caregivers know what your baby likes best and encourage them to incorporate it into the day.

During monthly check-ups, your pediatrician will assess how your baby is progressing with developmental positions including tummy time. If you need additional support or have questions about making tummy time more successful, you can consult your pediatrician, a physical therapist, or an occupational therapist.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Robert Cafaro, MS, OTR/L, has been an occupational therapist for 15 years and has worked in pediatrics across multiple areas (preschools, school districts, home care, inpatient rehabilitation, and outpatient rehabilitation). He graduated with a Bachelor of Science from Gannon University in 2000 and a Master’s in Health Care Policy and Management from Stony Brook University in 2005.  Robert is currently the supervisor of the Pediatric Occupational Therapy Department of Rusk Rehabilitation at Hospital for Joint Diseases. He is the father of twin three year old girls who have benefitted from tummy time provided throughout their development.

Megan Strong, PT, DPT, PCS, is a board certified clinical specialist in pediatric physical therapy. She is the supervisor of Pediatric Physical Therapy at NYU Langone Medical Center and received her Doctorate in physical therapy from The University of Scranton. She has close to 10 years’ experience working at Rusk Rehabilitation at NYU Langone Medical Center.

NYU Langone’s Pediatric Rusk Rehabilitation at Hospital for Joint Diseases helps babies, children, and teens with developmental disorders, neurological conditions, and physical injuries reach their full potential. We identify each child’s obstacles and capabilities and develop a treatment plan with the family based on specific, practical goals designed to optimize the child’s physical, cognitive and behavioral functioning.

NYU Langone’s Pediatric Rusk Rehabilitation at Hospital for Joint Diseases helps babies, children and teens with developmental disorders, neurological conditions and physical injuries reach their full potential. We identify each child’s obstacles and capabilities and develop a treatment plan with the family based on specific, practical goals designed to optimize the child’s physical, cognitive and behavioral functioning.

 

Why Tummy Time Is Important

Baby does tummy time!

A Brief History of Tummy Time

In the early 1990s, the American Academy of Pediatrics’ (AAP) “Back to Sleep” campaign recommended that infants should be placed on their backs when sleeping, which was a pivotal success in decreasing the rate of deaths caused by Sudden Infant Death Syndrome (SIDS). Since this campaign, however, a number of studies have highlighted the rise of developmental delays in infants and the flattening of the back of the head known as plagiocephaly. As a result, in 1996, the AAP recommended that infants should also be provided time on their stomachs throughout the day in order to promote developmental benefits and minimize time spent on the back of their head. As pediatric physical therapists and occupational therapists at NYU Langone Medical Center’s Rusk Rehabilitation, we promote the importance and benefits of “tummy time” while working with parents and caregivers to make this important play position for newborns and infants more successful and less stressful.

Why Tummy Time is So Important

Tummy time is the root of many developmental milestones within the first year. When babies are on their bellies, they engage muscles of the neck, arms, back, and hips against gravity in order to hold positions and move in a variety of patterns. Developing these muscles and movement patterns is the foundation for babies being able to lift their heads to visualize their environment, reach for a toy, roll to their sides, push up to a sitting position, sit independently, and eventually crawl. Tummy time also feeds important sensory needs such as vision and body awareness as the baby pushes up with their arms to lift their head and chest off the floor. Your baby continues to develop these skills across their age span and refines them with repeated use.

Tummy time also provides an opportunity to spend time off the back of their heads. Increasing tummy time throughout the day and avoiding too much time in car seats, strollers, swings, or bouncy seats will all help prevent your baby’s head from flattening. Proper positioning in an infant carrier is also a great alternative to the stroller for time off your baby’s head when feasible.

Happy Hands

Parents are often unsure about when they should begin to engage their infant in tummy time. First attempts at placing a baby on his or her belly can be overwhelming since a baby’s tolerance is often limited or non-existent. We encourage parents to start placing babies on their bellies when they’re awake as soon as possible after birth. As a general rule of thumb, it is never too early or never too late to start.

These new experiences on the tummy can be perceived by you and your baby as physically demanding. It is only natural for your baby to become upset and want to be moved out of this position. Your baby will often seek emotional and physical support by wanting to be picked up and remain close to a parent or caregiver. While this is important for nurturing and providing your baby comfort, it is equally important for them to explore and play on their tummies with happy parent hands ready to pick them up when a break is needed. You can also use a soothing voice to comfort them.

If you have questions about tummy time, speak with your pediatrician, physical therapist, or an occupational therapist.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Robert Cafaro, MS, OTR/L, has been an occupational therapist for 15 years and has worked in pediatrics across multiple areas (preschools, school districts, home care, inpatient rehabilitation, and outpatient rehabilitation). He graduated with a Bachelor of Science from Gannon University in 2000 and a Master’s in Health Care Policy and Management from Stony Brook University in 2005.  Robert is currently the supervisor of the Pediatric Occupational Therapy Department of Rusk Rehabilitation at Hospital for Joint Diseases. He is the father of twin three year old girls who have benefitted from tummy time provided throughout their development.

Megan Strong, PT, DPT, PCS, is a board certified clinical specialist in pediatric physical therapy. She is the supervisor of Pediatric Physical Therapy at NYU Langone Medical Center and received her Doctorate in physical therapy from The University of Scranton. She has close to 10 years’ experience working at Rusk Rehabilitation at NYU Langone Medical Center.

NYU Langone’s Pediatric Rusk Rehabilitation at Hospital for Joint Diseases helps babies, children, and teens with developmental disorders, neurological conditions, and physical injuries reach their full potential. We identify each child’s obstacles and capabilities and develop a treatment plan with the family based on specific, practical goals designed to optimize the child’s physical, cognitive and behavioral functioning.