by Linda Schoene, Congregational Nurse
In the early 1990’s, the association between placing infants on their abdomens to sleep and the incidence of SIDS (Sudden Infant Death Syndrome) gained worldwide attention. Subsequent “Back To Sleep” campaigns resulted in very significant decreases in SIDS. In the United States, as of March 2000, the incidence of placing infants on their abdomens dropped from 70% to 20%. The incidence of SIDS dropped 40%. The success and benefits of this important intervention are not in question, but there is new information that placing infants on their abdomens for sleep may be related to the increased number of infants developing positional plagiocephaly. There is also concern that it may be associated with delays in the developmental motor milestones like rolling, creeping, crawling and pulling up to a standing position.
Positional plagiocephaly is a condition also known as “flat head” and is recognized by asymmetric head shape, misaligned ears and facial asymmetry. At birth, infant skull bones are pliable and soft, characteristics that assist the birthing process. These bones remain pliable for many weeks, but especially between two and four weeks of age. In those early weeks, infants spend much of their time sleeping. Waking time is often spent in swings, infant seats and car seats. All these activities create more pressure on the back of the infant’s head. There is also little opportunity for baby to build and strengthen muscles in the shoulders and the neck.
The AAP (American Academy of Pediatrics) recommends that infants receive daily “tummy time”. Parents are encouraged to place their baby on his or her tummy while the baby is being supervised, NOT at times when baby is put down to sleep. Back to Sleep is still the rule for naps and bedtime. “Tummy time” can begin on baby’s first day by placing baby prone on mom or dad’s chest. This positioning allows for the suggested tummy time and at the same time gives the baby warmth, comfort and security. Infant slings also work well for carrying baby in a prone position. Parents should place baby on the tummy two to three times per day and increase the amount of time gradually. Other tips include:
1. Alternate the end of the crib that baby’s head is placed. Infants on their backs will naturally turn their head toward the door or center of the room.
2. Limit the amount of time spent in bouncy chairs and car seats.
3. For bottle-fed babies alternate the side on which the baby is healed for feeding.
Remember – Back to Sleep is still the recommended sleeping position for infants. Supervised daily “tummy time” can help baby’s motor development and help prevent unwanted head shaping. It also gives parents the opportunity to interact with baby – something that babies always love!