With the recent Back to Bed movement, there has been a rise in brachycephaly and plagiocephaly (“Flat Head Syndrome”). This is because parents are diligent in decreasing their baby’s risk of SIDS by putting them on their back during naps and bedtime (which is awesome!). But they aren’t receiving an equal amount of wisdom of how great tummy time in for their child’s development. Instead, we are marketed toys and positioning devices that favor “placed” positions where the child isn’t encouraged to move in all different directions (play mats with toys above to look at, mobiles on the crib, saucers or jumpers to sit in). When baby is awake, he/she should always be given the opportunity to play on their tummy (the prone position).
"Back to Bed" is the recent movement to decrease the incidence of Sudden Infant Death Syndrome (SIDS). The “back to bed” phrase refers to recommendations following scientific research which found that lying babies on their back is the safest position for sleep times. Recommendations include:
• Place the baby on his or her back on a firm sleep surface such as a crib or bassinet with a tight-fitting sheet.
• Avoid use of soft bedding, including crib bumpers, blankets, pillows and soft toys. The crib should be bare.
• Share a bedroom with parents, but not the same sleeping surface, preferably until the baby turns 1 but at least for the first six months. Room-sharing decreases the risk of SIDS by as much as 50 percent.
• Avoid baby's exposure to smoke, alcohol and illicit drugs.
• Offer a pacifier at nap time and bedtime.
• Do not use home monitors or commercial devices, including wedges or positioners, marketed to reduce the risk of SIDS.
• Infants should receive all recommended vaccinations.
• Supervised, awake tummy time is recommended daily to facilitate development.
There are many recent scientific studies supporting Back to Bed as a tremendous way to decrease the risk of SIDS. As a clinician who implements evidence-based practices, I support Back to Bed and followed the guidelines for all three of my children. I also researched it for my thesis (“The Effects of Pacifiers on Breastfeeding”), which I will cover on another day. However, I have a child who suffered from brachycephaly (coined “flat head syndrome”). I later found out he had severe reflux and an autoimmune disorder that made him really not like tummy-time, but again that is another story. Needless to say, when my third and final child was born, she started tummy time in her first week of life — despite persistent reflux. I was more persistent and armed with knowledge this time around. We just had to find the right times to do tummy time when her risk of reflux was at it’s lowest. As she grew and developed stronger head, neck, and trunk muscles, her reflux diminished and she became a a strong feeder. She went from an intrauterine growth restriction (IUGR) diagnosis to her recent measurements of above average weight and 75th percentile height.
From the time a baby is born, he/she can benefit from SUPERVISED tummy-time. The supervision part means that you, the parent or caregiver, are right down there at eye-level cheering them on and entertaining them to make that 30 seconds turn into 1 minute and eventually turn into 10 minutes as they grow. Crying is OKAY in short increments. Make sure they have unobstructed breathing room around their mouth and nose area, they are not turning purple or blue (never let them cry that long), they are being supervised by their caregiver, and they have no other medical issues. You can let them cry for a short time and then pick them up and console them. Then try again. Each day they should cry a little less and enjoy tummy time a little more. It's well worth it to make sure they develop adequate trunk strength and don't develop brachycephaly or plagiocephaly.
Tummy time is an amazing core strengthening exercise for little ones. The “core” is not just your stomach but the cylinder that surrounds it, including your sides and back. In yoga, one of the best strengthening exercises for your back is to do a reverse boat pose or “superman pose” (balance on your stomach and raise your arms, head, and legs). I dare you to try and see how long you can hold this pose. Of course, a baby cannot do that pose, but they can begin to learn how to hold their head up. The stronger their neck, back, and core become, the sooner they will master all the big milestones: lifting their head, turning it side to side, rolling over, pushing up onto hands and knees, balancing while cruising the couches, taking that first step, and eventually running and jumping!
Most parents don't realize how many big milestones depend on core strength. Here’s a hint — they relate to feeding, swallowing, breathing, and speaking. Here are a few:
• Sitting unsupported is a foundational skill for eating and drinking while in a highchair.
• The stronger and more supported the digestive and breathing matrix (stomach, esophagus, larynx [voice box], throat, tongue, and mouth), the more coordinated and safe your child will swallow.
• The sooner a baby masters physical milestones, the sooner he/she will focus on speaking milestones (babies tend to not be as good at multi-tasking as we expect from older kids).
• Crossing midline helps develop baby’s coordination, core strength, attention, ability to use both sides of the body and BRAIN, and executive function for planning tasks and following directions.
• With strength in the head, neck, and trunk comes strength and coordination of the suck, swallow, breathe sequence (reducing instances of aspiration where food/liquid goes into the lungs and may cause increased illnesses or pneumonia in severe cases).
• Improved receptive and afferent synapses for innervation of the voice mechanisms (larynx or voice box, pharynx or throat, tongue, and oral cavity) improve awareness of those structures and experimenting with sound and putting sounds together.
• Not to mention that being more mobile allows baby to get around easier to explore their environment and learn new things using their different senses!
There are options to help you ease into tummy time on the floor by letting your child lay on your chest, across your arm (if small enough), across your lap, or with a firm blanket or towel folded under his/her chest. The most important thing is to SUPERVISE the baby AT ALL TIMES and MAKE SURE THEIR FACE IS UNOBSTRUCTED. It is NEVER okay to place a baby face down on a soft, fluffy surface. Always make sure the surface is flat and firm to ensure the baby’s sufficient access to oxygen and enough space that they are not rebreathing carbon monoxide or already expelled air.
For more information on safe tummy-time ideas, email Speech Sisters at firstname.lastname@example.org. You may also find more information at the Inland Northwest SIDS Foundation online: https://www.inwsids.org.
DISCLAIMER: Please refer to the American Academy of Pediatrics’ most recent recommendations for safe sleeping to avoid Sudden Infant Death Syndrome (SIDS) below. Speech Sisters are evidence-based clinicians that follow the most recent scientific research for best practices.
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