The Truth About Tummy Time: A Parent's Guide to Sids, the Back to Sleep Program, Car Seats and More.

Contents

Preface

Introduction

1

PHYSIOLOGY AND DEVELOPMENT

2

REFLEXES

3

SUDDEN INFANT DEATH SYNDROME—SIDS

4

SCREENING

5

BACK TO SLEEP PROGRAM

6

BACK TO SLEEP AND SIDS

7

TORTICOLLIS AND PLAGIOCEPHALY

8

DEVELOPMENTAL DELAY

9

CAR SEATS AND CONFINEMENT

10

CONCLUSION

References

Additional Resources

Preface

Before my first child was born, I, like many new mothers, prepared for the arrival of my baby by reading every book available and listening to endless advice from those around me. One thing I remember hearing was Never wake a sleeping baby. After he was born, I heeded this advice and was very particular about not messing with my son while he was asleep—outside of checking on him frequently to make sure he was okay. At our four-month check up, the doctor told me that the back of my son’s head was flat and that I needed to go see a physical therapist.

First of all, I was offended! My baby was perfect; there was nothing wrong with his head. Second of all, I am a physical therapist and certainly didn’t need to go see one! Granted, at that time, I worked with adults. Once I left his office, I took a good look at my son’s head and realized he was right. It was flat on one side. It wasn’t until then that it occurred to me that my baby always lay on the same side of his head when he slept. In every picture we took of him, his head was turned that way. I was so concerned about waking my baby, that I left him alone while he slept even though his position didn’t change. In addition, I let him spend a lot of time in a soft bouncer and car seat. If he fell asleep in the car seat, I would simply put the car seat in the crib until he woke up. He spent a lot of time sleeping and playing in the bouncer as well as eating all of his meals there. The bouncer and his car seat reinforced that same favorite position.

No one advised me to rotate my baby from side to side to ensure his head would form correctly. The nurses at the hospital did not instruct me in proper sleeping positions, nor did anyone mention anything about the Back-to-Sleep program. The only reason I put my son on his back to sleep was because of the vague references I’d heard to always put your baby on his back to sleep and the little back to sleep logo on his diapers. Not one person or one source of information I read covered this topic in proper detail. I had to consider it was possible I didn’t read everything there was to read, and equally possible, I was too tired to read anything at all once the baby arrived. I guess everyone assumed I knew. And I clearly didn’t realize how important the position my baby spent most of his time in was.

I started rotating my son to different positions—away from his favorite side. During my routine checks on him while he slept, I would rotate his head off the flat spot, as he always found his way back there. At that point, I was more concerned with rounding his head out than waking him up. Interestingly enough, he didn’t wake up when I messed with him. Slowly, his head rounded out, and the flat spot got smaller. He is now ten years old, and unless you know where to look, you wouldn’t notice that he ever had a problem. What is more, his development took off once I started putting him in different positions. He started rolling and developing strength in his back and neck muscles from lying on his stomach. These important tools of development did not occur before I started changing his position. He met all the other milestones on time and is now a great athlete with well-balanced strength and coordination. In school, he is doing very well in all his subjects, displaying no indication of cognitive deficits. My interest in pediatrics grew after his birth, so I decided to switch my specialty to Pediatric Physical Therapy.

When my second baby was born, he was five weeks’ premature and spent eight days in the neonatal intensive care unit (NICU). The nurses there would routinely rotate my son to each side, his stomach, and his back. I was concerned about placing him on his stomach because of his prematurity, but when I asked our nurse about this position, she said the nurses found babies don’t struggle as much to breathe when they are lying on their stomachs. When they are really struggling or upset, we put them on their stomachs, and they consistently calm down and breathe easier.

I emulated this pattern at home with this logic: If the NICU nurses, who worked with babies every day, recommended it, then it was good enough for me. Considering the babies they were working with were at high risk for complications, I thought, who better would know how to care for an infant? Consequently, my second son has a perfectly rounded head. He was a little behind meeting his milestones, because of his prematurity, not because of any lack of opportunity to develop muscle balance; I made sure I changed his position every time I put him down.

Interestingly, my second son had a very unusual crawling pattern. He would sit on his right hip and propel himself with the left foot and right arm. As a pediatric physical therapist, I knew how important crawling was for development, so I would follow him around the house trying to correct it, but as you can imagine, that was exhausting. So, I waited until he was a little older and could understand my instruction and then encouraged him to crawl like a puppy on all fours. We played this game for several months, practicing this normal crawling pattern, to ensure that his brain received the essential connections that crawling creates between the left and right brain. Today, at eight years old, he is also a natural athlete and an excellent student.

When I gave birth to my third son, there was no doubt in my mind how to ensure the best outcome again. He was also five weeks premature and had the same unusual crawling pattern. (I joke that my second son left hieroglyphics on the inside to give my third son instructions.) We went through the same drill of the crawling game once he was old enough to understand the instructions. He is now six years old and lights up the soccer field with grace and agility. He is starting kindergarten this year, and I expect he