On a recent trip to the farmer’s market, a young mother was seen pushing her infant daughter in a stroller with her “helmet” in place. It made me stop to ponder, when will we as therapists be able to educate parents effectively in order to decrease the incidence of helmets to restore the natural alignment of an infant’s skull? If you think you are seeing more clients in the area of torticollis or plagiocephaly, you are correct!
The “back to sleep” program was initiated in 1992 in efforts to reduce the incidence of sudden infant death syndrome (SIDS). The initiation of this campaign was proven to reduce the incidence of SIDS as much as 40% in some studies (Persing, James, Swanson, Kattwinkel 2003). A not so desirable effect of the “back to sleep” campaign is the increased prevalence of delays in gross motor milestones, increased incidence of positional torticollis and positional plagiocephaly (Persing et al 2003, Jones 2004, Freed & O’Berry 2004). Reports of increased plagiocephaly or positional deformities of the skull are up by as much as 5-6X since 1992 (Persing et al 2003, Hummel & Fortado 2005).
Education to parents on the importance of “tummy time” for playing could prevent the occurrence of positional torticollis and positional plagiocephaly. How do reach these parents? You might say, it is really the physicians’ job to educate the parents about tummy time. As physical therapists, we can contribute to the public health of young infants by educating parents and caregivers on the importance of proper positioning and handling of their infant too! Now more than ever, we need to get the word out to prevent the costly fabrication of helmets and prevent developmental delays.
How do we help parents to understand how important “tummy time” is? Fully understanding the secondary complications could lead to better compliance and prevention of deformities. Instructing parents in methods to help their child tolerate or enjoy the tummy position better, would be more appropriate than avoiding prone positioning all together. A simple towel roll similar to a bolster shape could be placed under the child’s chest to assist and facilitate neck and trunk extension, enabling the child to maintain the position more readily. Fitting tummy activities into the routines of the day will help parents find success.
Research also points to use of infant car seats, bouncy seats, infant carriers, and infant swings as having an impact on positional plagiocephaly and positional torticollis. Frequent use of infant equipment (greater than 4 hours per day) resulted in a higher frequency and severity of plagiocephaly (Littlefield 2003). Head control improves as a child matures, increasing the importance of educating parents to limit the time spent in infant equipment such as car seats, carriers, bouncy seats and swings when their child is younger and has limited head control.
We need to be the voice to educate others on placing limits on infant equipment. We also need to be the voices to promote tummy time. After all, babies are fun to play with and hold! Yes, there will be times when we need the car seat or stroller, but let’s remember to carve out time to play on those tummies while we are young!
Wondering how to keep your baby happy during tummy time? Read my post ”Making Tummy Time A Pleasant Experience” with several tummy time activity ideas.
References
Freed S, O’Berry C. Identification and treatment of congenital muscular torticollis in infants. JPO. 2004 Vol. 16 (4): 18-23.
Hummel P, Fortado D. Impacting Infant Head Shapes. Adv Neonatal Care. 2005; 5(6): 329-340.
Jones MW. Supine and Prone infant positioning: A winning combination. J Perinat Educ. 2004 Winter; 13(1): 10-20.
Littlefield T. Car Seats, Infant Carriers, and Swings: Their Role in Deformational Plagiocephaly. JPO. 2003 Vol. 15 (3):102-106.
Persing J, James H, Swanson J, Kattwinkel J. Prevention and Management of Positional Skull Deformities in Infants. Ped. 2003 vol. 112 (1):199-202.
Sultz H, Young G. (2007). Healthcare USA: Understanding its organization and delivery (5th ed). Gaitherburg, MD: Aspen. www.physicaltherapy.com. Accessed on July 14, 2008.
Photo courtesy of dogs & music
What have you seen in regards to use of infant equipment and skull deformities? How have you been successful in educating parents about tummy time?
Great article Mary, I have a grandson coming soon and I’ll try the towel under the chest for tummy time!