Several years ago, at an international pediatric physical therapy conference, I asked a question that had been on my mind: had anyone else noticed a steep increase in the number of babies needing therapy for early motor delays?
The answer was a resounding yes. Colleagues and I agreed that not only had we seen more babies coming for evaluations who weren’t reaching their milestones on time, but that many of the conditions we observed – flat head (plagiocephaly), tilted neck (positional torticollis) and non-specific delays (baby wasn’t eating well, wasn’t lifting head or pushing up on arms by three months) could be directly attributed to the way the child was positioned when awake. Clinical evidence shows that one in 40 babies is diagnosed with an early motor delay, and 400,000 babies a year are at risk, a 150 percent increase in the last 25 years.
Baby Workout Needed
Today, all parents and early childhood professionals know it’s important for babies to get tummy time, but with the rising number of children exhibiting early motor delays, it’s essential to start baby “workouts” as early as possible. The back-to-sleep initiative has effectively reduced cases of Sudden Infant Death Syndrome (SIDS) by 40 percent, but babies now miss out on the 12 to 15 hours of tummy time they used to get during sleep. Additionally, awake time often is spent in car seats and bouncers. As a result, many babies don’t get the activation and strengthening of the back and neck muscles they need, which can lead to or exacerbate an early motor delay.
But parents have a lot of questions. How much tummy time does my baby need? When should I start? What exactly should I do with my newborn? I can’t just put him on the floor on his tummy!
Together with the members of the Pathways Awareness Medical Round Table – a group of pediatricians, surgeons, physical therapists, nurses, and researchers who are the nation’s leading experts on early motor delays— we developed a set of standards for tummy time that outline when to start, how much babies need, and the best ways to encourage tummy time.
Our overarching conclusions:
1) Babies can and should start tummy time right from birth
2) Parents should start with brief periods of tummy time, but by three months, babies should be experiencing about an hour of tummy time per day, spread out over the course of their awake time.
The Newborn Workout
Newborns sleep—a lot. And besides any sleep issues, crying, diapering and eating usually top parents’ lists of concerns. However, simple “moves” for soothing and carrying not only help baby develop her neck and back muscles, they get her used to being in a prone position for more tummy time down the road.
1) Lap soothe. Although it’s instinctual to calm a baby by holding her upright on the shoulder, occasionally try laying the baby tummy-down across your lap to settle him down. Be sure to provide support over the baby’s bottom to provide a sense of security and a comforting touch.
2) Tummy-to-Tummy. Enjoy some together time. Lie down and place baby “tummy-to-tummy” or “tummy-to-chest.” Make sure to keep your hands on the baby at all times to keep her from rolling off.
3) Tummy-down carry. When carrying baby during awake time, carry her tummy-side down instead of upright. Making this positional change has a big impact on building neck and back strength. Support baby with one hand beneath the legs and under the tummy, and the other hand supporting the baby’s head and shoulders. Baby should be nestled against the caregiver’s body.
4) Eye-Level Smile. Babies love voices and faces. When your baby is playing on his tummy, get down to his level and talk and sing while altering position. This encourages head lifting and turning.
5) Tummy Minute. Start to incorporate tummy time into the daily routine. For example, every time the baby gets changed, place her on her tummy for a minute or two.
Tummy Time For Three Weeks And Up
As early as three weeks, caregivers can start to implement the following techniques:
• On the floor, roll up a small towel or receiving blanket and place it under baby’s chest and upper arms to prop him up. Get down on the floor and play with him, and scatter some toys near him to look at and reach for. Mirrors are particularly interesting, but faces are the most interesting of all.
• Play “airplane.” Fly baby around the room, tummy down.
• Slowly increase the amount of tummy time per day, aiming to get an hour total of tummy time by the end of three months. This shouldn’t be all at once, but in spurts throughout the day.
What Baby Should – and Shouldn't – Be Doing At Three Months
The earlier a baby is identified with an early motor delay, the better. Intervention and therapy as early as three months can get baby on the right track immediately, at a time when his brain is developing more rapidly than it ever will. Early intervention drastically reduces treatment times, not to mention allays parent fears.
Research shows that caregivers and parents, when they know when to look for, are particularly good at identifying early motor delays. At the end of three months (adjusted for pre-term birth), look for the following:
While lying on tummy, baby...
• Pushes up on arms
• Lifts and holds head up
Signs of concern:
• Difficulty lifting head
• Stiff legs with little or no movement
• Pushes back with head when on back
• Always looking to one side only
• Tilted head/neck
• Using only one side of the body
• Significant flattening of the side or back of head
If a baby isn’t pushing up on his arms or lifting his head at three months, or is exhibiting any signs of concern, it’s an important topic to bring up with a health care professional.
There are many more resources for information and referrals, including the baby’s pediatrician, developmental-behavioral pediatricians, pediatric neurologists, nurse practitioners, and therapists. If a child is diagnosed with an early motor delay, the cost of therapy is often covered by insurance, and each state has an Early Intervention program which provides evaluation and physical therapy services for children with developmental delays.
The Pathways Awareness Web site, www.pathwaysawareness.org, and its “parent answered” help line – 1-800-955-CHILD (2445) – provides information on early motor delays and referrals to doctors, therapists and therapy centers.
Gay L. Girolami, PT, MS, FAACPDM, is a physical therapist and executive director of Pathways Center, a pediatric therapy center in Glenview, Ill. Girolami is also a member of the Pathways Awareness Medical Round Table, an esteemed group of early childhood medical professionals—therapists, doctors, nurses, and researchers—who specialize in early motor development.
i Data compiled by Pathways Awareness Medical Round Table members