Postitional Plagiocephaly

Positional plagiocephaly. Flat head syndrome- due to positioning of the infant on the back for extended periods of time. With the back-to-sleep campaign that began in the early 1990s, many parents became afraid of placing a baby on his/her stomach- and left their infants on their back, in swings, and/or carseats. Has the increase in positional plagiocephaly also caused a rise in developmental delays? According to a 2010 study that was published in Science Daily, babies with flat heads may be at a higher risk for cognitive and motor delays. It makes sense- when an infant is always on his/her back, he/she does not receive the proprioceptive input (feeling of where body is in relation to space) or the neck extension (straightening). The child could potentially be delayed in meeting milestones. After all, it is more difficult to attend to a stimulus while on your back (then on your stomach). Additionally, many babies will take longer to learn how to roll, crawl, sit, and stand, as the core muscles will not be strong enough to move against gravity. As an occupational therapist, I work with many kids that have positional plagiocephaly. During the session, I teach families how to place their babies during waking hours - as well as how to engage them - to prevent worsening of and correct the flat spot. Although pediatricians recommend back-to-sleep, I encourage families to keep babies OFF of their backs (out of the supine position) as much as possible during waking hours. What can you do? Here are three "quick" suggestions to PREVENT positional plagiocephaly. TUMMY TIME! I can't say it enough. Although a Tummy Time article on parents.com mentioned to place an infant on his/her stomach beginning "around the 3-4 month mark," I believe it should happen MUCH earlier. You can put your baby on YOUR stomach- after feeding, while he/she is sleeping, and during waking hours during the newborn stage. It is a great way to bond with your baby and can also help with burping! (In all fairness, the article DID mention this.) ***Just be careful until the umbilical cord has fallen off. Be a switch-hitter! Switch sides in your arms (after every feed) and in the crib (each night)- get your baby comfortable resting his/her head on BOTH sides. Just because it is made- does not mean it is right for your child. Meaning- just because Bumbo seats, exersaucers, jumpers, walkers, and swings (etc...) are readily available in many, many stores, they are not necessarily appropriate for your child- in his/her current stage of development. Although those items can be great distractions- extended use may NOT be recommended. It is very scary to be a parent nowadays- I TOTALLY get it. Remember that you are not alone. If your parent instinct tells your that your child may have positional plagiocephaly, speak to your pediatrician. I am also available to lend my expert opinion about positioning and engaging "activities" to do with your baby.

What Should We Play With? For Infants, Ages 4-6 Months

What Should We Play With? Part II Although it has been a while, I have received requests for the next post to be about the best toys for infants, ages 4-6 months. This is one of the hardest stages because your baby is beginning to be mobile but is not quite ready to be seated upright for extended periods of time in exersaucers and such (refer to this post for more information as to why). Babies at this stage are rapidly developing and becoming more like little people (and much less like little zombies, who primarily want to eat, sleep, be held, and be changed!). Therefore, toys at this stage should be more stimulating, to increase their level of awareness. In addition, toys that work on cause/effect (touch this and lights go on) are important. The following toys can all be found on Amazon.com. Tummy Time Mat Tummy time is one of the most, if not THE MOST, important positions for this stage of development. See Part I for more information. The Tiny Love Activity Gym mat is also a favorite, as the lights, sounds, and items to grab while on the back and stomach are stimulating for the babies. In addition, they can practice rolling all over because their are fun things to see at every corner! Sit them up on the mat- have them grab and reach the items that are at shoulder-level... This mat can have many uses!

Activity Table This Fisher Price table is a great example of the type of toy to give your growing infant. The legs can be modified accordingly to allow the baby to access the various components of the table while in tummy time, on the side, seated, and standing. This activity table has room to grow with your baby - and you will notice that he/she will play differently with the table throughout various stages of development (rolling, sitting, crawling, walking).

Activity Bars Your child is working on grabbing, pulling, and pushing. Keep your child busy on walks or long car rides with this activity bar! This is also a great way to have your child practice sitting up...

Board Books Touch and feel board books are my favorite for babies this age! Aside from beginning to see words, large pictures and feel textures, they are easy to clean and begin to teach babies how to turn pages (left to right). The books also offer entertainment when seated in tummy time and ensure that you are focusing attention on your baby (after all, who doesn't like attention!?!?!). This book of baby animals was/is a favorite of my EtiKids! They love to hear and make the sounds of the animals!

How To: Know When Your Infant is Ready to Sit Up

A mother in one of my Mom-groups on Facebook recently posed a question- regarding the positioning of her daughter. While in daycare, her 3-month-old was seated upright in a Bumbo seat with toys placed on a tray in front of her. While many parents agreed that it was ok to do so in order to prepare the infant for sitting upright, the OT (Occupational Therapist) in me said otherwise. This now leads me to the age-old question: When is it ok to start sitting up a baby? My response was/is: An OT is primarily concerned with the positioning of the child to help him/her improve all domains of development and meet milestones. At the infant stage, appropriate positioning will foster increased socialization skills and awareness by simultaneously developing strength. This will also enable the baby to maintain positions for extended periods of time. Skipping the important steps/milestones may actually delay your child's development! At 3 months of age, most babies do not have consistent head/neck control, as bobbing is frequently seen. To foster this skill, caregivers should gradually reduce the amount of support provided while holding the baby. For example, instead of supporting the head/neck with the whole hand- try using only fingers. Additionally, until a baby has developed very strong spinal muscles, they should not be placed in Bumbo seats or upright on Boppy pillows for too long. If there is curvature of the spine (and you can seen the vertebrae sticking out)or leaning to the side, the baby is not ready to sit by him/herself.

In her blog, Janet Lansbury writes that sitting babies in restrictive seats (exersaucer, infant seats, and jumpers) for extended periods of time will potentially cause your child to skip important milestones such as rolling and crawling! The belief of MANY parents is that these items are helpful for parenting (providing opportunities to shower and such). As with much of the equipment for babies, they should be used in moderation. Tummy time with toys placed in front of the child would be more appropriate at this stage to increase head/neck development, strengthen the extensor (straightening) muscles of the spine, increase grip/fine motor skills and continue to increase awareness of the environment that surrounds him/her. Placing the toys in front and around the baby will foster rotation and mobility, which will help the child learn to roll over and eventually crawl. Additionally, your child will receive more proprioceptive sensory input, which teaches about his/her body in space. But that being said- it is not an age thing so much as developmental. If your child has great head/neck control, the spine is extended (straight) when sitting up (while you hold her), and the baby can maintain an upright posture- go for it!

Raising My Advanced EtiKid

My son started crawling at 6 1/2 months and walking at 10 1/2 months. Although that is no small feat, I am even more excited (and proud!) that he is extremely social and loves to interact with other people. I am WELL aware that most of his abilities are due to nature (he was very active in the womb, frequently causing the need for repeat ultrasounds!). I will say that I did recognize signs that he was ready and provided him with opportunities that encouraged him to develop his skills. As I have friends asking me what I have done to promote his development, I thought I would share some tips (not just as a parent but from an Occupational Therapist's perspective). 1) TUMMY TIME! From the time he was born, I would hold him across my arms or on my lap on his belly. Once he got a little older (2-3 months), I placed him onto a mat on the floor- on his tummy. He definitely did not like it at first, but I always started floor time in this position. Toys that made noise were placed in front of him - encouraging him to extend his tolerance of tummy time. This helped him to get a sense of his body in space, as he received a lot of sensory input from his stomach and arms being on the floor. It also helped him learn to lift his head and upper torso off of the ground, promoting neck extension (straightening). He became more aware of himself and his surroundings once he was able to look at objects and happenings around him. Sheryl Berk from Parents Magazine has additional tips for Tummy Time. 2) Lots of playtime... Many people mistakingly believe that a child who doesn't move can be left alone on the mat. I feel that it is even more important to engage, talk to, read to, and just generally sit on the floor with the infant. As a parent, OT, and child development specialist, this time is especially formative in a baby's life. Demonstrate how to use toys and give the infant the freedom to explore the objects as well. Make sure that the toy is "developmentally appropriate" (more about that to come in future posts). Additionally - just because a toy is in the store does not always mean that it is right for your child. Use your gut instinct. If that is not working at the moment- perhaps due to extreme sleep deprivation, call/email me. 3) Model social behavior - your baby is NEVER too young to learn social interactions. Smile, respond to their sounds, and use LOTS of language to foster their own speech communication skills. Providing and modeling interactions as soon as possible can only help the child learn how to engage with others. The more engaging a baby is, the more likely others will respond to him/her. 4) Be consistent. It is definitely too early for punitive measures. However, after 6+ months, a child can begin to learn safe vs. unsafe. Redirection is the BEST method for preventing unwanted behaviors. Yes it is exhausting, but it will make it easier to raise a polite little person in the not-so-distant future. For example, when my child wants to play with electric outlets (he looks at me and smiles as he touches them because HE KNOWS HE SHOULD NOT BE NEAR THEM!), I immediately say (in a stern voice), "Not safe." I then redirect his attention to his toys (on the other side of the room), and sit with him as we build the simple blocks or read a book. This list can go on and on (I will share more tips in coming weeks). I firmly believe in the adage that it "takes a village to raise a child." Therefore, I am sharing my wisdom as an Occupational Therapist (and parent!) and welcome any other tips you may have. Of course, if you have any questions, you can call me or email me. I look forward to hearing more stories about your own EtiKids!