Tummy time and Crawling:
Preventing Neck Problems and Developmental Delays
Adapted from articles by by Judy Jennings PT, MA and Gayle Loyd, M.Ed./DMT
Occupational and physical therapists are seeing an increasing number of seemingly normal, healthy babies with head and neck problems, poor eye-hand coordination and weak hand function. Is it possible that some recommendations made to prevent other difﬁculties are contributing to these abnormalities?
What is Happening?
Physicians typically advise new parents to put babies on their backs for sleeping to lower the risk of sudden infant death syndrome (SIDS). Before the SIDS scare most babies slept on their tummies. Today, not only do babies sleep on their backs, but during awake time we bundle them into a variety of restrictive seats and recliners to keep them safe and include them in our activities. Doctors report that about 20% of normal babies have some mild ﬂattening of the head, asymmetry of the back of the skull and face or both.
Result: Developmental Delays and Neck Problems
Babies on their backs are neurologically upside down. From that position they can barely raise their heads, much less put weight on their arms and hands or begin to crawl and creep. Consequently, organization of the sub-cortical brain areas cannot occur. Although some of these babies appear to developing normally, lack of lower brain development may translate into later learning and behavior challenges.
Not only do these babies miss important tummy time, but many show a propensity to turn or hold their heads predominately to one side. Sometimes the neck muscles contract and medical help is required to restore the full motion needed for normal development. Untreated, this condition, called "torticollis," can require extensive therapy or even surgery. To avoid torticollis:
- Switch arms frequently when feeding;
- Frequently reverse the baby‘s position on the diaper table;
- Carry the baby in a variety of ways, allowing him to experience different head positions;
- In a baby carrier or car seat, keep the neck straight with head supports;
- Avoid equipment that holds the baby in a semi-reclining position.
Crawling and Cognitive Development
Crawling and creeping organize important parts of the central nervous system that provide the foundation for all future growth and learning. When the lower brain develops appropriately, higher level cognitive skills emerge naturally and easily. Disorders involving self-regulation, sensory integration and learning could signal a lack of appropriate development in these key areas.
Solution: Tummy Time!
Place newborn babies on their tummies several times a day after naps, eating and diaper changes, when they are awake and content. Tummy time promotes the development of strong head and neck muscles by allowing the baby to hold up the head against gravity. During tummy time, babies bear weight on their arms and hands, learn to reach with the eyes and the hands together, and eventually move through space to explore.
As babies gains strength in the third month, tummy time becomes more fun. Their ﬁrst random movements enhance posture and coordination, eye tracking, arm rotation and hand strength. The result is a ﬁrm foundation for crawling, creeping, manipulating toys and later drawing with a pencil. Four and ﬁve month old babies are more purposeful, scooting and pivoting to reach toys. If you place a rolled up towel under a baby‘s chest and armpits, allowing him to be slightly inclined, he will smile and then reach out for stimulating objects.
Schedule Sufficient Tummy Time
Many parents in today‘s busy culture do not realize that a baby‘s work is play. Semi-reclined seats provide safety and convenience, but not the best conditions for neural development. We must alert parents and teachers to the importance of tummy time, followed by crawling and creeping, for the child‘s developing mind. In addition, we must provide frequent opportunities for children to ﬁnish this important work when the earlier opportunity is missed.
Fortunately we can inﬂuence the organization of the sub-cortical brain at any age by providing opportunities to crawl and creep. Sometimes, because of illness, injury, or other trauma, a more intense intervention is necessary. In most cases however, simply adding crawling and creeping activities to the daily schedule will lead to improvement. Struggling readers will read more easily; overly active, inattentive students will stay focused; behavioral difﬁculties will diminish.
Prevention is best. Second best is early identiﬁcation and intervention by frequent position changes and more tummy time. If your baby fails to crawl, prefers turning to one side or is developing a misshapen head, see a pediatric specialist. Therapists trained in rehabilitation for torticollis in babies can provide remedies more easily when the referral is early (two weeks to two months).
Judy Jennings is a physical therapist in Fairﬁeld, Ohio and can be reached by email. Gayle Loyd is a developmental movement specialist in Seattle, WA. You can reach her at 206-367-7827.[Initially published in New Developments: Volume 9, Number 3 - Spring, 2004]