Are current lifestyles limiting our children’s physical and academic potential?
Movement, play and “safe danger” are essential to a child’s development, but there is now evidence to suggest that current busy lifestyles, anxiety and media pressure are contributing to an increase in Flat Head Syndrome and delayed motor milestone development babies, reduced motor planning in toddlers and “below normal” motor milestone achievement and risk assessment in primary school children. This is also adversely affecting academic attainment. In addition, an increasing number of primary and secondary aged children are now suffering back pain as they are simply not fit enough to cope with the daily demands of life. In addition to the social and moral obligations of giving children the best possible start, these children are our next working generation……
So why is tummy time and regular changes of positioning essential in the first few months of life?
Placing babies on their tummies to play every day (when awake, content and supervised) has numerous benefits:
- Helps improve ability to hold head up
- Builds strength in upper body and shoulders
- Helps develop core muscle strength and coordination – essential for rolling, crawling and walking
- Helps develop normal curves of the spine
- Begins to develop co-ordination and balance skills
- Helps baby learn about their body by taking weight through their arms
- Encourages baby to begin learn about their body, to explore surrounding and open their hands for toys
- Gives them a sense of “really wanting that toy”, learning to assess risk, influence their environment and achieve – this becomes instilled for life!
- Essential to help baby learn how to roll over or push up into a crawling position. Crawling is fundamental to improved co-ordination later on.
- Takes the weight off the back of the head to help avoid developing a flat head (plagiocephaply)
- Encourages symmetrical neck and back muscle development to reduce a head preference to one side (torticolis).
- Necessary for visual development as eyes learn to focus together.
Babies must be placed on their back to sleep. BACK TO SLEEP, TUMMY TO PLAY…EVERYDAY!
Are tummy time, movement and regular changes of position really that important?
YES! Research clearly shows that “ Gross motor performance is more advanced in infants who sleep supine and are placed in prone (on their tummy) while awake than in infants who slept supine but who had limited or no experience in the prone position when awake”. These gains and the self-confidence to explore appear to stay with children throughout life. Studies also confirm that early childhood skill development positively influences adolescent girls and boys participation in physical activity and fitness. We are all aware of the numerous health benefits associated with physical activity. Studies have shown that by ensuring children have the best start in terms of physical fitness they are more likely to continue their behaviour into adulthood.
Since the very successful Back to Sleep campaign in 1992, there has been an increase in the number of children being referred for delayed gross motor development and plagiocephaly (flat head). This obviously has implications cost for our NHS, in addition to distress for families.
A study by FSID (Federation of Sudden Infant Deaths) in 2006 reported that 19% of mothers with babies 0-6months never gave them tummy time play. Today, the age to trigger paediatric physiotherapy treatment for “delayed walking” is now considered to be 2 years old, rather than 18months.
The American Physical Therapy Association (2008) reported on a study that prior to 1996, the prevalence of misshapen heads amongst infants requiring treatment was reportedly 1 in 300 live births, it is now 1 in 60. Current research suggests that upto 50% of babies under 1 will now show some extent of positional plagiocephaly or flat spot.
A thought-provoking and emotive article (which receive nearly 300 comments online) on plagiocephaly and the importance of tummy time can be viewed via the link below (it is worth reading!) http://www.dailymail.co.uk/femail/article-2128383/Are-baby-bouncers-car-seats-blame-rise-Flat-Head-Syndrome.html
Postitional Plagiocephaly can occur because the skull is incredibly malleable, in preparation for descending along the birth canal. It is easily moulded by the pressure of the floor, cot, baby seat, bouncing chair etc on the back of baby’s head within the first few months of life.
When a baby is breastfed, a mother naturally changes the side her baby feeds from (and therefore head pressure). If a baby is bottle fed, it is very common for the caregiver to have a preferred, more comfortable side to feed from. Therefore, babies who are bottle fed, frequently feed from the same side have an increased risk of positional plagiocephaly.
Babies are born without the muscle strength to move their head from side to side, so in the first few weeks, it naturally rests to one side. Babies needs the opportunity and time to play on their tummy, back and sides, everyday – without restriction of modern contraptions in order to build up symmetrical neck strength and flexibility.
If the head preference is allowed to continue, the flat spot grows and it becomes even harder for baby to move their head fully, against gravity. A Torticolis (unilateral shortening of the sternocleidomastoid muscle) can occur before plagiocephaly but it frequently accompanies the persistent head preference. Therefore, both conditions should be looked out for.
A Torticollis often goes unnoticed within the first few weeks of life, parents may notice a lump in the muscle, level with the angle of the jaw which is apparent when the baby cries. It is generally a non-tender lump which reaches a maximum size in the first month of life before it gradually regresses.
However, It is more commonly noticed between 4-6months, not as a lump, but as parents notice a head preference to one side or a head tilt to one side. This is caused by neck tightness on one side as the baby does not have the length in its neck muscles to be able to move its head fully to build up strong, counteracting neck muscles.
If left untreated there will be progressive deformities of the face and skull apparent within the first year – flattening of the face on the side of the affected muscle may result in considerable cosmetic deformity, with the level of the ears and eyes becoming more asymmetrical during the years of growth up to skeletal maturity. Research has also indicated that children are likely to experience increased ear infections, visual difficulties, delayed gross motor development and scoliosis (twisting of the spine) if left untreated. Early intervention is essential and it won’t just “clear up on its own” – something GPs and Health Visitors need to be more aware of.
As with many conditions affecting health, prevention is always best. Regular changes of position (including the position of baby’s cot – do caregivers always approach from the same side as baby’s head preference? If so, let baby sleep the other way around or move the cot). Active movement and allowing baby to play on their tummy and both sides can help. This also forms part of the physiotherapy and medical management for children with torticollis.
Early gross motor skill acquisition core strength are a vital part of child development, with the benefits continuing throughout life.
The implications for primary children
In today’s world, there are many additional factors which are affecting child development. Babies often attend nursery from a very young age and are less able to explore their environment by themselves because of safety concerns, they are often confined to one room so that learning by experiment to climb stairs or crawl out of doorways is not an option.
Babies often have a very structured day with a whole host of “scheduled activities” with little time just “to be” on the floor. They are only exposed to limited movement opportunities as they are transported / cocooned in car seats and travel systems. There are also whole host of contraptions on the market to strap baby into, keeping them “safe” whilst we get on with our busy lives.
These factors naturally contribute to babies becoming under-developed physically (especially core muscle strength and coordination), emotionally passive, unsure of exploring and less able to safely assess risk.
Families often live hours away from one another, so a run around the park with grandparents is often an infrequent treat, rather than a weekly occurrence. The computer-generation of children are growing up with improving technology from an increasingly younger age. This is leading to sedentary, poor posture as even 2 year olds are hunched over handheld games.
The Children’s Society believe “Play is one of the crucial elements of a good childhood”. A Unicef survey (2007) found British children were among the unhappiest in a league of 21 industrialized countries.
Alarmingly, results from a study of over 500 children aged 7-8 years, has shown that over 75% did not achieve a “normal development” score when assessed against a gross motor development checklist. A pioneering 6 week school programme has been put in place, with 50% achieving “normal development” after the programme with associated improvements in handwriting, concentration and learning outcomes.
As the programme has been so successful, the tam involved are now developing a programme for Early Years children (0-5 years) with an emphasis on tummy time play for the very youngest.
Another piece of new research shows that the number of children receiving NHS treatment for experiencing back and neck pain is increasing in Wales. 72% of primary aged children said they had experienced back and/or neck pain.
Children need good core muscle strength to carry their bags and maintain healthy upright posture. Could this be related to the amount of time spent with curved backs in baby car seats?, a lack of core muscle strength from limited activity at an early?, being hunched over computers and hand-held devices?…..
Perhaps it is to do with our increasingly sedentary life full of technology, perhaps a fear of letting children play outside or in an unstructured way? With all the pressures on children and families today, we need to instil in our children, a desire to explore, assess risk and achieve from day one!
Alarmingly I think the introduction of “over the top safety and baby constraining devices” now offered by High Street retailers is reinforcing the sedentary, over-protective culture we live in. As a paediatric physio, I have serious concerns regarding this from a physical point of view and I wonder what an educational psychologist might make of it from an emotional point of view for both child and parent?
It is incredibly daunting as a new parent or parent-to-be, professionally developed products and advice which can be trusted and justified help enormously, but do we all really need web cams of our sleeping children, apnoea sleep mats and covers to protect our precious bundles from siblings? Children need space to grow, play, interact and develop. Parents need interact, play and nurture their children and not feel guilt if babies are given some downtime “just to be”, playing on the floor. We need to encourage that zest for learning, life and exploring. Are both children and parents becoming over-anxious, constricted and risk adverse?
Awareness of good practice needs to be raised and it is reassuring to know that the “tummy time play” message and its importance to physical and emotional development is now getting out there. However, there is always more which can be done!
Once rolling and sitting independently, the Jolly Back PosturePad can be taken to nursery, school and used at home – so many uses. However, it all begins helping Mum-to-be, support her growing bump for a better night’s sleep!
Thanks for reading!
Kind regards and enjoy many magical moments with your baby,
BSc (Hons) Physiotherapy, MCSP, HPC
Chartered Physiotherapist mum to 3 and creator of the Jolly Back PosturePad