As a new parent, Sarah Gainey realized the importance of putting her baby, Charlotte, to sleep on her back.
Gainey, 30, and her husband, Derrick, understood the “Back to Sleep” campaign and its warning not to let infants sleep on their stomachs because of the risk of sudden infant death syndrome, or SIDS.
But they also knew that some babies develop flat spots on their heads from sleeping on their backs and that some have to wear helmets, called cranial bands, to remold their skulls to a round shape.
So Gainey took notice when Charlotte, at about 2 months old, tended to sleep with her head to the left. Each time Gainey moved Charlotte’s head to the other side, the baby eventually turned back.
Gainey’s pediatrician referred her to Susan Slaughter, a Charlotte occupational therapist, who measured Charlotte’s head and found it slightly asymmetrical. The baby’s neck muscles were tight on the right, causing her to turn to the left. “That’s the way she got comfortable, and her muscles adjusted,” said Gainey, of Charlotte.
Instead of prescribing a cranial band, Slaughter first suggested more “tummy time,” daily stretching exercises, and less time in “baby equipment.”
Today, occupational and physical therapists and pediatricians are trying to spread the word that parents should limit the use of baby gear and give children more time on their stomachs to strengthen their upper bodies and reduce their risk of developing flat spots on their heads.
For two months at home, the Gaineys began placing Charlotte stomach-down on a blanket on the floor when she was awake. They surrounded her with mirrors and light-up toys to prompt her to lift her head and turn to both the left and the right. They alternated the way they laid her on the changing table and in her crib so she’d look in both directions. And they stopped letting Charlotte take naps in her car seat or an “inclined bassinet” that kept her slouched and comfortable but unable to move around.
“I thought being on an incline was safer,” Gainey said. “What I didn’t know was that it was causing her problems with range of motion. She never had to lift her head. … If she fell asleep in her car seat, we would just bring her car seat inside and let her sleep in that. I had no idea we should be limiting the equipment.”
Today, at 19 months, Charlotte’s head is perfectly round. And she never needed a helmet.
“With our next child, I’ll certainly do things differently,” Gainey said. “Not knowing is part of the problem. The awareness isn’t out there.”
Spreading the word
“Tummy time” is not just a slogan. It’s important for an infant’s development, according to Slaughter and other therapists and pediatricians. They stress that strengthening babies’ neck, shoulder and arm muscles can help prevent head-shape issues – and even correct early problems – without the need for a helmet.
Too much time in car seats, bouncy seats and swings is a contributing factor, experts say.
“In my practice, I almost never have a baby end up in a helmet because we make this a very big issue early on,” said Dr. Catherine Ohmstede of Dilworth Pediatrics. “Almost all helmets are preventable.
“I advise all parents to avoid leaving their babies lying on their backs when they’re awake,” Ohmstede said. “I try to get parents to use the equipment only when it’s necessary, only in the car or when you can’t get the baby to quit crying. Not because it’s a convenient place to put your baby down.”
In her new book “Retro Baby,” Anne Zachry, a pediatric occupational therapist at the University of Tennessee Health Science Center in Memphis, makes the case for cutting back “on all the gear” and returning to blocks, balls and homemade toys that kept babies occupied for generations.
“Parents feel so much pressure to buy all the latest – the carrier that turns into a stroller that turns into a car seat,” Zachry said. “Many babies spend long hours in equipment.”
Equipment may keep babies entertained, but it doesn’t generally allow them to explore, stretch or strengthen their muscles, Zachry said.
“They’re just kind of stuck in one position,” said Stacy Conder, a physical therapist who works with Slaughter. “The child benefits so much more from just laying on a blanket on the floor and turning their head to look at different things.”
‘It’s getting worse’
It’s been more than 20 years since the American Academy of Pediatrics first advised parents to put babies on their backs to sleep to reduce the risk of SIDS.
The “Back to Sleep” campaign was a big success, and SIDS declined by 40 percent. But there was an unexpected consequence: A rise in the number of babies developing flat spots on the backs of their heads, a condition called plagiocephaly. It’s not just a cosmetic issue. If not corrected, it could lead to vision problems or pain in the jaw.
The new slogan is “Stomach to Play and Back to Sleep” to encourage parents to give babies plenty of “tummy time” and to keep them off the backs of their heads.
Despite that, babies with flat spots on their heads continue to get fitted for cranial bands.
“It’s getting worse because of the equipment,” Slaughter said. “Other cultures (where babies) have always slept on their backs don’t have this head-shape problem that we have.”
Slaughter, who owns Carolina Kinder Development in Charlotte, holds classes to teach parents how to get their babies to spend more time on their tummies and their sides.
Ohmstede said neither of her children, now 4 and 6, liked to lie on their stomachs, so she carried them next to her chest in a BabyBjorn carrier. That avoided putting pressure on their heads and helped them develop neck muscles.
She advises parents to put their babies on their sides with a rolled-up blanket behind to hold them in position. “I don’t think side-lying gets enough attention,” Ohmstede said.
Do you want baby to lounge?
Toy manufacturers do such a good job of marketing that it’s tough for parents to resist, said Slaughter, whose work is cited in Zachry’s book.
For example, Fisher Price labels its swings as “swing/cradles” and “promotes them as helping development,” Slaughter said. “They promote them as being soft and snuggly – (but) the softer the material, the more the baby sinks into it and can’t reposition independently.”
Slaughter also cited the pitch for a Boppy pillow by Chicco: “Baby can lounge and relax while safely propped up to check out her surroundings.”
Slaughter responds: “Are you trying to promote lounging (for your baby)? Or when they’re awake, do you want them to be engaged?”
Kathleen Alfano, senior director of child research for New York-based Fisher Price, deflected criticism of the company’s toys and referred to its website that includes materials on the importance of “tummy time.”
“We have toys that encourage it,” Alfano said. She mentioned “floor gyms,” such as the “Link ’n Play Musical Gym” with mirrors and toys that can be placed in various positions to encourage babies to look around while on their stomachs.
Fisher Price’s “Rock ’n Play Sleeper” – advertised as a “wonderful sleep spot for newborns” – draws criticism from Slaughter and Zachry because it’s a comfortable place for babies to sleep that leads parents to overuse it.
Alfano said the Rock ’n Play is helpful for babies with indigestion or acid reflux because it “raises the baby up at an angle. … It’s a slight angle, and it’s never meant to be all day every day.”
Parents who bring their babies for occupational or physical therapy are often upset that they didn’t have enough information to have prevented their child’s head-shape problem, Conder said. That’s why she, Slaughter and Zachry are trying to spread the word.
“Parents want to do what’s best to help their babies. So many just don’t know necessarily the right things to be doing,” Conder said. “It’s not that all equipment is evil or going to cause these horrible problems. It just needs to be limited.”
Avoiding the band
When Sarah and Derrick Gainey brought their baby Charlotte to Carolina Kinder Development, they worked with both Slaughter and Conder.
The mother of three, Conder knew how the Gaineys felt because she had been in their shoes. Her older son, Vincent, now 7, wore a cranial band for three months as an infant.
“I was so worried about all the other stuff that comes along with being a new parent,” Conder said, that she didn’t notice until it became glaringly obvious that her son’s head was flat in one spot. “I felt we had somehow failed our son, especially me as a physical therapist.”
Conder and her husband, Ed, were initially referred to an organization that specializes in cranial banding, but they then met Slaughter, who fits babies with cranial bands “as a last resort,” but begins by teaching parents how to incorporate stretching exercises into their babies’ routine.
The Conders’ second child, Graham, now 5, began to develop a flat spot when he was only a few weeks old. They used Slaughter’s recommended stretching exercises, and by the time Graham was 4 months old, “his head shape had corrected,” Conder said.
Conder went to work with Slaughter after her two sons received therapy from her. She’s recently been on maternity leave with her third child, Molly Jane, 3 months old. “I’m watching her like a hawk,” Conder said. “We’re spending lots of time on the floor.”
This week, week of 17th she’s back at Carolina Kinder Development, teaching other parents how to help their babies develop properly.
“I feel like I can relate to parents in a very different way,” Conder said. “I see the physical therapy side of it, but I’ve also lived the parent side of it. I get that it’s hard to ask a parent to add something else into a day, but I’ve also seen firsthand what a huge difference it can make.”