NEW YORK (Reuters Health) - Infants who spend too much time on their backs have an increased risk of developing a misshapen head along with certain developmental delays, the American Physical Therapy Association (APTA) warns in a statement issued this month.
Infants need "tummy time" while they are awake to develop properly, the APTA notes.
The 1992 "Back to Sleep" campaign, which educated parents on the importance of putting their infants to sleep on their backs, rather than their stomachs, led to a dramatic reduction in the number of deaths from sudden infant death syndrome (SIDS).
"As a result though, new parents were afraid to put their babies on their bellies at all, even when awake," Colleen Coulter-O'Berry, a physical therapist at Children's Healthcare of Atlanta noted in an interview with Reuters Health.
"I see new parents all the time that, by 4 months of age, have never put their babies on their bellies because they are afraid the baby is going to suffocate," she said.
The combination of babies sleeping on their backs, as well as spending long periods of time in infant carriers that double as car seats, puts pressure on the head, which can flatten the skull, she explained.
"As a result, we've seen an alarming increase in skull deformation," Coulter-O'Berry said.
Babies who do not get enough time on their tummies can also develop tight neck muscles or neck muscle imbalance - a condition known as torticollis. "If a baby doesn't get early tummy time, they don't push up on their elbows, they don't get their heads up and looking around, and they don't gain strength in their neck and back muscles," she explained.
"Increasing the amount of time your baby lies on his or her tummy promotes muscle development in the neck and shoulders; helps prevent tight neck muscles and the development of flat areas on the back of the baby's head; and helps build the muscles baby needs to roll, sit, and crawl," Coulter-O'Berry added.
She said 90 percent of children with torticollis also have changes in their head shape.
Her message to new parents: "Don't be afraid to put your baby on their tummy for short periods of time while they are awake. After a nap, diaper change or feeding, roll the baby onto his or her stomach and encourage the infant to find, focus, and follow your face or a toy with their eyes looking up."
The football hold, where the baby's belly is facing down in the palm of the hand and the baby is looking up, is another good way to get extra tummy time, she said.
Coulter-O'Berry is co-author of "Tummy Time Tools" - a brochure that provides caregivers ideas and activities to ensure that babies get enough tummy time. It is available on the APTA website -- www.apta.org/consumer.
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SIDS deaths in the U.S. decreased from 4,895 in 1992 to 2,247 in 2004. But, during a similar time period, 1989 to 2004, SIDS being listed as the cause of death for sudden infant death (SID) decreased from 80% to 55%. According to Dr. John Kattwinkel, chairman of the Center for Disease Control (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just code shifting”.
In a 2006 letter to the editor in the Journal of Pediatrics Dr. Rafael Pelayo, Dr. Judith Owens, Dr. Jodi Mindell, and Dr. Stephen Sheldon asked the following question of the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome after their Pacifier and Co-sleeping report was published:
"...from the perspective of the field of pediatric sleep medicine, the policy statement's laudable but narrow focus on SIDS prevention raises a number of important issues that need to be addressed. In particular, the revised recommendations regarding cosleeping and pacifier use have the potential to lead to unintended consequences on both the sleep and the health of the infant. The potential implications of a SIDS risk-reduction strategy that is based on a combination of maintaining a low arousal threshold and reducing quiet (equivalent to Delta or slow-wave sleep) in infants must be considered. Because slow-wave sleep is considered the most restorative form of sleep and is believed to have a significant role in neurocognitive processes and learning, as well as in growth, what might be the neurodevelopmental consequences of chronically reducing deep sleep in the first critical 12 months of life?"
In a currently utilized model that explains the process in which slow wave sleep is involved in memory consolidation the hippocampus acts as a temporary storage facility for new memories which are then transferred to the neocortex during slow wave sleep (SWS) [8]. In this model, acetylcholine acts a feedback loop inhibitor inside the hippocampus during REM sleep and wakefulness. The activity during the high cholinergic wakefulness period is believed to provide an environment which allows for the encoding within the hippocampus of new declarative memories. The low cholinergic environment during SWS is thought to then allow these memories to be transferred from the temporary storage of the hippocampus to their permanent storage environment in the neocortex and for memory consolidation [9, 10].
A significant way of decreasing slow wave sleep in infants is by changing their sleeping position from prone to supine. It has been shown in studies of preterm infants [11, 12], full-term infants [13, 14], and older infants [15], that they have greater time periods of quiet sleep and also decreased time awake when they are positioned to sleep in the prone position.
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10. Hasselmo, M.E. 1999. Neuromodulation: Acetylcholine and memory consolidation. Trends Cogn. Sci. 3: 351–359.
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