I have received a number of messages via twitter and facebook about sleep positioning. Several of the responses related to back sleeping and the relationship to head flattening.

While there has been an increased incidence of plagiocephaly (flattening of the skull in either the front or rear of the head) since the recommendation that infants sleep on their backs, the reduction in SIDS has impressive. Several readers stated that their children had slept on their tummies and “they were fine”.

My own children were tummy sleepers (as that was the recommendation prior to 1992), but I personally knew 3 friends whose children succumbed from SIDS. That does not include the babies within our practice whose deaths were also attributed to SIDS, and there were several every year.

Since 1992 we have had 2 babies within our practice that died from presumed SIDS, one of whom was sleeping on their tummy.  I know that this is anecdotal data but nevertheless, a wonderful and impressive difference. While an article in the August issue of Archives of Pediatric and Adolescent Medicine confirms that there has been more than a nine fold increase in the incidence of plagiocephaly between 1999-2007, this finding should “in no way dissuade parents from protecting their babies from SIDS by placing them to sleep on their backs”. But there are ways to try and prevent head flattening while still adhering to “back to sleep”.

Tummy time can begin right from the start and an infant may be placed on their tummy off and on throughout the day (unless they fall asleep, when they MUST be turned over). Patients always ask, “how long” but it differs depending on the mood of the baby. Some babies love tummy time while others resist it.  But, just like many parenting issues, a baby has to have some tummy time and with time most babies will become less resistant.  

Those babies that “detest” tummy time often seem to be early rollers and flip from tummy to back just to get off their tummies!! At the same time, once a baby is rolling from back to front, you can’t be a”professional" tummy flipper” and be up and down all night or try to rig a contraption to keep your baby on their back. They will roll over in their sleep just like we all do and once they can roll on their own they may become a tummy sleeper.

The Bumbo chair is a huge help in preventing head flattening, as well as the exersaucer and the jumper-roos (or whatever they are called now).  These products all help support a baby’s back while keeping their heads upright which prevents flattening.  I encourage all of my patients to begin using these gizzzmos around 3 months of age, and especially for any baby that is already showing some flattening or tummy avoidance on their early newborn exams.

I also notice that more of my 2nd and 3rd babies seem to have some flattening because they spend a great deal of time in their car seats as they are “carted” around town with an older sibling. In these cases I encourage the parent to pick the child up once out of the car and carry the baby rather than keeping them in their carrier.  This is good for bonding, head control and keeps the baby off of their back as well. So with all of this being said, if a head is severely affected there are “molding helmets” that can be utilized to prevent the cosmetic consequences of head flattening.  This should be a separate discussion with your doctor, but my philosophy is to try and discuss the issue of positional head flattening at every visit to try and avoid the problem all together.

That’s your daily dose for today.  We’ll chat again tomorrow.