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In recent years paediatric health professionals in Australia and overseas have noticed a dramatic increase in the number of infants with persistent positional plagiocephaly (misshapen head).
It is common for a newborn baby to have an unusual head shape, but it usually moulds to a normal shape within six weeks after birth. However, a baby may develop a flattened spot at the back or side of the head and this is called plagiocephaly. This generally occurs in response to babies habitually lying with their head in the same position, which is usually due to:
- the shape of their head at birth
- occasional tightness in one of the neck muscles
- the preference for looking at light when awake.
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Plagiocephaly does not affect the development of the brain but, if it is not treated, may alter a baby's physical appearance by causing an uneven growth of the face and head, and can contribute to visual and sometimes hearing problems.
Why do babies need tummy time?
 In line with the teaching of SIDS and Kids, it is very important that infants sleep on their backs and the reduction in sudden infant deaths since the education on safe sleeping has been remarkable. However, in some instances, this teaching has lead to a general fear amongst mothers about ever placing their babies on their tummies. Contrary to this, it is very important that babies experience a variety of postural positions to enhance the development of their movement and balance skills. Physiotherapists working with infants and young children have combined with the SIDS and Kids to promote the safe positioning of babies on their tummies, under supervision, during waking times.
Babies have very strong protective and postural reflexes which make them want to keep their eyes horizontal and lift up their heads. The early development of these reflexes is evident in very young babies, while on their tummies, in that they can lift their heads, enough to turn it from side to side. Gradually they become able to lift their heads enough to look around and will start to prop higher using their arms for assistance. These movements strengthen their backs: a benefit for later core stability and balance. Babies who do not spend waking time playing on their tummies do not develop these skills.
Some babies do not like lying on their tummies, particularly in the weeks when they are not strong enough to lift their heads. During these times it is useful to find alternative ways of encouraging tummy play, such as carrying them with their tummies along your arm, or by putting their tummies over your knees. They often feel safer like this as they enjoy the close contact with the person playing with them.
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It is very important to follow the recommendations of SIDS and Kids for safe sleeping practices which is freely available at most maternity units, infant welfare organisations and childcare centres. Babies should be placed on their backs to sleep, as far down the cot as possible and with the covers secured firmly.
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| The benefits of infant massage |
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 Infant massage or baby massage is an age-old technique that is becoming very popular. Several studies also suggest that regular massage can contribute to faster weight gain in premature babies and improved overall development.
Parents find that massage:
- is very helpful in alleviating a baby's tummy discomfort, as well as providing a relaxing and enjoyable time to spend together.
- helps them learn the special language that their babies use through different cues and movements.
- lets them understand their babies in different ways which can help create a more relaxed atmosphere.
The International Association of Infant Massage offers comprehensive training certification. For more information please visit www.iaim.com.au.
Peta Bensted
International Association of Infant Massage
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Finding time for tummy time
From a very early age, infants should be introduced to being placed on their tummies. This can occur during the preparation for their bath when a parent is dressing or undressing them. This is a really good time for some gentle massage and play. Gently rolling a baby from back to tummy to allow for doing up buttons and straightening clothing is a lovely way to introduce some tummy time.
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Never leave a baby unattended, even for short periods, when they are on a table or bed. When placed on their tummies, even the tiniest of babies will make kicking movements with their legs. It is possible for them to make some forward movement even at this early stage and this is very dangerous if not supervised.
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An unsettled baby can often be comforted by being placed on his or her tummy across a mother's lap or along a forearm, while having his or her back rubbed. As a baby develops more strength and awareness, many will prefer to play on their tummies and, once they learn to roll, they are able to make a choice about their favoured playing position. Strong arm support and transfer of body weight to allow forward-reaching for a toy are important forerunners in the development of balance and coordination, which will eventually lead to walking skills and good hand use and writing skills.
| Strategies for protection |
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It is good to develop a pattern for going to sleep: babies generally respond well to routines. While adhering to the safe sleeping principles, it is good to vary the position of the cot or the end at which the baby sleeps, to alter the position of the light from the window or the side from which the baby will be approached to be picked up. It is remarkable how early babies will learn to look at the light or gaze in the direction of someone coming to get them. If this is continually the same it can lead to a head being held in one direction and thus flattening on that side.
A newborn baby has a very soft and mouldable head, something which is a great benefit during the birthing process, but continually lying, turned one way, will alter the shape of the head, causing flattening on the underside. We all have some element of asymmetry in our bodies but persistence of one head position will cause a marked asymmetry. Parents who have a concern about the development or head shape of their baby should consult their child health nurse, their doctor or a paediatric physiotherapist.
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Finding out more
The National Committee of the Paediatric Group of the Australian Physiotherapy Association has been working with SIDS and Kids and the Royal Children's Hospital Melbourne to develop a brochure to assist parents and carers in the prevention of plagioceplaly.
The brochure outlines some of the causes of this condition and offers those caring for babies some ideas and advice about management and prevention, and how to encourage good positioning and activity for baby's development. It is available for $1 each (less for bulk orders) from the National Office of the Australian Physiotherapy Association, Level 3, 201 Fitzroy St, St Kilda, Melbourne, Victoria 3182.
Sue Charlton
APA Paediatric Physiotherapist
South Australia
Email: suecharlton@internode.on.net
Acknowledgements
Thank you to Sharon Vladusic from the Royal Children's Hospital Melbourne, and Anne McCoy from the National Paediatric Group, APA for their work in the production of the poster and brochure, and also to SIDS and Kids for their assistance. Photos courtesy of Matt Hall, APA National Office.
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