Rehabilitation :: The Importance of Tummy Time
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More than a decade ago, the American Academy of Pediatrics (AAP) first recommended that parents put their babies to sleep on their back. That simple piece of advice cut the death rate from sudden infant death syndrome (SIDS) by more than half. An unexpected result has occurred, however: flattened heads.

The flattening, referred to as positional plagiocephaly, happens when a baby spends too much time on his or her back. These flat spots are "cosmetic" and not a medical problem. There is no evidence that the flat spots affect the brain and they usually occur on the back of the infant's head and are more pronounced on one side. The flattening may broaden the head and face, and in severe cases, the flattening may push forward one side of the face, creating an asymmetrical appearance. It is unclear how common flattened heads are, as the statistic vary greatly. In a 2013 Canadian study, researchers found that 47 percent of 440 2-month-olds having routine check-ups had positional plagiocephaly. Other studies in different regions in the United Stated and Canada with different sample sizes have shown incidents ranging between 3 percent and 61 percent in participating infants.


What is clear is that there are steps parents and caregivers can take to try to avoid flat spots on an infant's head:
  • Parents should still place babies on their back for sleep.
  • When babies are awake, put them on their tummy for a while. This eases pressure on the back of the head and helps babies build shoulder and neck strength.
  • Relieve pressure on the back of the head when you lay an infant down for sleep by propping the child slightly to one side. Alternate sides nightly.
  • Alternate which direction you place your child in the crib each night. Your child will then alternate which direction he or she looks out of the crib.
  • Minimize the use of car seats when not traveling in the car, as well as other types of seats such as bouncers and swings, in which babies are positioned on their backs.
  • Pick up the child often. The more time the baby is held in your arms, the less time he or she is lying down with pressure to the head.
Make Tummy Time Fun
The AAP mentions these suggestions to make tummy time fun for baby:
  • With baby on his tummy, place a favorite toy just a little bit out of reach to encourage him to stretch for it.
  • Surround baby with a circle of toys to encourage strengthening muscles by reaching in different directions.
  • Once baby is old enough, place baby belly-down on your chest so he will pick up his head to look at your face.
  • Encourage other young children to play with baby during tummy time, as long as you carefully supervise them together.
If the child develops a flat spot, contact his or her doctor. 

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