Shaping Your Baby’s Future… & Their Head: A Pediatric PT’s Perspective on Positioning, Part I

There is one thing I HATE about my job: telling parents that the positioning devices they
paid good money for – or worse, received FOR FREE – are actually not good for their child. At all. It’s actually bad for their development. I hate telling them this because I understand how much time it takes to put together a registry & all the pressure there is to have all the right things for your little love. Plus, I’m sure it’s confusing to see ads with those adorable babies standing in their exercise saucer, looking perfectly content while Mommy cooks dinner (oh, the bliss), & then to be told that this miracle device gives your little one a good chance
scene2to be developmentally delayed.

I’m telling you, it’s like popping a kid’s balloon.

 

 

 

Then I die a little inside when they ask the natural follow-up question: “Well, what about the jumper?” Or they sigh in relief as they say, “At least I have the baby seat to keep her safe when I have to put her down…” I’m dying because those pieces of equipment have the potential to be just as damaging. In this post I will address how artificial weight-bearing equipment affects our children’s development & in the next one I’ll talk about protecting the shape of their heads. Now that I’ve shattered the dreams of a nation, let me explain why we pediatric PT’s have the obligation to become life-ruiners by giving our parents this information…

Disclaimer #1 Even though my statements sound pretty dogmatic, I’m aware that not every child that is placed in positioning equipment becomes delayed. Many Already-Mommies may be thinking, “We used these all the time & my children are fine…” & that is awesome! But for some kids this isn’t the case & we see many of them on a weekly basis.

Disclaimer #2 Just like anything, moderation is key. 5 minutes every now & then in an exercise saucer probably won’t cause your child to walk late. An hour a day probably will. As a new mom I play the game of How-Much-Can-I-Get-Done-Before-He-Gets-Fussy, so I can see the attraction to place a child in a safe & entertaining space & leave them be. Then, before you know it they spend most of their wake periods artificially weight-bearing, which I’ll explain later. So, in our home we have decided to remove all temptation & not own any AWB equipment.

What is normal? Babies naturally develop postural & anti-gravity strength by exploring their environment in an age appropriate way. When he is brand new, he will learn to pick his head up by being placed on his tummy & being held on Mommy’s shoulder. Around 3 months, he will learn to roll over by lying on his back & seeing his favorite toy just out of reach. He will sit up, crawl, pull to stand, & eventually walk when he learns that he can build on the skills he has to get to whatever motivates him. This happens through practice, which creates literal patterns in his brain, as well as letting him “struggle” just enough to learn motivation. All the while he is strengthening his muscles in the process. This happens organically when I take a less-is-more approach to his positioning.

Artificial weight-bearing equipment: Any device that places baby in a vertical position with feet (or toes) in contact with the ground while being supported beneath his pelvis.

Why is AWB equipment bad? We are replacing the organic development of motor skills with a fake reality for our baby. Here is an example: as soon as he has head control (4 months) I place him in a very supported upright position. He loves it! But remember the motor patterns that form with practice? He is learning that he can be against gravity, on his feet, jumping, bouncing, even walking without using his core or proximal stabilizing muscles (like his glutes.) We obviously can’t walk, much less sit or crawl, without using these muscles. Fast forward to 6 months when he should be sitting, 10 months pulling to stand, 12-15 months walking, & he seems to be progressing slowly or abnormally, possibly unable to sit without propping or walking on his toes. This is because he already learned how to stand at 4 months, incorrectly. Now he must backtrack, learn correct weight bearing mechanics, then catch up to his peers.

In parents’ defense, we are fed bad information by labels. A random google search revealed this gem, which encourages parents to place babies  4-15 months inside with only their toes touching. The issue with this is that he is now learning that when he does walk, it needs to be on his toes, all the while ignoring his core. Toe-walking is another blog post for another day, with many contributing factors, including this:

61611767-2

In the last few decades, babies have been heavily marketized. Equipment claims to be beneficial for development, of course, when really they are continuing to saturate the marketplace with whatever parents are willing to buy. Regardless of whether is physiologically harmful or not. Along with this marketization of parenthood,  we in the physical therapy field have also seen

  • An increase in equinovarus gait, or toe-walking
  • Gross motor milestones being changed, i.e., skipping crawling is now normal, not walking by 24 months is of no concern, etc.

What about supportive seating? While the baby seat sounds like a great alternative to help babies engage with their surroundings when they can’t quite sit on their own, it can cause similar detriments as AWB equipment. In order to provide the support needed, they are forced to sacral sit, or “slouch.” (Photo 1) Their weight is shifted backward, opposite of the natural weight distribution & curve of the spine that develops when they learn to sit through correct practice (Photo 2).

So, is it ever ok to use AWB or supportive seating? The answer will differ from child to child. I would recommend not using them at all if your little one has weak tummy muscles or if they have been delayed in reaching any milestones. However, if your baby is taking independent steps & their motor patterns are well established, using an AWB device with their legs straight & feet flat will most likely do no harm since they already know how to weight-bear correctly. Similarly, if your child sits nicely at the appropriate time, using supportive seating while eating, for example, will probably not cause them to regress. However, babies are smart & bad habits can be learned by spending too much time in positions of ease, so make sure you are limiting the equipment & monitor for changes in their movement.

Wow, that’s a lot of info. Info that may possibly differ from what your pediatrician says & probably much different than what commercials tell you. So, if you have any questions or comments, just leave them below!

Stay tuned for more info & some good news in the next post!

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