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

Since my last post was full of What-NOT-To-Do’s, I figured I would pass along some PT AND parent approved answers to the baby positioning questions. I posed the question of what Mommas – especially of multiples – use to position or safely “contain” their children at different stages of development. First, I asked my fellow PT’s as well as a PT/OT Facebook group. Then, I asked a Facebook group of Moms who use our preferred method of home education. I’ll share those answers after I acknowledge some concerns!

Some great questions & comments that came up were:

  • I feel bad for putting my baby on her back (or tummy) for hours a day. Don’t they get bored? I feel neglectful…

Let me ease your conscience – putting your little one on their back &/or tummy is not neglectful, it is completely age appropriate! As one Momma put it, they learn to entertain themselves when & where they are given the chance. If they are used to AWB (artificial weight-bearing) equipment, then they will cry when placed on their back. And, of course, we would get bored spending hours on our back because we know how to stand up & find our entertainment of choice. But pre-crawlers’ worlds are naturally limited to floor play. As their awareness expands & they begin interacting with toys, people, etc. they will find the motivation to roll, get on hands & knees, crawl, but we must give them that chance. Another Mom addressed fostering independent play from day one by not providing constant entertainment & actually giving them alone time so that they can develop play skills. I’m glad I received this advice before my son was born because now, at 3 months old, he can entertain himself on his back for about 30 minutes & on his tummy for about 10 minutes at a time.

  • Won’t all that floor play cause my baby to get a flat head?
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source: Northwest Infant Survival & SIDS Alliance website

It’s no secret that the Back To Sleep program, while the safest way to snooze, is leading to increased rates of brachiocephaly (flat in the back) & plagiocephaly (flat on one side) in babies. Their skulls are just so soft! A couple ways to combat this is to safely elevate their overnight sleeping surface by an under-the-mattress crib wedge or lifting the legs, switch which end of the crib they sleep on, have them in age appropriate vertical positions & use tummy time to play as much as possible during the day.

Baby J spends a lot of time on his back developing his anti-gravity muscles & getting motivated to roll, so we use the removable head portion of the BenBat to provide total contact to the back & sides of his skull, dispersing the compressive force of the floor & preventing flattening. He also uses this in his swing & rock n play. It’s not safe to sleep with since he can still turn his head & nuzzle into it. Besides using this product myself, I recommend it to my patients who have torticollis/plagiocephaly/brachiocephaly. The lateral “pillows” can keep baby’s head in midline, providing a gentle stretch, & the body of the BenBat can keep tiny ones from leaning too much to one side, causing further tightness.

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Baby J with his BenBat (body portion not pictured) to prevent head flattening & his Happy Teether to promote midline play & oral exploration

UPDATE: Another recommendation for torticollis or brachio-/plagiocephaly is the Tortle. This fits like a cap & bolsters the head to keep from turning to the preferred side or to keep pressure off of the flat area.

  • I have multiple children. I need to have a safe place for my baby & a contained place for my toddler while I cook, clean, go to the bathroom, etc.

It’s easy for me to pass along my own positioning advice as my son & I sit at home by ourselves in a nice quiet house, free of other humans & animals. So for this question, I asked essentially everyone I knew, in person & on Facebook. Here’s what I found:

Answers from pediatric PTs & OTs, many of whom are mothers themselves

77% recommended gates to create “baby jails” or to block off rooms. It is no surprise that the therapists opt for areas where children have freedom of movement to explore & develop their motor & sensory skills. Specifically, this playard was recommended by several PT moms. But, beware – when all panels are connected it is sturdy enough for little ones to practice pull to stand & cruising, but climbers have successfully escaped, so this may be confined to the pre-walkers.

“As a mom of 2 and a PT this is my favorite product. A little one can start to explore a small space without all of the safety concerns! I believe they need to be able to explore and not be confined to a specific position all the time (baby equipment).”

– Darcie, PT & mom

Along with a “gated community” for the littles, 23% of therapists recommended foam mats in play areas, especially with hardwood. There is only anectodal evidence among us that the fairly recent fascination with all-hardwood floors has led to a delay in crawling, as well as a decrease in quality. Try crawling, or even walking barefoot, on your hardwoods all day & it is easy to see why! Colorful or animated mats can also provide visual stimulation, helping with independent play goals. We use this mat in our therapy gym & have found that our therapists & parents prefer it to the puzzle piece type of mats. This one with interlocking squares was also recommended – pros: you can customize the surface area, cons: kids will inevitably pull them apart.

15% recommended using a pack n play. Ours has a bassinet feature for pre-sitters, which IMG_2277saves my back! It is also on wheels so Baby J can always be in sight, (though it does not go through standard doorways as easily as you would expect an on-the-go pack n play to!)
During sleep his pack n play rests on Les Mis & Grey’s Anatomy to get that inclined angle, shifting the pressure on his head & helping with his congestion! One mom hangs interesting  things the over the top for her baby to play with & rotates toys every few days.

Other unique ideas include high chairs & space saver high chair seats, bath tubs (this came from my friend in South Korea where the faucets are out of reach of children!), sturdy cardboard boxes, diaper boxes, & laundry baskets.

Sturdy cardboard box for sitting! Diaper boxes usually work well, for when kids are just starting to sit independently but you can’t walk away from them. The sides of the box prevent them from falling all the way over and they still have to work their trunks some to return to upright when they start to lean. Here is my daughter in a box at 6 months old.      – Lauren H., PT & Mom

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Lauren cut the front panel out of the box to make her feel less confined

Check out Pathways & Healthy Children/AAP for evidence-based information on milestones & issues such as positioning!

Answers from moms in a classical education & Charlotte Mason based Facebook group, most of whom have multiple children
IMG_167952% utilize baby wearing. I won’t go into specific types since there are so many great brands & everyone’s needs & bodies are different! I love the Moby wrap & Moby sling myself. I am a little OCD about his body position & weight distribution, so the fabric wraps give me freedom to get him right where I want him.

29% preferred the pack n play or some sort of portable playard.

26% also gate off a baby-proofed area to let their kids roam safely. Most rigged their main living area to be 100% kid friendly. Some intentionally created their nursery or kids’ room to be a safe place to gate off & leave them be while doing chores, checking in often.

Again, 17% utilized enclosed gated corrals, Rugrats-style.
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Here are some of my creative favorites for

  • Pre-crawlers (good head control & sitting balance): laundry basket with toys, a designated kitchen cabinet away from the stove with pots/pans/tupperware/sealed groceries, a couple toys in the corner of each room (need to occupy a baby while potty training a toddler?), a bucket swing hanging from the ceiling (be careful with assembly!)
  • Crawlers: a puppy kennel! This mom made sure to specify that it was NOT locked!

When my first two were little (they are 11 months apart), I made sure their bedroom was completely safe for them. We lived in a small one story home. That way, when I needed a few minutes to do something, I could safely place them in that room with the gate in the doorway. As my family has grown (I’m expecting my 7th in June), I have found babywearing to be especially helpful. The high chair is great when we are sitting at the table for math or watercolors…    – Lauren M., mother of seven

Out of 23 responses from this group, only 2 mentioned AWB equipment along with more natural positioning & each also used the word “moderation.”

More than one of these moms recommended reading Magda Gerber. While I don’t agree with every aspect of her RIE approach, there are some great foundational principles for giving children a natural & developmentally appropriate space to grow.

I hope this tips are helpful! I know they have given me lots of ideas for natural positioning & baby safety for our household in the future. Any questions or comments? Any ideas that have worked for you?

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