Child Development Concerns

Back to:  Therapist Questions & Answers - Developmental Concerns

When my son was born his shoulder got stuck and was literally yanked out of me. I put him on his back to sleep from birth and he would always have his head in one position and he got a severe flat spot on one side. I took him to my chiropractor who got him to be able to get him to move his head and neck properly but the shape of his head wasn't changing. I then took him to a physio that works especially with the skull and after 6 months it is all pretty much normal.

The problem I am having that he hates tummy time. I force him to have it be he gets quite hysterical. He only likes to sit now. He can go from sitting to on his stomach but then screams until he can get back up. He loves to stand and when sitting can hold onto my hands and pulls himself up. He loves to stand. He is 9 months old now and not crawling. I have been told by the physio it is very important that he crawls. How can I get him to crawl when he wont go on to his belly. He use to be able to rock back onto his knees before in like a crawling position but know he wont even do that.

It sounds like your son had something called Torticollis early on, a condition which causes a baby's head and neck to tilt to one side. Babies with Torticollis benefit greatly from weekly physical therapy which includes stretching exercises to stretch the neck muscles and proper positioning to enable the baby to freely turn his head from side to side and to not keep it turned to one side or the other. Some babies with Torticollis develop positional Plagiocephaly, because of being on their backs or in a certain position in a car seat, crib, etc., which causes their heads to become flat/misshapen on the side or the back.

Both Torticollis and Plagiocephaly are much more common in babies these days since the "back to sleep" campaign began in the early 1990's to combat Sudden Infant Death Syndrome. What many new parents do not realize, is that while putting a baby to sleep on his back is important, that during the day and waking hours the baby should spend as much time as possible on his belly to develop neck and trunk strength needed for rolling and crawling. By 9 months of age it is not surprising that your son does not like tummy time, but as your therapist said, it is a very important position and should be encouraged. Crawling is a very important developmental milestone and today many therapists agree that bypassing crawling can sometimes lead to other delays down the road such as sensory issues or motor coordination problems. Crawling allows children to learn to move their heads, arms and legs independently and this helps them develop muscle strength and improve coordination. Since he likes to stand, we also want to encourage him to come to his hands/knees, then into a half kneeling position to pull himself up...we don't want him to hold onto your hands & pull himself straight upwards into standing without first bearing weight on his knees or one knee and one foot.

Here are a few ideas to try to encourage belly time and crawling:

• Remember he isn't going to like it at first, but it does not hurt him, so starting slow and putting up with some tears and fussing should be expected.
  
• You can begin working on getting him into a belly position for only 3-5 minutes per day and then building up to 5 + minute periods every hour or two during playtime.
  
• You can use a firm towel or blanket roll under his armpits while on his belly and lay on the floor in front of him to entice him to stay in this position briefly, sometimes putting a mirror on the floor makes it fun.
  
• Use a small firm ball, and place him belly down on the ball and gently roll the ball forward encouraging him to place his hands on the floor to bear weight and catch himself and then roll the ball backwards and encourage him to place his knees on the floor to bear weight. You can use music and make it a fun game.
  
•  You can also use a firm roll for the same exercise, covering large soup cans with a towel or foam, and then encouraging him to play kneeling behind the roll, gently roll it forward so he needs to place his hands on the floor and alternate bearing weight on hands then knees. You can use a low breakfast tray for a play table and support him in a kneeling position, making sure his feet are directly under his bottom, so he is bearing weight on his knees and then leaning on his elbows/hands on the tray to play with toys.
  
•  This same effect can be achieved using a wedge of foam, lying the baby on his belly on the wedge and encouraging him to place his hands on the floor to play with toys in front of him and to the sides.
  
•  When your baby is sitting, encourage him to transition down to his belly to reach for toys, by placing toys to his left and right sides, just out of his reach so he has to rotate his body to reach for them, you can help him rotate his way down to the floor.
  
• You can also make belly time more fun by lying on your back and placing your baby on your chest and encouraging him to push up on you to see your face as you talk and sing to him. Or lie on your back and place him on his belly on your legs and hold his hands and raise him up & down giving him a fun "ride".
  
• You can carry him in a sort of "football hold" by carrying him belly down with his belly resting on your arms as you support his chest. Or carry him in a sitting position facing away from you or a standing position facing away from you supporting him under his crotch and at his chest. Try to let him do most of the work.
  
•  Some babies enjoy back rubs and massage, so at night time or after a bath you can try lying him on his belly on the bed or across your lab and rubbing him with lotion and massaging him.

There is a great article on the internet from Children's Healthcare of Atlanta which explains some of these techniques a bit more and incorporates pictures of the various play, and carrying positions.  Good luck and please continue with your child's physical therapy. Remember, just a few minutes a day is ok at first and then try to build up to a total of 15+ minutes per day of belly time.

Back to:  Therapist Questions & Answers - Developmental Concerns