The Importance of Posture and Positioning for Play and Movement

As a pediatric physical therapist for many years, I keep returning to the idea that posture, alignment and positioning are crucial for helping all children  develop efficient  ways of moving for  play and exploration. Let's start by talking about infants and toddlers.

For many years now it has been recommended that babies be placed to sleep on their backs. This movement is now being called Safe Sleep for Your Baby: Reduce the Risk of Sudden Infant Death Syndrome (SIDS). If you Google "safe sleep" on the web, many hits come up. The site for The National Institute of Child Health and Development (NICHD)  has a Safe Sleep Top Ten List of how and why this is so important.

One of the most important items in the Top Ten List is number ten (to a physical therapist, all ten are important), reduce chances of flat spots developing on a baby's head. I have noticed a great increase in infants developing flat spots and different shaped heads (when severe, the medical term is  called plagiocephaly) .  The NICHD recommends "tummy time" and  "changing the direction the baby lies in the crib from one week to the next" and to "avoid too much time in car seats, carriers, bouncers etc." The other risk of too little tummy time and too much time  in carriers and similar equipment is tight neck muscles (the medical term is torticollis) which tilts the baby's head to one side and turns it to the opposite side.

"Tummy Time" is integral to a baby's development . One of my favorite brochures about Tummy Time is "Tummy Time Tools" from Children's Healthcare of Atlanta.  I found it on the web and one of the families I work with was given the brochure by their pediatrician. The brochure talks about why babies need tummy time, what tummy time is and different activities to help you position, carry, hold and play with your baby all with great photos and ideas. Ask any early intervention therapist no matter what their specialty what they think about tummy time and they will all recommend supervised belly time from day one of an infant's life.

Posture and alignment are important for everyone but especially for growing babies and children. One of the important jobs of a pediatric physical therapist is to pay attention to how a child is held, carried and positioned for both play and in chairs, strollers, seats etc. Have you ever noticed that when you go to buy your child's first car seat , stroller or highchair that they are way too big? How many children sit at tables in preschool where the table height is up to their chins or their feet don't touch the ground? When I work with families we always look at how the child is positioned in chairs, etc to allow the child the maximum stability and mobility to be able to be comfortable, be well aligned and be able to play.

One of my favorite books that I use in my work is "Positioning for Play: Interactive Activities to Enhance Movement  and Sensory Exploration" by Rachel B. Diamant , MS, OTR/L, BCP and Allison Whiteside, PT. I share handouts from this book with families for ideas on positioning and moving their child  to enhance their ability to move and explore.  Posture and positioning are important for everyone to help us move against gravity efficiently and with good alignment.

Lynn Kisseloff  PT, MS, PCS

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