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The importance of Tummy Time and various positioning in the early life

     Benefits of providing various positioning in the early life
  • Prevent and improve head shaping and decrease cosmetic deformity
  • Prevent muscle tightness and asymmetry
  • Facilitate normal patterns for growth and development
  • Provide sensory exploration of self and environment

The developmental issues when lack of variety of positioning

1) Skull deformity: is the result of staying in the same position for long period of time.

  • Plagiocephaly: Flattening of the right or left occiput due to the head tilt to only one side when laying on the back results in asymmetry head flattening, oblique head shape or also known as plagiocephaly.
  • Brachycephaly: Flattening of the occiput (the back of the head) is due to the consistent pressure on the back of the head when staying in supine position (laying back). This results in infants with square heads.
  • Dolicocephaly: Lateral head flattening in the preterm baby is a common skull distortion due to consistent pressure on the sides of the head. This results in infants with long and narrow heads.

2) Muscle tightness and asymmetry: is due to the lack of variety in positioning.

  • Torticollis: asymmetry shortening of the sternocleidomastoid muscle (SCM). Shortening and/or elongation of the sternocleidomastoid muscle occurs when an infant is positioned prone (on the tummy) or supine (on the back) with the head always to one side. For example, when the head is turned to the right, right SCM is contracted and the left is elongated. When this is maintained for a long period, the right SCM can become shortened, making it difficult to fully turn the head to the left.
    Unsupported head positioning in car seats and infant seats can lead to head always fall to the same side hence facilitate this shortening.
    Torticollis is always accompanied by plagiocephaly (flat head) because torticollis perpetuates the position of the head on the flattened side.
  • Likewise when only one position is provided, asymmetry muscle tightness also develop in the arm and leg muscles and resulted in 'W' arm positioning (elevated and externally rotated shoulder position) and 'Frog' leg positioning (external rotation of the legs). When only one position is provided, muscular shortening can develop rapidly which can then lead to delay in motor development.

3) Delay motor development: when only one position is provided, muscular shortening can develop rapidly which can then lead to delay in motor development.
When baby's arms are tight with a "W" position (see muscle tightness in arms and legs) and is placed on tummy, he becomes uncomfortable. This leads to irritability and crying. When this occurs parents always put baby back to supine position. As a result baby spend less time prone and develops weakness of the upper body muscles, making it difficult to push up in prone position, which then impedes normal milestones.

4) Sensorimotor feedback for learning and self exploration deficit: baby who are only placed supine and is not given sufficient prone and side-lying positioning lacks in sensory feedback for learning and self-exploration.
In prone position, infants easily discover their hands and have their whole body in contact with the surface, providing sensory feedback through their hands, face and other body parts. The baby can easily suckle on his fists and is exposed to a lot of tactile sensory input to the face and mouth when in prone position. Side lying also facilitates this oral and visual exploration. This feedback of normal posture and movement is essential to the development of normal motor control.