In 1994 the Academy of Pediatrics adopted and promoted the "Back to Sleep Program" after research suggested that Sudden Infant Death Syndrome or "crib death" could be prevented by that sleeping position. SIDS is the unexplained death of a child usually 2-4 months of age, during sleep and diagnosed by autopsy where other causes of death are ruled out. 60% of victims are male, 70% are 2-4 months of age, 90% by the age of 6 months and with an increased incidence during the winter months January to March. Infants who may be at risk are of low birth weight, poor weight gain, and have mothers younger than 20. Their mothers are more likely to have been anemic, have had poor prenatal care, smoke cigarettes, take illegal drugs and suffer with sexually transmitted disease or urinary tract infections. Most parents think that the "back to sleep" program reduces the chance of suffocation, which it may, however asphyxia has not been a consistent finding on autopsy. The Academy of Pediatrics has gone further in recent years by suggesting a "clean sleeping environment" where there are no bumpers, covers, pillow, stuffed animals, etc. Since the inception of this program the incidence of SIDS has decreased by 52%!
Unfortunately, the "back to sleep" program did not include recommendations or training to pediatricians or families regarding how to provide necessary tummy time. In fact, the importance of tummy time may not have been as clear to those of us in developmental medicine until this program became reality and we began to see more infants who were "developmentally delayed" or just not reaching milestones as expected. Of course, the standardized tests that we use were normed on tummy sleeping infants, or at least infants who were not related to only sleeping on their backs. That may skew our analysis and diagnosis of delay, however, we are seeing a definite increase in other diagnoses such as torticollis, plagiocephaly, brachiocephaly and overbalance of extension (stiffness).
The problem of tummy time was addressed in the Circle of Moms website baby community recently when Kim Dill commented of her son that "at tummy time which he really hates he wont raise his head up." She further requests help in how to get his neck muscles stronger. Research has suggested that 90 minutes a day on the belly will help a child achieve developmental milestones at the rate as his tummy sleeping counterpart. This information is not imparted to parents nor are suggestions on how to accomplish this.
I recommend to parents a tummy time (baby must be awake) goal of 90 minutes a day starting as soon as the belly button falls off. This is no different for infants with G-tubes for feeding or post abdominal surgery (as long as cleared by surgeon). It can be accomplished in the following ways:
1. Place infant on sofa facing room, have parent sit on floor to be at infant's eye level. Parent can assist infant to place elbows under shoulders so he/she can effectively push up to lift head. Parent can speak or sing to infant to get their attention. DO NOT LEAVE CHILD UNATTENDED
2. Place infant on kitchen table on blanket with parent sitting in chair in front of them and follow steps in #1. DO NOT LEAVE CHILD UNATTENDED
3. . Take two receiving blankets and fold them in half. Roll them together to form a roll to be placed at child's nipple line, elbows forward of the roll. This assists the infant to displace the weight of the head to the pelvis (think teeter totter principle). Boppies tend to be too hi and babies merely hang in space.
4. Place infant on parent's chest and recline at various angles until fully horizontal. Child should have an easier time lifting head while held upright. This gets harder as parent reclines further. Again, parent should support infant in holding elbows under shoulders to allow push off (think baby push up).
5. Engage siblings in reading or singing to infant while you are practicing this.
