Time on their backs, in seats, reportedly slows babies’ growth
By Jeremy Manier | Tribune reporter
For months before anyone saw a problem with her infant daughter, Ellen Burkhardt would park the child in a bouncy seat without a second thought, grateful for the extra minutes it gave her to make dinner or do a load of laundry.
But then the Arlington Heights mom noticed that 6-month-old Natalie still could not quite straighten her neck or lift her head, and the back of her skull seemed oddly flattened.
Natalie’s doctors said the problems occurred in part because of seemingly harmless products like the bouncy seat. By keeping the girl immobilized and on her back, they said, such seats prevented her from using all the muscles she needed to grow normal.
It’s a controversial theory, but a vocal contingent of doctors and physical therapists believe the strap-in chairs and carriers that millions of parents have come to rely on are contributing to an increase in cases of misshapen skulls, contorted neck muscles, and delayed motor skills such as crawling and walking.
A few frustrated therapists even have a name for the problems that can occur in immobilized infants: “container syndrome.” The best solution, they say, is to get children out of their seats and put them on the ground for “tummy time.”
“These things may be great for convenience, but they’re horrible for your child,” said Dr. Frank Vicari, director of the head-shape evaluation program at Children’s Memorial Hospital.
Downside to back sleep
Some of the developmental issues appear to stem from a benign source: the “back to sleep” campaign that began in 1994 and has achieved a dramatic drop in infant deaths by persuading parents to put infants to sleep on their backs. No expert interviewed for this story suggested any change to that policy.
But the change in sleeping habits came with a downside. Infants who sleep on their backs are more likely to develop a somewhat flattened skull, which also may throw off neck development. That, combined with the modern affinity for products that keep infants on their backs, can result in developmental delays that take thousands of dollars in therapy to correct.
Therapists who treat such disorders say they have observed an increase, though no one has done a thorough national study. Vicari said that in the early 1990s, he typically would see a dozen cases of misshapen skulls, or plagiocephaly, each year. Today, that number stands at about 750.
At Children’s Healthcare in Atlanta, senior physical therapist Colleen Coulter-O’Berry said that a decade ago she saw about 30 children annually that needed therapeutic helmets to correct head shape. Now they treat about 500 kids that way.
“It’s unbelievable, the difference,” she said.
Slowly, evidence has mounted that infants who sleep on their backs are more likely to have slight developmental delays, though experts are divided over whether the effects are long lasting. A 2006 Canadian study published in the Journal of Pediatrics found that 22 percent of babies who slept on their backs had some delays in motor skills, such as sitting up, rolling over, and climbing stairs.
“Tummy to play”
Parents can compensate for this trend by putting babies on their bellies while they’re awake and having them play in that position, the 2006 report found. Many therapists now have lengthened the old slogan to “back to sleep, tummy to play.”
That can be harder than it sounds. Infants who rarely spend time on their bellies often cry and fuss when parents try to give them more tummy time.
“If you haven’t put a baby on her stomach by the time she’s 5 days old, she decides she shouldn’t be on her stomach,” said Mary Weck, a clinical specialist and physical therapist at Children’s Memorial. “They really get in the mind-set that they shouldn’t have to work physically.”
The time infants spend on their backs has risen with the proliferation of products such as detachable car seats that can be used as infant carriers or snapped into strollers. Such seamless transitions are convenient, but many physical therapists recommend that parents reserve car seats for use in the car.
“Children who sit all the time have little motivation to exercise their muscles,” Weck said.
“When babies are on their tummies, they’re driven to move around … but when they’re lying back in a seat they can just look out and see what’s going on,” she said. “They don’t have to move to keep themselves entertained, so they lose that drive.”
Some therapists also point a finger at exersaucers, stationary devices that suspend the child in a bucket seat. Use of exersaucers grew in the 1990s as a replacement for mobile walkers, which can cause injury if a child tips down stairs while strapped inside.
But being strapped in an exersaucer can force babies to keep their legs bent or stand on their toes, which may lead to “toe-walking” when the child gets older. Walking on toes instead of the whole foot can prevent a child from developing proper coordination and can cause back pain later in life, therapists said.
“Exersaucers are often marketed as a way to help your baby learn to stand,” said Timmie Wallace, a physical therapy instructor based in Santa Fe. “But all of these baby containers just restrict how they move.”
That view is common among physical therapists, yet many doctors and surgeons are not convinced that baby seats and other products can slow development.
In addition, so far there is no evidence that the documented delays linked with sleep position and lack of tummy time affect children permanently, said Dr. James Kemp, a specialist in the pediatric sleep laboratory at St. Louis Children’s Hospital.
“If you don’t give kids tummy time they may learn some skills a bit later, but unless the child has to run over mountains it may not be a big deal,” he said. “Kids figure out a lot of stuff in spite of you.”
Even if the delays are not permanent, many families seek therapy to get their kids on track, and that can be costly. Weck of Children’s Memorial said a typical course of therapy for plagiocephaly or toe-walking can cost $10,000 to $12,000, most of it covered by insurance plans.
Devices hard to resist
Still, many parents say it’s hard to resist all the baby equipment that seems to pour in when a new infant arrives.
Katie Turek of Chicago said relatives gave her three exersaucers when her son Charlie was born last year.
But Turek became concerned when Charlie, at nine months, still could not get into a sitting position on his own or crawl normally.
Turek took Charlie to Children’s Memorial, where physical therapists counseled her to stop putting him in exersaucers and other devices, and start doing more play activities centered on tummy time. If she needed time for chores, she could place him in a playpen, where he could move around more freely.
Charlie, now one, can crawl and do many tasks that were impossible a few months ago, said his therapist at Children’s, Katie Rule.
“When you take the equipment away, the problem goes away,” Rule said.
From Chicago Tribune, 2008