Safe Sleep

The American Academy of Pediatrics “Back to Sleep” Campaign reduced SIDS deaths by 40%. Parents should follow all recommendations of their pediatrician and family doctors as to the best sleep position and best sleep environment for their infants.

The National Institute of Health provides guidelines for safe sleep.

The key to preventing your infant from developing a flat area on their head while sleeping on his back, is to rotate the head to alternate sides each time you put him down to sleep. One time put him down with his head turned to the right, the next time turn his head to the left. Some people do this by putting the baby down at one end of the bed one time and the other end the next. This will work, as long as you are sure his head is turned the opposite way he was looking the time before! It is also a good idea to alternate the head position when he is in the car seat too.

Not just “Back to Sleep”, but TUMMY TO PLAY too!
About the same time as the Back to Sleep program was launched, portable car seats and other equipment with reclined seats became popular. The combination of back sleeping and spending awake time in reclined seats and swings, has reduced dramatically the amount of time infants are on their tummies. Increasing numbers of children are developing flat head syndrome with frequent pressure on one area of their head. Premature infants, and infants with some flattening from birthing are especially susceptible to developing a persistent flat area on their head. It is very important that infants continue to sleep on their backs, but the importance of having pressure on different areas of their head and spending awake time on their tummies has become increasingly important. As an added bonus, increasing tummy time is great for encouraging optimal motor development, sensory experiences and bonding with your child! Preventing Flat Head Syndrome is done throughout your day as you handle and care for your baby.

The first key to preventing Flat Head Syndrome is to rotate the head to alternate sides each time you put him down on his back to sleep. One time put him down so his head is turned right, the next time turn his head left. Some people do this by putting the baby down at one end of the bed one time and the other end the next. This will work as long as you are sure the head is turned to the opposite way he was looking before!

Provide Tummy Time Every Day
Supervised tummy time is important for preventing head flattening, and for optimal physical development. It is recommended that babies spend one half of their awake time in tummy time positions!
Here are some guidelines for providing tummy time for your infant:

• Start providing tummy time as soon as your infant’s cord falls off
• Provide tummy time every day
• Only put your baby on his or her tummy while they are awake
• Always provide direct adult supervision during tummy time

Many parents avoid tummy time because their baby doesn’t seem to like it and get fussy. There are many ways to give a baby tummy time without tears. Be persistent! With frequent short tummy playtimes throughout the day, your baby will find he/she can do so much more from this position!

Here are some different tummy time options:

• laying on your chest, tummy to tummy
• laying across your lap
• propped on your leg
• on a small “Boppy”tm or cushion
• with a blanket roll under their chest
• on the floor with you to look at
• snuggle your baby on your chest, sometimes looking right other times left
• on a firm, flat surface with a mirror or toys the baby can look at
• when diapering and dressing roll him side to side to fasten the tabs and put on clothes
• after a bath, dry and massage her while she’s laying on her tummy
• after each diaper change, roll your baby on his tummy to finish

Avoid Extended Time in Car Carriers

The infant car carriers are a wonderful convenience. However, when infants are left to sleep in the car carriers, or shuttled from house, to car, to store, and back again, without ever leaving the carrier, they are spending too much time in a slumped position and putting pressure on one area of their head. Car carriers and car seats should be used for infant safety in the vehicle, but babies should be taken out of the carrier as soon as possible when not in the vehicle. Especially when an infant is very small, it is easy to find them leaning one way in the seat. They just don’t have the strength to sit more erect! Their body curves one way and their head tilts to one side.

When putting them into the car seat vary the head position just as you do when you put her into bed. Try to make sure her hips and trunk are lined up and centered. Sometimes have the head looking straight ahead, but you also rotate it right and left for variety.

Carry Your Baby in Your Arms
Despite the many colorful and convenient pieces of equipment available, much of the equipment puts babies in the same position on their back with pressure on their head for long periods of time. Carrying a baby takes the pressure off their head. Soft slings or carriers are great for a baby’s head shaping, and an infant can be carried while leaving the parent’s hands free for other tasks.
Here are some ways to carry your baby and also take the pressure off the back of the head:

• On your shoulder
• On your arm, face down
• On your hip - both right and left
• Facing outward
• Like an airplane
• Like a football
• In a sling - this gives you both hands free

Some Alternate Positions
Prevention of Flat Head Syndrome can also be part of other activities you and your baby will do during the day. It is very common for infants to get used to looking in one direction more than the other. Feeding time and playtime are good opportunities to make sure your baby can turn their head both ways easily. Here are some ideas to use:

• feed in your right arm just as often in your left
• bottle feed with his head centered on your lap
• lean him forward for burping
• spoon feed from the right, left and center
• let her play in sidelying, both right and left
• under a baby gym, vary the sides where you put the toys
• when he is strong enough have him sit between your legs
• as her strength improves, support her to the back and sides as she sits (supervise this!)

As Your Baby Grows, Tummy Time Will Lead to More Advanced Skills
Your baby will first gain strength in his neck muscles. Strength will then progress to the shoulders and upper trunk. As strength improves you will start to see him move. Tummy time continues to be important to lead to the progression of motor skills: reaching on belly, rolling, pivoting, belly crawling, pulling to kneel, hand and knee crawling, getting in and out of sitting, pulling to stand, taking steps, holding on and walking independently. Babies who have lots of practice with these developmental steps build strength, stability, coordination and flexibility. Encourage this optimal development by giving your baby a safe area to move around and try his new skills!

• reaching
• rolling
• pivoting
• belly crawling
• pulling to kneel
• hand and knee crawling
• getting in and out of sitting
• pulling to stand
• taking steps holding on
• walking independently

Remember: Back to Sleep and Tummy to Play!