Take caution with elevated sleeping for baby

In the past few months, I have done ten evaluations for babies who have torticollis (a condition where the neck muscles are tight) and/or plagiocphaly (a condition where one side of the head is flat). The one thing that each of these babies had in common was that all of the babies slept in elevated position at all times, either in a carseat, bouncy seat, a swing or some other upright container (e.g. a Rock and Play). In fact, I have noticed over the last year that more and more parents are sleeping their babies in an upright position.

Don’t get me wrong, there can be a time and place for elevated sleeping and certainly it may be a necessity. If a baby has reflux, they need to be upright for at least 30 minutes after each feeding in order to allow the baby to properly digest their feeding and to decrease discomfort associated with acid reflux. Therefore, putting the baby in an upright seat for night sleeping may be necessary. However, out of the ten babies that I evaluated, only two were diagnosed as having reflux and were on reflux medications already. One of the parents thought that maybe the baby had reflux, therefore exercised reflux precautions to improve the comfort of her baby. Therefore, in this small sample, 70% of the babies were sleeping in an upright position because he or she “slept better” when in an upright position. As a Mom of three, I COMPLETELY understand the need to get sleep and the necessity at times to do whatever you can so that you and your baby sleep at least a few winks. However, I am going to try to help you understand why sleeping flat as soon as possible is essential for a baby’s developing muscles, head position, symmetry of movement and head shape.

Full term infants are born with what is called physiological flexion. They have tightness in the muscles in the front of their body. This includes the neck muscles. Initially a baby can only move his or her head approximately 45 degrees to either direction. In order to gain full rotation range of motion, a baby needs to be flat on his or her back allowing the weight of the head to lengthen the sternocleidomastoid muscle (the muscle of the neck that helps with rotation) and other muscles allowing for full rotation of the head so that the baby can get her chin over her shoulder. The baby also needs adequate tummy time so she can lift and turn her head from side to side to lengthen the neck muscles fully.

When a baby sleeps in a rock in play, swing, bouncy seat or another elevated surface day in and day out, gravity is not allowed to help the baby to lengthen their neck muscles fully, therefore the baby’s neck muscles remain tight. As a result of elevated sleeping, one of two things can happen

1. The baby consistently holds his/her head in the middle causing the head to get flat on the back of his or her head, called Brachycephaly . The muscles of the neck also get tight if the baby does not experience side to side movement causing restricted rotation of the head/neck, elevated shoulders and difficulties with lifting his/her head when the baby is on his or her tummy.


2. Since the baby does not have enough strength to hold their head up vs the pull of gravity, the baby’s head starts to fall to one side all the time causing flatening on one side of the head, called Plagiocephaly. This position, if continued, can also cause Torticollis (tightening of a neck muscle) or generalized tightness of neck muscles. If there is muscle involvement in the neck it can affect the baby’s ability to symmetrically use his body, preferring one side over another for movement.

So, you may be asking, my baby is sleeping elevated, how do I transition him to a flat sleeping position . . . When I do an evaluation for a baby that has been sleeping elevated, it is one of my goals to help the family transition baby to a flat sleeping position, not to just tell them that the baby has to sleep flat. Here are some tips to transition baby to flat sleep.

1. If your baby does have reflux, try to place a small wedge under the baby’s mattress (not under the cribsheet). The baby will be sleeping flat, but will be slightly elevated and will help the baby transition to a flat surface. If your baby has trouble transitioning and does not have reflux, this technique may also help.
2. Infants like the containment of a bouncy seat or swing, it feels like they are being held. Therefore, swaddling baby may be effective in getting baby to transition to a flat surface. (click here for video on how to swaddle)
3. Attempt flat surface sleeping when you are awake (e.g. for naps) at first. Attempting it for the first time at night will be very difficult for you and baby.
4. If your baby sleeps in a swing, with the swing moving, try to transition the baby to no movement in the swing before you transition the baby to flat sleeping.
5. Once your baby is sleeping flat, if he or she has a preference for head rotation to one side, try to rotate head to the opposite side each time you put him or her down even if they only tolerate that for a few minutes (or seconds) so they know this will be a consistent way you put them down. With time, the baby will improve his or her rotation. If you notice that the baby is unable to rotate to the opposite side, cries when attempting to rotate to the opposite side, or has significant flattening of his or her head on one side please discuss with your doctor and see a pediatric physical therapist who will help you to integrate exercises and positioning into your day in order to progress your baby’s symmetrical skills.

Happy sleeping!

Fitting it all in! How to integrate baby exercise into your busy day!

As a mother of three children four years old and under and working out of the home full time, it is difficult to fit eveything in. I leave the house at 7:15 and arrive home at 5:30. By the time I leave in the morning at 7:15, I have worked out, pumped once, nursed the baby once, dressed three kids, made four beds, fetched a number of snacks, gave morning kisses, wiped morning tears, got myself ready and packed a lunch. My work day is like a breath of fresh air, even though I work with kids, it is predictable, I know exactly what is going to happen that day (mostly). By the end of my work day, I have pumped twice and seen 9 patients. I then get in my car, strap on the pump and pump in the car and make any appointments, phone calls necessary in order to not waste any time with my kids. I walk in the door at 5:30 to a number of demands on my time, barely putting my bags away, I am asked for any number of things from wiping noses to wiping bottoms to cleaning spilled milk to playing outside which is then followed by making dinner, cleaning after dinner, getting snacks, bath time, reading books, playtime, snuggle time with the big ones and nursing the baby. . . My day is no different from any other mother or father with children, working in or out of the home, full! . . . So the question I get often is how are we collectively as parents expected to fit every thing in and exercise our babies and toddlers? The answer is simple . . . have the tools to exercise baby available to you at all times in a dedicated area and integrate it into your day.

Here are a few tips to integrate exercise with your baby into your busy day . . .
1. If you bathe your baby and diaper your baby . . . you can exercise your baby.

Exercise with baby can  be paired with your every day activities with baby. For example, doing some visual tracking exercises side to side to help baby strengthen her neck during bath.  After bath, doing a bit of massage while putting on baby’s lotion is a great way to bond with baby and does not add too much extra time into your day. Further, if your baby always tends to look to one side, during diaper changes position yourself so that you are to the non preferred side will help baby look in all directions and does not take any extra time, just being efficient and effective with your time.
2. If you carry your baby . . . you can exercise your baby.

Specific carrying positions can be great ways to exercise baby. Holding baby belly down in the first few months is a great way to work on strengthening the neck.  Holding baby facing out after four months is a great way to strengthen the back of the neck and the lateral (side) muscles of the neck. Using a front carrier helps baby get stronger by making him respond to your movements with neck and trunk muscle activation.
3. If you sit and play with your baby . . . you can exercise your baby.

Having the exercise equipment available to you in the baby’s play area if the key here, making sure that you have a dedicated area for baby to play and have her exercise equipment available so that it is easy for you to play with baby in an effective manner. For example, if you are working on getting baby to reach for a toys when on his or her back, be sure to have the play gym always set up in the baby’s area so that you can put the baby under the play gym and work on active reaching. If an exercise ball is used in your baby’s exercises, have it handy in your baby’s play area, so you can bring it out for a few minutes each day.

004 Create stations in baby’s play area where you work on different activities in different areas. For example, make a busy box to use to work on sitting by hanging toys on the edge of a square fabric box with links, place a mirror in the area where baby works on tummy time and a play gym in the area where baby does back time.

4. If you pick up your baby . . . you can exercise your baby

Being more deliberate when you pick your baby up from a layng down position, can help your baby strengthen his neck and trunk muscles.  Rolling baby from back to tummy after a diaper change or whenever you are picking him up can strengthen baby’s lateral neck and trunk muscles.  click on this post to see how, Baby Time: Is there a best way to pick up baby?

There are so many daily care techniques that we already do with our baby, doing these activities deliberately with intention can help us exercise our baby and have fun and bond with baby at the same time.  Stay tuned for all of the great exercises you can do with baby!

What is a baby container . . . and why is it bad?

I’m not sure where it started, and I have searched the web to determine who coined the phrase “containment syndrome” but I cannot find who started this phrase. (If you know . . . please tell me!) Anyway, containment syndrome is the description for babies who are in some sort of a container all the time. Containers are car seats, bouncy seats and swings (I would also add exersaucers).  These are helpful devices and are not bad all the time . . . but they are bad when used all the time!

Containment devices do not allow babies to move with the freedom of movement that they need.  None of these devices, if you think about it, allow a baby to do any sort of extension (movement into a straight position of the spine).  With the exception of the exersaucer, they all put baby in a position where the spine is rounded into flexion.  I had a baby once that was adopted from a mother who sadlyneglected the baby.  The baby was never moved out of the carseat.  The baby’s spine was exactly the shape of the carseat and was stuck there. It took a lot of therapy to improve the spinal alignment.  It does not have to be that severe though, I have had many well intentioned families sleep their babies in the carseat and the baby’s head is very misshapen and the baby has a lot of unnecessary tight muscles as a result.  Some families just don’t know that every product out there is not necessarily good for baby.  My least favorite product that was out a few years ago was a swing base made for the carseat.  This meant that a baby never had to get out of their carseat!

So, as parents, we cannot avoid carseats, swings and bouncy seats altogether.  We definately need them!  But, how can we allow our babies varied movement experiences even though we use them?

First, make sure that your containment devices have varied footprints.  Make sure the bouncy seat, swing and the carseat do not all have the same angle of rounding.  A flatter seat (like a sling bouncy seat) will make the baby work a bit harder, allow more extension movement patterns and be less passive than the deep bucket of a carseat.

Second, use an upright baby carrier like a BabyBjorn or Ergo Baby Carrier.  Both of these allow the baby the unique experience to adjust their body in relation to what you are doing.  For example, if you bend over the baby will activate their flexor muscles a bit more to attempt to stay upright if the baby is facing toward you. If facing out (BabyBjorn), the baby will activate extensor muscles to stay upright (outward facing should only be done when baby has independent head control).

Finally, and most importantly, I always tell my families to follow the TBS rule whenever you have a put a baby down.

TBS Rule

T – Tummy First

B – Back Second

S – Swing (or Bouncy Seat) next

Basically what this means is that if you have to put a baby down (which is a lot), try to put the baby on tummy first, then if they fuss try back then try a bouncy seat or swing.  This ensures that the baby is allowed sufficient time in the day to move his or her body with appropriate freedom and no restrictions.


Welcome to Babies First Fitness

Image Welcome to my blog about fitness for babies!  This is the place to be if you are interested in putting the fitness for babies (and toddlers) first.  I am a pediatric physical therapist that treats primarily infants and toddlers.  I work in the hospital NICU, an outpatient setting as well as in family’s homes. I am also a devoted mom to three lovely (very) young children.

I have been inspired to write a blog that shares tips and tricks to exercise with baby.  When searching for exercises with baby, the internet is flooded with exercises for mom, perhaps with the baby, but mostly for Mom . . .  I guess perhaps it is mom searching for the exercises!  Some sites will talk about how important tummy time is, but they lack in telling you how to do it if your baby hates it.  Other sites talk about how important it is to be active with your toddlers, but they do not provide games and activities that will improve their balance and coordination. 

Parents who are involved in pediatric therapy for one reason or another have an advantage, they have someone telling them how to exericise their babies and toddlers.  However, typically, most parents do not have this benefit.   I am here to provide my services to offer tips and tricks from a professional baby and toddler exerciser on how to really exercise your children so that they strengthen the muscles they need to create coordinated and efficient movement patterns.  Does this mean that baby is going to crawl early or walk early . . . no. . . talk to any therapist they don’t want that, but their movement will be smooth and coordinated and delays may be averted if the baby is exercised effectively. 

So, follow along and learn ideas on how to exercise our babies effectively.