Back to Sleep, Tummy to Play

Over the past few years there has been an increase in the number of babies diagnosed with the conditions: Plagiocephaly (mis-shapen head) and torticollois (crooked neck). One of the reasons associated with this is the reluctance of parents to place babies on their tummies.

The SIDs campaign has worked wonderfully at educating parents about the risks of a babies sleeping on their tummies but unfortunately this is often mistaken to means never placing baby on their tummies.

When a baby is born the bones of the skull are not fused. They are flexible and the shape of the head is determined by the position the baby assumes. The first 6-8 weeks is critical. So a baby that stays on his/her back all of the time, such as in the cot/pram/capsule/floor,  has a risk of developing a flattened spot at the back of their skull. If they always have their head turned to one direction, such as looking towards the same noise or light, they could develop a flat area on the side of the head and also a tightening of the neck muscles on that side. The more they assume this position the more risk they are at because of the compression on their flexible skull. This also becomes more difficult for the baby to correct as he/she is yet to develop their neck muscles against gravity.

Unfortunately one of the consequences of this is some asymmetry of facial features with the ears or eyes becoming uneven. This does not alter development and is not cause for concern but can be cosmetically alarming for parents.

A simple measure to avoid this problem is to ensure the baby has a variety of position changes during the day when they are awake. These different positions are also important for the baby to strengthen muscles used for rolling, sitting and crawling.

Supervised tummy and side lying time is important from the age of 3 weeks. Change the position of toys to encourage your baby to look both ways.

Avoid prolonged times in the car capsule, cot, pram and on the floor.

Encourage baby to look in both directions by alternating the end of the cot they sleep in or change the position of the cot in the room.

Alternate the head position when your baby is put down to sleep.

Vary the holding and carrying positions including the use of slings and carrying baby over your arm on their tummy.

If bottle feeding alternate the side you feed from.

All of these activities will not only reduce the risk of plagiocephaly and torticollis but encourage your baby to develop strong health neck muscles and excellent head control.

What can be done about Plagiocephaly/Torticollis?

Ensuring there is no other cause for the condition, a paediatric physiotherapist can assist with stretching, head control activities and positioning. If your baby’s head shape does not appear normal when they are 6-8 weeks old, intervention is suggested. If conservative management is not successful or intervention is late, your baby may be referred to the Royal Children’s Hospital for assessment and helmet therapy. This is where a moulded helmet is fitted to your baby’s head and worn for up to 3 months, being modified as the head changes shape.

A baby’s head will mould up until the age of 12 months but is more difficult to change later in their first year so prevention is better than cure.


Back to sleep, Tummy to play.

Changing baby’s head position reduces the risk of mis-shapen head.

The first 6 weeks is the most important.