June 2005

Summer is almost here and with that comes additional parental concerns of   "what do I do with my child now?". Parents want to ensure that children are well entertained. My mother never did that, probably because there were no options available. I remember having to organize my own "play dates" by walking a few blocks to a friend’s house and asking if they could play. Summer play time meant figuring out your own daily schedule. It may have meant sitting on the back porch and repeatedly asking a friend, "What should we do?". It meant sitting on someone’s swing set, turning yourself around and around, as you asked that same question. We always found something exciting to do all on our own. Sometimes we made tents in the back yard from blankets hung over clothes lines; sometimes we explored the woods; sometimes we walked to the store and bought comic books to read and exchange. After dinner, all the neighborhood kids would play badminton, volleyball, softball or freeze tag. All ages participated.

If you think about how many of us grew up, it was unstructured creative play and completely kid oriented. It was vestibular (swings, bikes); it was tactile (inside tents, water play); it was proprioceptive (tug of war, hammering); it was visual/spatial (softball, badminton).

AIDS BIKE-A-THON is being undertaken by Greg and Zach Myers, our receptionist’s (Diane) sons, from San Francisco to Los Angeles beginning on June 5. Please help by visiting their web sites: www.aidslifecycle.org/6025 or /6024.

Northern Virginia Therapeutic Riding Program’s (NVTRP) summer session begins June 18- August 12. Call 703.764-0269.

Are you putting your baby... "BACK TO SLEEP"? The following is from a brochure by City Kids, a pediatric therapy group in Chicago.

The "Back to Sleep" Campaign was launched in 1994 in response to the recommendation of the American Academy of Pediatrics (AAP) for healthy infants to be placed on their backs during sleep in hopes of reducing the incidence of Sudden Infants Death Syndrome (SIDS). Since the launch of the “back to sleep” campaign, SIDS has decreased more than 40% in the United States.

The other side of "Back to Sleep". Despite the impressive success that has followed, professionals have voiced their concerns about the facts of supine (back) sleeping on infant development. Children are facing developmental challenges that they have not had to face in the past.

• Flat Heads (Plagiocephaly)  This is a flattening of the back side of the head as a result of chronic pressure on the head of babies that frequently lie supine. The result of this sleep position can be an asymmetrical head shape.
• Wry Neck (Torticollis)  Caused by a tightening of a large muscle in the neck (sternocleidomastoid). The head is pulled to one shoulder, while rotated towards the opposite shoulder. This may result from plagiocephaly.
• Delays in Motor Milestones  Infants sleeping in supine are found to reach motor milestones later in life. For instance, children sleeping on their front (prone) side are more likely to roll, crawl and pull-to-stand sooner than those sleeping on their backs.
• Delays in Fine Motor Skills  Sleeping prone allows children to develop necessary strength and coordination of the hands and arms--crucial for fine motor skills, such as proper handwriting. Since the implementation of the "Back to Sleep" campaign, therapists are seeing increasing numbers of kindergarten-aged children who are unable to hold a pencil.
• Self-Calming and Self-Regulation  Supine sleeping tends to give an overwhelming amount of stimulus to babies, whereas prone sleeping allows infants to be more gathered and secure, providing a calming environment for the baby.

In response to the increased incidence of plagiocephaly as well as delays in motor milestones, the following preventative measures are advised.

• Tummy Time  The AAP Task Force on Infant Positioning and SIDS stresses the importance of "tummy time." This position strengthens the neck, arms, trunk, shoulder girdle and extensor musculature. Placing infants on their front side for as little as 15 minutes a day has shown to reduce the degree of delays as compared to infants that never spend time on their tummies. “Tummy time” also helps with plagiocephaly, reducing the time babies spend lying on the back side of their head.
• Treating Plagiocephaly  Several suggestions to consider:
  • Feed with alternating head positions
  • Decrease amount of time in car seat
  • Change position in crib regularly
  • Turn head from right to left on alternate days from the first day of life
  • Water pillows or gel-pads
  • Skull-molding helmets

• Try wearing a baby carrier on your front or back side when carrying your baby throughout the day, instead of transporting your baby in a car seat. This position gives the baby similar benefits as having “tummy time” while still allowing the baby to be in an upright, calming position.
• Start small. Tummy time may be difficult for your child if he has never been placed on his tummy for an extended period of time. Use a timer and gradually progress the time spent on their tummy. Starting at smaller increments of time and slowly increasing from there can help with the adjustment period. Then, at 2 months, try to allow your baby to nap on their tummy under supervision.
• Play with your baby! Handling your infant more allows for greater sensory as well as motor input.

For more information or questions, speak with your pediatric therapist or pediatrician.