What are the possible effects of ‘Tummy Time’ on children who are faced with special challenges?
It is a common belief that babies will benefit from ‘tummy time’ to strengthen their backs.
First, let me clarify. There is a huge difference between placing your child on their tummy briefly so that you can observe what they can or cannot do in this position versus ‘keeping’ them on their tummy in order to strengthen their backs.
In the first case you will carefully observe your child’s response and gently guide them to roll onto their back when they want to. In the second case, you are going to keep them on their tummy bracing their arms and body in ways your therapists might have taught you.
Furthermore, you or your child’s therapists might encourage your child to hold their head up while cheering them on, sometimes despite their fussing. Often times these children, in an effort to keep themselves from falling over, have no choice but to tighten up their torso and stiffen their arms and legs.
Without knowing it, we are teaching these children to tense up their whole body. At its best, maintaining postures like this might eventually teach a child to stay on their tummy for a while. However, it would not provide any information that could teach this child to roll over.
It is especially counterproductive for children with spasticity as this would reinforce their already high muscle tone and further ‘groove’ this spastic pattern into their nervous system.
A ‘spastic’ child will have a hard time bending their elbows when placed on their tummy. Also they will likely lock their legs straight and stiffen up their pelvis as a reflexive response to being put in this position. This state of heightened muscular tension makes it virtually impossible for the child to feel the movements that are necessary for them to learn balance.
A child with low muscle tone will have a hard time propping themselves on their elbows or holding their heads up. They would throw their head backwards, possibly over-extending their neck, in attempts to hold their head up. This could cause a lot of undue stress on their cervical spine.
Children with spasticity or low muscle tone do not have sufficient control of their body to allow them to figure out how to roll over on their own. However, they have the same body structure just like any typically developing child.
The movement processes required for rolling over and maintaining balance on the tummy are dictated by the physiology of our body. We all have the same skeletal and muscular structures and the mechanics of movement are the same. We all need to overcome the effect of gravity.
The challenge here is this: How can we help these children experience similar processes so that they too will have the opportunity to learn movement just like typically developing children.
The unique challenges of each child might prevent them from producing these movement processes on their own. However, we as therapists and parents could ‘fill in the gap’ and provide these children with sensory and movement input that could support them in this learning process.
When parents bring their children to me, I move through movement processes specific to the needs of each child. I then provide these parents with tools to support their child’s practice at home. It is very important that parents become active participants and contribute to further support their child’s on-going development.
Rolling is the first major developmental milestone. Learning to roll over supports infants to form movement strategies and develop problem solving skills. These skills will continue to evolve and support the child through subsequent developmental stages.
As parents, when you have an understanding of which needs come first and what could be more supportive of your child’s overall progress, you will be better able to make decisions with regard to which activities to practise with your child.
In my next and final issue of this series, we will review the Pros and Cons of ‘Tummy Time’ which hopefully will help you, as a parent, to make well informed decisions on how best to support your child’s overall development.
Until next time,
3 PRACTICAL TOOLS FOR YOU TO EXPLORE
Here are 3 ‘movement ingredients’ that can help support your child with learning to roll over.
Can your child hold their feet with their hands?
The ability of your child to hold their feet with their hands necessitates that they have a flexible spine. The forward bending movement of your child’s body is very important for rolling over.
Typically, developing babies use this strategy when they first discover how to roll onto their sides. By curiosity, babies grab their feet and pivot on their backs as a result. Before they know it, they may have fallen over onto their side!
This can be a challenging position for your child if:
- they have a habitual pattern of arching their back
- their hips are tight
- they have a habit of retracting their arms and shoulders
In this case, it might be easier to do this initially in sitting. Very gently bring your child’s foot towards their hand. Notice if your child is interested. Touch and let go. Repeat many times until your child becomes curious.
When your can help your child hold their hand(s) while lying on their back, gently rock your child along their spine and from side to side as if to roll over.
Make it fun for your child by changing the rhythm, speed and range of the movement while making sure that they are easy for your child!
Can your child lift his head up and see his tummy?
The ability of your child to have controlled movement of their head is very important for initiating any action. This is especially important for children with spasticity and for those who arch their back a lot.
Try carrying your child in a round bundle so that their chin is close to their chest. This round posture helps your child actively stretch the often tight muscles at the back of their neck while developing head control.
Your child’s head might seem more wobbly in this position initially. These wobbling movements provide the sensory input necessary for your child to figure out how to hold their head in this upright position.
With your child on their back, very gently lift your child’s head while moving their chin towards their chest and encouraging them to look at toys placed on their tummy.
Alternatively, lift your child’s head slightly towards the right to look at toys on the right side of their body. Repeat this to the left side.
You will find that one side will be easier for your child. This side will also be the easier one for your child to learn to roll onto.
Can your child reach with their arms across their Body?
The intention of reaching for a toy helps infants discover rolling. If your child is able to grasp, encourage them to grasp a toy and gently bring the toy (along with your child’s arm) across the front of their body. This will initiate the movement of rolling over.
Repeat this movement many times but reaching only as far as is comfortable for your child. Their facial expression will tell you how much they are enjoying the movement.
Resist the temptation to move beyond what is comfortable for your child as this could cause your child to lose interest in the process.
To take this one step further, you can also gently guide your child’s pelvis to move in the same direction of their arm to help your child feel the sensation of rolling over. Do this movement very slowly so that your child will have the opportunity to participate!
While repeating these movements, talk to your child about what they are doing. “You’re rolling onto your side…” “You’re on your back!” Make it rhythmical and vary the speed to make this interesting for your child.
What can you do to help?
Remember, at the end of the day your child needs to figure out all of these movements by themselves. Our helping them to feel is just that, we are helping them to feel the ease of movement.
If your child is exerting too much effort or senses any discomfort, it’s unlikely that they will want to repeat these actions.
However, if your child feels these movements as being easy and enjoyable, they are so much more likely to practise them on their own. Smile and your child will smile back!
It is with frequent practice that your child could learn to develop the co-ordinated movements that can help them figure out how to roll over!
