Did you know babies are able to turn their heads from side to side from the time they are born?

Babies are stronger than we think, and while holding the full weight of their heads by themselves does take some time, they are building strength from the minute they are born.

Born with a soft skull, babies’ heads grow between 1 – 2cm per month for the first 6 months. By age 2 both fontanelles (the space between the bones of the skull) have closed, at which point growth slows until skeletal maturity is reached in the twenties. Since the introduction of the ‘Back to Sleep’ campaign in 1992, there has been a significant reduction in SIDS-related deaths. However, unfortunately it is suspected this has also lead to an increased incidence of flat spots, or plagiocephaly, as it is technically known.

Along with more time spent on their backs, babies will often demonstrate a preference for turning to one side. In some cases, this can lead to the development of flat spots. The best way we can reduce the risk of a spot developing is to encourage tummy time and neck movements to both sides from the time babies are born. A baby should develop the strength to hold their head independently by age 3-4 months, however these muscles require training and strengthening, like any other muscle in the body.

Many parents are aware of the importance of tummy time but feel overwhelmed as to how to achieve the recommended 30 minutes each day. Rest assured, tummy time can come in many forms and can be achieved over a number of smaller sessions. Tummy time can be as simple as lying on a care-givers chest, lying directly on their tummy on the floor, or even lying supported over a rolled up towel or fitball. Young babies won’t tolerate long periods, but cumulative time adds up. The act of rolling onto their tummy or back can also build up additional strength to assist with tummy time, while adding valuable input into their other sensory systems such as balance, visual focus and spatial awareness.

While some loose ties have been made between flat spots and developmental delay, this has not been shown to be as a direct result of a flat spot but more likely one of a number of symptoms that present together. Studies have shown that the more confident a parent feels in teaching their baby to move, the quicker they are able to build sufficient strength to achieve movement. Similarly, when identified in a timely manner, research suggests that conservative management is equally as effective as helmet or bracing techniques to reduce a flat spot.

– Try to avoid leaving a baby with their head in one position. Move toys and objects of interest around their visual field to promote active movement and engagement. This includes time in rockers or car seats where they can spend long periods with minimal variation in movement.
– Build up a tolerance to tummy time by introducing short periods from birth. Remember that cumulative time is just as effective as longer practice sessions.
– Encourage babies to follow your voice or a toy in order to look both ways as often as possible. Nappy changes are a great time to do some eye tracking exercises.
– Try not to always place your baby on their back. Assist them to roll each way and build up that invaluable neck strength.

If you have any concerns about the shape of your baby’ head, or ability to move and interact, speak to one of our paediatric physiotherapists about ways to encourage and promote independent movement and strength in your little one.

Zoe Lorenzo

Senior Physiotherapist
BSc (Physiotherapy) Masters (Paediatric Physiotherapy)