Dr. Robert Needlman
Specialist in pediatric behavior and development.
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 Ask Dr. Needlman
Worried about A Lack of Motor Skills | | | QUESTION | | | Dear Dr. Needlman,
I work for a day care where a 13-month-old boy attends. He is only allowed to sleep on his back. Therefore, his head is extremely flat in the back. At this point in time he does not crawl or walk, has just recently begun to roll over when placed in the laying down position, and can not put himself into the sitting position. These skills are usually typical of a 13-month-old child. Is this lack of skills due to his flat head and development of his brain because of it? Please let me know as his provider what I can do to help him? Thank you for the help.— Donna in Harrisburg, PA | | | ANSWER |
April 25, 2001 | | | Dear Donna,
The "back to sleep" rule that has been so important in preventing Sudden Infant Death Syndrome (or SIDS), also known as crib death, applies to infants up to six months of age. After that, SIDS is quite rare, and most infants are rolling all over the place anyhow.
While it's true that "back to sleep" can cause mild flattening of the head and even mild delays in gross motor milestones, I would emphasize the word mild. The flattening is rarely obvious; when it is, a simple procedure (having the child wear a helmet for several months) corrects it completely and safely. There is no harm to the brain from having a slightly flattened skull. The motor delays (for example, taking longer to roll over or crawl) don't make any difference in the long run, and compared to the risk of crib death, these risks are minimal.
However, the child you describe has serious delays in gross motor development. Most babies are able to roll before age six months, sit on their own by or around eight months, and take a few steps holding on by twelve. This baby's delays are probably the cause of the head flattening, rather than a result of it. His head flattened out because he has spent an abnormally long amount of time lying on his back, not moving around. Flattening of the head, even when rather severe, does not cause brain damage. But this child, who has significant delays, may well have a neurological abnormality that needs medical and developmental attention.
I suggest that you talk with his parents and urge them to take their son for a medical and developmental evaluation. He may benefit from early physical and other therapies. All states now have Early Intervention Programs, as you probably know, that provide free evaluations for children with developmental disabilities from birth on as well as assistance in finding needed therapies. Doctors who care for children are familiar with the services in their areas, and can make referrals. You also can find the Early Intervention coordinator for your state by looking at the National Early Childhood Technical Assistance System (NEC-TAS) state list.— by Robert Needlman, M.D., F.A.A.P. |
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