As a new parent you probably have heard about putting your baby on their back for every nap and sleep. What you might not have heard, is that you also need to put your baby on their tummy everyday while they are awake. This prevents your baby from developing a flat spot on their head (also known as plagiocephaly).

The soft spots on your baby’s head

• Your baby’s skull is made up of many bones that protect and support the brain. At birth these bones are not joined together firmly. This allows baby’s head to change shape so it can pass through the birth canal.
• Babies are born with “soft spots” (called fontanelles) on their heads to allow for rapid growth of their brains and skulls. 
• Your baby will have two main soft spots:
  • one on back of the head, which generally closes by one to two months of age.
  • one on the top of the head, which generally closes between nine to 18 months of age.

Why do flat spots happen?

• Because newborns neck muscles are weak and their skulls are not firmly joined yet.
• When your baby lays in one position for too long it puts pressure on their bones which cause the flat spot. This can happen if they sleep for long periods in one position. 
• This can also start before the baby is born from the way they are positioned inside your uterus.

What can I do to prevent flat spots?

When your baby is awake

• Give them supervised tummy time every day for two to three minutes at a time. Many babies will not like tummy time at first, but as they grow stronger, they will enjoy it. You can start this the first day you get home from the hospital.
• Make it fun by getting on the floor and playing at their level.
• Put a toy or mirror in front of them.
• As your baby gets used on being on their tummy, do it a bit longer each day. Don’t be afraid to do it a few times a day.
• You can try lying on your back with baby on your chest facing you; this encourages them to lift their head to look at you.

Position changes throughout the day

• Try holding your baby or wear your baby rather than putting them in a carrier seat. This allows your baby to be close to you and look around.
• Try putting your baby in a side lying position when playing on the floor with them. You can put a rolled towel behind their back to prop them up. Be sure to change sides and supervise.
• Alternate which hip you use to carry your baby. This encourages looking, turning and balancing.

When your baby is asleep

Always put them to sleep on their back. Your baby will naturally turn their head towards you, so alternate the direction your baby lies in the crib. This will encourage them to turn their head in different directions and avoid resting in the same position all the time.

Tummy time helps your baby develop head control and strengthen their upper body. This prepares them for pushing up onto their hands and knees, which leads to rolling and crawling. This leads to more exploring and learning!

What if my baby doesn’t like tummy time?

• Make sure they are not hungry or tired before you start.
• Try laying your baby on your chest.
• Keep your baby company by getting down to their level and talk to them.

How will I know if my baby has a flat spot?

• You may be able to see it.
• If you notice your baby always looks in one direction, check to see if a flat spot is forming.
• Your health care provider will check during your baby’s regularly scheduled appointments.
• If you are concerned ask your public health nurse or health care provider to assess your baby’s head and neck.

What can I do if my baby has a flat spot? 

Not all flat spots can be prevented. Most can be. If your health-care provider notices a flat spot, they will check the muscles in your baby’s neck. If needed, your baby may be referred to physiotherapy.

Reference

• Caring for Kids – Preventing Flat Heads in Babies who Sleep on their Backs    

As with all stages of child development, there is a range during which children develop their skills. So, if your child is not doing everything at every stage, it is not necessarily cause for concern. However, a wait-and-see approach is not necessarily the best either, especially when early intervention can make a difference.

Lisa Fehr, a speech-language pathologist with the Winnipeg Regional Health Authority, often tells parents that a child’s language development can be compared to climbing a set of stairs, with a child at the bottom and moving up one step at a time. 

Babies start reacting to sound right at birth. At around four to six months, they will start cooing or “talking,” followed by babbling at around six to 12 months. 

You will usually hear your baby’s first words at around 12 to 18 months. As your child continues up the steps, you should be seeing them using around 50 single words by 18 to 24 months. By 24 months, children start to use some two-word phrases, such as “Ahdah mama” (“All done mama”) or “Wawa peas” (“Water please”). 

The words and sounds of a two-year-old are not necessarily spoken clearly, but this is normal. From two to three years of age, you should be seeing a rapid change in speech and language development, with an increasing vocabulary and use of language. At this stage, you should be wondering, “Where did our child even learn certain words?”

By three years of age, you should understand your child’s speech 75 per cent of the time, and they should be telling you short stories, and using three-and four-word phrases (“Me goed to the pawk (park)”, “Her is awdone (all done) now”). Their speech may not be completely perfect yet, but that is still okay. 

From four to five years of age, children are gaining more and more words, ideas and concepts, and should be able to express themselves with longer sentences and in a smooth, clear way. They should understand your questions and directions and their speech should be understood almost all the time by an unfamiliar listener. That is a lot of stairs, in a short time.

Here are a few tips to help your child’s speech and language development:

1. Limit screen time according to the Canadian Pediatric Society’s recommendations. That means no screen time (TV/tablet/phone) for children up to two years of age and limited screen time (less than one hour per day) for children between two to five years of age.
   We don’t talk much when we look at a screen and the same goes for your child. This is a tough one in this day and age, but children learn how to communicate through active play and engagement with the people and things in their world.
2. Provide lots of verbal input to your child. Talk to them all the time about what you’re doing, what they’re doing, what you’re seeing and hearing and where you’re going. Talk throughout your day. Talk to them in the language you are most comfortable. When you talk to your child, wait for them to do or say something in response. Mealtime, bathtime, playtime, driving, walking, shopping are all opportunities for your child to learn words.
3. Use books right from birth with your child. Use them to snuggle up and enjoy some time together. Aim to read at least one book every day. Use the library. Don’t feel you have to read the entire book. Look at the pictures and name the items on the page. Even if your child is only interested in one page, that is still a great start and a great way to learn words and ideas.
   The stories and books you share in the early years shape your child’s: 
   • understanding of the world 
   • sense of humour, compassion and interests

Sharing your own traditional stories, songs and poems in your home language helps your children understand your culture and family values.

Lisa Fehr is a speech-language pathologist/clinical service leader with the Winnipeg Regional Health Authority’s ACCESS Downtown. This column was originally published in the Winnipeg Free Press on Friday, December 4, 2018.