By Jennifer Hoffmann
Babies need to move. They need to wiggle, stretch, rotate, and learn about how their bodies move in order to get stronger. Experience with movement is key to the development of muscle tone (strength) in young children (Wiener, Welsh, Blasch, 2010). Time which allows for movement is often of increased importance for the baby with a visual impairment because the lack of visual motivation to reach and move is absent. Parents and EIVI (Early Intervention Visual Impairment) professionals must keep this in mind when positioning a baby to ensure safety and active engagement (Fazzi, 2011).
Two positions parents and EIVI professionals are familiar with for young babies (0-6 months) are from the pediatrician recommended programs Back to Sleep and Tummy Time. The first of these successful campaigns which positions babies on their backs for sleeping has helped to reduce the incidence of Sudden Infant Death Syndrome (The Institutes, 2014). Unfortunately, this led to motor developmental delays as infants who previously slept on their tummies (prone position) began lacking skills like pushing up on their arms, stretching their necks, and looking around (Davis, 1998). Tummy Time or scheduled and supervise time of lying on the floor while prone during the day was introduced to mediate this developmental delay (The Strange, 2018).
Outside of sleep time and tummy time, there is a significant amount of day where baby needs to play. The availability of safe, comfortable, child-friendly seats like swings, bouncy seats, nursing cushions and car seats have become an affordable, preferred option for many families. This convenient hands free, baby-pleasing seating has led to a third type of positioning frequently being used for infants: the contained position (The Institutes, 2014). The use of baby seats can be a great comfort for babies and families, however, overuse of these seats can lead to problems. Baby seats do not allow the unrestricted movement required for proper infant development- much like what occurred with the Back to Sleep campaign. Babies seated in the same position, tucked in safely have restricted movements, are unable to extend, move and rotate their bodies. They are at risk for developing some health concerns such as flatness to one part of their head (plagiocephaly), facial asymmetry and torticollis (tightening of one side of the neck) (Hobbs, 2014).
In addition to the health implications mentioned, one motor area is significantly impacted by container seating the ability to turn one body part without turning all body parts (rotation). Rotation is used for most motor tasks such as rotation of hips to crawl/walk, of the head to look, and of the wrists to reach and grab an object but this key ability of rotation can be overlooked and taken for granted (Ferrell, p. 168). Rotation develops in the body following the path from large to small body parts. It begins with rotation of the trunk, to outer body (hips, shoulders), then to wrists (Ferrell, p. 227). When an infant is tucked in or swaddled in an infant seat, the ability to rotate the core or trunk of the body is removed. Although play and interaction may occur in the seat, the infant is not rotating the body for overall gross motor development. Due to reduced visual input, infants with limited vision are less likely to rotate their heads toward objects and people of interest. This can affect to the development of rotational patterns in general (Lueck, p.182).
EIVI professionals must work with parents in understanding the need for uncontained play and encourage the rotational progression of the child. Encourage parents to use their voice near baby’s head to prompt baby to turn and rotate. Change sides and try using a sound making toy, rattle, or music box. Practice shifting weight of legs to encourage twisting the body. Place crinkling paper near feet to encourage shifting around and encourage rotation (Ferrell, p. 168-169). All four of the infant positions (back to sleep, tummy time, container seating, and unrestricted play time) have benefits and balance between them will be best for baby’s development.