Flat heads in babies

We have significantly decreased the risk of SIDS by placing babies on their backs to sleep, but have seen a rise in flat heads due to their positioning. Prevention of the flatness involves several positioning strategies.

Supervise tummy time when Baby's awake!

It's important for babies to sleep on their back, but they tend to have their head facing one direction or another. They should alternate which side they face, but many babies have a stiff neck and favor looking to one side. Think of when you wake with a stiff neck - probably from positioning overnight. Many babies are in the same position for quite awhile at the end of pregnancy - of course they're stiff!

If Baby's neck is stiff, you can massage his or her neck and shoulder muscles gently and then slowly move the head right and left (chin to each shoulder) and side to side (ear to shoulder). Don't quickly force the head movement, but think of what you do if you have a stiff and sore neck. The more frequently you stretch it out, the better it feels, right? I recommend stretching Baby's neck with each diaper change (before the change or after you wash your hands!) until it isn't stiff for several days and Baby moves his or her head easily without your help.

Start supervised tummy time early on - the longer you wait to start, the more Baby might resist it. I see so many parents who are hesitant to put Baby on his or her stomach. Concerns range from the umbilical cord stump still being on and bothering the baby (it won't) to spitting up will worsen (test it out, for many babies it's actually better) to "I thought babies should never be on their stomachs" (only when sleeping or not supervised).

Tummy time is an important time for baby to develop muscle strength. It needs to be supervised, but it can be a fun time to interact with Baby. Lay face to face and talk to Baby, encouraging him or her to look up. Grab a brightly colored object and move it around for Baby to watch. Enjoy your play time.


For more information on issues related to stiff necks in babies and how to treat the stiffness, see this Torticollis information.

AAP article on how to prevent flat heads in babies.

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Baby Monitors… Are they safe or effective?

The uses and applications of baby monitors have grown over the years. There are audio-only versions, video monitors, and now motion sensors. Soon they will be able to tell you baby's oxygen level and temperature or predict how long your baby will sleep. How did parents ever have kids before these? (Big sarcasm here!)

photo source: Shutterstock. Baby on a hospital monitor

Some of the newer baby monitors claim to be able to help a parent learn a baby's sleep patterns to help with sleep training. I think it is wonderful to have all the research that is being done on sleep and I know that it is hugely important for babies and their tired parents to sleep, but I wonder how we did it for so many centuries by just paying attention to our babies and learning their cues? I don't think it is a good thing that parents rely on gizmos to "learn" about their babies.

Unfortunately monitors are sold with the hint of prevention of SIDS. Parents often feel a sense of comfort when they sleep with a monitor to alert them when baby cries. When I was a new mother the monitor was rarely used. I had more anxiety when it was on and I couldn't sleep as well. I could hear the cry just as well without the monitor, but the monitor allowed me to hear every deep breath, grunt or sighing noise common to a sleeping baby. The monitor highlighted every sound, keeping me awake. I know our neighbors used a monitor when we would gather outside on their driveway or deck and their baby was asleep or if they were in the basement and baby was upstairs on the 2nd floor. I can actually see a benefit to that, but I hope parents would never use the smartphone app to use it when they stray far from home.

Parents are starting to ask about the newer generation monitors that sense baby's movement and alarm if no movement is felt. Some will even vibrate the baby if no movement is sensed after 15-20 seconds. Before you think these are the answer: the FDA has NEVER approved a baby product to prevent or reduce the risk of SIDS. I know of one product that is working with the FDA and projects that by 2015 they will get FDA clearance. At this point, their sock only tells parents the vital signs and oxygen. It doesn't even look like it alarms when the level gets low. Until it has been shown to work and be safe for general use, I would not waste money on any device. And yes, some of these devices have actually strangled babies to death, so they are not without risk!


If you really want to help prevent SIDS, use the precautions recommended by experts. (For more, see my previous blog on SIDS Prevention Guidelines.)

• Before baby's born: get regular prenatal care and do not smoke, drink alcohol, or use illicit drugs during pregnancy. 
• Put baby on his back to sleep. Every time. Even if you're in the room. When baby can roll on his own, he can sleep in the position of comfort he finds. 
• Use only a firm sleeping surface made for infant sleep. Never leave baby on the couch, in an adult's bed, in a car seat, in a sleep positioner, or in a swing.
• Check your crib and bassinet for recalls. 
• Pacifiers have been shown to help prevent SIDS, so it is okay to use one for baby's sleep times. If your baby won't take one, that is okay. You cannot force it. Some breastfeeding experts say to wait until 3 weeks to allow breastfeeding to be established, but I do not find that it interferes with breastfeeding if you use a pacifier earlier.
• Keep all soft objects (pillows, loose blankets, bumper pads, stuffed animals) out of the bed until your baby is over 1 year of age.
• Keep baby out of your bed, but in your room.
• Breastfeed as long as possible. Yes, it has been shown to help prevent SIDS!
• Vaccinate your baby. Research shows immunizations may protect against SIDS and we know they prevent illnesses that cause death.
• Get baby regular health checkups to insure proper growth and development.
• Keep baby away from smokers and places where people smoke. If you smoke, talk to your doctor about ways to quit. If you cannot quit, never smoke in your home or car. Always go outside where the smoke is less likely to settle on your hair, clothes and furniture.
• Keep the room at a comfortable temperature and avoid over wrapping your baby. When babies get too hot, they are more likely to suffer from SIDS.
• Do not use home cardiorespiratory monitors to prevent SIDS. Some babies leave the hospital with these due to heart or lung problems, but they have never been shown to decrease SIDS.
• Do not use other products that claim to reduce the risk of SIDS. As stated above, none have been shown to prevent SIDS. 
• Give baby tummy time when you can watch and play with him. This strengthens baby's muscles to allow him to learn to roll over safely by 4-6 months.
• If you are overly tired or are under the influence of certain drugs or alcohol: you may not be alert enough to care for your baby. Ask for someone else to help until you are more alert and able to wake to baby's cues.

Baby Safe Sleep Resources

• AAP Policy Statement on SIDS
• NIH Back to Sleep Campaign
• NIH Preventing Sudden Infant Death Syndrome and Suffocation
• National Institutes of Health. Eunice Kennedy Shriver National Institute Of Child Health And Human Development. What Does a Safe Sleep Environment Look Like? 2006. No. 06-5759
• Changing concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position. 2000 Mar, 105(3 Pt 1):650-656
• A Parent’s Guide to Safe Sleep
• Dear Fisher Price is an open letter to Fisher Price from KCKidsDoc regarding their Rock n'Play Sleeper

New SIDS Prevention Guidelines

As pediatricians we practice a lot of preventative medicine.  Our patients are generally young and healthy... and we want them to stay that way!  One way we do this is to discuss safety at well visits.  We try to share safety tips on our facebook page, website, and here.

A big safety issue is the sleep position of babies.  Most parents by now have heard that it is safer to put babies to sleep on their back, not belly.  Occasionally we hear of young babies sleeping on their stomachs because parents have realized they sleep longer that way, and they do.  But this is dangerous. Babies don't wake up as much when on their stomach, this is true.  Some babies simply don't wake up.  Please put your babies on their back to sleep!

Parents often want to sleep with their babies because it also is associated with longer sleep time for the baby and more convenience for the parent (especially the breastfeeding mother).  Despite ease and convenience, this is not a safe sleeping arrangement for babies. Arguments that this is safe because world wide many families share beds is not often a valid argument. Americans tend to sleep on a bed with a headboard and bedding.  Babies can get their head stuck between the mattress and headboard (or wall).  They can suffocate from the bedding.  Parents can roll over in their sleep and smother the baby.  There are simply safer options for all to sleep better.

Recently the American Academy of Pediatrics (AAP) released new Sudden Infant Death Syndrome (SIDS) prevention guidelines.  AAP SIDS prevention Guidelines that are based on strong evidence:

• Back to sleep every time.
• Use a firm sleep surface covered with a fitted sheet.
• Room share without bed share (put the baby in a crib or bassinet near the parent bed).
• Keep soft objects and loose bedding out of the crib.
• Pregnant women should receive routine prenatal care.
• Avoid smoke exposure during pregnancy and after birth.
• Breastfeed.
• Consider a pacifier at nap and bed times, but do not attach it to the infant or infant's clothing or stuffed toys.
• Avoid overheating.
• Do not use home cardiorespiratory monitors as a strategy to reduce SIDS.

Other recommendations based on limited evidence:

• Immunize in accordance with the AAP and CDC guidelines.
• Avoid commercial devices marketed to reduce the risk of SIDS (postitioners, co-sleepers, wedges).
• Supervised, awake tummy time is recommended to help development and reduce the risk of  positional plagiocephaly (a misshapen head from laying on one side routinely).

Other issues addressed:

• Co-sleepers are not recommended.
• Absolutely no bed sharing the first 3 months.
• No bed sharing at any age if a person in the bed is a smoker.
• No bed sharing with anyone who is excessively tired.
• No bed sharing with someone who is using medications that increases drowsiness or impairs alertness (pain medicications, alcohol, illicit drugs, certain antidepressants).
• No bed sharing with anyone who isn't a parent. This includes no bed sharing with siblings or other children.
• No bed sharing with multiple persons.
• No bed sharing on a soft surface (waterbed, old mattress, sofa, armchair)
• No bed sharing on a surface with soft bedding, including pillows, heavy blankets, quilts, comforters.
• Because of the high correlation with SIDS and suffocation on couches and armchairs, infants should not be fed on these when the parent is extremely tired and at risk of falling asleep.
• When choosing a crib, be sure it has not been recalled and all the parts are put together properly.
• Use only mattresses designed for infants.  Do not add any comforters, quilts, pillows, or other soft bedding to the sleep area.
• Bumper pads are not recommended.
• Infants should wear clothing that will keep them warm (not excessively hot) and that will not cover the head/face.
• Keep dangling cords or window coverings away from the sleep area.
• If infant slings are used, it is important to keep the infant's head up and above the fabric so the face is visible (unless currently breastfeeding).  
• Infants should not routinely sleep in car seats or other sitting devices (strollers, carriers, or backpacks/slings).

NOT safe!!!!!!
Picture actually taken to show the person who gave the comforter and bumper pad set, then it was put away. 

Keep your baby safe by placing her in a safe place at all times.  It only takes one accident to have life-ending consequences.  To say that you've always slept with your babies and they are fine, so it's not a problem for babies to sleep with their parents is like saying you never wear a seatbelt and haven't had any problems.  Just wait until that first crash...