Optimising your baby’s development – By Dr Shalom and Helene Drimer

Optimising your baby’s development – first published in Nuture Parenting Magazine Autumn 2015

As humans we have evolved to perform tasks that are unmatched by any other species in the animal kingdom. We talk, write, dance, sing and perform many other activities. We often take these skills for granted, even though they are incredibly complex and are complicated to perform and master. All of these activities require a highly intricate and evolved nervous system. As humans our very survival would be challenged if we were born with our brain fully developed, because our babies’ heads would be too large to be able to move through the birth canal. Instead, our human brains and nervous systems develop in the two to three years after birth. This period is sometimes referred to as the ‘fourth trimester’ because the spine and the brain continue to grow and develop so much during this period. Therefore, it is vital to make sure that there is nothing that will interfere with the optimal development of your baby’s spine and nervous system in this crucial period.

An amazing discovery of modern neuroscience is that there is a connection between the development of your baby’s spine and motor skills (such as the ability to lift their head, crawl, sit and walk) and the development of skills such as writing, reading comprehension and language development. Studies have shown that optimal neuro-musculoskeletal development leads to optimal learning at school too.1

Marianne Hermsen-van Wanrooy expands on these ideas in her book Baby Moves. Her book is a wonderful guide for parents who are interested in learning how to foster optimal neuro-musculoskeletal development from birth. Marianne is a physiotherapist who specialises in neuro-paediatric physiotherapy and she has observed that putting your baby or child into positions that he or she cannot get into by themselves can be unhelpful (as this can encourage muscle imbalance and can prevent your child from correcting movement abnormalities). Unfortunately for some children, this can have an impact on their brain development and could potentially contribute to behavioural and learning challenges. 1

Hermsen-van Wanrooy states that motor function develops in stages, just like the different stages of learning that children will progress through during their education. For optimal neuro-musculoskeletal development, it is important to allow your baby to move through these stages without being rushed or helped (and without skipping any stages e.g. crawling). She does not recommend putting your baby into any positions, or asking them to perform any activities that they are not developmentally ready for. The easiest thing to remember is to ‘follow their lead’ and not to ‘help them’ as they are developing their physical milestones. 13

We have included a list of practical tips below that will help you with ‘not helping’ your baby as they master new skills. All of the developmental milestones are important. If stages are missed, your child may have an increased risk of challenges such as poor balance and posture. 1

When we see our babies trying to turn from their tummy to their back or vice versa, it is natural for us to want to ‘help’, but this robs them of the opportunity to develop these skills by themselves (and figuring out how to master these skills on their own is necessary for their optimal development). They might feel frustrated in the process, but this is ok because the struggle is important for them. Please note, however, that if your baby is getting very distressed, then you can help them. But it is ideal if they can develop all of these skills without interference from us.

The information in this article is different to many mainstream parenting practices. Our intention in writing about these subjects it is to give you the opportunity to facilitate optimal neuro-musculoskeletal development for your child. It is our belief that the more information you have, the more choices you have. It is not our intention to cause you concern if you have done some of the things that we do not recommend in this article (these are very common practices). If you have any concerns about your child’s development, we encourage you to seek professional assistance.

Dr Drimer’s Top Tips

1. Do not ‘sit your baby up’ before they can get into a seated position entirely on their own, 1 and avoid the use of baby seats (except for high chairs during meals and after the age of 6 months).

2. Only use your baby capsule for travelling in the car and for minimal periods of time (your baby is not positioned for natural development in a baby capsules). 1 Your baby’s movement is also restricted in a capsule (especially movement of their head), and extended periods of time in a capsule can contribute to the development of a flat head (more about this later).

3. If you use a pram, ensure that your baby lies completely flat in a bassinet attachment (ideally from birth to nine months; or for as long as possible). By nine months our little girl was flipping onto her tummy in the bassinet and looking over the top, so it was time for her to start sitting in the pram. However, She spent very little time sitting in the pram, because the majority of the time we wore her. When you are choosing a pram, it is ideal to choose one that will allow your child to sit at a 90-degree angle (without reclining). 1

4. Do not ‘walk’ your baby. Allow them to develop their motor skills unassisted and in their own time. Trust that they are developing their motor skills optimally at their own pace.1

5. Avoid jolly jumpers and baby walkers. Your baby’s spine may not be strong enough to be in an upright position and their pelvis may be put under unnecessary strain in these devices. Babies that are put in these devices tend to have a more robot-like walk, which might indicate incorrect muscle activation. 1

6. Avoid baby bouncers because they can inhibit the development of your baby’s flexor muscles. 1

7. If your baby has missed a developmental stage, such as crawling; or if your baby is developing a flat head, take them to see a practitioner that specialises in neuro-musculoskeletal development, such as a pediatric chiropractor, physiotherapist or cranial osteopath.

Burping your baby

Many parents feel that they need to help their baby burp after eating. As a result they tend to put their baby on their shoulder and to hit the baby on the thoracic spine. However, this practice can be unhelpful for a number of reasons:

1. The spine of a newborn is very delicate and hitting your baby on their mid back can be jarring on their tiny spines.
2. It also can over stimulate the sympathetic nervous system, which is responsible for the stress response of the body (fright or flight) and can place your baby into survival mode. This is the opposite of the calming effect that most parents are seeking.

If you believe that your baby needs help (many times they don’t really), it is preferable to gently rub their back in an upward direction, or to gently tap them on their bottom. This can stimulate the parasympathetic nervous system (which is responsible for the relaxing and thriving functions of the body).

Tummy time and avoiding flat head

These days many babies develop a flat head (deformational plagiocephally or DP) in infancy. To prevent your baby from developing a flat head, ensure that they are not left in any one position for extended periods of time. It is best to alternate between safe baby wearing (please refer to our article in the Winter 2014 edition of Nurture Parenting Magazine), laying your baby flat on their back, and tummy time. This will help to reduce the risk of your baby developing a flat head and it will give them the opportunity to develop milestones at their own pace.

The bones of your baby’s skull are meant to be able to move gently as your baby breathes. If your baby develops a flat head, this may restrict their cranial bone movement. In the past decade, there has been a staggering increase in the number of DP cases. This can be attributed to the ‘Back to Sleep’ campaign. 2 Sadly, however, there is an increasing body of evidence that shows a correlation between having a flat head in infancy and an increased rate of delayed cognitive and motor development in school aged children. This may not be the case with all children, however, our reason for sharing this information is that we are passionate about helping parents to facilitate optimal development for their children. We want children to reach their full potential and to be able to really thrive.

DP is a condition that seems to develop as a result of strain within the cranial dural system (which is the soft connective tissue inside the skull). The dural system surrounds and protects the brain and spinal cord. Strain can result from pressure on the head during pregnancy and birth, from early trauma and from torticollis (a condition in which a baby’s neck muscle is shortened causing their neck to twist. It can also occur from a difficult birth). 2a

A flattening of the occiput is usually evident in DP. Many parents, who are worried about their baby’s flat head, are told by their doctor that it has no effect on development. However, research over the last 15 years does not support this assumption. Studies have found that:

• DP is associated with early neuro-developmental disadvantage – most evidently in motor function. 2
• Infants with DP comprise a high risk for having developmental difficulties during the school age years, needing more special education classes, physical, occupational and speech therapy. 4
• DP infants have a higher risk of auditory processing disorders 5 and visual field development disorders. 6
• There is a correlation between DP and the severity of otitis media. 7
• There is also increasing evidence to show that infants who have little or no tummy time while awake have higher chances of experiencing delayed motor development. This was checked at 2, 6 and 10 months.

The good news is that the time your baby spends lying on their tummy on you, and being carried (facing inward) count as tummy time too.

Sometimes babies can develop a restriction in their necks (often from birth trauma), however, they cannot communicate when they feel uncomfortable turning their little heads. A good way to tell if your baby is in discomfort is if you observe that they:

• tend to predominantly sleep or lie with their head facing one side,
• do not feed equally from both breasts. If there is tightness in their neck, your baby may feed well on one side, but may prefer not to feed from the other breast. Or they might have a very weak suction or attachment to the nipple and areola.

If you baby is showing any of these signs, have them assessed by a pediatric chiropractor, physiotherapist or osteopath. If your baby is having any trouble with breastfeeding, have them assessed by a professional who is trained in the diagnosis and treatment of tongue and upper lip tie (e.g. an Orofacial Myologist, Doctor, Paediatric Dentist or Lactation Consultant). Tongue and upper lip tie are common causes of breastfeeding challenges, but sadly these ties are often missed by healthcare providers who are not specially trained in this area.

Dummies

We’d like to touch on the topic of dummies from a chiropractic and psychological perspective. As a chiropractor, Shalom seeks to optimise the function of the body (and nervous system) as a way to optimise the overall health and wellness of his patients. One body part that he focuses on as a chiropractor is the cranium (all of the bones of the head, face and lower jaw). Your cranium moves and this movement facilitates the flow of Cerebral-Spinal Fluid (CSF). The movement of CSF and of your cranium is also enhanced by respiration (or breathing). This movement in adults is very subtle, but it is much more pronounced in children. The flow of CSF is needed for the proper function of the brain and central nervous system. CSF supplies nutrients and removes waste products and this process and is crucial for the homeostasis of the body (it also has an impact on functions such as immunity and respiration).

The bones that make up the roof of the mouth create the floor of the nose and inner skull. If the top palate is high and narrow, it reduces the size of the nasal passages. This in turn can affect the space that is available for breathing through the nose. We are meant to breathe through our nose. Nose breathing facilitates the correct exchange of oxygen and carbon dioxide and the hair in the nose cleans the air from pollutants (such as dust and microbes). As a matter of fact, the nose is one of our first lines of defense against infection. When we breathe through our nose, our tongue should sit in a groove on the roof of the mouth and this is important in the development of the maxilla (the bone of the upper jaw).

Studies have shown a very strong link between the use of a dummy and developmental changes to the structure of the upper palate and inner nose. 8,9,10 If a child has a very narrow upper palate (sometimes caused by dummy use), this can increase their chances of becoming a mouth breather (and mouth breathing can narrow the upper palate too). In turn this can have an impact on a child’s immunity. Children that are mouth breathers have a higher incidence of sinus congestion, enlarged adenoids and tonsils, and snoring (which may affect sleep quality and school performance). Mouth breathing can also cause abnormal development of the upper and lower jaw, creating crowding of the teeth. 8,9,10,11

Dr Aleta J Solter (the creator of Aware Parenting), writes about the psychological considerations of dummy use in her book The Aware Baby. According to Dr Solter, many books for parents state incorrectly that all crying indicates a need or discomfort. The authors then suggest methods for settling babies. These methods often involve movement, noise or giving the baby something to suck on. However, according to Solter, none of these methods is beneficial to babies when they need to cry, because it teaches them to hold their feelings inside, rather than releasing them. If these methods are used repeatedly, babies can become dependent on them to repress their crying and they can learn that “people are unable to listen and accept their emotions”. 12 Dr Solter calls any behaviour that represses crying a ‘control pattern’. She states that if a parent continually offers their child a dummy when they are crying, the child will learn that no one wants to listen to them when they are crying and the child will demand a dummy every time they are upset. This then develops a dependency on the dummy to suppress crying. Similarly, babies may also console themselves by sucking their thumb and this can become a habit that the child does every time they need to cry.
According to Dr Solter, some professionals believe that it is a good sign when babies learn to sooth themselves with the help of a dummy or their thumb. However, Solter disagrees. She sees these behaviours “as a means of shutting off feelings and suppressing the need to cry in an environment that does not understand or encourage crying”. 12 Please note that Dr Solter is not an advocate of ‘cry it out’. She recommends supported crying in the arms of a loving and attentive caregiver as a way for a child to release stored stress and tension. You could think of it like ‘listening therapy’ for babies. It was Dr Solter’s intention to teach patents how to listen to their babies and children’s feeling when they are young in the hope that they may not then need so much therapy as adults.

References

1. Hermsen-van Wanrooy, Marianne (2006) Baby Moves, Baby Moves Publications, New Zealand.
2. Speltz, ML, Collett BR, Stott- Miller M, Starr JR, Heike C, Wolfram Aduan AM, King D, Cunningham ML (2010). Case-control Study of Neurodevelopment In Deformational Plagiocephaly. Pediatrics Feb 15
2a.http://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=90&ContentID=P02070
3. Kordestani RK, Patel S, Bard DE, Guritch R, Panchal J. (2006). Neurodevelopmental delays in children with deformational plagiocephaly. Plast Reconstr Surg ;117 (1):207-18;discussion 219-20.
4. Miller RI, Clarren SK. (2000) Long-term developmental outcomes in patients with Deformational Plagiocephaly. Pediatrics;105 (2):E26.
5. Balan P, Kushnerenko E, Sahlin P, Huotilainen M, Naatanen R, Hukki J. (2002). Auditory ERPs revel brain dysfunction in infants with plagiocephaly. J Craniofac Surg:13(4):520-5:discussion 526.
6. Siatkowski RM, Fortney AC, Nazir SA, Cannon SL, Panchal J, Francel P, Feuer W, Ahmad W. (2005). Visual field defects in deformational posterior plagicephaly. J AAPOS ;9(3):274-8.
7. Purzycki A, Thompson E, Argenta L, David L. (2009). Incidence of otitis media in children with deformational Plagiocephaly. J Craniofac Surg; 20(5) :1407-11.
8. Zardetto CG1, Rodrigues CR, Stefani FM. (2002). Effects of different pacifiers on the primary dentition and oral myofunctional strutures of preschool children. Pediatr Dent. Nov-Dec ;24(6):552-60.
9. Cintia Regina Tornisiello Katz, PhDa, , , Aronita Rosenblatt, PhDb, Pedro Paulo Costa Gondim, PhDc. (2004). Nonnutritive sucking habits in Brazilian children: effects on deciduous dentition and relationship with facial morphology. AJO-DO, July;126:53-57.
10. Warren JJ, Bishara SE, (2002). Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition. AJO-DO;121:347-56.
11. Peltomäki T. The effect of mode of breathing on craniofacial growth—revisited (2007). Eur J Orthod ;29 (5): 426-429.
12. Solter, A.J. Ph.D, (2001). The Aware Baby. California, USA: Shining Star Press

By Shalom and Helene Drimer.

Shalom is a chiropractor and Helene is a nutritionist and Reiki practitioner. They have a multi-disciplinary practice in Glebe called Light Chiropractic and Wellness (lightchiro.com.au). Helene is also the creator of Evolving Mamma (evolvingmamma.com), a blog about conscious parenting and healthy living. They have a three year old daughter named Lior, which means ‘my light’ in Hebrew.

With love, light and appreciation

Helene

www.evolvingmamma.com
www.lightchiro.com.au