Motor development in infancy

Inactivity starts in infancy: consequence of sleeping position and inactivity

As a pediatric physical therapist in primary care, attention is drawn to the fact that a new inactivity problem has arisen where healthy children acquire physical disabilities already during the new-born period. The children are too passive, to be compared to "orphanage passivation" and when the children are passive for a long time one risks permanent problems and a "wrong programming" of basic neuromotor systems. Sweden has been at the forefront of child health care internationally. Today, Sweden is behind countries like the Netherlands, Canada and the United States in the ability to see and remedy the negative consequences of the supine position (lying on the back) of infants and its consequences.

In clinical work, children with asymmetric skull forms, neck problems, weakness, impaired motor development and passivation in walkers and backward leaning strollers is the largest patient group. It is thus healthy children who have acquired inactivity problems.
Research show that infants spend to little time on their stomachs, which can have consequences for both the child and public health in the long run. Sudden infant death syndrome has been reduced by introducing children to sleep on their backs. It is pleasing and positive. However, the guidelines have led to a shortage of time in the prone position (on stomach) during the child's awake time, which has had far-reaching negative consequences for the entire child's development. Research from the United States and Canada show that just over a quarter of parents are so frightened that the children will die that they never put their child on their stomachs when awake, even though they are told to do so.

Almost half of Swedish infants today have an asymmetric shell shape which affects neck function and the whole body's motor skills. When a newborn baby is lying on his back, the head is large, unstable and often falls in one direction. Since the skull sutures are soft one side of the skull becomes flat and the ear and forehead on the flat side are moved forward relative to the opposite side. The neck muscles on one side are activated while the other side is inactive.


Asymmetric head shapes are called “Plagiocephaly”

In a child's development, the first thing the child learns is head control with a straight neck and the eyes in the horizontal plane. The programming of head control is synchronized by receptors in the neck, vision and the vestibular system. In the abdominal position, the child lifts the head from side to side, the eyes moving before the neck. The lift activates the vestibular system in the inner ear. The child bears weight on the cheeks and hands, doing weight transfers left and right and initiating eye-hand coordination. Pretty soon, the baby can keep his head straight and look up. When children lie on their backs, none of this happens and they become weak and cannot keep their heads vertical. One side is strong the other side is weak. Many wait with abdominal position until the child is 3 months. When the child suddenly is put on the stomach and unable to lift the head, the child protests and starts crying. Many parents feel sorry for the child and pick him up. Often the child is placed in a walker or some other chair or carriage since the parents may think that something is wrong when the child is crying. A child who is strong and capable often becomes a satisfied and happy child. A child who is weak becomes frustrated and sad. Physical well-being has a connection to mental health already during infancy.

In normal motor development you can expect:

  • That the child can lift the head from side to side in abdominal position already during the newborn period

  • At 3 months, children are expected to be able to lie on their stomach, have good head control and switch between forearm and hand support.

  • Between 3 and 6 months, children move around their own axis in prone, moving in a circle

  • During the third quarter, children learn to crawl or to transport the body in some way.

Today, there are many 7-month-old children who barely can lift their heads in the prone position and who lie with fisted hands. Lack of knowledge about children's motor development and lack of child physical therapists in primary care has led to a lack of information for parents. Child health care in Sweden needs to pay attention to the consequences of inactivity and asymmetric head shapes. The children need be referred to child physical therapists early when identifying asymmetric neck function. In the United States, research has shown that asymmetric head shapes can affect brain development, including fewer connections between the brain halves and poorer developed posterior part of the brain.
In Canada, baby walkers are banned - they cannot be sold or imported. Research shows that they cause accidents, delayed and impaired motor development and even worse development of the child's cognition. The children become "inattentive", they do not need to problem solve, they cannot fall and do not develop the movement strategies which, among other things, teaches them how to bear body weight and increase range of motion, how to activate muscles, how to regain balance and how to perform movements.

In the clinical day-to-day life, we see a clinical picture that previously did not exist. It shows impaired hand function, weakness, impact on balance and neck back problems. Children can walk with tilted heads, they do not know what "straight" is. Often, the children have walked in baby walkers or sat with rounded backs on rear-tilted seats which made it impossible to keep their back and neck straight. Incorrectly baby carriages with a rear-tilted seat are called "ergonomic", which is false marketing when the children sit passively, cannot balance and become weak.

Knowledge and efforts are needed to counteract this passivation and deterioration of infant development. In addition to having children lying in the prone position from the first day of life, environmental factors that affect children's development need to support activation of postural muscles and good motor development. The Swedish Standardization Institute and other regulatory authorities for product quality assurance need to prohibit baby walkers, non-ergonomic strollers and poor seating for children. All this is needed to ensure that newborn healthy children are given tasks that are needed for development and an environment that leads to a good development, with active and happy children with good physical self-esteem that creates a prerequisite for play and movement.