Let me just get this out of the way first – I love wearing my son. I love holding him close in my arms while we do mundane daily tasks like grocery shopping. I love being able to bury my nose in his hair and breathe in his unique baby smell when he is cuddled on my front in his carrier. I love being able to wrap him on my back when he is teething or tired or over-stimulated, and feel his little body relax and melt into mine, as he rests his sleepy cheek on my neck. It feels like the most natural thing in the world to me to hold my baby boy close, and babywearing has made this possible for us.
Positional Plagiocephaly and Babywearing
Now with that out of the way, by both personality and training, I am a scientist. I love having hard facts to back up my sometimes admittedly alternative beliefs. Nothing makes me happier than being able to cite an evidenced-based, peer-reviewed journal article that shows that babywearing is the greatest thing ever for you and your baby. Except that there are very few articles like that in existence. One recent study in the European Journal of Pediatrics found decreased rates of positional plagiocephaly when parents were provided with education on environment and positioning for their infant.(1) Babywearing International has four citations for “The Benefits of Babywearing.” And the most recent of these articles is from 1998.(2) To me this means that there is a huge shortage of critical research on the tangible benefits of babywearing. Those of us who wear our children know what an amazing experience it is for so many reasons, from the snuggles to the calming effects to just plain having your hands free to wash the dishes! This has lead to a plethora of anecdotal information on the internet stating that babywearing is good for positional plagiocephaly, but a lack of evidence-based research to back up this claim.
Here are the facts about positional plagiocephaly or flattening of a baby’s head. In 1992 the American Academy of Pediatrics released their recommendations on positioning infants on their backs to sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS).(2) Since that time there has been a noted increase in positional plagiocephaly, a cranial deformity which can result from intrauterine constraint, or positioning of the head after birth.(4) There are several other conditions which can result in plagiocephaly including premature fusion of the sutures in the skull (craniosynostosis), excess fluid in the skull (hydrocephalus) and depressed skull fractures.(4) These conditions are relatively uncommon – but the rates of positional plagiocephaly at four months of age range from 19.7-48%.(5) Some risk factors for positional plagiocephaly include prolonged labor, breech position, male sex, twin or multiple births and prematurity. (5, 6)
So here is where babywearing enters the picture. In the course of my literature review for this article, I looked at a large portion of the current research and recommendations with regard to plagiocephaly. None of the articles that I reviewed specifically mentioned babywearing as a strategy to assist with cranial remodeling. However, in every article that I looked at repositioning and/or physical therapy was listed as a first line intervention in most cases of mild to moderate plagiocephaly up to the age of four months. (5,6,7) Repositioning in its most basic sense is not leaving a child resting on the area of flattening (i.e., the back or side of the head) for extended time periods, except while sleeping. “Supervised prone positioning,” i.e. “tummy time” is recommended for at least 30 minutes per day while awake. (5)
From both personal and professional experience I know that many newborns less than four months old are not huge fans of tummy time. This does not mean that it is not still beneficial for them, but some of the benefits of tummy time can be obtained through babywearing. When you wear your baby, he is working neck and core stability. Another benefit that babywearing can provide is repositioning the baby’s head. When you are wearing your child in a carrier on your front, most babies will try and practice holding their heads steady for short periods to look at the world around them. They may rest one check or the other against your chest as their neck muscles begin to tire out. This has the added benefit of the parent being able to reposition the baby’s head from one side to the other, thus gently stretching his neck muscles, which is a recommended treatment for torticollis (asymmetrical tightening of the neck muscles). (7) What the baby is not doing is resting any pressure on the back of the head.
Another of the recommendations from the literature on the prevention of plagiocephaly is that infants should spend as little time as possible in positioning devices like swings, bouncers and car seats (when not riding in the car) which put pressure on the back of the skull.(6) Once again, wearing the infant prevents putting pressure on the infant’s developing skull. In general, the use of cranial molding orthotics (helmets) is only indicated when repositioning and/or physical therapy has not produced desired results.(4)
For those who don’t know what occupational therapists (OTs) do, we help people to gain the skills they need for maximum participation in daily living activities across the lifespan.(8) The literature recommendation for the prevention and treatment of most cases of plagiocephaly is repositioning. As an OT, I would look for the best tolerated strategy for repositioning for both the infant and the caregiver. In many cases, babywearing can achieve the goals of repositioning (keeping pressure off the flattened area of the infants head) in a manner that is not just tolerable, but enjoyable for all parties involved. The position paper released by the Baby Carrier Industry Alliance (BCIA) also has many references on other benefits of babywearing, including caregiver attachment and safe development for the baby.(9) Wearing your child can help you keep your child in a position which doesn’t place increased pressure on his developing skull, and may also be sustained for a longer period of time than “tummy time.” Wearing the infant also allows the caregiver to participate in other activities including shopping or caring for older children, while simultaneously keeping the infant in a recommended position. Wearing your baby also allows you to monitor the baby’s signs such as breathing and temperature, which can also be reassuring to new parents. All in all, the literature supports the concept that babywearing could be used as a preventive measure and as part of a treatment program for mild to moderate positional plagiocephaly.
Please see the list of references below, and as always, if you have concerns for your child’s health or development, please speak with your healthcare professional.
If you’ve enjoyed this article, you might also like to read our short summary of the Baby Carrier Industry Alliance’s position paper.
- Aanivala H, Vuollo V, Harilla V, Heikkinen T, Pirttiniemi P, Valkama AM. Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial. Eur J Pediatr. 2015. Pubmed prior to publication.
- Babywearing International. http://babywearinginternational.org/what-is-babywearing/babywearing-resources/benefits-of-babywearing-2/ Accessed May 30, 2015.
- American Academy of Pediatrics Task Force on Infant Sleep Positioning and SIDS: Positioning and SIDS. Pediatrics. 1992; 89:1120-1126.
- Morrison C, Chariker M. Positional plagiocephaly, pathogenesis, diagnosis and management. J Ky Med Assoc.2006;104:136-140.
- Robinson S, Proctor M. Diagnosis and management of deformational plagiocephaly. J Neurosurg Pediatrics. 2009;3:284-295.
- Persing J, James H, Swanson J, Kattwinkle J: Prevention and management of positional skull deformities in infants. Pediatrics. 2003;112:199-202.
- Flannery A, Looman W, Kemper K. Evidence-based care of the child with deformational plagiocephaly, part II: Management. J of Pediatric Health Care. 2012; 26(5):320-331.
- American Occupational Therapy Association. http://www.aota.org/About-Occupational-Therapy.aspx. Accessed May 30, 2015
- Baby carrier Industry Alliance. http://babycarrierindustryalliance.org/about-us/position-paper/. Accessed June 14, 2015.
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