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Positioning for Greatness: Positioning babies for healthy Sleep, Play and Development.

tummy-time-babyBy Osteopath, Melissa McDougall.

Back to sleep and tummy to play. Most parents are aware of the basic guidelines of healthy infant development. In this article, we discuss why and how these positions assist healthy and balanced development, and the role osteopathy has in helping babies rest comfortably in all positions.


Back to Sleep:
The Back to Sleep campaign was initiated by the American Academy of Paediatrics in 1994 to support positioning babies on their back or side to decrease the risk of Sudden Infant Death Syndrome (SIDS). The program has been very successful, with the incidence of SIDS decreasing by around 50% since 1992.

iStock_000014994841XSmallThere is another reason why Back to Sleep positioning can be valuable. Babies at full term (40 weeks gestation) have a preference to ‘scrunch up’: elbows bend and drawn towards the shoulders and knees bent and drawn to the chest. This preference to ‘scrunch up’ develops over the last few months before birth and is believed to vital for normal body movement and control- for example, when placed on the tummy, optimal strength and scrunching at the front of the shoulders allows for a baby to push up from the ground with the arms.  Babies born before 40 weeks may not have a strong preference to ‘scrunching up’ because this preference becomes greater the longer the baby is spent inside the womb.


Babies who are born a little early or do not seem to have a strong preference to ‘scrunch up’ can benefit from swaddling (wrapping in a blanket snugly).

A guide to swaddling to support ‘scrunching’:

swaddle arms1. Arms: Gently encourage both shoulders to come forward and bring the hands together along the centre of the body. The elbows may bend so that the hands rest just outside the blanket near the mouth. Alternatively the hands ban be brought together lower inside the blanket, with one placed over the other.


swaddled-baby2. Legs: Allow the knees to bend and come towards the abdomen. This position can be encouraged by gentle tension offered from the lower edge of the blanket. It is important that the hips and legs are able to move a little as this supports healthy hip development, however the lower edge of the blanket should offer a firm base that the feet may kick against as the legs straighten.


3. Swaddling technique: You can use which ever safe swaddling technique you prefer, always ensuring that fabric is kept away from the babies face. The key is to create a swaddle encourages ‘scrunching’: shoulders forward, hands to the centre of the body, hips and knees gently bent to allow the knees to move towards the tummy.



Tummy (& Side) to Play:
Just as important as Back to Sleep is Tummy to Play. Although the risk of SIDS has decreased since the introduction of the Back to Sleep campaign, there has an increase of plagiocephaly (flat spots or head shape imbalance), torticollis (head turned to one side by shortening of a muscle at the front of the neck) and changes in the sequence and timing of postural patterns and developmental milestones.

Positioning babies on their tummy and side is one of the easiest ways to provide postural support that has both an immediate and lasting impact on development. Spending time on their tummy or side offers babies:

    • the opportunity for balanced moulding of the back of the head
    • environmental feedback through the sensation of the floor in contact with the tummy and side
    • the oppurtinity for hand discovery with the eyes (visual) and mouth (oral)
    • sensory feedback to the brain about the body’s posture and movement in various positions, which is essential for the development of timely, balanced and coordinated movement patterns.


Tips for happy Tummy and Side to Play:

1. Supervised: tummy and side to play should always be supervised.
2. Join in: get down on the floor, with your face in front of your baby’s. Offer your face, bright coloured toys, or the sound of your singing voice to soothe your baby in this position.
3. Quality over Quantity: several short periods of happy tummy time are better than one long period of miserable tummy time.
Towelunder shoulders

4. Make it easier: place a rolled up hand towel under your baby’s arms, hands out in front of the body. This position allows your baby to lift the head using less muscle effort.



baby aeroplane5. Aeroplanes: yep, these count as tummy time, are soothing for newborns and great fun for older babies.
For newborns and smaller babies, place the baby, tummy down, over one arm.



areoplanesFor older and bigger babies, place one arm under the baby’s shoulders and use your opposite hand to support the baby’s pelvis. Provide gentle rocking by moving your body side to side. Often babies that like movement to settle enjoy this exercise.



These guidelines are just that- guidelines. It is not unusual for an infant to dislike a certain position and prefer another-
Osteopathy for Infants & Children

This is where osteopathy may be able to help. The osteopaths role is to provide very gentle massage and stretching techniques to release areas of tension in the baby's body that may be creating a preference for lying in certain position, turning their head more to one side or using one arm or leg more than, or in a certain way different from the other.

Balanced posture and varied positioning allows for each baby to explore their environment in a balanced way so that the brain maps an accurate position of the body in space, and for the postural muscles become stronger and develop in a balanced way: equal left/right and back/front. This allows for all milestones to be reached in an optimal sequence at an optimal time.

So next time you tuck your baby into sleep or play aeroplanes, rest assured you are also helping your baby’s development!





Waitzman, K.A. 2007. The Importance of Positioning the Near-term Infant for Sleep, Play & Development. Newborn and Infant Nursing Reviews, 7(2): 76-81.

About the Author

Melissa McDougall

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