Importance of free movements in  development - supine position -  playpen usefulness 


The debate  between those who keep babies supine and those who advised to have  them  sleep  prone is all but closed.  That  sudden deaths of infancy occur much more frequently  when babies sleep on their stomach is established beyond doubt. The supine position does not increase the risk of bronchial aspirations (milk entering bronchial tubes from the stomach), quite the contrary. And it is worth mentioning that no traditional society puts babies on their stomach. 

Some parents underrate this danger. They put babies  to bed prone  because they believe that the child sleeps more soundly  in that position, or fear that he won't be able  to sleep supine as well or at all.  This idea ignores  that during sleep,  babies go through quite  hypotonic phases. In a prone position their muscle relaxation may impair breathing,  causing a  rise of  blood carbon dioxide (CO2) resulting in lethargy (carbonarcosis) and low  blood oxygen (hypoxia). Sleep is indeed  deeper, but abnormal, and  it cannot  be said that the child sleeps "better". This  CO2 accumulation with hypoxia may be the mechanism of most  sudden deaths of infancy.  

However,  it is possible to argue that, in some  abnormal situations, the prone position may be transiently beneficial, under close supervision and monitoring.  This may be true  when bronchial tubes are filled with secretions, including shortly after birth. In such situations, bronchial postural drainage is more efficient in a supine position.  It also seems that spitting up and  some gastro-esophageal refluxes may decrease when the child is prone.

But it is essential to stress that those benefits are   marginal, transient, and  of little  significance when compared to the  risk of sudden death  during the  first  year of life, a very  rare accident  when the baby rests upon his back. 

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During the first few months of life, the prone position  impairs and decreases  motility through significant  movement restrictions.  This creates an unnatural  immobilization. During the day, it  also impairs the visual exploration of  surroundings, and decreases eye contacts with  close relatives, including primarily the mother.  

In average, the child  raised  prone sits and walks a little earlier, but this precocity  is an illusion  to a large extent. Its price is a loss of developmental quality linked to poorer  early experiences : a motor impoverishment, perhaps also mental and relational.   In any case, global coordination, gestures harmony and precision are better  in children left on their back and free of their movements.

A baby placed on his back develops  eye-hand coordination in  three dimensions. Very early he starts playing with hands and feet.   Supine, a baby sees only one hand  and  can  perform movement coordination only in the bed's  plane.  The "parachute"  reflex which throws hands forward when balance is lost is often defective in children raised on their stomach who tend  to throw hands along their body,  backwards and fall more easily on their face. 

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Children raised prone often present some eyelid edema since the eye is crushed against the bed. Always kept on its side, the head is flattened, and narrows the  face.  Lower limbs deformities are  commonly observed with internal rotation (sometimes external) of legs. When they stand up,  the foot  leans too much on  its medial part.  

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As a conclusion, in order to leave the child as free as possible in his movements  and more generally to  respect his surges (including  emotional ones), the supine position is certainly better during the first six months of life. 

For the same reasons, and from the first few months on, it is necessary to take the child out of bed  when he is awake,   providing him with enough room to move, roll over, crawl, and with  objects to reach and grasp.  

And for  the same purpose,  the traditional playpen, sometimes scorned by those who claim to oppose the child's confinement (an idea unlikely to come to an infant's mind !)  is a precious educational tool, to be started  at  about  six months or even earlier.  It introduces the notion of limits, as restraint, protection, guide and support. Its  bars will provide handles  for  the child's  attempts to rise and stand up.  It offers a  secure space,  the child's personal domain. It  gives substance to the room and  consideration  he can  expect from others and the adult world, helping to loosen the close relationship with the mother (normal in early infancy, potentially choking when too tight, too long). And the playpen is  also a first step toward the awareness of  privacy and property.  







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