Baby So Stiff She Can't Roll Over
When Do Babies Roll or Crawl?
Most parents track their children's physical milestones, but may not know how much of a delay is too much.
Credit... Subin Yang
This guide was originally published on May 13, 2019 in NYT Parenting.
The first time our first son started crawling, I was trying on shoes at a store, and he found my ratty, discarded sneakers too enticing to ignore. He went for those shoes like a lion after a gazelle, right on schedule — between 6 and 9 months old. Our second son, however, baffled (and amused) us when he began scooting instead of crawling. Our first was average-sized, but our second was extra chubby, so scooting on his buttocks seemed easier for him. He scooted around the house faster than his brother had ever crawled, but we didn't know whether to be impressed with his speedy efficiency or worry that he never got on all fours. His pediatrician didn't seem concerned. One day he just got up and walked.
"While most typical kids crawl, not all do," said Dr. Gary Noritz, M.D., an associate professor of pediatrics at Ohio State University, director of the Comprehensive Cerebral Palsy Program at Nationwide Children's Hospital and lead author of the American Academy of Pediatrics' clinical report on motor delays.
Rolling and crawling both tend to be softer milestones that are less essential to subsequent developmental stages than sitting and walking, Dr, Noritz said.
Read this first.
Historically, babies were expected to be able to roll in both directions — front to back and back to front — around 4 to 5 months. (Dr. Nortiz estimates about 85 to 90 percent roll by 6 months, based on an early gross motor study and the Denver Developmental test, though there's little solid data on the subject.) Expectations changed after the Back to Sleep campaign began in the 1990s. It told parents to put their children to sleep on their backs to reduce sudden infant death syndrome (SIDS), explained Dr. Lisa Asta, M.D., a clinical professor of pediatrics at University of California San Francisco School of Medicine. The campaign worked — SIDS rates dropped by half — but babies now spend much less time on their stomachs, a placement that encourages muscle development when they try to push up and roll over.
"Sometimes there isn't a problem with the child. It's more of a problem with what kind of life experiences they've had," Dr. Asta said. "It's important for parents to give the baby the environment, and positioning for these developmental milestones will come."
Make sure you're doing enough tummy time.
It's easier for babies to roll from their stomachs to their backs first, Dr. Asta said, and doing that just once is often all the motivation a baby needs. "Oftentimes that first roll is completely accidental, and then babies realize, 'Wow, look at this whole world now that I've rolled back,' and then they'll repeat that activity," Dr. Asta said. "But if you're not put on your belly, you're not going to have that experience."
The recommended tummy time is at least 30 to 60 minutes of awake time over a 24-hour period, said Dr. Jennifer Shu, M.D., author of "Heading Home With Your Newborn" and a pediatrician based in Atlanta. "Tummy time can strengthen the muscles they're not using while they're lying on their back and combat flat heads."
Place toys nearby to encourage rolling and crawling.
Parents can also entice their children to roll over or crawl by putting toys just out of reach. "It depends on the personality of the child," Dr. Asta said. "Some of them are like Indiana Jones and some kids are more cautious."
When it comes to supporting your child's development, all you need is a towel or blanket to set your child on and any toys or interesting objects you can use to encourage them to make a move. Some items, such as Bumbo seats or Boppies, give parents an opportunity to cook dinner or do other household tasks while the child remains in one place, but these are conveniences for parents, not tools that aid development, Dr. Shu said.
If you're concerned, take a video for the pediatrician.
If your child is exhibiting awkward or unusual movements, they may not demonstrate them during a well visit. So Dr. Shu recommends that parents attempt to video the movements. (This is what we did when our younger son made strange facial movements that looked like mini-seizures, which were ultimately determined to be reflux after testing revealed no neurological abnormalities.)
If your child does have physical delays, seek early interventions.
Pediatricians should take two actions when a child appears to have delays or atypical muscle tone: send the child to physical or occupational therapy and refer the child to a specialist who can do a diagnostic workup looking for potential disorders.
Worried about the cost of therapy? You might not have to, as many early intervention services are free in every state, regardless of parents' income. Other services may come with a fee, but it's charged on a sliding scale, and no child can be denied services they need simply because a parent cannot afford to pay.
"Sending them to therapy early is important because the brain is plastic the more you start working with a kid," Dr. Noritz said. "There are lots of kids who will be a little behind in these milestones or maybe a little bit floppy, and most of these kids don't have a motor disorder," Dr. Noritz said. "They may be behind, but they'll catch up."
Other, more serious and rarer conditions may have new or emerging treatments — for example, a new drug was recently approved for spinal muscular atrophy. "That's why we have to have an early diagnosis, so they can get to the right places or get into a clinical trial," Dr. Noritz said.
The therapy a child receives will depend on their needs. For example, for children with bilateral cerebral palsy — where only one half of the body is affected — constraint therapy is effective, particularly the earlier it's done. "If they have a good or bad side, you constrain the good side and force them to use the bad side, and it rewires the brain," Dr. Noritz said.
When to Worry
Parents whose children don't roll over by 6 months or crawl by 12 months should watch for other delays — for example, not having head control by 2 to 4 months, not sitting independently by 9 months or not walking by 18 months.
They should let the doctor know about unusual muscle tone, such as babies who feel particularly "tight" or "floppy," Dr. Noritz said. "One of the hallmarks of floppiness is if you feel like you have to hold onto the kid really tight or else they're going to drop through your hands," he said. Floppiness can indicate peripheral nervous system problems, such as muscular dystrophy, and tightness may be a sign of cerebral palsy or a central nervous system disorder.
"If the baby is super stiff and doesn't relax when you're holding them, that can be sign of a problem," said Dr. Shu. "Stiffness or being too rigid can sometimes come across as being too strong, and being really, really strong is not necessarily a good thing if it just means the baby is too rigid and inflexible."
Parents should also watch for twitching, jerking or writhing and snake-like movements — a child who seems to lack control over their limbs even when trying to stay still, Dr. Shu said. Movements that look nonpurposeful, off-kilter or asymmetrical are also worth mentioning to your child's doctor.
Tara Haelle is a health and science journalist and co-author of "The Informed Parent: A Science-Based Resource for Your Child's First Four Years." Follow her @tarahaelle.
Baby So Stiff She Can't Roll Over
Source: https://www.nytimes.com/article/when-do-babies-roll-crawl.html
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