Fwd: Baby Not Crawling? Reason Seems to Be Less Tummy Time

From: Wade T.Smith (wade_smith@harvard.edu)
Date: Sun Apr 29 2001 - 17:11:52 BST

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    At least one still has to learn to walk before one can run....

    - Wade

    ******************

    Baby Not Crawling? Reason Seems to Be Less Tummy Time

    By GINA KOLATA and HOWARD MARKEL

    http://www.nytimes.com/2001/04/29/national/29CRAW.html?pagewanted=print

    When Gary Slaughter turned 6 months old, his mother, Charlene, began
    waiting for him to crawl. After all, that is when the books said that
    babies can be expected to reach this developmental milestone. But nothing
    happened. He did not even roll over.

    Ms. Slaughter, a teacher in Ann Arbor, Mich., was seriously concerned.
    Her pediatrician told her not to worry, but, even though Gary was sitting
    up when he turned 7 months old on April 15, he still is not crawling and
    seems perfectly content to lie on his back. When Ms. Slaughter tried to
    nudge Gary along by putting him on his stomach, he protested. "He cries
    and he doesn't like it," she said.

    It is, many pediatricians said, a common situation. They are noticing
    more and more babies who are not lifting their heads when they used to,
    who are not turning over and who are not crawling at 6 to 8 months, when
    popular baby books say they should.

    Developmental specialists say they think they know why babies are acting
    this way: it is an entirely benign, but unexpected and unintended,
    consequence of a public health campaign to teach parents to put babies to
    sleep on their backs to prevent sudden infant death syndrome.

    An increasing number of babies never crawl at all, pediatricians say,
    going directly from sitting to toddling. And they are seeing more parents
    like Ms. Slaughter, who are worried that something is wrong.

    Researchers say they have evidence from two studies, one in the United
    States and one in England, that the doctors' impressions reflect a real
    change in infant development.

    The studies' researchers emphasize that there seems to be no medical
    consequence to this developmental change. The babies are normal in every
    other way, and they sit up and walk at the same time they always did.
    That, however, can be a subtlety that eludes many parents and some
    doctors who know nothing of the studies, both published in 1998 in the
    journal Pediatrics.

    "Language skills are far better markers of developmental delay in
    babies," said Dr. Beth Ellen Davis, a developmental pediatrician at the
    Madigan Army Medical Center in Tacoma, Wash., who led the American study.
    "But, like it or not, many parents are focused on these physical
    milestones when they roll over, when they crawl, when they walk."

    Dr. Catherine D. DeAngelis, who is editor of The Journal of the American
    Medical Association and a professor of pediatrics at the Johns Hopkins
    University School of Medicine, said she worried that doctors were not
    getting out the message to parents that crawling is not much of a
    milestone.

    "Who says you have to crawl before you walk?" Dr. DeAngelis said. "We
    need to reassure parents that this is all within the range of normal
    infant development and that their child is not suffering from any serious
    problem. Otherwise, we set up people for a condition called vulnerable
    child syndrome where, because of a real or perceived illness, parents
    treat their kids with kid gloves, so to speak, and problems really do
    start to appear."

    The campaign urging parents to put babies on their backs to sleep, known
    as Back to Sleep, began in this country in 1994, when the American
    Academy of Pediatrics and the United States Public Health Service became
    convinced that although they did not know the cause of sudden infant
    death syndrome, epidemiological evidence indicated that this sleeping
    position could help prevent it. For decades, doctors advised parents to
    put babies on their stomachs to sleep, fearing they could choke if they
    were on their backs. But, nervously at first, they began changing their
    recommendation.

    The result, the pediatrics academy reports, is that the percentage of
    American babies sleeping on their backs has increased to more than 70
    percent today from 20 percent before the campaign. And the incidence of
    sudden infant death syndrome has decreased by more than 40 percent.

    Babies, it has turned out, liked being on their backs so much that they
    appeared to have no incentive to turn over onto their stomachs.

    "If you're lying on your tummy and you want to see the world, you have to
    flip over," said Dr. Ellen Perrin, a developmental and behavioral
    pediatrician at Tufts University School of Medicine and the Floating
    Hospital for Children at the New England Medical Center. "If you're on
    your back, there's no reason to flip onto your tummy."

    But then they might not discover how to crawl, Dr. Perrin said. "It's
    totally consistent with what we know about how babies learn during
    infancy," she added.

    "The way babies used to learn to crawl was they figured out that if they
    squirmed, they propelled themselves," Dr. Perrin said. "But it just takes
    a lot more understanding than a 5- or 6-month-old infant has to say,
    `Gee, if I'm on my back I can see more, but to move around I have to be
    on my tummy.' "

    The best evidence that these developmental changes happened came from
    Britain, where researchers realized they had a perfect opportunity to ask
    whether putting babies on their backs affected the time at which they
    turned over and crawled.

    A long-term study of child development, intended to follow nearly 15,000
    infants from birth until adulthood, began in 1990, just as Britain began
    its Back to Sleep campaign.

    Dr. Peter Fleming of the University of Bristol, a director of the British
    study, said that at first doctors and parents were wary about the new
    advice, and many doctors suggested that the babies lie on their sides.
    But gradually, as their fears were allayed and data accumulated tying
    sudden infant death syndrome to sleeping on the stomach, virtually all
    doctors began urging parents to keep their babies on their backs.

    The British study tracked this change. In the early 1990's, when most
    babies slept on their stomachs, they turned over and crawled when the
    books said they should. Within the last five years, as parents uniformly
    began putting babies on their backs, more and more babies did not roll
    over or crawl on schedule, and increasing numbers never crawled.

    But, Dr. Fleming said, the babies were normal by every other measure. "In
    medicine, whenever you introduce something new, you worry that it might
    cause problems," he said. But, he added, that did not happen. "When the
    cohort was 18 months old we looked again at developmental milestones and
    there was absolutely no difference in these children's development," Dr.
    Fleming said.

    In the United States, Dr. Davis's study of 351 babies in Washington and
    its suburbs found the same thing. The babies who slept on their backs
    started crawling, on average, at about 9 months, and about a third of
    them never crawled. But the back- sleepers and the stomach-sleepers
    started walking at the same age on average when they were about a year
    old.

    For parents who pore over baby books, these delays can be frightening.

    Dr. Leon Eisenberg, a child psychiatrist at Harvard Medical School, said
    one mother was so worried that her baby was not crawling at 9 months that
    she insisted on taking the baby to a physical therapist.

    But it is hard to blame parents, said Dr. Elizabeth Triggs, a
    pediatrician in private practice in Nashville. "There are some books that
    say babies have to develop in a certain order or they will be warped,"
    Dr. Triggs said. "They say that if you don't crawl before you walk you
    will not develop certain tracks in your brain."

    Dr. Michael Lyons, a pediatrician in private practice in Leominster,
    Mass., said he tried to explain to parents that they should not worry if
    their baby did not crawl.

    "I say, `Don't even look for that as a milestone anymore,' " Dr. Lyons
    said. For those who are not reassured, he suggests putting the baby on
    its stomach during the day, while they play with the baby. "We say to
    parents, `Have some belly time and stimulate the babies to be happy on
    their bellies.' I'm not sure it makes a difference in terms of crawling
    ability, but it makes a difference for the parents."

    Ms. Slaughter, for one, said that she had finally learned to relax about
    the crawling issue.

    "The best advice I got was from my mother, who told me to put all the
    baby books down and simply listen to Gary," she said. " `When he crawls,
    he crawls,' she told me."

    Copyright 2001 The New York Times Company

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