Since the initiation of the "Back to Sleep Campaign" parents have been advised to place their infants on their backs to sleep. This sleep position has been shown to decrease the incidence of Sudden Infant Death Syndrome (SIDS).

Because of a fear of SIDS, many parents fail to place their infant on their stomach during supervised awake time. Failure to place an infant on their stomach during awake time, along with the prolonged time infants are spending in things like car seats and infant swings, may be resulting in negative consequences, including: delayed development and a flattening of the back of the head.

The delayed gross motor milestones commonly seen in infants sleeping on their backs include holding the head up, crawling and pulling to stand. These gross motor skills all require the use of core muscle strength that an infant develops while playing on their stomach. The delayed development of these important skills may prevent an infant from exploring their environment.

Prolonged positioning on the back may also lead to a flattening of the posterior aspect of the head, often referred to as positional plagiocephaly. This flattening occurs due to an increase in pressure on one area of the head. If positional plagiocephaly is not identified and managed early, an infant may require the use of an orthotic device to correct the head position.

These negative consequences can, however, be prevented by placing infants on their stomach to play. This play time, often referred to as "tummy time", should be supervised. "Tummy time" will provide an infant with the opportunity to strengthen the muscles necessary for skills such as holding the head up and crawling.

Placing an infant on their back to sleep is crucial in the prevention of SIDS. Infants must, however, be placed on their stomach during supervised awake time. This will allow an infant to develop the skills necessary for optimal development.

Kathryn N. Oriel, PT, EdD is an Assistant Professor at the University of Medicine and Dentistry of New Jersey and Rutgers - The Graduate School Camden. Email: orielkn@umdnj.edu