HOW BIRTH CAN INFLUENCE YOUR CHILD’S DEVELOPMENT
In 2020 49% of births in Australia have some form of instrumental intervention (caesarean, vacuum or forceps). (1) During these births there are additional forces of between 12.2kg-20kg (2,3,4) placed onto the fragile head and neck of newborns. This stress increases with repeated attempts. Have you ever thought about how this may create potential tension through your baby’s neck? How the pressure of birth natural or assisted might cause irregular movement of the important skull bones? And how this altered skull shape or movement might affect the growing brain?
If we look further back than just the birth experience we see that some babies take up weird and wonderful positions in-utero (brow presentation, breech, shoulder, transverse, posterior) and during labour which may also contribute to tension and restriction through your little ones head and spine.
Brain development through infancy sets the foundation for the rest of our lives. The way that our brain develops is by receiving sensory rich information from our internal environment (proprioception, interoception, vestibular) and external environment (touch, sound, smell, taste, sight). In fact 1.8 million brain connections are formed every second until 2 years of age! So you can understand why it’s important that the information your child’s brain is receiving is balanced and vast from the get go. Proprioception is the information that your brain receives about where your joints are in space, interoception is feedback from the organ systems (hunger, thirst etc.) and the vestibular system coordinates information from our ears, eyes and neck about where our head is in space and contributes to core control and balance.
How your baby's spine and skull bones move can influence how much of this internal information your baby's brain receives and connections that are made which is why many families take their babies to see a Chiropractor soon after birth.
Your joints, muscles and fascia are incredibly dense with receptors which respond to movement, stretch, pressure, vibration and it is this feedback which allows your brain to create a map of your body. If that map is faulty from day 1 it doesn’t come as a surprise that this can start a catalyst for poor coordination and delayed development. In practice we commonly see 3 factors that contribute to poor function in a baby and the potential for delayed milestone achievement.
Restriction in the neck due to position in-utero, birth journey or repeated postures may cause a head preference which may contribute to weakness of the muscles in the head and neck. In fact a small study found that of the 176 children they assessed 78% had reduced neck range of movement regardless of birth method. However those born using instrumentation had higher rates of restriction. (5)
Lift your hands to the side of your face, now wiggle your fingers, with your head straight you should see both equally. Now turn your head to the left, what hand do you see? Imagine if you could only turn your head to the left, your awareness is only stimulated by the left hand and the environment on the left of your body thus creating imbalance in the mind-body map.
If your baby is always looking to the left or right their soft malleable skull can also start to distort to adapt to the sustained pressure on one side. This is seen as flattening of the skull and is called deformational plagiocephaly. 2 systematic reviews of the literature in 2017(6) and 2021 (7) revealed a strong association of plagiocephaly with developmental delay primarily in motor control aka muscle control.
Studies have shown that low muscle tone aka a floppy baby may also contribute to development of plagiocephaly and delayed milestone achievement as well as babies with high muscle tone like torticollis aka wry neck. (5,9) The nerves that control our muscles exit the spine, if the spine is restricted this can cause incorrect messages to go to our muscles affecting their strength and tone. Chiropractor’s look at where these restrictions are and use safe and gentle techniques to release this tension and restore proper movement. This allows babies to function better and it is the innate healing ability of our bubs that begins to unwind and self correct head shape and movement patterns.
Another large scale study showed delay in motor and psychosocial development and mentioned that no child who exhibited plagiocephaly had accelerated development. (8) With an estimated 46% of children exhibiting some form of deformational plagiocephaly at 3 months of age (9) it is important to recognise some of the signs and who to see for assessment and intervention. The bones in a baby's skull stay mobile until around 24 months of age when the fontanelles (soft spot) finally closes, so the best results for improving head shape will occur within the first 6 months of life.
When to have an assessment:
Was there instrumental or surgical intervention in your birth?
Was your labour long?
Did your OB or midwife use their hands to pull baby out?
Does your child only look to 1 side? Have a look at pictures from birth if they are always pictured looking 1 way this may indicate neck restriction
Can you turn your babies head to the left and right or does 1 side not go as far or the baby gets agitated?
Does your baby feed better on 1 side? Or constantly arch their back and pull off the breast?
Are you noticing any flattening of the back of the head on 1 side? Or at the very back?
Does your baby hate tummy time so it’s not something that gets done often?
Was your baby premature?
Who to see:
Consider a paediatric Chiropractor for parents who answered yes to any of the above. These professionals will assess not only spine movement and head shape but will also do age specific assessments for muscle tone, primitive and postural reflexes and milestone achievement. They will also know when it is important to refer, as in rare cases plagiocephaly may be due to early fusion of the skull which needs further investigation. Movement of the skull bones, neck and spine are pivotal in your baby's ability to move and grow. Without good movement any at home exercises may not be as effective. This is why a cranial, spinal and neurological assessment by a paediatric Chiropractor is important. Chiropractors use safe, gentle techniques to care for babies; this means no popping or cracking. In fact the pressure used is no more than what you would use to check the ripeness of a tomato or avocado.
If you are concerned about your baby’s head shape, muscle tone or you answered yes to any of the above questions you can use this paediatric chiropractic database https://icpa4kids.com/find-a-pediatric-chiropractor/ or contact me via demi@wombtowellness. or on instagram @wombtowellness_chiropractic
For those who aren’t sure if Chiropractic is for you but you have concerns about your baby's milestone achievement, muscle tone or head shape, here are some at-home tips to support good function.
EXERCISES
Tummy time. This can be started from birth. Check out instagram for details on different forms of tummy time and how long.
Ball rocking. This stimulates the vestibular system which is important for our core muscles. Remember that low tone may contribute to flattening of the head. Find a video of ball rocking here
Minimise time spent in capsules and prams. If you do have a capsule that clips in and out of the car, opt to use a carrier or sling when transporting babies rather than keeping them strapped in the capsule. Sustained pressure on the back of the head contributes to flattening.
Changing environment. If your baby’s bassinet is always on the left of the bed they will turn to look for you and try to change the position of the baby in their bassinet. Ensure there is balanced stimulation for babies so they are encouraged to turn their head both left and right. If your baby can’t move their neck both ways this needs to be assessed by a Chiropractor or Osteopath.
Vitamin D supplementation. Vitamin D is important for bone strength. Soft bones may distort more easily.
As the twig is bent so grows the tree. Our nervous system is designed to adapt and will do this around imbalances that may be present from birth or before. When a baby’s spine, skull and nervous system have tension this has the potential to impact the development of that baby past infancy and into childhood. All parents want to provide the best environment for their child’s growth and development and seeking the care of a paediatric Chiropractor has the potential to help your child thrive!
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References
Australia's mothers and babies, method of birth (no date) Australian Institute of Health and Welfare. Available at: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-data-visualisations/contents/labour-and-birth/method-of-birth (Accessed: December 10, 2022).
2. Ashton-Miller JA, DeLancey JOL. On the Biomechanics of Vaginal Birth and Common Sequelae. Annu. Rev. Biomed. Eng. 2009;11:163–76. ROM in Infants Fludder Chiropractic Journal of Australia Volume 46, Number 2 171
3. Vacca A. Vacuum-assisted delivery: An analysis of traction force and maternal and neonatal outcomes. Aust N Z J Obstet Gynaecol 2006;46:124–7.
4. Pearse WH. Electronic recording of forceps delivery. The American Journal of Obstetrics and Gynecology 1963;86:43–51.
5. Fludder, C. Keil, B. Instrument-assisted delivery and the prevalence of reduced range of motion in infants. Chiropractic Journal of Australia 2018;46(2)
6. Martiniuk AL, Vujovich-Dunn C, Park M, Yu W, Lucas BR. Plagiocephaly and Developmental Delay: A Systematic Review. J Dev Behav Pediatr. 2017 Jan;38(1):67-78.
7. Rohde, JF. Goyal, NK. Slovin, SR. Hossain, J; Pachter, LM; Di Guglielmo, MD. Association of Positional Plagiocephaly and Developmental Delay Within a Primary Care Network. Journal of Developmental & Behavioral Pediatrics 42(2):p 128-134, February-March 2021
8. Flat head syndrome linked to motor, language and cognitive delays (2017) ScienceDaily. ScienceDaily. Available at: https://www.sciencedaily.com/releases/2017/01/170124111344.htm (Accessed: December 12, 2022).
9. Epidemiology of positional plagiocephaly in children (2023) The ISPN Guide to Pediatric Neurosurgery. Available at: https://ispn.guide/congenital-disorders-of-the-nervous-system-in-children/positional-plagiocephaly-in-children-homepage/epidemiology-of-positional-plagiocephaly-in-children/ (Accessed: January 20, 2023).
