Dear Therapist,

“Our 10-month-old baby is still not rolling over. She is a happy and content baby and whenever we sit her down on the floor, she can stay in that position for long periods of time, playing and cooing. If she wants something, she starts crying and we usually give her whatever she wants. Then, all of a sudden, she just falls over and lands on her head! What should we do?”

Development is a tricky thing. Pure developmentalists have generally believed that each stage of development is necessary in order for the next stage to develop fully. For example, a child must roll over before he/she begins to crawl, or a child must crawl before beginning to walk. Recently, however, in the past 20 or so years, since the passage by the American Academy of Pediatrics of the Back to Sleep Campaign (see our article “To Crawl or Not to Crawl” in The Jewish Link of Bergen County May 7, 2013), there are more children than ever who have delays in their development. Some of these children will require some type of therapeutic intervention. In general, however, there are some strategies that you can implement right now to help your baby progress and develop.

First of all, babies are spending more and more time on their backs. Since motivation to be a part of the world around them is what gets babies moving, there is less motivation because the world comes to the babies who are on their backs. Meaning, that when babies are on their backs, they can easily look around their environments and see all that is around them. Rolling onto their stomachs is complicated and frustrating. We have to give them a reason to want to roll. Also, it is much more difficult to roll from the back than it is to roll from the stomach. Please make sure that your baby spends most of the awake time on his or her stomach. This begins from day one. Not from three months old. Consider that typical development considers rolling front to back starting at three months, you will already be behind if you first begin then. Obviously, for the 10-month-old baby, you don’t have an opportunity to go back in time, so instead, try these ideas:

*Keep your baby on the floor, mat, rug or playpen as much as possible. Use a carseat, baby bouncer or any other baby holder as minimally as you are able.

*Please stop placing your child in a sitting position. Your baby should only sit once she can achieve sitting independently by transitioning into that position. If you feel that you must sit your child up, try a high chair for playtime either before or after meals. Otherwise, if a baby knows that you will place her in a sitting position, there is little motivation to try it on one’s own.

*Your baby should be on her belly during awake time. Obviously if your baby has reflux or is a big spitter, or there are any other medical considerations, this is a situation you should discuss with your pediatrician.

*Place some developmentally appropriate toys around your baby. Not too many, though. And as your baby starts to move around a bit, move the toys a couple of inches away so that your baby has to begin reaching.

*As your baby is already a little bit older and may become frustrated by this new plan, get down on the floor on your belly, face to face with your baby, and play games. This usually helps a baby feel more comfortable positioned on belly. You can also lie on your back and place your baby face down on your chest. This is not as beneficial as actual Tummy Time on the floor; however, it helps transition your baby if she does not like the position.

*It is okay for your child to become a little bit upset when you do not put her in a sitting position. Hopefully, this will motivate her to try and sit by herself. Obviously, you should not allow your child to become excessively upset or frustrated. It is up to each parent to decide how to handle this situation.

If you are diligent about implementing these strategies, your baby should begin to progress within a few weeks. If your child does not make any progress or does not tolerate the Tummy Time position, a few sessions with either an occupational therapist or physical therapist who specializes in pediatrics should get things moving. Your therapist can train you to implement strategies at home. If your baby is not responding quickly, that will be an indication for you that your child might actually require more intervention in order to reach all of the developmental milestones.

By Alyssa Colton and Aviva Lipner