Belly up

She may not, in the end, have proved the saviour of daytime television, but Anne Diamond can console herself that her influence has been significant all the same. It is now more than a decade since the presenter became involved in a campaign to educate parents in a simple but incredibly important piece of advice. Babies should sleep on their backs, not their bellies, the campaign said, to cut the risk of cot death (Diamond's four-month-old baby Sebastian died suddenly in his sleep in 1991).

It ran contrary to the parenting advice given to the previous generation, but the results of the campaign were remarkable: within a year the incidence of cot death or Sudden Infant Death Syndrome (Sids) had halved. In 1991 around 2,000 babies a year died suddenly in their beds. Ten years later the figure was 371.

But is it possible that in protecting our babies from cot death we have risked their development in other ways? Reports at the weekend suggested that putting babies to sleep on their backs has raised a generation of infants who risk never learning, or learning only very belatedly, how to crawl. Because they are rarely placed on their tummies, the argument goes, babies don't learn to push themselves up with their arms, thus hampering the development of their upper body strength and dexterity. There was even a suggestion that the "Back to Sleep" generation would struggle with their handwriting and motor skills when at school if urgent corrective action - placing them on their tummies - was not taken.

The solution, in the fast-moving world of competitive parenting, has come to be known as "tummy time", a prescribed period of play each day in which the baby gets used to lying on its belly. In the US, where the activity is a much more familiar parenting concept than on this side of the Atlantic, tummy time has, perhaps inevitably, provided a marketing opportunity, allowing toy manufacturers to trumpet the virtues of products such as raised playmats which supposedly encourage the baby to push upwards, and also claim to protect against the risk of the rather terrifying-sounding "flat head syndrome", which they claim is an associated risk.

So should parents be worried? And if so, why haven't we heard more about tummy time on this side of the Atlantic? Devala Dookun, head of physiotherapy at Great Ormond Street children's hospital in London, concedes that there has not been as much information on the virtues of tummy play as there might have been. In her view, the "Back to Sleep" dogma has had a significant impact on many children's rates of development.

"We support the campaign, since there seems to be clear evidence that it has reduced Sids. But what has happened is that parents have taken it as meaning that babies should never be on their fronts. We do see a lot of children with very poor 'prone development', which is the ability to push up on their arms, hands and knees - all the things to do with crawling."

But isn't it normal for children to develop at different rates? "I'm reluctant to say it delays you by X weeks or by Y months because you could never quantify when a particular child would be ready to crawl or push up in the first place," she says. "But as paediatric physiotherapists we do feel that it is having a detrimental effect in the short term." Infants who don't learn to "weight bear" on their arms when learning early prone development may struggle with handwriting, she suggests, when they stabilise themselves with one arm while learning to scribble with the other.

Which is not to suggest that big-bellied, weak-necked babies will much enjoy being beached with their nose in a carpet, unable at first to push themselves up or to roll over. Ali Fell's son Rory screamed non-stop when she first put him on his tummy at two-and-a-half months, she says. No one had told her officially that tummy play was good for his development, though her mother had suggested it might help with his colic.

"A lot of that stuff is just people chatting, you just pick it up," she says. "But it was just awful, he was like some wounded animal, it would break your heart. He hated it at first, and got really distressed, so I would only put him down for a couple of minutes at a time. And then one day, he just stopped, and pushed himself up. He realised he could do it."

Rory is now one, and has been walking for two whole days, so his crawling days will soon be behind him. But coaxing a reluctant baby to play on its belly is not the only way to encourage muscle development, according to childcare author Deborah Jackson, who says that even carrying a baby around in a sling will exercise its muscles, urging the baby to try to cling on, in vestigial traces of the climbing impulses of baby monkeys.

"We do put babies in the middle of a room like handbags at a disco, and not ask them to do very much except sit there. Either let them have opportunities every day to play on their tummies, if they are ready for it, or put them on your back and get on with your life. We may be getting a little too over-anxious here."

So in the long term, does it really matter? Dookun stresses that while flat head syndrome, in which the soft bones at the back of the head flatten under the pressure of the baby's head, can occur when a baby spends too much time on its back, it is only really a risk for babies who are never removed from their cots or who have a specific muscle-wasting syndrome. Similarly, she acknowledges that children are perfectly able to catch up with their peers if their prone development has been hampered through lack of tummy play.

"Of course you can learn those skills and pick up that strength later. But it might be the equivalent of a child who picks up a second language from their parents, rather than trying to learn it at a later stage. It's a great shame not to develop these skills at the time they were meant to be picked up. Because it is inevitably that little bit more difficult later on."

Bedtime and tummy time

· Always place babies on their backs to sleep. Even putting them to sleep on their sides is less safe as they can roll onto their tummies.

· Place the baby in the cot in the "feet to foot" position, with their feet at the foot of the bed, so they can't wriggle down under the bedclothes.

· Tuck bedclothes in tightly and do not bring them higher than the baby's shoulders.

· Babies' bedrooms should be between 16 and 20 C.

· Use blankets rather than duvets or quilts for babies under a year old. In warm weather babies may not need covers at all. Never use electric blankets or hot water bottles.

· Encourage babies to play regularly on their tummies, even if they don't like it at first. Try placing a rolled up towel under their chests, or putting them on your chest as you lie on the floor.

· Babies should always be closely watched when they are on their bellies. Don't leave them alone or let them fall asleep.

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