Articles
Baby Handling, Morphological Changes & Impact
By Poh Ying Bin, Rehabilitation Specialist & Personal Trainer
Being a young father and one that’s pretty ahead of the curve, I’ve never realised how small little things could greatly impact the child’s physical, emotional and mental development. And now that I know a lot more about developmental kinesiology together with the fact that I’m seeing marriage proposals, weddings and baby shower of my friends on my facebook newsfeed almost on a weekly basis, I thought I should share this to help parents and parents-to-be give their kids the best gift they can ever give – a good healthy body, heart and soul.

My wife remarks at how unusually my son walks. As someone who works with movement and rehabilitation, it bothers me greatly. How did it come about? And how do you even get a toddler to follow complex instructions on movement to help change that without compensation? And what are the implications of what I’m seeing?

Then Dynamic Neuromuscular Stabilization (DNS) came into the picture.
CNS, Function & Structural Development
From newborn till adolescent, the child is constantly learning, experimenting and perfecting various movement patterns. The playtime they have is literally lesson time and through that, a healthy baby will see a good development of various movement capabilities as their central nervous system (CNS) starts to mature. From sagittal stabilisation in the third month, to oblique sitting in the eight month and standing up and gait in the 12th to 16th month, this development of function continuously affects structural development to produce much of the morphological variations we see nowadays. Morphology is the study of form and structure of organisms.
To put it simply, CNS affects muscle function, which determines the development of the bone and joint.
From caput-collum-diphyseal (CCD) angle to femoral neck anteversion (both being in the neck region), the ability to progressively weight bear in different positions influences muscle fiber pull and therefore osteoblastic (related to bone-forming) and osteolytic (related to dissolution of the bone) activities that dictates skeletal maturation. The very essence of Davies’ & Wolff’s Law –Mechanotransduction- can be said to have one of the greatest influence on the child’s following years as their motor patterning influences and shape the structural foundation that they move off of.
In the words of Professor Pavel Kolar, the developer of DNS and a renowned physiotherapist from the Czech Republic: “The quality of development (& verticalization) during the first year of life strongly influences the quality of body posture for the rest of a person’s life.”
Morphological Changes & Impact
Much more than genetics, the lack of ideal motor patterning can possibly be one of the many cause of structural issues like bunion, flat foot, knocked knees, kyphotic spinal column.

Aesthetics aside, these structural changes will overload the joints and soft tissue to expose the child to higher risk of injury and chronic musculoskeletal issues. On top of that, the physical and sports performance will suffer as these decentrated joints (from structural deviations) will afford the body with less potential for balanced force production and good foundation of movement too.

Apart from the emotional repercussions of looking different from the other kids, chronic injuries and the exclusion of participation in activities and possible social groups in those activities now further predispose the child to emotional distress which in any parent’s point of view is an unnecessary suffering.

One common example will be excessive femoral neck anteversion resulted from lack of balanced co-activation of the lumbar and hip musculature. This structural variation now allows excessive hip internal rotation and decreases the potential for hip musculature (especially the gluteus) in balanced co-activation thus exposing the child to potential lumbar spine, hip, knee and ankle issues.
Baby Handling Affecting Development?
Wait a minute, according to the above understanding, if the CNS is healthy (which is the case in majority of the babies) there will not be so much potential structural deviations and issues right? The answer is sadly no. Technically it makes sense but practically, due to human intervention, the CNS is not given the optimal platform to groove good motor patterning and therefore the morphological changes that follow.
A good instance will be passively sitting the baby upright always when they are not ready for it. When they are so used to being passively put into that position, it sets them up to skip the developmental stage of oblique sit in the seventh to eighth month as they don’t need to try to get up from lying down and now be able to take in more of the world relative to when they are still lying down. All the baby has to do to sit up is to fuss and the caregiver will prop the baby up.

Have you seen babies moving around on their bottom, hardly going through the crawling stage, and progressing to walking? Imagine what their posture be like after they grow up.
With oblique sitting being a crucial transitional position to learning quadruple- an important contralateral pattern (the coordinated movement of the opposite sides of they body) that forms the foundation for good walking gait - the child misses the chance to progressively load the hips, shoulders and lumbo-pelvic-hip complex, further depriving the CNS of chance to fully master motor patterns through those segment. Needless to say, the resulting overload of ligaments and joints from these passive positions will cause abnormal skeletal development as their muscular activities aren’t fully developed to maintain those passive positions.
Baby Handling Ideas
So how should a baby be handled? The general rule is to only change the position of the baby to positions he can obtain by himself. Other than tummy time before the baby can roll over into prone from supine, artificial positioning/ support like passive sit, baby walkers and jumpers, teaching a baby to walk via holding are not suggested. If there is a real need to sit the baby passively like in baby car seat, the best option will be 45-degree inclination for as short a duration as possible.

When carrying infants, the back should be upright to prevent spinal and head hyperextension. Prior to six months old, it is imperative to give as much support to the baby as possible to prevent dysfunctional development. Various methods like slight head nod via hand behind head and along the spine will help encourage deep neck flexor development and lessen chances of cervical spine issues in the future. When holding baby in prone, support via arm from one side chest to contralateral shin with hand encouraging hip and knee flexion to reduce anterior tilt.

It is also advisable to change position frequently to stimulate not only motor (control movement) and sensory system (provides CNS information and sensitivity), but also the vestibular system (sense of body position in space).

Also there’s a need to stimulate active postures on top of passive postures. Presenting stimulus to encourage baby to move into not as frequently used position can be a good choice too. If there is strong preference and usage of a side, it will be good to present stimulus (caregiver, toy or anything that piques the baby’s interest) on the other side as the dispreference of a certain side or movement pattern will see the baby developing through that movement less too. The toy placement as well can play a role in affecting function as too high a placement will see excessive trunk and arm extension. Thus the significance of suitable placement of stimulus in encouraging good movement patterns.

Lastly, in moving the baby for daily activities, it will be good to do it in accordance with the natural movement of the baby. When changing diapers, instead of pulling the legs up to lift the hips off to pull out the diapers (though it’s easier and faster to do it that way), turning the baby to a side-lying position to remove and tug the diaper underneath the baby will be good to start reinforcing the transition from supine to side lying/ prone (a vital patterning in the initial development stage).
Building Champions
All in all, who would not want their child to be happy and do well in life? I will feel that in parenthood, it’s most important to first learn how to handle that child rather than just planning the financial future, education and so on and so forth.
As much as athletes are born, they are also made starting from the moment they are born. Now that my son is two and a half years old, I may be a little late to build the world-class climber (he’s very timid too so climbing might be out of the question) but you who are going to have a baby can make that difference for your kids!
I can only bank all my hopes on my ever so daring and agile one-year-old daughter (because we didn’t gave her a lot of artificial support and had her a lot of floor time) to do well in climbing, though only if she wishes to.