Q&A: How To Reduce Baby’s Hyperextension When Sleeping

How can I position my baby to reduce hyperextension when sleeping? He is 12 months old, has low tone and decreased strength, poor head control, low vision and seizures when sleeping and is unable to crawl or turn over.

I would definitely consult with your child’s physical therapist (I am hoping your son is already in your local early intervention program?) or physician to get the best suggestions for sleep positioning for your son that will meet his medical needs and allow him to sleep more comfortably and easily.

The aim would be to try to position your son in a nighttime position that involves flexion and prevents him from hyper-extending his body during sleep. This can be achieved using positional adaptive equipment. If he is only cleared to sleep on his back, the Versa Form pillow from Sammons Preston is a multi-functional pillow that has been really helpful for many medically fragile children I have worked with in the past. The Versa Form looks like a small mattress or large pillow and comes in several sizes. It is filled with styrene beads and works with a reverse air pump. When a child is placed upon the Versa Form in a certain desired position, the air is removed from the pillow and the pillow molds to the child’s body to hold him in that position. The Versa Form becomes very rigid when the air is removed and it prevents the child from changing to a less desirable position. Here is a link to Versa Form.

There are other pediatric positioners that are also commercially    available, such as the Tadpole Set, in which the different pieces can be arranged in many positions for side-lying, sitting, tummy time, etc. and by using Velcro straps, half rolls and blocks the child can be positioned correctly. If he is medically allowed to sleep in a side-lying position, this may be one way to encourage flexion and prevent the hyper-extension. This is the link for the Tadpole Pediatric Positioning set.  The Tadpole is similar to the Universal Side-lyer set for older children.

Most of this commercial adaptive equipment is very expensive and    requires a letter of medical necessity to obtain through insurance (and sometimes is not covered at all) so often a physical therapist can adapt equipment at home for you to create something similar without the extensive cost by using such things as sand bags covered with cloth cases, firm pieces of foam that are cut and hollowed out to fit your child’s body and Velcro strapping, etc. Any commercial or home made equipment should be used under the direction of your physical therapist or physician so that your son’s medical & especially respiratory needs are met and not compromised during sleep. If you need information on early intervention services in your area please let us know and we can try to locate a program with physical therapy in your area.