By Dr. Cheryl S. Reid, M.D.
FAAP Member.
Medical Advisory Board, LPA, Inc.

A number of families have asked for some general guidelines about the physical handling of newborn and young infants with achondroplasia. Hopefully, this brief article will address some of the most common questions.

Introduction: Infants with achondroplasia are different from average-sized babies in their relatively large heads, their shorter limbs and their loose joints. One special concern is with the looseness of the control of the neck. There are three major considerations in the neck. First, the young infant has a smaller chest, which works less efficiently in breathing: a bent over position increases the difficulty in expansion of the chest and may lead to difficulty breathing. Second, the windpipe in the neck is softer and more compressible in the young infant: bending the neck with the chin toward the chest may narrow the windpipe and cause breathing problems. Finally, the opening in the skull base and neck bones which contain the spinal cord are tighter than average and may not tolerate too much bending in any direction. In addition to the neck, the backbone joints are looser than average: the back has a tendency to curve out in infants with achondroplasia. If no undue stresses on the back occur, it will tend to straighten as the child walks. However, too much bending for long periods of time may work against the tendency for back correction. It should also be noted that the combination of a larger head, shorter limbs and loose joints causes mechanical disadvantage for the young infant with achondroplasia. We therefore expect these infants in general to sit and walk later than average infants.

General Guidelines:

1. Avoid devices that bend the back: this includes: Snugli and other soft infant carriers, infant swings (such as the Swing-O-Matic), umbrella strollers and other soft devices.

2. Use hard backed carriages, strollers and supportive devices.

3. Support the baby's head and back of the neck at all times.

4. Avoid trying to get the baby to sit until he or she does it without help. No supported sitting for about the first year.

5. Avoid infant walkers and Johnny Jump-up type devices: they force head support before the baby is ready and may also cause neck injury.

6. Pad the infant car seat around the baby's head to support it and prevent the chin-on-the-chest position.

7. Leave the baby on his or her backs or stomach most of the time.

8. Ask for help from physicians knowledgeable about Little People and look at the articles in LPA Today: more details are available in many recent articles.