Side-Lying Soapbox

Side-lying Positioning

As a physical therapist with three decades of experience, I’ve seen an increase in the number of problems with development that might be avoided with more emphasis on positioning a baby in side lying.

This position is important for a myriad of reasons.

–First of all it helps shape the head and may avoid helmet use later.

–Second, this position gives your child a way to stabilize and look at a toy when placed between her hands.

–Another reason this position is wonderful is that it helps your child bring a toy into her visual field, even when she may have very little use of her arms.

–Maybe the child will pull the toy or rattle to her mouth to begin exploring, which is another wonderful activity and important for feeding and speech development.

–This position also brings your child’s hands together at midline. This is the magical place where good things happen in the brain. The two sides of the brain can begin to talk to each other and help your child understand the world much better as well as learn to use her hands together to accomplish a task.


If your child uses one arm more than the other (NEVER OKAY BEFORE AGE 4), you can position her with her favorite arm on the bottom and tucked in where she cannot “cheat” and allow her to use the less favorite arm that is on top.

Your child may resist this position, but she must be taught how to stay in this position and learn to play here, even if only for a short time period. Use a toy to bat at or reach for OR put a soft toy or rattle between her hands.

A few therapy tricks:

–Try side lying (always supervised) on a couch where you can tuck her into the soft cushions and sit beside her and talk to her so she can see your face. Never leave a child unattended like this. By using this position and alternating the sides that you let your child lay on, you will be able to help your child develop more effectively. By bringing her hips up slightly you can reduce some of the extensor thrusting that a lot of children have.**

—Roll your child from her back to her side gently. If she resists, you can try laying her on a blanket and helping her roll. She needs to feel safe and happy with this.

—Try 1/4 and 3/4 positioning. This is just like it sounds. You put a small towel roll under one side so that she is only about 1/4 way over OR you can take her almost to her belly but not all the way. Sometimes, a child will not resist this as much. Make sure her face is clear so she can breathe.

—Lay down beside her on the floor and gently roll her toward you. She might even reach for your face!

In Summary

These are only a few simple ideas, but the point is that side lying is VERY important and should be used until a child is smoothly rolling tummy to back to tummy. This is another position to use during the day besides putting her on her back.

**If your child thrusts a lot into extension, she really needs to be checked for this. It could indicate that she is just overusing extension patterns which can be broken with therapy or it could indicate some underlying stomach problems (such as silent or not so silent reflux and trying to stretch out to keep from burning). Just because she doesn’t spit up does not mean that she’s not refluxing.

Other reasons for this could be neurological and all of these things need to be checked and evaluated to make sure that she is going to develop correctly and that she doen’t have a medical problem that needs attention.

A pet peeve of mine is that abnormal movement is not cute. In fact, it can lead to major problems for that child later in life. When you see something that doesn’t look like other children, it needs to be evaluated and addressed. Abnormal movement in early development can be redirected and changed to normalize the movements, but as that pattern stays in place, the motor plan for that is more difficult to break and will be much more difficult for your child to ever learn to move normally. No matter how old the child is, if they have abnormal movement patterns, as a physical therapist, I would want to see them and help them.

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