Diastasis Recti in Babies: What It Is and How It May Affects Development

Diastasis recti is a condition commonly associated with postpartum women, but it can also occur in newborns and infants. While it often resolves naturally in babies, understanding its effects on development and ways to support core strength will go a long way in setting a strong foundation for complex movement and overall function later in life.  I have learned this from personal experience, and here are the things I wish I knew right from the start!

What is Diastasis Recti?

Diastasis recti occurs when the rectus abdominis muscles (the "six-pack" muscles) separate due to a weakening/lengthening of the connective tissue (linea alba) between them.  The linea alba is supposed to be like an anchor for the core muscles. In babies, this separation is often visible as a soft bulge down the middle of the belly, particularly when they cry or lift their head up towards their chest.

Diastasis recti is common in typical newborns, and more prevalent in premature infants, infants with low muscle tone and/or hypermobility. In most cases, this separation is temporary and resolves as the baby grows, moves and gains muscle strength.

However, in some infants, it can take longer to resolve and contribute to:

1. Weakened Core Strength: The abdominal muscles stabilize the trunk and if its anchor is weak then the deep core muscles remain weak or poorly engaged. This can impact balance and coordination, sense of well being, as well as breathing and integration of primitive reflexes.
2. Mild Delay in Milestones: Some babies with pronounced diastasis recti may take longer to develop strong core stability, which is necessary for rolling, crawling and sitting.
3. Exaggerated Abdominal Protrusion (Buddha Belly): A persistent separation can cause the belly to stick out more than usual, which makes it more difficult to recruit abdominal muscles. 
4. Constipation: if the belly muscles distends easily, this decreases the intra-abdominal pressure needed to empty the bowels.  This can also delay potty-training.  
5. Umbilical Hernia Association: In some cases, diastasis recti is accompanied by an umbilical hernia, though most hernias in babies resolve on their own. 

Babies with diastasis recti may adjust their movement patterns to compensate for core weakness. Some common compensatory strategies include:

• Using More Upper Body and Breath Holding: Instead of engaging their core, babies may rely on their arms and shoulders to push up during tummy time and while transitioning between positions.  Another compensation is to breathe in and hold their breaths during any movement. 
• Increased Arching of the Back: Some babies may excessively extend their backs when crying.  They will also extend their back instead of activating their abdominal muscles when attempting to roll or in an upright position when starting to walk.  Others will slouch and be unable to sit upright.
• Favoring One Side: Babies may roll or pivot using one side of their body more than the other.  Usually it is whichever side was already tight due to the position of the baby in the womb.  
• Delayed or Modified Crawling: Some babies may opt for bum scooting rather than a traditional hands-and-knees crawl. Others will opt for a three-legged crawl, with both hands and one knee and one foot on the floor. This is due to the movement patterns adopted early on to compensate for the diastasis recti.  The body will adapt due to its “history of use” which affects the whole fascia chain and complex movement later on. 
• Prolonged W-Sitting: To compensate for reduced core strength, some toddlers may prefer sitting in a W position for stability because their core muscles are too weak to have them sit up for a prolonged period of time.  

How to Support Babies with Diastasis Recti

Encourage natural core strengthening through movement and play:

• Tummy Time: Regular tummy time helps strengthen the core and promote better alignment of the abdominal muscles.  Babies with diastasis recti often resist tummy time, so you might need to start small and short periods of time. 
• Provide floor time play in various positions: Provide opportunities for side-lying play, as well as on their backs and their stomach.  This will help strengthen the core muscles.
• Encouraging Rolling and Crawling: These movements naturally engage the deep core muscles and support midline development.
• Minimize asymmetry: bring your child to a pediatric physiotherapist or massage therapist to help resolve any fascia restrictions in the trunk and body.
• Assist with trunk alignment: Guided movements (guided by a pediatric physiotherapist) to assist with alignment of the ribcage and trunk will help with core muscle activation.
• Monitor Gross Motor Progress: If diastasis recti persists significantly beyond the first year or is accompanied by other developmental concerns, a pediatric physiotherapist should evaluate the baby.

While most cases of diastasis recti in babies resolve on their own, parents should consider consulting a pediatric physiotherapist or doctor if:

• The baby has difficulty reaching gross motor milestones like rolling, crawling and sitting.
• There are signs of an umbilical hernia that does not appear to be improving.
• Concerns arise regarding overall muscle tone or motor delays.
• The abdominal separation remains wide beyond 12-18 months.

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