Sunday, May 4, 2014

Tummy Time

What is Tummy Time and Why is it important?

Tummy Time is an important activity for your baby’s development and is endorsed by the American Academy of Pediatrics (AAP). Tummy Time is the supervised time your baby spends while awake on it’s abdomen (belly).  Tummy Time helps to strengthen head, neck and upper body muscles, provide sensory input to hands and trunk, helps provide and develop appropriate visual and vestibular input and reactions, and gives baby a different view of the world. 

The vast majority of babies now sleep on their backs, a recommendation of the AAP, to help prevent Sudden Infant Death Syndrome (SIDS).  This movement is commonly known as the Back-to-Sleep campaign, and has had good results reducing the risk of SIDS by 40%.  HOWEVER, because babies are back-sleeping and spending increased time in “containers” – car seats, bouncers, strollers - now, babies are losing vital hours of tummy time and opportunities to develop their neck and trunk muscles – necessary for further skills such as reaching, crawling, rolling.  ALL babies benefit from Tummy Time – even newborns!

Because being prone (on abdomen/belly) is such a crucial position for strengthening the neck, trunk and eye muscles of babies, the impact of limited Tummy Time is becoming evident.  A survey performed by Pathways Awareness confirmed “what early childhood medial professionals have been observing: 2/3 of therapists reported a rise in early motor delays in infants in the past 6 years, and those who saw an increase said that lack of tummy time while awake is the number one contributor to the escalation in cases.”1  Each year more than 400,000 children in the US are at risk for an early motor delay, and the actual incidence is 1 in 40, a 150% increase from 25 years ago, and a rate even higher than incidences of other accelerating conditions like autism.2 

Just a little Tummy Time everyday can help promote appropriate motor development in babies!

Benefits (recap)
- strengthens neck muscles, so baby can hold head up and look around
- strengthens trunk muscles, so baby can develop the muscles for sitting, crawling, walking
- provides sensory input to hands and front of body; baby is able to feel different textures and develop the touch sensation
- provides vestibular and visual input for eye and vision development; baby strengthens eye muscles and sense of space
- helps baby’s head become round instead of developing flat spots on the back of the head (prevents positional plagiocephaly)

When to Start
Tummy time can begin right after birth or definitely by the time your baby is a month old. You may want to delay tummy time until the umbilical cord stump falls off, but as long as your baby is comfortable, baby can safely participate in Tummy Time.
Remember: When you put your baby on her tummy, always place baby on a smooth, flat surface with no loose items (toys, blankets, pillows) which might block the airway.
Babies often complain about being placed on their tummy, but if tummy time is begun early (even from just a few days old) and maintained on a consistent schedule, it will become a part of their daily routine.  Tummy time can improved head control which is needed for the next stages of development.  Tummy time is critical for building muscle strength in the back, neck and shoulders, strength that children also need to meet their developmental milestones.  Simply holding and soothing baby in a different position can help infants become accustomed to tummy time. 

How Frequently and for How Long
There really is no set time for how much time each day baby should do Tummy Time.  Some research says babies should be prone for 1 hour a day (cumulative, not all at one time), but there did not seem to be a consensus on amount of time just that Tummy Time was essential for all babies. 

Here are some guidelines to help get your Tummy Time minutes. 
            - at least once per day
            - try for 5-10 minutes several times a day
            - incorporate some Tummy Time into the time baby is being held
            - as baby grows, build up Tummy Time (this is where you can aim for 1 cumulative hour every day)
Many babies often resist Tummy Time initially.  This could be because baby does not have good control of body and head yet and Tummy Time is a workout.  Just remember, just as it was hard to run that first lap on the track when you first started, practice makes perfect.  Your baby will begin to tolerate Tummy Time – just keep at it!

How to Make Tummy Time Fun
Here are some tips for making Tummy Time more fun (for you and baby
            - When your baby can't support her own head yet, put her on your chest tummy down. Or put her across your lap on her stomach for burping or to settle her down instead of holding up at your shoulder.

              - Enjoy some together time. Lie down and place your baby “tummy-to-tummy” or “tummy-to-chest.”

            - Get on the floor with your baby. Interact with your baby – funny faces, talking, singing.

- Encourage your baby to look up by talking or singing above her head.
              - Place your baby next to a mirror or musical box -- or something else she’ll want to reach for.  
              - Change your position or position of toy/mirror to encourage head turning and looking up
            - Place your baby's upper body and arms over a nursing pillow (Boppy pillow) or rolled up towel.   This positioning may be more comfortable to in the beginning. 

- When carrying your baby around the house, carry her tummy-down instead of upright.

            - If your baby starts to fuss, divert her attention. Turn her on her back, then blow "raspberries" on her tummy. Flip her onto her stomach and make the same raucous noises on her back. That’s distraction at its silly best.
              - Waiting an hour or so after feeding may be more comfortable for baby – preventing less spit up and baby may be  less fussy. 

Nice table from American Occupational Therapy Association3
If you want to:
Consider these activity tips:
Make Tummy Time part of your family’s daily routine.

Begin with short intervals, such as 2 to 3 minutes a day, and work up to at least 20 minutes per day. Daily Tummy Time can be done in short increments or all in one session, depending on your baby’s tolerance and needs.
Pay attention to signs that your baby is getting tired, such as crying or resting his face on the surface, and be sure to end Tummy Time before your baby becomes fatigued.
Incorporate Tummy Time into the activities you’re already doing with your baby, such as towel drying after bath time, changing diapers, or applying lotion.
When burping your baby, try laying her across your lap on her tummy.
It is never too early to begin to read to your baby, and Tummy Time is a great opportunity for storytelling.
Increase your baby’s ability to reach and play

While your baby is playing on his belly, hold a toy in front of his face to get his attention. This will encourage your baby to lift his head and reach. Sit or lie down in front of your baby during Tummy Time for safety and supervision.
During Tummy Time, arrange toys in a circle around your baby to promote reaching in many different directions.
Initiate eye contact and talk, coo, or sing to your baby while she is on her belly, because this will attract your baby’s interest and motivate her to participate.
Your baby will be encouraged to lift her head, reach, and play when she sees your face and hears your voice. Get your whole family involved.
Position your baby to enjoy Tummy Time.

Roll up a thin towel or blanket to make a bolster that will provide extra support during Tummy Time. Place the bolster under your baby’s chest, and position his arms over the roll, with his hands stretching out in front of it. Your baby’s chin should always be positioned in front of the bolster so that the airway is not blocked.
Always supervise your baby during bolstering.
Be sure your baby distributes his weight evenly on both sides of his body while on his tummy to strengthen muscles equally.
Limit the time your baby is constrained in swings, exersaucers, and other baby gear, and encourage active play to strengthen his muscles through Tummy Time.
Engage your baby’s senses.

Place a plastic mirror in front of your baby so she will be interested in lifting her head to look at her own reflection.
Use blankets or towels with different textures and colors so your baby can experience different visual and touch sensations (e.g., switching between a terry-cloth towel and a fleece blanket).
Consider alternatives to “typical” Tummy Time.

Positions for Caregiver:
A great way to carry out Tummy Time is to place your baby on your stomach or chest while you are awake and in a reclined position on a chair, bed, or floor. This is also a great way to begin Tummy Time with a newborn.

Positions for Baby:
Side-lying is another positioning option. Position your baby on a blanket on his side, and support his back with your hand or use a small rolled up blanket. Make sure both of your baby’s arms are in front of him, and slightly bend his hips and knees so your baby is comfortable. This position can also aid in reaching and playing.

Tummy Time Trouble
Tummy Time is hard work!  Not every baby is going to enjoy laying on their stomach.  Remember that even if baby squawks or whines, it does not mean that baby does not like it.
What if your baby is just plain angry about tummy time? KEPP TRYING!!! DON’T GIVE UP!!!  The more exposure and practice the better.  Baby will get stronger and hopefully tolerate the position better in time. 
Try to keep the tips above in mind.  Start in small time segments.  Interact and play with baby during Tummy Time.  If your baby likes routine (most of us do!), try doing Tummy Time every time you change baby – she will come to expect it and may not resist as much. 
If you see that your baby prefers to hold her head to one side, try to do activities (make faces, sounds, talking) to encourage her to turn her head to the opposite side.  If you are unable to change the preference, bring this up with your pediatrician or healthcare professional.   Also, if you have done a lot of Tummy Time and are concerned baby is not meeting her developmental milestones (remember there are averages for when babies meet milestones, but these are not hard and fast rules!), you should feel comfortable letting your pediatrician know!

1.  Pathways Awareness.  National Survey of Pediatric Experts Indicates Increase in Infant Delays; More Tummy Time is Key.  Accessed at:

2.  Statistics compiled by the Pathways Awareness Medical Round Table from a variety of sources, including the March of Dimes, Pediatrics Annual Summary of Vital Statistics, and the Centers for Disease Control and Prevention

Resources for Families
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For more research on Tummy Time see the below articles:

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