Since the National Institute of Health initiated their “Back to Sleep” campaign in 1994, parents have become more educated about the dangers of putting babies to sleep on their bellies. The overall rate of SIDS (Sudden Infant Death Syndrome) has decreased over 50 percent, due largely to this change in sleep position. However, some parents falsely assume that this warning against belly sleeping also applies to the waking hours. Spending time on his or her belly (aka “tummy time”) is an important part of an infant’s motor and cognitive development. While a child is awake, it’s important to spend some part of the day on her/his belly. This not only gives your baby a different view of the world, but it also encourages her/him to lift the head (which is vital for strengthening the muscles of the neck and upper back). Your baby needs those muscles later on for rolling over, sitting, and crawling.
So, what exactly is “Tummy Time” and how do you do it? Here are a few answers:
WHY?: Children who are not exposed to a sufficient amount of tummy time (in addition to developing an aversion to this position) can also show a delay in holding up and turning the head. If avoidance of tummy time continues, the child often will not develop adequate shoulder stability needed for crawling and good hand strength needed for fine motor development. As an Occupational Therapist working with preschool through school-aged kids, I often hear that the child that I am now treating for upper body and hand weakness, delayed fine motor and visual-motor skills, and poor oculomotor control, also hated being on their stomach and did not crawl as a child.
WHAT?: Tummy time is any time during the day where you are engaging your child while she is getting input on the front of her body, namely the belly and chest, and attempting to lift and/or turn her head. This can be as simple as having her laying chest to chest with you (where the amount she has to lift her head to look at your face is minimal)…or it can be as challenging as having her lay face down on a mat on the floor, while you encourage her to lift up her head to the sound of a bell or rattle, or look at your face or a mirror. As your child gets older and gains head control, tummy time should continue. The typical motor progression would begin with a child lifting her head in midline, then lifting and turning, then propping herself on her elbows, then holding herself up on extended arms, then reaching with one arm, and finally assuming the “all fours” position for crawling. As you can see, something as simple as time on her tummy is a building block for many important motor milestones.
WHEN?: Tummy time can start immediately for newborns (although some parents prefer to wait until the umbilical cord stump has fallen off). The sooner you start tummy time, the more normal it is for your little one. Some babies may have strong opinions about being placed on their stomachs; after all, tummy time is hard work! In general, it is best to wait at least an hour after feeding, to avoid any spit-ups. Pediatricians and therapists vary on their responses to “how much” is adequate tummy time. Some say 30 minutes a day should be done, broken into shorter segments that the child can tolerate. As a parent myself, I think it’s difficult to work in this much time for a newborn. More conservatively, I would recommend doing tummy time at least twice a day, for as long as your child will tolerate. For some kids, this may be only 30 seconds at first; for others it could be 5-10 minutes or longer.
HOW?: Here are a few suggestions about how to incorporate this important activity into your child’s daily routine.
- If baby is still very young and can’t yet support his or her own head, put baby on your chest for a comfy tummy time cuddle and a lullaby before nap or bed.
- Lay your child across your lap for burping, a good way to get baby used to being on his stomach.
- Get down on the floor with your baby, face-to-face. You can make faces, talk to them, and hold toys or a rattle in front of them.
- If you feel that the floor or a mat is too hard on her belly, try placing baby’s upper body and arms over a nursing pillow (or even your thigh). This has the benefit of giving your little one some elevation (less of an angle to lift the head) and it may be more comfortable, too.
- You can make tummy time part of the after-bath routine (so that you sleep-deprived moms and dads out there can remember to do it!) After bath, give your baby a massage with lotion, starting him on his back, face-to-face with you. As you turn him over for his baby back rub, he’ll be getting belly time and head turning, too.
One final note…remember that tummy time should only be enjoyed by babies when they’re awake and supervised. It is important that parents continue to adhere to the Back-to-Sleep guidelines, which include putting your baby to sleep on her/her back, on a firm crib mattress with a fitted sheet, in a crib without blankets or pillow-like bumpers, and without any stuffed toys or loose bedding. And, avoiding smoking around your baby is also important for preventing SIDS. Here is an excellent reminder of what a safe bed looks like: http://www.nichd.nih.gov/publications/pubs/upload/Safe_Sleep_2009_Eng.pdf
Lynn-Marie Herlihy is an Occupational Therapist in private practice in Park Slope, Brooklyn. She has over 12 years experience treating children from birth to school-age, with a variety of sensory and motor deficits, developmental delays, and learning issues. You can also visit her website at http://www.ParkSlopeOT.com/.