I’ve talked quite a bit about tummy time on my Instagram, and it’s become such a buzz word in the area of infant development. Doctors will tell you to make sure you’re giving your baby chances for tummy time, and there are a slew of Instagram sites and people telling you how to do it. But what is it and why is it important?
For some background, I’m a pediatric occupational therapist by day. In a nutshell, occupational therapists work with kids on self-help skills, fine motor skills, and play. (There’s a lot more- but I’ll save that for another post.) I tend to get a lot of referrals for kids who have a hard time with handwriting, shoe tying, buttoning, and other things that require small, precise motor movements. So why do kids struggle with these skills? There are a number of factors that impact their success, but, in most cases, these kids show decreased strength throughout their core (stomach/back) muscles. And how do we build those muscles? You guessed it- tummy time!
If we break down the body into parts, the core is basically the powerhouse of the body. In order to have strong hands, you need strong wrists. In order to have strong wrists, you need strong elbows. In order to have strong elbows, you need strong shoulders. In order to have strong shoulders you need, you guessed it, a strong core. Neck strength is also vital because it provides stability for the eyes. Imagine trying to thread a button through a hole while your head bobbles around. Sounds frustrating, right? Yeah, any kid with decreased strength through their core and neck will tell you it is.
So back to infants. Essentially, we want them to work on strengthening their core and neck muscles now so they have a strong foundation to build on. Obviously, a kid isn’t expected to write their name or tie their shoes until they’re 5 or 6, but it takes a lot more time and energy if they don’t have the strength and stability required for those skills.
Tummy time also helps kids achieve developmental milestones, such as rolling, crawling, pulling up, and walking. If a child skips any of these milestones, it can have implications for other aspects of development. For example, kids that don’t crawl may have deficits in their visual system because they aren’t switching their gaze between close up (the floor in front of them) and far (to look up for mom/dad/anything else interesting). Crawling also develops core and upper extremity strength so skipping it can further contribute to overall decreased strength.
We can’t talk about tummy time without talking about plagiocephaly, or flattening of the head. This flattening can cause asymmetries of the face, and most doctors will recommend a helmet if the flattening reaches a certain degree. These helmets are a great, painless solution for this common issue, but they can be expensive, require additional hair/scalp care, and annoy some babies. Unfortunately, I think a lot of parents aren’t given great information and tools up front to prevent the need for helmets, and I’ve said to Denny more than once “I don’t know how parents raise kids when they don’t have a bunch of therapist friends to bounce questions off of!”
Charlie developed a preference for his left side really early on. By the time he was 2 weeks old, I noticed he was almost exclusively looking to his left side. A condition called torticollis can occur when babies consistently turn only to one side. Basically, the neck muscles on the side they look towards tighten, and the neck muscles on the opposite side stretch. These muscle imbalances perpetuate the issue as it’s easier to turn towards the tight side so baby continues only turning that way. Constantly turning to this side means they’re always lying on the same spot on their head which- you guessed it- causes a flat spot.
Charlie’s pediatrician did talk to us about torticollis, and he checks for flat spots at all of Charlie’s appointments. However, I can’t help but wish there was more parent education and resources available. Most parents aren’t given good information on tummy time and its implications for development until there’s already an issue, and that’s through no fault of their own!
Historically, babies were put to sleep on their stomachs so they naturally worked on building their core, neck, and upper extremity muscles. However, research emerged in the 1990s that indicated babies who slept on their stomach could be at a higher risk of SIDS (sudden infant death syndrome). While this correlation has never been proven, most doctors agreed it was better to be safe than sorry, and the American Academy of Pediatrics recommended all babies begin sleeping on their backs. The concept of “tummy time” was introduced shortly after once doctors noticed an increase in the cases of plagiocephaly and torticollis.
I should say that skimping on tummy time doesn’t necessarily guarantee a child will have issues. Most kids develop just fine through exploration and play. Kids are also great at compensating for their challenges and usually find ways to accomplish skills they struggle with. However, it may not be as efficient, and it can lead to a lot of frustration and meltdowns. (Who likes doing things that are hard for them?) That’s why most pediatric therapists will recommend tackling these foundational skills (strength, head/neck control) early.
The hardest part about tummy time? So many babies hate it. It’s a position that challenges their bodies, and they get used to being on their backs most of the time. Charlie was very vocal about his disdain for tummy time in the early weeks, and I was totally guilt of skipping it on more than one occasion. Luckily, his tolerance notably improved around 6 weeks, and it’s been much less stressful (for mom and baby) to fit it in everyday.
Here are some general tips to help make tummy time a little more bearable-
- Most importantly- join in on tummy time with your baby! It’s always more fun to do things with a friend, and your baby will appreciate someone enduring tummy time with them. So get on the floor and look at them, make faces, sing songs- whatever they respond to.
- Place a rolled up towel under their chest/armpits for additional support. We used this trick to bridge the gap from tummy time on our chests to tummy time on the floor, and then we ditched the towel once Charlie got used to being on the floor. You can also use the boppy once they’re big enough (~6 mo)
- If the floor is a total no-go, keep doing tummy time on your chest. I find this one easier to do throughout the day so I add it in whenever I can.
- Babies can start doing tummy time the day they’re born, but it should always be supervised to prevent suffocation risks. Aim for 10 minutes per day split up however you need to.
- Keep tummy time cry-free. This isn’t the time to “cry it out.” Let your baby dictate how long they can tolerate being on their stomach. The amount of time should increase with practice and exposure.
- In the beginning, your baby is really just lying on their stomach. It takes time for them to learn how to push up through their arms. That being said, sometimes I do position Charlie so he’s propped up on his forearms, but I only started this once he could maintain head control during tummy time on my chest. I also position his arms wide enough that he can put his head back on the mat when he needs to.
- Place a mirror directly in front of them. It’s good for baby to practice keeping their head “at midline” (aka centered) so having something directly in front of them gives a good visual target.
- Get your baby onto their tummy by rolling them from their back onto their stomach. This gives them the opportunity to experience the sensation of rolling, and it’s early practice for the milestone of rolling.
Tummy time is the first opportunity your baby gets to practice a skill that will benefit them in the long term. Plus, it’s an opportunity to play and interact! Hopefully, these tips can make it a little more enjoyable for everyone involved.