Parents are always asking why is tummy time so important? When do I start tummy time? How much tummy time does my baby need? Why does my child always cry when placed on their tummy?
Let’s explore further and understand the importance of tummy time.
Why is tummy time so important?
In the past 25 years, there has been an increase in the number of babies diagnosed with early motor delay. In 1992, the American Academy of Pediatrics launched the back to sleep initiative and this has significantly reduced cases of Sudden Infant Death Syndrome (SIDS), but now babies are missing out on the 12-15 hours of tummy time they used to get during sleep. According to the American Physical Therapy Association, new parents are told of the importance of babies sleeping on their backs to avoid SIDS, but are not always informed about the importance of tummy time. It’s important for babies to get tummy time and essential to start tummy time as early as possible.
In a study by Majnemer and Barr in 2006, they compared the motor skills of stomach and back sleepers and determined that at age 6 months, stomach sleepers demonstrated significantly higher motor scores than back sleepers, whereas 22% of back sleepers exhibited gross motor delays.
Many caregivers are not informed of the important of tummy time in infancy. It is so important for pediatricians, PTs, and OTs to communicate with caregivers on the importance of supervised tummy time during waking hours and to stress the point that by providing infants with tummy time, they can reduce the risk of developmental motor delays and flatness on the back of the head. Parents should be educated on tummy time during pre-natal visits or prior to leaving the hospital.
The American Academy of Pediatrics (AAP) encourages “back to sleep, tummy to play”. Infants who are positioned prone use muscles that are necessary for head control, pulling up, reaching, crawling, and other developmental milestones. Tummy time provides the infant opportunities to strengthen their neck, arm, shoulder, back, and upper body muscles. In 2007, a study by Dudek-Shriber and Zelazny concluded that infants who are provided tummy time for >80 minutes daily achieved greater success in acquiring many stomach and back motor milestones than infants who were exposed to less tummy time.
So what are the recommendations?
In 2008, the journal of Physical and Occupational Therapy in Pediatrics, published the article “Conveying the message about optimal infant positions”. This article reported that newborn babies should be placed on their tummies after every nap, diaper change, and feeding, starting with 1-2 minutes.
In 2013, the American Occupational Therapy Association recommended performing tummy time as soon as the baby is born. The AOTA proposed the following guidelines:
1) Make tummy time part of your family's daily routine: Newborns should begin with 3 to 5 minutes of tummy time a few times throughout the day. Work up to a total of 40-60 minutes daily by the end of two months of age. Tummy Time can be done in short sessions throughout the day, based 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 them across your lap on their tummy. It is never too early to begin to read to your baby, and Tummy Time is a great opportunity for storytelling.
Courtesy of moveplaygrow.com
2) Increase your baby's ability to reach and play: While your baby is playing on his/her belly, hold a toy in front of his/her face to get his attention. This will encourage your baby to lift their head and reach. Sit or lie down in front of your baby during Tummy Time for safety and supervision. Sing or talk to your baby. During Tummy Time, arrange toys in a circle around your baby to promote reaching in many different directions.
3) Position your baby to enjoy tummy time: Roll up a towel/blanket or use a boppy pillow to make a bolster that will provide extra support during Tummy Time. Place the rolled towel/boppy pillow under your baby’s chest, and position their arms over the roll, with 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. Make sure your baby distributes their weight evenly on both sides of their body while on their 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 the muscles through Tummy Time.
Courtesy of tummytimetips.com
4) Engage your baby's senses: Place a mirror in front of your baby so he/she will be interested in lifting their head to look at their 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 bath towel and a soft fleece blanket).
Courtesy of moveplaygrow.com
5) Consider alternatives to "typical" tummy time: 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.
Why does my child cry or get upset when placed on his/her tummy? If your baby is having a hard time tolerating tummy time and is continuously crying, here are some suggestions to motivate your baby to tolerate tummy time (click on each title to see a picture):
1)Lap soothe: Although it’s natural to calm a baby by holding him/her upright on the shoulder, occasionally try laying the baby face-down across your lap to settle him/her down. Be sure to provide support over the baby’s bottom to provide a sense of security and calm them.
2) Tummy-to-Tummy: Lie down on the floor or bed and place your baby “tummy-to-tummy” or “tummy-to-chest.” Make sure to keep your hands on the baby at all times for security.
3) Tummy-down carry: When carrying baby during awake time, carry your baby tummy-side down instead of upright. Making this positional change has a huge impact on strengthening the neck and back muscles. Support baby with one hand beneath the legs and under the tummy, and the other hand supporting the baby’s head and shoulders.
4) Eye-Level Smile: Babies love voices and faces. When your baby is playing on their tummy on the floor, get down to their level and talk or sing to them. This encourages head lifting and turning.
5) Tummy Minute: Start to incorporate tummy time into their daily routine. For example, every time the baby gets a diaper change, place your baby on their tummy for a minute or two or do the same right after a bath.
6) Use a therapy ball to make tummy time fun and relaxing for the baby: Place your baby on their belly over the therapy ball and make sure you have a good hold of your baby. Once you and your baby are comfortable, start slowly rolling the ball forward and backward. It’ll be easier for you to be behind your baby while holding him/her. Place a standing mirror in front of the baby so they can see their own face and you as well.
Research shows that earlier identification of motor delays allows for timely referral for developmental interventions and treatment planning. At the end of three months of age (adjusted for pre-term birth), look for the following:
1) While lying on tummy, can your baby:
Push up on arms
Lift and holds head up
Turns head from one side to the other side
2) Signs of concern:
Difficulty lifting head
Stiff legs with little or no movement
Always looking to one side only
Uses only one side of the body
Significant flattening on the side or back of head
Make Tummy time a place of ease, comfort, and pleasure. And Always Remember Back to Sleep, Tummy to Play!
1) American Academy of Pediatrics, Task Force on Infant Sleep Position and SIDS. (1992). Positioning and SIDS. Pediatrics, 89, 1120–1126
2) Majnemer, A., & Barr, R. (2006). Association between sleep position and early motor development. Journal of Pediatrics, 149, 623–629. doi:10.1016/j.jpeds.2006.05.009
3) Dudek-Shriber, L., & Zelazny, S. (2007). The effects of prone positioning on the quality and acquisition of developmental milestones in four-month old infants. Pediatric Physical Therapy, 19, 48–55. doi: 10.1097/01.pep.0000234963.72945.b1
4) Zachry, A. H., & Kitzmann, K. M. (2011). Brief Report—Caregiver awareness of prone play recommendations. American Journal of Occupational Therapy, 65, 101–105. doi: 10.5014/ajot.2011.09100
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