While the American Academy of Pediatrics recommends putting infants on their backs to sleep to reduce the risk of sudden infant death syndrome, they also recognize the importance of prone play, or tummy time, to infant development. According to the AAP, tummy time should begin on the first day home from hospital. They recommend playing or interacting with your baby when he is on his tummy 2 or 3 times each day for a short period when he is awake and alert, increasing the amount of time as the baby enjoys it more.
Tummy time doesn’t just have to mean laying a baby on his belly. Any variations in play positions from lying on his back can help develop strength, movement, and sensory processing. This can include side-lying and variations on tummy time like laying the baby tummy-down on your tummy, chest, or lap. It is important to vary position throughout the day, limit use of carriers and bouncers, and let them explore and move around environment independently. However, it is important to remember that babies should not sleep on their tummies. If they fall asleep during tummy time, turn them onto their backs.
Cranial (Head) Symmetry: Too much time spent lying on his back can lead to flat spots on a baby’s skull. This is because when infants don’t have enough strength to independently re-position their heads, they leave their heads resting on one side and the repeated pressure can cause flat spots to develop. Tummy time encourages the development of strength and head control needed to independently re-position the head, as well as a break from the supine positioning they get when they are sleeping and laying on their backs in carriers.
Neck Control and Back Strength: When they lie on their backs, babies can see most things around them without lifting their heads, so this position is not ideal to encourage them to “work out” those muscles that will help them gain neck control as well as back strength and extension. Placing baby on his tummy, even for a few minutes, encourages him to try to lift his head up to see what is around him, especially if you are down at his level with toys or songs to give him an incentive to try to lift or turn his head. As we mentioned above, once he begins to be able to independently move his head from side to side, he will be less susceptible to the head-flattening that can happen when babies leave their heads on only one side all the time.
Prevention of Torticollis: Torticollis is abnormal or asymmetrical neck positioning, due to tightness in a neck muscle. Infants can be born with this condition, or acquire it through excessive supine positioning. Tummy time, side-lying, and any type of non-supine play or positioning can help stretch the neck muscles and help prevent torticollis from developing.
Arm and Shoulder Strength: Once a baby has started to gain some head control, the next step is to begin to lift himself up from the floor during tummy time. The shoulder and arm strength this can help develop is key to the later skill of crawling.
Babies can have difficulty with tummy time due to limited strength and poor head control, so they tend to cry when placed on their bellies and some parents avoid it. Begin with brief sessions, then gradually increase time as they gain strength. If the baby resists tummy time, get down on his level and talk or sing, use a toy to distract him. At first he may only tolerate it for a few minutes at a time until he gets used to it. If you feel that your baby consistently resists tummy time and you have any concerns, see your pediatrician for recommendations. These recommendations may include exercises, techniques, or a referral to pediatric therapy office like Therapy Solutions for Kids for more help.
For more ideas about how to work tummy time into the daily routine, check out these resources:
“Educating Caregivers about Tummy Time,” A. Zachry, S. Slaughter, OT Practice Magazine 11/25/13