To reduce the risk of SIDS and suffocation, you know the mantra: Place babies to sleep on their backs (unless your pediatrician advises otherwise) at naptime and nighttime in a crib that meets the latest safety standards.
Since the “Back to Sleep” campaign was initiated in 1994 by the American Academy of Pediatrics, SIDS rates have declined by more than 50 percent. That’s good news. Still, there’s a downside. Because babies are on their backs when they’re sleeping, they may not be spending enough time on their tummies when they’re awake to develop appropriately.
“Tummy time is critical,” says Brannon Perilloux, M.D., a pediatrician at Associates in Pediatrics in Baton Rouge. “It develops head control, which helps develop walking skills, and increases neck and body strength and improves balance.” When babies are on their tummies, they instinctively do the infant version of push-ups: They use their shoulder muscles to push their head and shoulders off the floor. As a result, babies who put in enough tummy time develop head and neck control early on and strong shoulder muscles that can improve their posture and neck strength, a prerequisite for crawling and other physical skills.
Conversely, without adequate time on their tummies, babies may experience deficits, including weak neck and shoulder muscles, which can delay a baby’s ability to roll over, sit up without support, crawl and pull to standing.
“Typically, though, by the time they’re walking, babies catch up,” says Melanie Mintz, DPT, a boardcertified pediatric physical therapist at Moreau Physical Therapy in Zachary, La. Studies show that infants who don’t spend much time on their tummies learn to walk when they’re supposed to. “But walking doesn’t use the same muscle groups that tummy time does,” Mintz says. Tummy-timedeprived toddlers can end up with weak neck, shoulder and jaw muscles that can impact their ability to hit other developmental milestones.
“Adequate neck control can impact a baby’s eating and speech development,” Mintz says. The same muscles that babies use to hold their head up also support their jaws. When babies push themselves up through their hands when they’re on their tummies, they develop the shoulder support that can impact the fine motor skills they’ll eventually need to learn to eat, hold a crayon and dress themselves.
Moreover, the muscle tone babies develop from tummy time helps them feel more in control of their surroundings, which has global repercussions. “The more relaxed babies are with their environment, the more they can attend to visual and auditory stimuli going on around them, which helps develop language,” says Rebecca TimlinScalera, Ph.D., a pediatric neuropsychologist in private practice in Norwalk, Conn. Tummy time can also help prevent plagiocephaly (flat-head syndrome) and torticollis (weak neck muscles on one side), both of which have increased in babies since the back-to-sleep campaign began.
Tummy Time Limits
“Tummy time should start from day one,” Mintz says, beginning with 3 to 5 minutes, two to three times each day as soon as they get home from the hospital. Continue to up the ante and add increments of tummy time. “I give parents a schedule, such as 15 minutes, four times a day,” Perilloux says. There isn’t a consensus for how much tummy time is needed, “but as your baby gets older, 30 to 90 minutes total per day is optimal,” says Mintz. Feel free to break that time up into five or 10-minute spurts, or whatever lengths of time your baby can tolerate. Official tummy time can end when your baby starts to roll and crawl. In the meantime, here’s how to make the most of this important developmental activity.
Be your baby’s play mat. For the youngest babies who cry when they’re placed on the floor or for babies with reflux, try an inclined version of tummy time: Have your baby lie on your chest, while you sit at a semi-reclined position. An incline is easier on babies because they don’t have to use as much muscle strength to hold their head up and most babies enjoy the skin to skin contact. Talk to your baby while you’re at it, or sing songs or tell him a story, anything that engages your baby and makes eye contact, which is also important for cognitive, social and emotional development. “Work your way down to a reclined position,” Mintz says.
Invest in an activity gym. A take-off on the mobile, activity gyms typically feature charming, brightly-colored floor and hanging detachable toys that make sounds, play music and sport tantalizing textures. Some may include unbreakable, embedded mirrors, a definite plus. Babies love to look at their own image. Activity gyms help babies explore their environment through their sense of sound, touch, sight and taste. Their fine motor skills also get a tune-up when they bat, reach and grab for toys.
If your baby fusses during tummy time on a play mat, “distract him with the gym’s lights, music and crinkle toys until he gets used to it,” suggests Kristina McMorris, who would also roll her son, Tristan, onto his back for a 10-second rest at the first signs of frustration, then back on the mat for more tummy time. Both tricks worked. At five months, “Tristan now thoroughly enjoys being on his tummy,” McMorris says. Also, take turns with your baby making the activity gym’s elephant ear crinkle, for example, or helping her pull the giraffe’s tail. When your baby is around 4 months old, detach her favorite toys and place them just out of her reach in a circle during tummy time,” says Mintz, either lying down or supported by you or a Boppy. At first, your baby might just make general movements in direction toward the object. Eventually, she’ll be able to reach out and pull objects forward. “One of the precursors to crawling is being able to shift your weight and pivot on your tummy,” Mintz says.
A warning: Your baby might find the arcade that is her activity gym so entertaining, you’ll be tempted to park her there while you get things done around the house. For safety and other reasons, however, it’s best to stay involved. You want to make sure your baby doesn’t end up with her face smooshed into the floor. And besides, your baby learns best by interacting with you and other caregivers. When you choose activities like tummy time, you’re helping him foster motor, cognitive and social skills he can build on. But don’t give tummy time all the credit. You’re a key player in the process. Babies crave one-on-one social interaction and need the security it provides.
Stay grounded. To enhance tummy time and make it more tolerable, here are more tricks to try: Get down on the floor with your baby and shake a rattle or keys at various points of your baby’s sight so he’ll enjoy the surprise of hearing the toy’s sound from different angles. Also, have your baby grab for toys with either hand to help develop both sides of her brain; sometimes present toys on her right side, sometimes on her left. (Your baby won’t show true hand dominance until age 2.) And try tracking; hold a toy six to 12 inches from your baby’s face, which is where babies 4 months and under see it best, with your baby lying down, and move it back and forth slowly. This technique helps develop eye coordination and vision. In time, take turns playing with a toy to help establish the notion of turn taking, an important lesson for kids of all ages. For more ideas on how to integrate tummy time into your baby’s routine, visit pathways.org and click on “Five Essential Tummy Time Moves.”
Sandra Gordon is a freelance writer who specializes in medical content.