The American Academy of Pediatrics highly recommends placing newborns and infants on their back for naps and when sleeping at night (more in AAP statement).
It says that back sleeping for babies reduces the risk of Sudden Infant Death Syndrome (SIDS) by between 1.7 and 12.9 times.
However, these health experts also advise placing infants on their bellies for a few minutes throughout the day when they are awake- what is commonly known as tummy time.
In this article, we’ll be taking you through everything you need to know about tummy time, when and how it should be done, as well as its benefits to the baby’s development.
Tummy Time – What Is It?
Tummy time is just that – the time that your baby spends playing while resting on their bellies or what is scientifically known as the prone position.
This session is considered a key building block to other baby development milestones down the road. It’s a type of baby’s workout that helps them develop the muscles necessary for crawling, rolling over, sitting up and walking.
However, it only yields positive impacts if it’s done correctly. Also, it should only be done when the baby is awake and should be supervised.
How It All Began
Before 1992, most parents in the USA placed their babies on their stomach when sleeping and napping. And there was no objection to this. However, Sudden Infant Death Syndrome was so common.
In 1985, a report showed that SIDS was very rare in Hong Kong where Chinese were used to back (supine) infant sleep position.
This report led to a campaign advising parents to place their babies on the supine sleeping position in the Netherlands, United Kingdom, New Zealand, and eventually in the USA and Canada in 1992.
Impressively, after successfully adopting the back infant sleep position (supine), the incidences of SIDS were reduced by a whopping 50%.
But several other problems emerged!
After embracing the back to sleep infant sleep position, researchers got back to work and started assessing whether the newly introduced supine sleeping position would have any adverse impacts on the development of the baby.
True to their suspicion, one study team found out that by 6 months, infants who were primarily put to sleep on supine position had statistically lower social, gross motor, and total development scores compared to babies that slept on the stomach position (prone).
In addition, the introduction of the supine sleeping position brought about an increase in positional skull deformities particularly the flat head syndrome (also known as positional plagiocephaly).
The flat head syndrome is a lasting flat spot that is caused by sleeping or lying in the same position for long.
Among other recommended ways of dealing with this condition, it was found that providing plenty of tummy time was effective in promoting normal shaping of the head at the back.
Consequently, pediatricians started recommending a mix of the two: sleeping and napping on the supine position, and spending a considerable amount of time in the prone position while awake and under supervision.
And thus, Back to Sleep and Tummy to Play was born.
When Should You Introduce Your Baby To Tummy Time?
The American Academy of Pediatrics (AAP) is not exact on the right time to introduce tummy time to your baby’s daily routine. However, the team says that this could be as soon as you get home from the hospital and as long as the baby doesn’t have any health complications. The exact time of introducing your baby to tummy time should be consulted with your pediatrician.
The APP notes that tummy time should always be done when the baby is awake and when someone is watching over him/her closely.
How Long Should Tummy Time Be?
The APP encourages parents and caregivers to aim for a few minutes per session, and several sessions every day.
Of course, your baby’s neck and shoulder muscles aren’t powerful enough to allow prolonged tummy time right from the hospital. So, at first, you should consider 1-3 minutes per session for a total of 10-15 minutes every day.
As the baby develops more head, neck, and upper body muscles and strength, you can stretch the total amount of tummy to 30 minutes per day or more by the age of 3 months. This should, however, be spread throughout the day.
How To Safely Introduce Your Baby To Tummy Time
Tummy time is commonly done on the floor. But keep in mind that a few days after birth, the infant’s musculature around the neck is weak, tight, and fragile.
This causes the head to bob around and could lead to brain trauma (also known as Shaken Baby Syndrome) in case the baby slammed his/her head on the floor.
This is one of the main reasons why you have to ensure that the session is closely monitored by a grownup.
In addition, tummy time should be done only when the baby is awake and ideally when he/she is from a nap or after a diaper change.
Again, don’t set the baby tummy-down soon after feeding time as it is generally uncomfortable and could lead to spit-ups or acid reflux. Ensure that the baby isn’t tired too.
Here is how to do tummy time:
- Start by clearing a small area on the floor and spreading out a baby blanket, towel, or playmat (check my favorite crawling mats for tummy time);
- Place the baby on the mat on his tummy;
- Surround the area in front of the baby with his/her favorite toys (for newborns, the toys should be black, white, or gray);
- Have someone else sit in front of the baby and interact with him/her;
- For newborns, aim for 1-3 minutes. Build on this to 5 minutes and even 10 minutes as the baby gets older.
Tips & Activities For Babies Who Hate Tummy Time
Some babies generally love lying and playing on their bellies. But others like seeing and interacting with their world from an upright position and will be very miserable once you set them on their tummy.
If your kiddo starts screaming the moment you put her/him on their belly, know that it’s normal and there’s nothing wrong with your baby. You only need to come up with tactics to make tummy time interesting and comfortable.
Tummy On Chest
The skin to skin contact that the mom makes during the early hours after birth is actually the first form of tummy time for the baby.
Slant your back at 45 degrees and place your baby on your chest and start chatting or studying each other. The good thing here is that you’ll be killing 2 birds with one stone: bonding and tummy time.
Stroll Around Tummy Down
If your baby cries only when you place her/him on the floor during tummy time, consider strolling around with her/him in your arms, tummy down. This is a great way to help the baby start interacting and getting used to viewing her/his world from an upside-down position.
This one requires you to sit on a chair and bring your knees together. Spread a clean baby towel on your laps and place the baby on it tummy down. Start rocking their back and forth while gently stroking their back and/or singing.
You could also place their favorite toys on the floor to increase interaction with the environment from a belly-down position.
Show The Baby That Tummy Time Is Fun
Tummy time is generally a scary experience for some babies. But getting on the ground with them as you play with toys together can create an assurance that it’s safe and they can do it too.
If you think that you’ve done everything possible but the baby still hates the idea of being tummy down, don’t stress but don’t give up too. Even a minute of tummy time is good to start with. You could also take a breather by taking a day or two off and then trying again.
As long as you try it when your baby is happy and playful, the chances are that she’ll soon buy the idea and engage positively.
More tips how to make the tummy time more interesting for the baby in this article.
Importance Of Tummy Time To Baby’s Development
The American Academy of Pediatrics says that placing the baby belly-down increases the risk of SIDS. But they also advise ensuring that the baby spends a good amount of time on this position every day. So, what benefits does tummy time has on the infant’s development?
Prevents The Risk Of Flat Spots
The fact that the back sleeping position is touted as the best for infants means that they could remain in this position for up to 15 hours. This is made even worse by the increased use of swings, carriers, and infant car seats.
This increases the chances of the baby developing flat spots at the back of the head. Placing babies on their belly for a few minutes and frequently throughout the day minimizes this risk significantly.
Encourages Them To Work Their Muscles
While sleeping on their back, babies are less likely to engage most of their muscles, especially during the first 3 months.
By resting them on their bellies while awake, they are technically forced to make use of their neck, hand, legs, and back muscles for stability and support.
This greatly helps in developing and strengthening these muscles and also prepares them for further activities such as rolling over.
It’s A Precursor To Crawling
Placing the babies to play on their belly from zero to three months is often cited as a crucial step towards crawling.
In addition to strengthening their back, arms, and trunk muscle strength, plenty of tummy time also helps babies to develop the confidence to push up on all fours thereby making it easy to reach for toys.
Tummy Time: What Studies Say About it
Ever since the American Academy of Pediatrics started the Back to Sleep Tummy to Play campaign, a lot of studies have been conducted to assess the impacts that this could have on the babies’ development.
John M. Graham, MD, ScD – a pediatrician for more than 35 years has done extensive research on infant sleeping position and effects on skull deformations particularly brachycephaly and dolichocephaly.
Brachycephaly is when the head is flat at the back and wide at the center. A dolichocephalic head, on the other hand, is flat at the back but long towards the face.
One way of differentiating between these two skull deformities is determining the cephalic index (CI). This is measured by dividing the width of the head by the length and then multiplying the result by 100 ((W/L) x 100%).
A normal head should have a cephalic index (CI) of between 76% and 81%. Brachycephalic heads have a CI of above 81% while dolichocephalic ones have a score of less than 76%.
In one his works entitled “Tummy Time is Important“, John Graham says that in cultures that put their babies to sleep in supine sleeping position (back), cases of brachycephaly are higher than those that mostly prefer prone (stomach) infant sleeping position.
On this note, he says that positional brachycephaly is a sign that parents are not giving their infants enough tummy time.
He adds that while the back to sleep campaign has successfully reduced the risk of SIDS by half, it is essential to place babies on the stomach whenever they are awake. He says that this will not only reduce the risk of skull deformities, but it will also sharpen their motor skills and encourage full neck rotation.
Studies On Non-Compliant Babies
Despite the widely documented benefits of tummy time, it often evokes lots of tears and non-compliance among most infants.
One study published in the Journal of Applied Behavior Analysis aimed at identifying the effects of introducing a preferred stimulus on the baby’s behavior during tummy time.
The participant in this study was Meadow, a 7-month-old girl, born at 33 weeks with no perinatal complications. The researchers analyzed and found her gross motor skills, cognitive development, and general physical growth to be typical for infants her age.
The study involved placing the baby on her tummy and allowing her access to her favorite stimulating object (an infants’ video playing on a laptop) during the observations only.
The observations happened at the child’s home and only when she didn’t have negative vocalizations such as whining and crying.
This study found out that, when the infant was placed tummy down without the stimulating object, her negative vocalization was 74.8% while the mean percentage time of head elevation was 28.1%.
When the stimulating object was introduced, negative vocalization immediately reduced to 0% and the mean percentage of head elevation shot to 81.7%.
In the subsequent observations, the mean percentage of negative vocalizations during tummy time without stimulus was 53.9% (slightly lower than the initial recording) and an elevated head mean percentage of 52.2%.
Finally, when the stimulus was reintroduced, the mean negative vocalizations reduced to zero again, while the mean percentage of head elevation rose to 83.6%.
This study illustrates that non-compliant kids can be introduced to tummy time by presenting a stimulating object. It also shows that the behavior of these kids improves with persistence.
Graham Jr, John M. “Tummy time is important.” Clinical Pediatrics 45.2 (2006): 119-121.
Kadey, Heather J., and Henry S. Roane. “Effects of access to a stimulating object on infant behavior during tummy time.” Journal of applied behavior analysis 45.2 (2012): 395-399.
Task Force on Sudden Infant Death Syndrome. “SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment.” Pediatrics 138.5 (2016).
Please keep in mind that this article IS NOT a medical advice. The purpose of this article is informative. It is an overview of recent studies on the subject of tummy time and its effects on baby’s development. It’s not a substitute for consultation with a pediatrician. Always consult your health concerns and decisions with your doctor.