What's the Big Deal About Tummy Time?
Why is Tummy Time So Important?
As a pediatric occupational therapist, parents frequently ask me if I believe that tummy time is important and I always answer, “Absolutely!” Tummy time plays a critical role in building the foundational skills needed for infant motor skill development. When an infant is awake and positioned on the stomach, he is using and developing the muscles needed for adequate head control as well as the shoulder, trunk and upper body strength needed for rolling over, pushing up, pulling up and crawling. Also, when babies spend awake time on the stomach, this gets them off their backs and helps to prevent flat spots from forming on the head.
The American Academy of Pediatrics recommends that all infants sleep on their backs to reduce the risk of Sudden Infant Death Syndrome, and they also formally recommend that babies get tummy time on a daily basis to prevent motor skill delays and to prevent flattened head syndrome. Because babies are sleeping on their backs and aren't familiar with being on their stomachs, many of them resist tummy time. In fact, my research has revealed that up to 50% of infants don't tolerate the position. Parents report that their infants cry and resist tummy time, and as a result, many infants are missing out on this important developmental experience.
Working as a school therapist, I frequently get referrals for students who are having problems with fine motor skills such as cutting, pasting, coloring, and handwriting. Believe it or not, in many cases these problems all started with not enough tummy time as an infant! You see, development is a sequential process and oftentimes, when one step in the sequence is missed, there can be negative consequences later on. In order to use the hands effectively for manipulation, children need a stable base of support through the trunk, shoulders and arms, and if these muscles haven’t developed properly due to not enough tummy time as an infant, problems with fine motor skills can occur.
In therapy, I take a step back and work on strengthening the trunk and shoulder muscles before addressing manipulation skills and muscular development in the hands. This can be done with simple and fun activities such as weight bearing over a therapy ball, sit-ups, push-ups, wheelbarrow walking, and tug-of-war games. Once a child’s core foundational strength has improved, I then begin to address muscular development and manipulative skills in the hands and fingers. Effective therapy often essentially involves stepping back and filling in the gaps that were missed in the child’s earlier development! So if your child didn’t get enough tummy time as an infant and is now having problems, don’t panic. Therapy and exercises can provide a solution to the problem.
If you have an infant who resists tummy time by fretting and crying, remember that this is an important position that can have an impact on future motor skills. Introduce the position gradually beginning in the first days of your infant's life. You can even begin while you and your infant are still in the hospital. Make sure that baby is calm and content when you first attempt tummy time and provide lots of distractions, such as interacting with your child by playing peek-a-boo, making funny faces and singing. As baby gets older, you can provide a variety of interesting and colorful toys and even a baby-safe mirror to keep baby occupied. If baby resists tummy time even when you use these distractions, take a break and try again later. You don't want your child to have a negative association! Short periods of one or two minutes at a time are better than nothing, and if you gradually extend the time, your infant's tolerance to the position will increase.
Remember, being on her tummy doesn’t always have to take place on the floor. Any position in which baby is positioned on the stomach during the waking hours counts, including placing baby tummy down on your chest or in your lap. You can even carry your infant tummy down in a "football hold" with one arm supporting the trunk and one arm between her legs, and this will work the neck and trunk muscles and take pressure off of the head. Just make sure that your baby is always awake and closely supervised during tummy time. You never want to take a chance of baby falling asleep while in this position. Remember, the more time that baby spends on the stomach, the more strength and coordination gained. A sufficient amount of tummy time now can prevent future problems that no parent or child should have to deal with in the future! If your child resisted tummy time as an infant and is now having problems with fine motor skills, you may want to consider consulting your pediatrician about a referral for an occupational therapy evaluation.
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American Academy of Pediatrics, Task Force on Infant Sleep Position and SIDS. "Positioning and SIDS". Pediatrics, 1992.
American Academy of Pediatrics: Task Force on Infant Positioning and SIDS. "Positioning and sudden infant death syndrome (SIDS): Update". Pediatrics, 1996.
Zachry, A.H., Kitzmann, K.K. "Caregiver Awareness of Prone Play Recommendations". American Journal of Occupational Therapy, 2011.