In 1992, the American Academy of Pediatrics started encouraging parents to lay healthy infants younger than 1 on their backs for sleep rather than on their side or stomach. In 1994, the National Institute of Child Health and Human Development joined in the public education effort with its “Back to Sleep” campaign. The goal was to reduce the risk of Sudden Infant Death Syndrome (SIDS).
It worked! SIDS cases dropped 50 percent. A side effect of the movement, however, has been that babies are now lying on their backs for at least 14 hours a day.
Add that to the increased use of car seats as carriers, plus infant swings and bouncers, and you have babies spending even more time reclined.
It’s the polar opposite of what babies experienced before. For years, babies slept on their stomachs and were held more often, too.
Why it’s so important now
This shift, while triumphantly saving lives, has caused other unforeseen problems — poor development of gross motor skills, delays in reaching age-appropriate milestones and a dramatic increase in plagiocephaly, also known as flat-head syndrome.
Stacey Siats, a pediatric physical therapist from Savage explains: “If you are laying on a group of muscles, you cannot work or contract them. Without a balance of both the front and back sides of the body, children are struggling to engage in activities that require head control and they are experiencing a delay in self-initiated mobility.”
If a baby can’t roll or move to sit independently, she ends up spending even more time on her back. Rolling and crawling and general opposition from the earth are important parts of child development, affecting both binocular vision and perspective.
A deficiency in both trunk strength and head control can delay self-feeding when it’s time for a child to try drinking from cup and eating solid foods.
Finally, flattened areas of the head may cause more than cosmetic issues. Recent research suggests that plagiocephaly could lead to developmental delays or neurological issues.
Babies with a severely flattened heads may need to wear a special therapeutic helmets designed to restructure their soft skulls.
To ameliorate the issues brought on by Back to Sleep, the AAP started encouraging parents to give infants intentional periods of play with the tummy side down.
Using an updated slogan of Back to Sleep, Tummy to Play, the AAP now recommends tummy time 2 to 3 times a day for 3 to 5 minutes per time from birth, with more time added gradually. Other authorities, such as the Mayo Clinic, recommend about 20 minutes a day.
Siats, meanwhile, recommends at least 84 minutes a day to counteract the time babies spend reclined. Many physical therapists follow suit with a recommendation of gradually working up to 90 minutes of tummy play per day by age 4 months.
If 90 minutes sounds like an unrealistic amount of time, fear not. Tummy time can be accrued not just on the floor but also with Baby in arms with a variety of positions, including simply holding your baby to your chest while you’re reclined. (See pages 44-45 for a wealth of tummy time ideas.)
Tummy time’s goal is to develop the head, neck, shoulder and trunk muscles. Before that development occurs, the baby, unable to lift her head, will press her face to the ground and express distress — crying, kicking, even shaking her head no.
To ease frustration, parents should stay involved and positive, Siats said.
“Babies need to be entertained during tummy time,” she said. “It requires the parents to engage.”
While getting down on the floor with the infant, a parent can prop the baby’s upper body gently with a small pillow or rolled up receiving blanket, so that he’s not face down and miserable.
Turn it into playtime
Tory Kielas-Jensen is the director at Welcome Baby Care, a Minneapolis-based company offering in-home postpartum support. Like Siats, she enthusiastically encourages parents to embrace tummy time.
“It’s a fun and easy, hands-on way to help your child develop while you bond with them,” she said. Kielas-Jensen encourages parents to “rotisserize” the baby. This means equal time on each side — burping on both shoulders, alternating sleeping directions in the crib, carrying with the left arm as well as the right. She says that this helps the baby “explore all sides of his environment, body and family.”
Siats, meanwhile, is a stickler about minimalizing equipment use. This includes car seat use outside the vehicle, swings, bouncers and floor gyms that encourage more back-lying time.
“The equipment we use for our infants is for our convenience and not for their actual development,” she said.
Siats also contends that if babies can’t attain a certain postures on their own, they shouldn’t be forced into it with the help of a device. Simply put, they’re not ready to stand or sit upright if they can’t get there independently.
It all adds up
What gets Baby ready for an upright existence? You guessed it: Tummy time.
But take heart. You have options beyond the old face-in-the-floor. Be creative, relax and try to see tummy time as a natural part of your daily life, rather than another item on the to-do list.
Walks to the changing table, burping sessions, baby wearing — it all counts! See the sidebar for some additional ideas to incorporate tummy timy into you child’s day.
Many parents are delighted to learn that tummy time can be accrued with Baby in arms. All of the following holds count as tummy time:
• The “superbaby” hold. This is when the baby is cradled tummy down rather than chest up, with limbs splayed on either side of the caregiver’s arm;
• Holding baby chest to chest while reclined;
• Most burping positions;
• Many breastfeeding holds, particularly the laid-back nursing position;
• Infant carriers in which the child faces the parent’s body, such as the Moby Wrap, Maya Wrap and Ergobaby.
Beyond tummy time
Here is some additional information to help you in this phase of your child’s development:
• Crib trick: Alternate which end of the crib you place your baby’s head. This will cause her to naturally turn toward lights, sounds or objects from different positions, which will give her strength and lessen the pressure on any one particular spot on her head.
• Don’t get in a bottle rut: A breastfed baby would normally change breasts during feeding. If you’re bottle-feeding, be sure to switch positions regularly.
• Side lying: This is a great alternative to tummy time if your baby doesn’t tolerate being on her stomach yet. Place your baby on a blanket on her side. Prop her back against a rolled-up towel for support, if necessary. Place a small, folded washcloth under her head. Both of baby’s arms should be in front of her. Bring her legs forward at the hips and bend her knees if it makes her more comfortable.
• Any time an infant is pressing away from or pushing off a surface rather than lying back upon it, the right muscles will be engaged. If a caregiver makes an effort to carry baby to the changing table in a way that encourages tummy time every time a diaper change is needed, those minutes can really add up.
Jen Wittes lives in St. Paul and is a mother of two. She’s helped many Twin Cities families in her work as a postpartum doula. Send questions or comments to firstname.lastname@example.org