Back to Sleep, Tummy to Play

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A question I always ask during the initial physical therapy evaluation of an infant is, “How is tummy time going?” The majority of the time, the response from the parents is a muttered, “Not well.”

Since the Back to Sleep campaign was initiated in the early 1990’s to decrease the risk of Sudden Infant Death Syndrome (SIDS), babies have been spending more and more time on their backs. While it is very important that an infant be placed on his back to sleep, as it has reduced the incidence of SIDS by 40 percent, it is equally important to a baby’s development that he be given frequent episodes of supervised tummy time throughout the day.

Most infants find tummy time difficult, and will often fuss and cry during it, making parents less likely to place their infants in tummy time positions.

Tummy time promotes the development of muscles in the neck, shoulders and back. It helps build the strength and coordination needed for rolling, crawling, reaching, and playing, and helps improve body awareness.

Tummy time also helps to prevent tight neck muscles and the development of flat areas on a baby’s head. This flattening at the back or side of a baby’s head is called plagiocephaly. Plagiocephaly and torticollis, which is a term used to describe the tightness and/or weakness of a single muscle or group of muscles in the neck, often go hand in hand. The problem is cyclical, as the flat spot can cause neck muscles to shorten. Shortened neck muscles create decreased movement of the head, perpetuating a flat spot. So not only does tummy time strengthen a baby’s extensor muscles, it also decreases the risk of plagiocephaly and torticollis.

In following with the guidelines of the American Academy of Pediatrics (AAP), always remember “Back to Sleep, Tummy to Play” to help your child reach developmental milestones.

Tummy time recommendations, as per the AAP, are as follows:

  • Tummy time should be supervised.
  • Tummy time should take place when the infant is alert and awake.
  • Place the infant on a safe and firm surface, such as the floor.
  • Begin practicing tummy time the day the infant comes home from the hospital.
  • Start with short bouts of tummy time, approximately three to five minutes, two to three times per day.
  • Increase duration of tummy time as the baby’s tolerance increases.

If your baby has a poor tolerance to tummy time, there are several strategies that can be implemented to improve it. With continued practice, your baby will strengthen his back and shoulder muscles and even begin to enjoy tummy time. Tummy time is adaptable, and will evolve as your child grows and develops strength.

Some strategies to improve tummy time success include:

  • Start with short durations (three to four minutes) and an increased frequency of tummy time (five to seven times per day).
  • Create a tummy time schedule, such as after each diaper change or after napping.
  • You can place baby on a small pillow, thinly rolled blanket or a Boppy pillow for a modified tummy time position until baby can tolerate flat on the floor tummy time
  • Position baby’s elbows beneath their shoulders to provide a stable base for baby to life his head.
  • You can place baby on his belly on a parent’s chest while in a flat or inclined position for face-to-face tummy time.
  • Provide tummy time opportunities throughout the daily routine (place the baby on their belly for towel drying or while applying lotion after bath time, over your lap for burping, etc.).
  • Tummy time is more enjoyable for babies when it involves face-to-face eye contact, with music and toys that are interesting to your baby.

If you have tried the above strategies with your baby and feel that your child is not making improvements in tummy time or is not meeting their developmental milestones, please speak to your child’s primary care provider. A pediatric physical therapist can work with you and your child to promote your child’s motor development.

Kristin Andraka, D.P.T., is a pediatric physical therapist at MidMichigan Health.


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