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Motor Milestones

The Complete Guide to Tummy Time

Dr. Allison Mell, DPT
January 9, 2023
The Complete Guide to Tummy Time

What is tummy time and why is it important?

Did you know Tummy Time is a relatively new concept? Today, parents are encouraged to place babies on their bellies during wake windows as part of their daily routines.

Ever since the American Academy of Pediatrics instituted the Back to Sleep campaign, now renamed Safe to Sleep, to combat Sudden Infant Death Syndrome (SIDS), babies have been put to sleep on their backs. This change in sleep practices has been proven effective at decreasing the rate of SIDS by almost 50%! However, spending too much time on babies’ backs also has its downsides, leading pediatricians and child development specialists to educate parents on prioritizing tummy down play. Here’s why:

Head shape. When too much consistent pressure is applied to the back of baby’s soft head, a flat spot can develop. And because babies spend so much time sleeping on their backs, we want to alleviate that pressure on baby’s head during wake windows.

Strengthening. When babies are born, they're not exactly the strongest little creatures. Those wobbly little heads are kind of adorable, but also a reason why tummy time is so important. It helps build strength in their neck and back muscles and encourages the development of arm and hand strength. All of these muscle groups are crucial for skills like pivoting in circles, rolling belly-to-back, and eventually crawling on all fours. So, while tummy time may seem like a small activity, it's actually laying the foundation for some pretty big milestones.

Sensory input. Full body contact with the floor or another surface provides babies with great proprioceptive input. This sense helps us understand where our bodies are in space through pressure on the skin and joints. That’s why newborns find close snuggles and tight swaddles comforting as they provide this calming proprioceptive input. Tummy time is a great way to start developing this sense from the very beginning.

Vision Development: Baby’s vision is not fully mature at birth. Newborns can only see high contrast colors 8-12 inches in front of them, they don’t have a sense of depth perception, and can’t move their eyes separately from their heads just yet. Tummy time helps develop baby’s visual motor skills, depth perception, and visual tracking skills as the eye muscles strengthen against gravity and learn to work together as a team.

What Tummy Time Should Look Like from 0-6 Months:

Newborns. You can start tummy time right away on your baby’s very first day of life, even before the belly button stump falls off. While he may not be able to play in this position just yet and may even fall asleep quickly (continuous supervision is important), starting tummy time early can help him become comfortable in this position and make it a regular part of your routine.

2-3 Month. At this age, your baby might look like an adorable little Bobble Head during tummy time. Without full head control just yet, babies struggle to keep their heads up. Try placing her over a tightly rolled up towel or a tummy time pillow for some mild support. Changing the angle against gravity can improve baby’s endurance to hold her head up for longer periods, making these sessions more comfortable and beneficial.

4-5 Months. At this age, your baby might be able to lift his head and chest off the ground while on their stomach. They’ll be able to prop up on their forearms and reach out with their hands to play with toys placed in front of them. You may even see your baby rocking from side to side and start rolling over!

6+ Months: Baby is now lifting her upper body off the floor by pushing up through her hands and extended arms. But don’t expect baby to stay still for long. She’ll likely be pivoting in circles and rolling over. This is a good thing! Baby is continuing to get all the benefits of tummy time through rolling over to get around.

What if my baby hates tummy time?

There are several reasons a baby could struggle with tummy time like lack of exposure or tight muscles from torticollis or tongue/lip tie. Digestive difficulties like reflux or silent reflex may cause baby to be in pain in a tummy down position. If your baby is mildly annoyed or whining a little, you can try to entertain and extend the session by an extra few seconds or minutes before taking a break. If baby is consistently screaming during tummy time, it’s a good idea to reach out to your baby’s pediatrician.

Ways to help baby tolerate and enjoy tummy time include:

  1. Short Sessions Count. Tummy time doesn’t have to last 10, 20 or 30 minutes! Try aiming for just a few minutes, or even a few seconds at a time, several times a day. It all adds up!

  1. Different Surfaces. If baby doesn’t like tummy time on the floor, try a softer surface like a bed or couch to see if it makes a difference. Just make sure to watch very closely and never leave baby unattended.

  1. Entertainment. Tummy time doesn't have to be a chore. Add in some toys, a mirror, or put yourself at baby's eye level to enjoy some quality time with you.

  1. Try an Incline. Changing the angle against gravity can give baby just enough support to make tummy time more tolerable. Have baby lie on your chest as you recline on the couch or place a rolled up towel under baby’s armpits. This can make a huge difference and yes, it still counts!

How do I fit tummy time into the daily schedule?

So many parents have the best of intentions every morning to prioritize tummy time for the upcoming day. All of a sudden they look at the clock and it’s 9PM and they’re not even sure how much tummy time their baby got all day.

Here’s a quick tip - place baby on his tummy after each diaper change, even if it’s only for a minute or two. You change a lot of diapers throughout the day and this will help you to get into the habit of making tummy time a part of the daily schedule and routine.

These shorter sessions will all add up, ensuring your baby gets a good amount of tummy time over the course of the day. Have some unscheduled time after nap time or bath time? Add more tummy time in when you can. As your baby’s wake windows increase, so can the tummy time sessions.

When can I stop worrying about tummy time?

As babies roll both belly-to-back and back-to-belly, they are strengthening the same muscle groups and gaining even more sensory input through their rotational play. As they become proficient rollers, it’s important to prioritize open floor play where they can move freely without any restrictions from play equipment (ex. exersaucers). We can't expect babies to stay on their tummies once they realize they can pivot, roll, or squirm around the room so open floor play is just crucial for building motor planning skills and helping them reach their next milestones as tummy time is in the prerolling stages.

Even though you don’t have to “worry” about tummy time after your baby is consistently rolling, toddlers and big kids can continue to benefit from tummy-down time. Reading books, coloring, or playing games on their bellies will strengthen their upper bodies for gross motor activities like swinging on monkey bars and throwing a baseball along with fine motor skills like buttoning, cutting and writing. Switch over to playing a matching game or reading stories together on your bellies. You’ll feel your shoulder muscles working hard!

Bottom Line: Tummy time is one of the most important activities a baby can do to set a strong foundation for all future milestones, and it can start right from day one! Tummy down play alleviates pressure on the head to help prevent flat spots on the soft skull, strengthens the upper body muscles, provides proprioceptive input for body awareness, and supports vision development. Many babies struggle with tummy time due to discomfort in this unfamiliar position or pain from digestive issues. Laying baby on an incline on your chest, placing a rolled up towel under your baby’s armpits, and aiming for short tummy time sessions after each diaper change can help make this time more comfortable. If your baby is consistently screaming during tummy time, it’s a good idea to check in with your baby’s medical doctor.  If you want additional tips to support your baby through tummy time and each milestone of baby’s first year, check out the Tots On Target Membership, which includes resources, guides, and courses to help you support your baby each step of the way!

Dr. Allison Mell is the founder of Tots on Target and a physical therapist based out of New Jersey.

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