Whether you are a new parent, a professional who works with babies, or a caregiver to a newborn, knowing the importance of "tummy time" is key to a baby's development. 

What is tummy time?

In its simplest terms, tummy time is time that a baby spends on his or her belly while awake.

Some parents are not familiar with this term or may not have adequate information about the importance of tummy time. This may be due to the Back To Sleep campaign launched in the early 90s where suddenly, babies nationwide were spending more time on their backs instead of their bellies for much of their awake hours.

When to Start Tummy Time

Babies can start tummy time as early as one day old, unless otherwise specified by a doctor. In early infancy, place your baby on your chest while you are seated or lying down. This is a great time for skin-to-skin contact with your baby too.

Tummy Time Milestones

Tummy time is essential for infants because most important milestones are achieved in this position, and it also provides a great opportunity for babies to build essential strength.

Tummy time milestones include:

• neck and core strengthening
• rolling
• upper body strengthening
• crawling
• and in later years, handwriting!

When a baby lifts his or her head against gravity, even for a few seconds, this helps  to strengthen and coordinate the  back and shoulder muscles.  These muscles and skills are necessary for a baby to learn how to roll, sit up, and crawl!

Benefits of Tummy Time

In addition to strengthening skill milestones, tummy time helps to prevent flat spots on the back of the baby's head, which is also known as positional plagiocephaly. This occurs because babies' heads are made of soft, moveable plates that harden as they grow older.  In order to avoid flat spots, it is important for babies to play in various positions throughout the day.

Tummy time also provides the baby with new  sensory experiences.  If a baby is in one position all the time, they are not able to experience various head positions, touch new textures, and see new angles.  Letting babies get too comfortable in one position can lead to sensory challenges as they get older. 

Adequate tummy time also helps develop your baby's vestibular system, which tells us where we are in relation to the ground and space. Tummy time provides babies with an opportunity to develop their vestibular system, as their head is in a new place in space and their whole body is feeling a new sensation by placing pressure into the floor/mat with their legs, palms, and belly. One reason babies don't necessarily enjoy tummy time is because of their under-developed vestibular system. So it is our job as parents, caregivers, and professionals to slowly integrate this position into their daily routine. 

Do you ever wonder why some kids hate swinging in a swing, tilting their head back to get their hair washed, or just being in different positions besides sitting or lying on their back? This could be due to limited opportunity for their vestibular system to mature. 

But let's not forget that laying babies to sleep on their backs for safety is a must.

How long should babies spend in tummy time?

As a pediatric occupational therapist, I am often asked how long  babies should tolerate tummy time. Listen to your baby's cues and go from there.  Place a blanket on the floor in a clear area after nap time or a diaper change and place your baby on his or her stomach for one or two minutes (or 30 seconds if that's all baby can tolerate), two to three times per day. The Mayo Clinic suggests that you  aim for 20 minutes of tummy time per session by the time your baby is three or four months old, to ensure they will reach their gross motor milestones of rolling and "army crawling" that emerge around this age.    

Why is my baby grunting during tummy time?

A little grunting during tummy time is normal! This means your baby is exerting effort to try to crawl. Your baby is growing stronger and strengthening muscles.

What prevents parents from starting tummy time for their infants?

One of the biggest reasons parents shy away from playing with their babies in the tummy time position is because their baby doesn't enjoy it, gets upset, and cries. 

Although it is normal for babies to grunt while they are working hard in this position, we do not want them to become overly frustrated or to cry inconsolably. One of the best ways to help babies enjoy this time a little more is to engage with them and start slowly.  Get down to eye level with your baby while they are lying on their tummy and talk or sing to them for a few seconds at a time. 

What to Do if Your Baby Hates Tummy Time

1. Lay Your Baby on Your Chest

As mentioned above, babies can start tummy time laying on your chest as early as day one of their life (unless otherwise specified by your doctor). Place and hold the baby on your chest while you are seated or lying down and talk to him or her.  Babies usually enjoy this position because of the closeness and skin to skin contact with their parent/caregiver. Watch them try to lift their head ever so slightly. This is hard work for them, so give them praise and smile!

2. Use a Boppy Pillow

You can place your baby's armpits over a boppy  pillow or rolled up towel.  This position helps to free up your baby's hands for movement, rather than being tucked under his/her body and can also help your baby raise his head and look around with more ease. When using this method, make sure your baby's head/face is in front of the pillow to keep her airway free to breathe.

 3. Use a Therapy Ball

You can also use a therapy/yoga ball for tummy time.  The parent, professional, or caregiver sits in front of the ball and stabilizes it with their legs while holding the baby securely in your arms with their belly on the ball.  This position puts you and baby face to face, giving you so much opportunity to engage by singing, talking, making silly faces, and interacting with each other.  

4. Use a Mirror

Place  a mirror on the floor in front of the baby so they can see themselves during tummy time.

5. Use Toys

Place black and white cards or books low and  within reach, so the baby can start to look at and reach for them.

6. Use Siblings or Pets

To encourage your baby's interest in tummy time, have siblings nearby playing with their toys or the family pet  so that your baby can look around at his/her environment and enjoy this play position for longer periods of time.

7. Take tummy time outside!

Place a blanket in the grass in your yard or at a park and let your baby (and you!) enjoy some fresh air, grass, and new sounds while they strengthen their bodies in tummy time.

8. Get Those Hands Wet

As your baby gets stronger, place a tray with some water in it so she can splash in the water for a new sensory experience. 

Important tips to remember during tummy time

Remember to always supervise the baby during tummy time. They should never be left alone; it is a time to connect and engage with your baby, not a chance to walk away or take a break.  Your baby will enjoy this time much more if they can see your smile, your face, your hair, and hear your voice.  Tummy time is only for when a baby (and you) are awake and alert, not for when they are napping or sleepy. Never leave your baby  unsupervised.

I hope this information  will help you and your baby enjoy tummy time. Always feel free to reach out to your pediatrician if you have any concerns about your little one's development!

DISCLAIMER: These tips and ideas are intended for “typically developing” infants. If your baby has certain medical conditions, tummy time positions may not be appropriate or may need modifications. As always, discuss any concerns specific to your child with your child’s pediatrician or pediatric occupational or physical therapist.

Resources:

 Mayo Clinic: Infant/Toddler Health (Visited September 2020)

NIH: Safe To Sleep Campaign (visited September 2020)

American Academy of Pediatrics: Tummy Time and Infant Health Outcomes (visited January 2023)

Photo by Jimmy Conover on Unsplash