So you just left the hospital overwhelmed with new information on how to best care for your new baby. As you get accustomed to your child’s immediate needs — meals, changing diapers, learning to safely strap them into their car seat — it is easy to forget the importance of early initiation of tummy time.
As pediatric physical therapists, some of the most common questions we receive from parents are “When should we start tummy time?” and “How much time should my child spend on their tummy?” We also hear “My child hates tummy time. What should I do?” If you also have felt this way, you are not alone.
What Is Tummy Time?
Tummy time is a term used to describe the action of placing your baby on their stomach when they are awake and being supervised. Your infant should never participate in tummy time when they are asleep or unsupervised. Infants should sleep positioned on their backs to prevent what is known as sudden infant death syndrome (SIDS).
Remember this helpful phrase: “Back to sleep, tummy to play.”
Why Is It Important?
Tummy time is essential for developing neck muscle strength and control, as well as stability within the shoulder girdles. Positioning your child on their stomach allows them to gain the strength and coordination they need for future motor skills like rolling, sitting, crawling and walking.
Delayed onset of developmental milestones has been associated with a lack of tummy time. It fosters visual-motor development, cognitive functioning and oral-motor skills important for feeding and speech development. Tummy time is the most important method to prevent conditions frequently seen with children who spend sustained periods of time on their back such as torticollis and abnormal skull/facial shaping (plagiocephaly and hemihypoplasia). It also allows for appropriate jaw development.
When Should I Start?
You can start tummy time when your child is as young as one week old. The best way to initiate this is by laying your child on your chest when you are in a reclined position. This allows them to adjust to tummy time in an environment where they feel safe. As they do so, you can recline further until you are lying on your back and they are on their stomach. As soon as possible, transition to tummy time positioned on a firm surface, such as a mat on the floor.
How Much Time on Their Tummy?
The first tummy time sessions can last for only a few minutes, depending on your child’s tolerance. Work up to 80 cumulative minutes a day by the time they are three months old. The more, the better!
What if They Hate It?
Begin slowly and be persistent, even if they don’t appear to enjoy it. Start with what they are able to tolerate and gradually add more time. Provide them with reassurance and encouragement. Be aware of the difference between your baby crying because they are angry and crying because they’re distressed. Babies learn early that crying gets them picked up. Consider allowing them to cry for 30 seconds before doing so if it’s an angry cry.
Throughout tummy time, monitor for pain or distress symptoms (abnormal breathing, a change in facial color) and terminate immediately if you notice this behavior. Allow them time to be soothed and reassured prior to resuming.
You may make tummy time easier by doing it with your baby on your chest or positioned over your lap. Visual work helps! Provide a toy for them to interact with. Toys are best positioned within arm’s reach and near their waist. Once they adjust to tummy time while on your chest or lap, you may progress to positioning them on a blanket on the floor. You also can roll up a blanket and place under their chest to provide additional support.
What if They Have Reflux?
Many infants who experience reflux (frequently spitting up after feeding) have a poor tolerance of tummy time. To improve their comfort level, we recommend waiting at least 30 minutes after their feeding to position them on their tummy. It is helpful to gradually transition them to their stomach by allowing them to play while positioned on their back. After a few minutes, gradually roll them to their side (preferably the left). Allow them to play in that position for a few minutes before helping them roll to play while on their stomach.
Be encouraged that despite any chaos you may feel as an early parent, you are doing a great job! As therapists, we repeatedly observe that once a child adjusts to tummy-time positioning, it becomes their preferred position for play.
Be brave and be focused. You can do it!
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