Tummy Time Matters

     In 1994, the American Academy of Pediatric (AAP) initiated a
"Back to Sleep" marketing campaign instructing all parents,
caregivers and health care providers to place healthy infants on their backs to
sleep. Since this recommendation, 50-percent fewer infants have died from SIDS.
Putting babies to sleep on their backs turned out to be an easy and effective
way to save their lives. However, a recent survey of pediatric physical,
occupational and speech therapists reveals an increase in early-motor-skill delays
in infants since the AAP supine sleep recommendation. Pediatricians and
therapists also are reporting a rise in babies diagnosed with flat spots on the

     The AAP now formally recommends that all infants be exposed to
tummy time on a daily basis to prevent flat spots from forming and to promote
growth and development. Although most parents know that they should expose
their baby to tummy time every day, 50 percent of parents in my study reported
not doing so because their infants will not tolerate being positioned prone for
play. As therapists, we know that when a baby is not exposed to regular tummy
time, he is likely to have weakness with head, trunk and upper-extremity
control, and limited strength in these muscles can make tummy time quite uncomfortable
for baby.

     So what can we as therapists do about this situation? As heath
care professionals, we have a responsibility to educate parents and caregivers
about the critical nature of tummy time. Parents need to understand why tummy
time is important and how it should be implemented in the early days of an
infant's life so that baby learns to tolerate the position. As occupational
therapists, we need to explain to parents that there are ways to introduce
tummy time that can make the experience tolerable for baby, as well as for mom
and dad.

     In fact, tummy time should be a pleasant experience, providing a
wonderful opportunity for parents to bond with their infant. It does not
necessarily have to take place on the floor. It can be carried out in a variety
of ways, such as positioning the baby prone on a caregiver's chest when the
caregiver is in a reclined position. Baby can also be positioned tummy down on
a caregiver's lap, or held and carried in a prone position.

     Therapists need to explain to parents that tummy time can be
initiated in the first week of life. Baby may only tolerate a few seconds of
tummy time on the first attempt, but the seconds can gradually be increased as
tolerance increases. Parents should add 10 to 15 seconds each additional session
in order to build baby's tolerance for tummy time. Additionally, parents can
use creative ways to motivate baby to stay tummy down, such as getting at
baby's eye level and making silly faces, singing, and talking in animated
tones, etc. Shaking a rattle and placing colorful toys or a "baby
safe" mirror at baby's eye level are also effective distractions.

     Parents also can roll a small towel or receiving blanket into the
shape of a bolster and position baby's arms over the roll with her hands
reaching out in front of the roll. This assists with head control and helps
baby stay in a comfortable position. Parents also need to understand that it
best to only try tummy time when baby is rested, comfortable, and has not just

     Finally, it's important to develop and follow a regular schedule
for tummy time, such as immediately after diaper changes, naps or bath time.

     It is also critical for parents to understand that in order to
foster infant physical development and prevent flat spots on the head, time in
car seats, carriers, and plastic equipment should be limited. Many infants
spend long hours in plastic equipment, which can have a negative impact on
sensory and motor skill development. These devices have an unyielding surface
on which the head rests; and while normal use is not a concern, extended use,
especially allowing a baby to sleep for long periods in these devices, can
cause major problems.

     Interestingly, research has even revealed that there is a
relationship between plastic equipment use and infants' scores on developmental
scales, with babies who spend more time in equipment scoring lower on motor
development scales than those with less equipment use.

     The education of parents regarding the importance of tummy time is
the responsibility of all health care providers, including physical and
occupational therapists. It is critical that all of us as health care workers
join together as a team to communicate the tummy time message to parents and

Anne Zachry, PhD, is a pediatric occupational
therapist with a doctorate in educational psychology. Her websites are
www.drannezachry.com and www.drzachryspedsottips.blogspot.com.