TUMMY TIME – Let’s learn to love it

Tummy Time…so important and yet so many parents feel it is a major challenge for their little one. The start of my physical therapy evaluation for an infant includes a question about tummy time tolerance.  So often the response is, “well, we are trying, but they hate it”. So many factors go into why a baby may not like tummy time, but as a pediatric PT my job is to help offer solutions to increase the babies willingness and endurance for tummy time. A baby with hypotonia and joint ligament laxity, as is often the case in babies with down syndrome, has extra hurdles to get over before enjoying tummy time.  The struggle is real, but the payoff of spending increased time on their belly is so worth it. No other time in our lives do we spend as much time bearing weight through our shoulders, arms and hands. All babies learn about their bodies by bearing weight through their body parts, looking at their body parts and mouthing those parts they can reach. Babies begin the process of developing coordination, strength, postural control, body awareness and endurance as they begin to press up higher off the surface.  With hands open, palm strength develops, as does the foundation of fine motor control when they look at their hands and learn spatial awareness.

Vision is the primary motivating factor for a baby to move.  From a baby’s point of view, tummy time is the least desirable position for a quality visual experience.  All other positions, including being held, sitting in a supported seat, or being worn by a parent  lead to far more exciting views. Traditional tummy time on the floor, in contrast, leads to a face in the blanket or counting the dust bunnies under the couch.  I encourage all of my families to change the scenery. My favorite spot for tummy time is elevated. The unused formal dining table is a wonderful PT spot. Placing a yoga mat on the table (and obviously never leaving the baby unattended) provides the firm but cushioned surface that allows the reward of being able to press into it and lift off the surface.  A bed or sofa is too soft and does not allow the baby the ability to get a solid press on the surface to be rewarded quickly enough to lift their head. Additionally, the table provides a far superior vantage point; when the right combination of muscles are engaged and the baby lifts their head, they are rewarded with a novel view . The table also allows the parent to sit comfortably at eye level with the baby while also protecting their back. Another fun spot for tummy time is having the baby lay on your chest.  They can press up and see their favorite person. Couldn’t we all use a little more time snuggling our baby, laying back on the couch?

Increasing tummy time increases overall endurance, which takes time to build.  We can not and do not expect new babies to be able to lift and sustain their heads off the surface while on their belly.  To increase both tummy time and endurance, I encourage all of the families I work with to weave tummy time into their daily routine. After every diaper change I recommend rolling the baby over onto their belly.  They may last 5 seconds, they may last 5 minutes. When the position is used regularly it is easy for babies to build both tolerance and endurance for tummy time, and it is easy for parents to remember to do it. Rolling the baby instead of just placing them in tummy time allows the baby to learn how to connect the transition from back to belly. There will be diaper changes where it does not and cannot happen, but the increased frequency has proven to be what the entire family needs to make for improvement in this skill. One important request is that parents do not let their babies “cry it out” while on tummy time if they have not yet learned how to roll; the crying baby is stuck. We are developing a relationship, teaching them how it is ok to to be treated.  If they are sending a signal that they are distraught, roll them onto their back and try again at the next diaper change. A little but of fussing is fine, but as parents we know the difference between fussing and truly upset.

As vision and endurance improve, and mobility starts, the elevated surface is no longer appropriate.  But don’t worry, there are other strategies to enhance tummy time. A long door mirror placed on its side along the couch widens the babies visual experience.  They love looking at other babies and you have now provided them a friend, who happens to be wearing the same outfit as them! Saving a favorite toy and using it only during tummy time can be extra motivation. The baby is such a social creature, so company during tummy time is sure to assist in increasing the tolerance for it; siblings and pets are the best partners during tummy  time. If you make the decision to make tummy time part of your daily routine and not a timed task that must be done each day, the enjoyment and length of time will increase for the whole family.

Colleen Weitekamp, MSPT

Board Certified Pediatric Clinical Specialist