What is tummy time
Tummy time refers to the process of putting a baby on his stomach when he is awake, to help enhance his flexibility and enable him to meet his motor milestones with ease [1, 3].
When to start tummy time
The American Academy of Pediatrics (AAP) recommends beginning tummy time right from the day an infant comes home from the hospital , as starting early allows him to get used to it sooner. But, some may prefer to wait a few weeks so the umbilical cord stump can fall off, otherwise it may irritate the baby when put on his stomach . However, as the baby grows in months his muscles get stronger making it convenient for him to stay on his stomach for a longer time.
How much tummy time does your baby need
According to the APCP (Association of Pediatric Chartered Physiotherapist) and the National Childbirth Trust (NCT) babies can be given tummy time several times in a day for shorter durations .
Neonates should not be placed on their tummy for any longer than three to five minutes as they require time to get adjusted to being in that position [3, 8]. Initially, your baby may find it difficult to raise his head for more than a few seconds, with the span increasing as his neck muscles get stronger . Certain research recommends about twenty minutes of tummy time for three to four-month-old babies .
Why is tummy time important
Overall muscle development: Strengthens the muscles of their head, trunk, neck, back and shoulders  as the baby tries to keep his balance when put on his stomach.
Achieving physical milestones: Being on his belly gives him liberty to make hand and leg movements in varied directions, which assists him in doing push-ups and finally rolling over from front-to-back and back-to-front .
Gross motor skills (crawling, sitting, walking): Other motor skills like crawling on all fours, sitting unassisted and pulling up to a standing posture are achieved earlier by children spending more time lying on their stomach .
Better coordination and tracking ability: It even helps in developing his eye muscles, also improving his tracking ability as he follows you with his eyes all the while during tummy time [3, 4].
Tummy time and prevention of flat head syndrome
Since the skull bones of your baby are not fused together for a few months after birth, keeping him on his back for long periods may lead to an asymmetric head shape, known as plagiocephaly or flat head syndrome , due to the constant pressure at the back of his head [5, 13]. Since the 1994 Back to Sleep Campaign popularized the idea of making babies sleep on their back, it has reduced the risk of SIDS (Sudden Infant Death Syndrome) [5, 10] to a great extent, while increasing the risk of positional plagiocephaly at the same time.
As your baby needs to be on his back while sleeping, keeping him on his tummy as much as possible during the waking hours allows him to move his head in all directions, preventing too much pressure on any one point [1, 5]. So, tummy time helps minimize the chances of plagiocephaly.
How to do tummy time
- You can practice tummy time with your newborn by keeping him across your lap or on your chest for a few minutes two or three times a day . Putting him on a mat may be irritating in the early days due to the cord stump.
- As the baby gets older, tummy time can be practiced on the floor by placing him upon a padded mat or blanket . You may place a rolled towel under his shoulders and chest to support his head . Nursing pillows and cushions are also a good choice.
- If your baby detests being on the floor, make them rest on your chest while you are reclining on a chair . In this way, he gradually begins getting habituated to tummy time, also not having to be far from you.
- Another way of trying to get your baby lie on his tummy without putting him down is by implementing the rugby hold style, where you put him on his stomach across your forearm, supporting him with the other arm. Once you find your kid enjoying this posture, you can try the floor exercise. If your baby is high on reflux, holding him in the rugby style tilts him to an upward angle, lessening his chances of throwing up milk .
- Putting your baby on a huge exercise ball and rocking it back and forth can also be an interesting way of keeping him on his tummy. However, have a strong grip on them to prevent them from falling.
- Follow a set schedule so that your baby gets used to the routine. Certain daily activities like changing his diaper or applying lotion on his body may be done when he is on his belly to make the little one get acquainted with this posture.
Why does your baby hate tummy time
Some babies may find it tedious to lie on their tummy with their head lifted up especially when their muscles have not developed too well. Moreover, they are used to spending most of the time on their back whether it be at home or when made to sit in car seats or carriers. The change in posture limits their vision to a smaller area, making them feel isolated [2, 11]. If your baby cries during tummy time or does not like it, introduce interesting activities to make this experience an exciting and fun-filled one for him instead of avoiding it.
Exercises and activities to encourage tummy time in babies
- Rather than going for a simple play mat, opt for colorful ones with hanging toys . You can even place a variety of toys like bright colored stuffed animals, rattles and big blocks to keep him busy.
- Keeping a plastic mirror in front of him may encourage the baby to be in that posture for a while, also making him lift up his head to look at his reflection excitedly .
- While your baby is on his belly massage gently in a circular direction starting from the shoulder blades to his back to give him a relaxed feeling and stimulate his muscles [3, 12]. This is also effective in releasing the wind or gas, relieving your baby if he is too colicky .
- Make your presence felt by joining your baby when he is on the ground. Interact with him constantly by talking, singing songs or making funny faces and sounds to divert his attention. It even helps in deepening your child’s bond with you.
- If your baby is over three months of age, encourage him to flex his arm muscles and do pushups by holding his favorite plaything at a distance above him. The urge of getting it will make him look upwards as well as use his arms .
- If your child has older siblings, making them play together during this time can make it a fun activity. However, make sure you are present there to avoid any accidents.
Safety tips for tummy time
- Do not put your baby on his stomach within an hour after a meal as it might cause him to spit up or vomit .
- If you find your baby to be constantly crying while being on his tummy or looking sick and pale, do not keep him in that position any longer.
- Always put him on his tummy when he is lively and active as a tired baby will fall asleep in that posture, which may increase the risk of SIDS.
- Ensure that the ground is not too slippery or cold as it might be uncomfortable for the baby or even make him fall ill.
By the time the child is one year of age the risk of SIDS minimizes, making it convenient for him to sleep on his stomach sometimes . Though a pediatrician’s advice is to be sought before implementing it.
If your baby behaves abnormally during tummy time and is not properly active and flexible, talk to your health care provider about the same.
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