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Why Tummy Time Matters

Vol. 28 • Issue 3 • Page 27

Reflections on Practice

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 head.

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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 eaten.

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 caregivers.

Anne Zachry, PhD, is a pediatric occupational therapist with a doctorate in educational psychology. Her websites are and


Another great article Dr. Zachry! As an occupational therapist that has worked with thousands of infants with torticollis and plagiocephaly, this article to reflect what I find clinically. We have developed video-on-demand to help parents and professionals with supporting infant development and headshape. One of them is on youtube (link below). Others can be watched immediately from our website. youtube:
Please watch it and pass it on!

Susan Klemm Slaughter, MS, OTR/L,  Director/Owner,  Carolina Kinder DevelopmentSeptember 09, 2013
Charlotte, NC


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