The Importance of Tummy Time

Most new parents have heard of tummy time, and know that their baby should be doing tummy time; however, no one ever explains why tummy time is so important! In reality, the benefits of tummy time are endless, and can be even more important for babies with tethered oral tissues (TOTs- tongue ties, lip ties, buccal ties). Here are some of the highlights:

1. Oral motor skill improvement - Tummy Time is essential to stretch the hypoglossal (tongue) and neck muscles necessary for improved oral motor skills. The tongue is the only muscle in the body that does not have an insertion point (unless there is a tongue tie present). The tongue originates in the hyoid bone in the neck. In order to have full tongue mobility, the neck must stretch so that the tongue can reach full range of motion. This is essential for feeding skills like when we use our tongue to move a bolus of food to our molars to chew and to the back of our palate to swallow. In addition, the tongue assumes optimal positioning in the palate in tummy time and is an excellent way to improve sucking strength for more efficient feeding.
2. Extension position - Babies spend so much time in flexion in the womb. When they join us earthside, they are often in a scrunched position. Spending time on the belly helps to elongate the extensor muscles and activate muscles that have not been used. This will help babies adapt to their new world and achieve appropriate positioning.
3. Increases core, shoulder girdle, and neck strength - Tummy time improves overall strength in the core, shoulders and neck. Fine motor skill development starts proximally with core and shoulder strength, and moves distally once strength is developed. Therefore, strength is essential to future fine motor coordination and control. In addition,strengthening the core and neck is essential for digestive processes. This is why tummy time is very helpful for babies with reflux.
4. Gross motor development - Tummy time provides foundational skills and strengthening needed to meet gross motor milestones such as rolling, sitting, transitioning and crawling. In moving through these developmental stages, babies integrate their primitive reflexes. Children who have retained their primitive reflexes experience interference with biochemical, psycho-emotional, and neurological development.
5. Vision and oculomotor skill development - Tummy time improves vision and the ability for both eyes to work together (oculomotor skills). In the prone position, both eyes are working together and learning to move together. These oculomotor skills are essential for developing depth perception, as well as developing visual saccades and visual tracking skills necessary for hand-eye coordination and future reading skills.
6. Improves fine motor skills - in addition to strengthening the proximal musculature in the core and shoulder girdle as a foundation for fine motor skill development, tummy time promotes reaching and grasping skills resulting in improved upper extremity control, coordination and fine motor precision.
7. Indirectly improves head shape - with the introduction of ‘back to sleep,’ babies are spending more and more time on their backs. Although this is the safest way to sleep (and definitely recommended) we are seeing more cases of torticollis (tight neck muscles) and plagiocephaly (head flattening). Tummy time will improve and stretch the tight neck muscles associated with torticollis therefore reducing head turn preferences and head tilt that leads to head flattening. In addition, tummy time will allow for time spent off of the head to improve head shape.

Tummy Time FAQ

In treating infants, I have come across these commonly asked questions about tummy time

Q: How much tummy time should we do?

A: This really depends on the baby’s tolerance for tummy time. If your baby hates tummy time and screams, they are likely experiencing tension and getting very uncomfortable in tummy time. There are a few tricks to make tummy time more tolerable; however, it does get easier as they gain more strength. As a general rule, spending some time in tummy time 3x per day is my recommendation. Sometimes the baby will tolerate longer stretches, sometimes they will not, which is why I do not recommend a set time. My daughter needed a cumulative 15 minutes of tummy time each wake window if she was going to nap at all, so part of the recommendation is based on what the baby needs.

Q: When can we start tummy time?

A: You can start tummy time as soon as your baby enters the world! Tummy time lying on a parents chest counts, and skin-to-skin contact has endless benefits. It is important to ensure some tummy time is spent on the floor, and many people like to wait until the umbilical cord falls out to do this, but it is not entirely necessary. Do what you are comfortable with!

Q: What if my baby falls asleep in tummy time?

A: I love a SUPERVISED tummy time nap! It still provides all of the benefits! Your baby can nap in tummy time as long as you are watching them and their airway is not obstructed. Placing your baby back to sleep for naps and for night sleep is still recommended if they are in their crib or bassinet and if you are not able to watch them closely.

Q: What are some tummy time tips?

A: I have several tips and love working with families to determine what their babies respond best to. Here are some of my go-tos

• Make sure the baby is ready for tummy time. Try an infant massage to warm them up so that they enter tummy time in a regulated state
• Place the baby in a supported seated position first, then slowly lower them down to their backs, tuck an arm under, and roll into tummy time. This helps baby understand their body positioning and provides a much more gentle transition than simply placing them on their tummy
• Provide manual feedback. Babies love movement, providing a gentle rocking motion by placing your hand on their behind and gently moving them goes a long way. In addition, any movement should start at the head and arms, squirmy legs are a sign of compensation. Try gently holding the legs still or placing your leg behind their feet for feedback
• Tuck their arms under their shoulders. Babies do not have full control over their upper extremities in the beginning and just do not know what to do with their arms. They will be more comfortable with their arms tucked. As they get older, this position will also encourage them to lift their heads.
• Keep it interesting! Use high contrast cards, books, light up toys, rattles, your voice, etc. to entertain your baby during tummy time. I am not a huge fan of buying everything you can, but I am a huge fan of using whatever you have around the house to keep it novel (think noise making kitchen staples, a pet, etc.)

Q: When should I seek help?

A: Tummy time will ebb and flow. Some sessions will be great and some sessions will not be the best and that is okay. If your baby is unable to tolerate any tummy time, it may be a good idea to reach out to an experienced OT or PT as there may be an underlying issue such as tension, tethered oral tissues, or torticollis at play. It is always a good idea to seek treatment from an OT or PT if your baby has tethered oral tissues or is getting a release to complete necessary bodywork strategies for optimal results.