It’s always a good time to be reminded about the importance of babies experiencing enough “tummy time” through their early developmental months. As happens with many interventions, the Back-to-Sleep campaign1 to prevent sudden infant death syndrome (SIDS) has produced some unintentional consequences. The campaign was successful in decreasing the occurrence of SIDS; however, parents seemed to become afraid of putting their babies on their tummies even when they were awake2. This increase in time spent laying on the back is associated with plagiocephaly…. a big word that means misshaped skull. The increased pressure on the back or side of the developing skull causes a flatness that may or may not become a permanent deformity.
Developing bone tends to form according to the forces placed upon it over time. When a baby is actively playing on his or her tummy, a lot of things are happening. Gravity acting downward and the surface acting upward help to depress the lower front part of the rib cage. Because an important breathing muscle, the diaphragm, attaches from the front of the spine to inside of the ribs, it is dependent on rib position for it’s functioning. The forces of being on one’s tummy are ultimately helping to make sure that important breathing muscle is in the correct position for proper breathing.
The tummy down (prone) position offers a unique opportunity for movement against gravity. When the baby tries to clear her airway by raising and turning her head, or to look up at an object , the muscles of the back and sides of the neck get strengthened. Conversely, the muscles in the front of the neck get lengthened, further promoting proper rib position (these muscles connect to the jaw, neck and upper ribs).
When a baby on his tummy begins to push up through his hands, he is starting to strengthen his triceps (the muscles in the back of the upper arm that straighten the elbow) as well as the muscles that hold the shoulder blades in place. The proper development of these muscles contributes to proper reaching posture later. It is also preparation for another very important skill: crawling on hands and knees (see previous blog topic).
Things to keep in mind:
* Awake Tummy Time is a necessary part of active infant movement development, but always supervise a typically developing infant until at least 3 months of age. Once a baby can lift her head in prone, she can clear her airway independently.
* If your baby has reflux, consider doing short (15-20 minutes) episodes of Awake Tummy Time right before feeding rather than after.
* If your baby fusses or cries while on his tummy, ease him into it by having him lie on his tummy on your tummy while you recline. Your face will be a good distraction. Slowly progress to laying your body flat and then eventually remove your body but still keep your face in his visual field. Slowly replace your face with a mirror or other visually attractive toys. Keep track of how long he tolerates the prone position and see if you can increase by one minute each time he tries.
* If all else fails or you have other questions/concerns, give me a call!
Lisa Mangino, PT, DPT, PCS, CNDT is a pediatric physical therapy specialist with 15 years of experience in acute, outpatient, and home health settings. She can be reached at Advance Physical Therapy at (919) 932-7266.
- Willinger M, Hoffman, HJ, Hartford RB. Infant sleep position and risk for sudden infant death syndrome: report of a meeting held January 13-14 1994. National Institute of Health. Bethesda, MD. Pediatrics. 1994:93:814-819.
- Robertson, R. Supine infant positioning- Yes, but there’s more to it. Journal of Family Practice., 60(10): 605-608.