What is tummy time

Babies spend the majority of their days lying on their backs, which is why time spent on their tummy is very important. Tummy time is laying your baby on the stomach for brief periods while awake is an important exercise because it helps strengthen neck and shoulder muscles and prepares your baby for crawling. Tummy time is especially useful for a baby with torticollis and a flat head and can actually help treat both problems at once. Always place babies on their backs to sleep, even for short naps.

Tummy time should start soon after birth as part of a pleasurable daily routine. You might begin with 1 to 2 minutes a few times a day.

Over time, you can gradually build up to 10-15 minutes, several times a day. You might start by laying your baby across your lap on their tummy. As your baby grows stronger, you can put them on a rug on the floor to play.

Tips for tummy time

It’s best to choose a time when your baby has had their nappy changed and is happy, alert and interested in their surroundings. To make tummy time more fun, you can:

• lie alongside your baby and chat to them, perhaps turning the pages of a picture book and talking about what you see
• let your baby know they have company by singing, or by stroking their back or hands
• hold a non-breakable mirror next to your baby so they can see their reflection
• place safe toys near your baby, moving them from side to side to encourage your baby to move their head, focus their eyes and stay interested
• do tummy time in different locations, including outdoors on a rug in warm weather.

If your baby becomes sleepy during tummy time, put them on their back to sleep in their crib. As your baby gains more control of their head and arms, give them a ball to play with, rolling it back and forth from you to them. As they start to move around more, clear away any objects that might be dangerous, and introduce new toys and games.

An adult should always be there during tummy time to make sure the baby is safe.

Safety considerations

Always supervise your baby during tummy time. As your baby gets closer to an age where they are strong enough to roll over, be careful where you place them so they don’t roll off a surface.

How to do tummy time

Here’s how to do tummy time:

• Lay your baby on your lap for tummy time. Position your baby so that his or her head is turned away from you. Then, talk or sing to your baby and encourage him or her to turn and face you. Practice this exercise for 10 to 15 minutes.
• Baby can lie across your legs while you’re sitting, or on your chest while you’re leaning against the couch or lying on your back against a pillow. Your baby will love feeling the warmth of your body and your heartbeat.
  • Get down on the floor in front of your baby and sing or talk face to face.
  • If getting tired, you can roll your baby onto the back to rest for a moment, or carry for a while, and then try tummy time again.

Tummy time strengthens the back, neck, and arm muscles, which are needed for holding the head upright, rolling, sitting, and crawling. Tummy time is also good for visual and mental stimulation because your baby is encouraged to look around to explore the surroundings.

Why tummy time is important?

Experts recommend that babies sleep on their back to reduce the risk of sudden infant death syndrome (SIDS). So babies spend a lot of time lying on their back.

Tummy time gives your baby the chance to try a new position and helps prevent them getting a flat spot on their head from lying on their back so much.

Tummy time builds your baby’s head, neck and upper body strength.

It also helps to develop the skills they’ll need to crawl, roll over, sit up and stand.

When to start tummy time?

The sooner you start tummy time, the sooner your baby will get used to it, benefit from it, and come to enjoy it. Babies who have not spent much time on their tummies may need extra encouragement and practice to get used to it. Here are some ideas to help your baby learn to enjoy tummy time. Remember, tummy time should always be supervised, never leave baby alone on her tummy or on these positioning products.

• Back to Sleep, Tummy to Play
  • Healthy babies are safest when sleeping on their backs at nighttime and during naps. Side sleeping is not as safe as back sleeping and is not advised.
  • Tummy time is for babies who are awake and being watched. Your baby needs this to develop strong muscles.
• It works best if your baby is well rested and happy before trying tummy time.
• Start with 5 minutes of tummy time every time your baby is awake and slowly work up to 20 minutes.
• Put your baby’s favorite toys within reach. Play some favorite music.
  • Put a mirror in front of your baby.
• Your baby will need to first develop the strength and experience to lift the head and play. If playing on the floor is challenging, propping your baby at an angle can make it easier to lift the head. You can use:
  • a small pillow (such as a Boppy® pillow).
  • a towel roll under the arms and chest.
  • a foam wedge.

Be patient. Your baby may be challenged a bit at first, but it is important to keep trying. As your child gets stronger, tummy time will be more fun. The benefits are worth it.

Talk with grandparents, child-care providers, and babysitters. Make sure everyone who cares for your baby knows about safe sleep:

• Every sleep time counts! Put baby on his or her back for sleep in a safety-approved crib.
• Keep soft items out of the bed:
  • No pillows
  • No blankets
  • No bumper pads
  • No toys
• Put your baby on the tummy to play during supervised awake time.

How can I exercise the baby while he is on his tummy?

There are lots of ways to play with the baby while he is on his tummy.

• Place yourself or a toy just out of the baby’s reach during playtime to get him to reach for you or the toy.
• Place toys in a circle around the baby. Reaching to different points in the circle will allow him to develop the appropriate muscles to roll over, scoot on his belly, and crawl.
• Lie on your back and place the baby on your chest. The baby will lift his head and use his arms to try to see your face.
• While keeping watch, have a young child play with the baby while on his tummy. Young children can get down on the floor easily. They generally have energy for playing with babies, may really enjoy their role as the “big kid,” and are likely to have fun themselves.

How much tummy time should an infant have?

Beginning on his first day home from the hospital or in your family child care home or center, play and interact with the baby while he is awake and on the tummy 2 to 3 times each day for a short period of time (3-5 minutes), increasing the amount of time as the baby shows he enjoys the activity. A great time to do this is following a diaper change or when the baby wakes up from a nap.

Tummy time prepares babies for the time when they will be able to slide on their bellies and crawl. As babies grow older and stronger they will need more time on their tummies to build their own strength.

What if the baby does not like being on her tummy?

Some babies may not like the tummy time position at first. If your baby becomes restless during tummy time, try changing the activity or the location. If your baby doesn’t like being on the floor, lie down and place them on your chest while you gently play with their hands and feet. Give them a gentle rock, sing songs or rub their back.

Place yourself or a toy in reach for her to play with. Eventually your baby will enjoy tummy time and begin to enjoy play in this position.

Some babies with reflux don’t like tummy time at first, but if you persevere, you will probably find they are able to tolerate it for longer periods as they grow older and stronger.

Why should babies sleep on their backs?

More than 3,500 babies in the U.S. die suddenly and unexpectedly every year while sleeping, often due to sudden infant death syndrome (SIDS) or accidental deaths from suffocation or strangulation. The American Academy of Pediatrics ¹⁾ has recommended the following to help reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep related infant deaths, such as suffocation.

• All healthy babies should sleep on their backs, in a safety approved crib bassinet or play yard on a firm mattress covered by a fitted sheet.
• Keep the head of the crib flat, unless the doctor gives other instructions because of your child’s medical condition.
• Keep loose bedding (pillows, blankets, bumpers) and soft toys out of the crib.
• Consider using a wearable blanket to keep baby warm for sleep rather than a loose blanket
• Keep baby in the same room-not the same bed. Babies and children younger than 2 years should not sleep in the same bed with anyone else, due to the risk of suffocation. If you bring baby to bed to breastfeed place him back in his own crib, bassinet or pack and play when you are finished.
• A pacifier is okay when settling to sleep. When it falls out after your baby is asleep, leave it out.
• Babies who can roll over should be put to bed on their backs, but allowed to change positions as they like. You don’t need to roll them back.

How to keep your sleeping baby safe

The American Academy of Pediatrics Recommendations for Infant Sleep Safety ²⁾

• Until their first birthday, babies should sleep on their backs for all sleep times—for naps and at night. Scientists know babies who sleep on their backs are much less likely to die of SIDS than babies who sleep on their stomachs or sides. The problem with the side position is that the baby can roll more easily onto the stomach. Some parents worry that babies will choke when on their backs, but the baby’s airway anatomy and the gag reflex will keep that from happening. Even babies with gastroesophageal reflux (GERD) should sleep on their backs.
  • Newborns should be placed skin-to-skin with their mother as soon after birth as possible, at least for the first hour. After that, or when the mother needs to sleep or cannot do skin-to-skin, babies should be placed on their backs in the bassinet. While preemies may need to be on their stomachs temporarily while in the NICU due to breathing problems, they should be placed on their backs after the problems resolve, so that they can get used to being on their backs and before going home.
  • Some babies will roll onto their stomachs. You should always place your baby to sleep on the back, but if your baby is comfortable rolling both ways (back to tummy, tummy to back), then you do not have to return your baby to the back. However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads around your baby, so that your baby does not roll into any of those items, which could cause blockage of air flow.
  • If your baby falls asleep in a car seat, stroller, swing, infant carrier, or sling, you should move him or her to a firm sleep surface on his or her back as soon as possible.
• Use a firm sleep surface. A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (https://www.cpsc.gov/) is recommended along with a tight-fitting, firm mattress and fitted sheet designed for that particular product. Nothing else should be in the crib except for the baby. A firm surface is a hard surface; it should not indent when the baby is lying on it. Bedside sleepers that meet Consumer Product Safety Commission safety standards may be an option, but there are no published studies that have examined the safety of these products. In addition, some crib mattresses and sleep surfaces are advertised to reduce the risk of SIDS. There is no evidence that this is true, but parents can use these products if they meet Consumer Product Safety Commission safety standards.
• Room share—keep baby’s sleep area in the same room where you sleep for the first 6 months or, ideally, for the first year. Place your baby’s crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The American Academy of Pediatrics recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby.
• Only bring your baby into your bed to feed or comfort. Place your baby back in his or her own sleep space when you are ready to go to sleep. If there is any possibility that you might fall asleep, make sure there are no pillows, sheets, blankets, or any other items that could cover your baby’s face, head, and neck, or overheat your baby. As soon as you wake up, be sure to move the baby to his or her own bed.
• Never place your baby to sleep on a couch, sofa, or armchair. This is an extremely dangerous place for your baby to sleep.
• Bed-sharing is not recommended for any babies. However, certain situations make bed-sharing even more dangerous. Therefore, you should not bed share with your baby if:
  • Your baby is younger than 4 months old.
  • Your baby was born prematurely or with low birth weight.
  • You or any other person in the bed is a smoker (even if you do not smoke in bed).
  • The mother of the baby smoked during pregnancy.
  • You have taken any medicines or drugs that might make it harder for you to wake up.
  • You drank any alcohol.
  • You are not the baby’s parent.
  • The surface is soft, such as a waterbed, old mattress, sofa, couch, or armchair.
  • There is soft bedding like pillows or blankets on the bed.
• Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby’s sleep area. These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing.
• It is fine to swaddle your baby. However, make sure that the baby is always on his or her back when swaddled. The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips. When your baby looks like he or she is trying to roll over, you should stop swaddling.
• Try giving a pacifier at nap time and bedtime. This helps reduce the risk of SIDS, even if it falls out after the baby is asleep. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 2-3 weeks. If you are not breastfeeding your baby, you can start the pacifier whenever you like. It’s OK if your baby doesn’t want a pacifier. You can try offering again later, but some babies simply don’t like them. If the pacifier falls out after your baby falls asleep, you don’t have to put it back in.

What Moms Can Do: Recommendations for Prenatal & Postnatal

• Do not smoke during pregnancy or after your baby is born. Keep your baby away from smokers and places where people smoke. If you are a smoker or you smoked during pregnancy, it is very important that you do not bed share with your baby. Also, keep your car and home smoke-free. Don’t smoke anywhere near your baby, even if you are outside.
• Do not use alcohol or illicit drugs during pregnancy or after the baby is born. It is very important not to bed share with your baby if you have been drinking alcohol or taken any medicines or illicit drugs that can make it harder for you to wake up.
• Breastfed babies have a lower risk of SIDS. Breastfeed or feed your baby expressed breast milk. The American Academy of Pediatrics recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. Even after you add solid foods to your baby’s diet, continue breastfeeding for at least 12 months, or longer if you and your baby desire.
• Schedule and go to all well-child visits. Your baby will receive important immunizations at these doctor visits. Recent evidence suggests that immunizations may have a protective effect against SIDS.
• Make sure your baby has tummy time every day. Awake tummy time should be supervised by an awake adult. This helps with baby’s motor development and prevents flat head syndrome. See Back to Sleep, Tummy to Play for more information and ways to play with the baby during tummy time.

Use Caution When Buying Products

• Use caution when a product claims to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS, according to the American Academy of Pediatrics.
• Do not rely on home heart or breathing monitors to reduce the risk of SIDS. If you have questions about using these monitors for other health conditions, talk with your pediatrician.
• There isn’t enough research on bedside or in-bed sleepers. The American Academy of Pediatrics can’t recommend for or against these products because there have been no studies that have looked at their effect on SIDS or if they increase the risk of injury and death from suffocation.

How does sleeping on the back affect my baby?

As a result of these recommendations, the SIDS (Sudden Infant Death Syndrome) rate has dropped almost 50 percent. During this same time, however, plagiocephaly (head flattening) and torticollis (a one-sided tightness in neck muscles) have increased.

Some babies tend to keep their heads in a favorite position while on their backs. This can affect their development. It makes it hard for them to strengthen their neck muscles evenly, and hard to learn to use both sides of their body.

Sleeping

Place your baby on the back to sleep, alternating head position so not always lying on the same side of the head. Or alternate positions in the crib (feet toward one end, then the other end) so your baby needs to turn the head to look toward activity in the room.

If your baby always lies on one side of the head, try changing the direction of the crib or move things in the room that your baby likes to look at.

Some products claim to be designed to keep a baby in one position. These products have not been tested for safety and are not recommended.

Equipment

Limit the use of toys such as swings, infant seats, and exercise saucers. Always use a car seat for travel, but take your baby out of it as soon as the trip is over. When awake, babies need to be held, or on the floor exploring and developing motor skills as much as possible.

Doesn’t sleeping on her back cause the baby to have a flat head?

Parents and caregivers often worry about the baby developing a flat spot on the back of the head because of sleeping on the back. Though it is possible for a baby to develop a flat spot on the head, it usually rounds out as they grow older and sit up.

There are ways to reduce the risk of the baby developing a flat spot:

• Alternate which end of the crib you place the baby’s feet. This will cause her to naturally turn toward light or objects in different positions, which will lessen the pressure on one particular spot on her head.
• When the baby is awake, vary her position. Limit time spent in freestanding swings, bouncy chairs, and car seats. These items all put added pressure on the back of the baby’s head.
• Spend time holding the baby in your arms as well as watching her play on the floor, both on her tummy and on her back.
• A breastfed baby would normally change breasts during feeding; if the baby is bottle fed, switch the side that she feeds on during feeding.