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Tummy Time

It's hard for me to think of a trend more on the pediatric physical therapists' radar today than the dramatic increase we are seeing in the diagnoses of torticollis and plagiocephaly and the severe dislike today's infants show for tummy time. When I first began working with infants in 1992, I can honestly tell you that babies loved being on their tummies. It was quite natural for them. Back then, babies were sleeping on their tummies. They practiced lifting their heads as they fell asleep and when they first woke up. Because babies were so comfortable on their tummies, parents very naturally placed their baby on his/her tummy for play. Babies practiced lifting their heads early and rather routinely learned to crawl and explore the world on their tummies. Movement and exploration was FUN!

Today we are seeing a new trend in development. Many of our babies today HATE tummy time. I cannot tell you how many times a day I hear a parent say to me, "my baby hates tummy time." I can hypothesize that this dramatic change stems from a few factors that have changed in our world since my early observations in 1992.

First, in 1992 the American Academy of Pediatrics (AAP) published a statement recommending that infants be placed to sleep on their backs or sides to reduce the risk of sudden infant death syndrome (SIDS).1  Then, in 1996, the AAP amended their position to recommend back sleeping as the preferred position. The result was a dramatic decrease of 40% in the incidence of SIDS.2  However, there have also been some dramatic unanticipated results. There has been a significant increase in torticollis. Torticollis is the tightening of muscles in the neck resulting in a tilted head or a preference for looking one direction. There has also been an increase in the incidence of positional plagiocephaly. Plagiocephaly is defined as an asymmetrical deformity of the skull. You might notice your baby developing a flattening on the back of his/her head or on one side of his/her head.

What does this mean to you as a parent? As recommended, a baby should be sleeping on his/her back. This means that your new infant is likely spending 18-20 hours on his/her back just sleeping. This back position is becoming the position of comfort for your baby. It is important to know that your baby's skull is quite soft. If left for extended periods in this position, his/her skull will begin to get flat. You may begin to notice a flattening straight across the back of the head or you may notice an asymmetrical flattening and a tendency for your baby to have a preference for looking in one direction. These may be early signs of torticollis or plagiocephaly and should be discussed with your pediatrician. No change should be made in the recommendation to place your baby to sleep on his/her back.

As your pediatrician has discussed with you, early daytime, supervised tummy time opportunities while your baby is awake are essential for helping minimize pressure on the back of the skull as well as for strengthening the neck and back muscles and preparing your baby for all the exploration opportunities that come from being on your tummy.

Placing your baby on his/her tummy during daytime, supervised periods may sound simple to some. As a pediatric physical therapist, I know firsthand how incredibly difficult this may be for you if your baby already dislikes being on his/her tummy. Pediatric physical therapists have a large repertoire of positioning ideas, carrying techniques and exercise ideas which can help your baby learn to enjoy being on his/her tummy. If this is something your baby is struggling with, consult your pediatrician and feel free to make contact with us. Learning to love being on your tummy should not be an unpleasant experience; a trained pediatric physical therapist should be able to give you the tools to help your baby gain strength, balance and the ability to move and explore on his/her tummy.

1) American Academy of Pediatrics. Task Force on Positioning and Sudden Infant Death Syndrome. Pediatrics 1992; 89: 1120-1126
2) American Academy of Pediatrics Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. Changing concepts of Sudden Infant Death Syndrome: implications for infant sleeping environment and sleep position. Pediatrics 2000; 105: 650-656

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