Since the 1994 Back-to-Sleep campaign was initiated, the rate of sudden infant death syndrome (SIDS) has decreased by 50% (1). It is not surprising that since then we have also seen an increase in the prevalence of plagio- and brachiocephaly (flat head syndrome). (2)
As a parent, this may be confusing. I get lots of questions from parents on when, where, how and why they should be starting tummy-time with their babies – and I am here to clarify it all for you!
Let’s start with why tummy-time is important. There are three main benefits of putting your baby in a prone position for play while they are awake:
- Strengthens the muscles on your baby’s shoulder, neck and back (4)
- Gives them an optimal environment to learn their milestone skills, such as crawling and sitting up (4)
- Prevents/reduces flat spots on the back of your baby’s head (4)
In fact, a recent survey conducted by the American Physical Therapy Association showed that “physical therapists who saw an increase in motor delays said that the lack of “tummy time,” or the amount of time infants spend lying on their stomachs while awake, is the number one contributor to the escalation in cases.” (3)
How early is too early?
Never! Your baby should start practicing tummy-time as soon as he or she gets home from the hospital. You can start by laying your baby on your chest – this not only encourages time on their tummy but also allows for bonding!
How long should my baby tolerate tummy-time?
By 3 months of age, your baby should tolerate up to 1 hour on their tummy. Start with short 3-5 minute bouts, several times daily, or however long he or she can tolerate and build up from there.
My baby hates tummy-time!
Tummy-time may be uncomfortable for babies, especially if they don’t have the neck strength to lift their head and see their environment. It is important to continue practicing tummy-time as this will build your baby’s sensory receptors, muscle strength and build their tolerance to this position. If your baby has a specific issue (e.g. reflux) that prevents them from tolerating tummy time, talk to your physiotherapist on strategies to help them feel more comfortable in the prone position.
How about Sleeping?
We continue to recommend that your baby sleeps on his/her back to reduce the risk of SIDS. During waking hours, however, your baby should be practicing tummy-time to get them on their way!
What are some other ways I can prevent a flat spot on my baby’s head?
Other than tummy-time, you should limit the amount of time spent in the car seat, bouncers, swings and carriers. When sleeping, change the head of the bed everyday so that your baby is encouraged to turn their head equally in both directions to see their environment.
This may seem like a lot to remember. If you are finding that your baby is still struggling with tummy-time, make an appointment with your paediatric physiotherapist to discuss other options to help your baby love time on their tummy.
And whenever in doubt, just remember this rhyme:
Back to sleep, tummy to play, change the head of the bed every day!
Pelvic Floor & Paediatric Physiotherapist
Sandra graduated from Dalhousie University with a Masters degree in Physiotherapy after completing her Bachelor of Kinesiology degree with honours from McMaster University. She has worked with a variety of clientele but has developed a true passion in working with both the paediatric and women’s health populations. Sandra has extensive experience assessing and treating a variety of paediatric conditions and most recently has become certified as a pelvic health physiotherapist. She also has additional training in acupuncture and kinesiotaping. Sandra finds great value in guiding each individual through a tailored rehabilitation program to optimize their function and quality of life. In her free time, Sandra enjoys yoga, pilates, traveling and spending time with family and friends.
1 – Trachtenberg FL et al. (2012). Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign. Pediatrics, 10, 2011-1419.
2 – Biggs, W. S. (2003). Diagnosis and management of positional head deformity. American Family Physician, 67, 1953–1956.
3 – American Physical Therapy Association. (2008). Child Development: Lack Of Time On Tummy Shown To Hinder Achievement. ScienceDaily.
4 – “Babies Need Tummy Time!” Eunice Kennedy Shriver National Institute of Child Health and Human Development, U.S. Department of Health and Human Services, safetosleep.nichd.nih.gov/safesleepbasics/tummytime.