A Guide to Tummy Time: When to Start and How to Do It

What is tummy time and why should you do it?

Before the Back to Sleep campaign was introduced in 1994, babies were put to sleep on their tummies, sides, and backs with ease. Tummy time was not a household term and was not considered something that needed to be done daily to aid in milestone achievement and strengthening. As babies spent plenty of time sleeping on their tummies and having to move out of this position, they were strengthening their backs and necks as they went along. This, in turn, aided in their milestone achievements, and the ages at which these milestones were reached formed the basis for the age-related milestones we measure babies against today.

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During the 20th century, SIDS (Sudden Infant Death Syndrome) was a feared term and as the cause was (and still is) unknown, researchers all over the world aimed to uncover any risk factor or cause that they could find.

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Research found that babies who sleep on their backs have a lower arousal level (meaning they wake easier) and less slow-wave sleep (deep sleep). It is theorised that some infants (especially preterm infants) might have an immature brainstem which increases their risk of being unable to arouse from a deep sleep and therefore have an increased risk of SIDS. So, although babies sleep deeper and longer on their tummies, they might not be able to wake from this deep sleep and are therefore at a higher risk for SIDS.

Did you know that in 1992 75.7% of infants in the USA were put to sleep on their tummies? Since the start of the Back to Sleep campaign, the occurrence of SIDS has decreased by more than 50% in the USA. To learn more about the other risk factors for SIDS you can check out the Shaw Academy Early Childhood Development course.

Why is tummy time important?

After a few years, paediatricians worldwide started seeing more and more flat-headed babies in their offices, as well as a general slower attainment of milestones. New research shows that this change in sleeping position has brought with it new concerns, such as the slower attainment of gross motor milestones like rolling over, sitting up, crawling, and pulling to standing, as well as the development of positional plagiocephaly (often referred to as flat headedness) since the start of the Back to Sleep campaign.

Because babies were no longer sleeping on their tummies, they were not working up against gravity as often as they did. With this, babies took longer to innervate and strengthen their back and neck muscles. These muscle groups are very important for the development of lifting and maintaining a steady head position, strengthening the shoulders and arms to be able to push up, and for skills like rolling, sitting up, crawling, and pulling up to standing.

Tummy time was then introduced to be used synonymously with Back to Sleep, in a way to counteract plagiocephaly as well as to encourage the reaching of gross motor milestones. Tummy time in the 21st century is therefore important to engage the senses, promote movement, facilitate reaching and playing as well as strengthening gross motor muscle groups.

When should you start tummy time?

Tummy time in its essence does not have to be a specific activity that you do with your baby, but should rather be looked at in terms of the position a baby is in. Tummy time, therefore, means any position or activity where a baby is lying forward onto their stomach and has to work up against gravity to move their head and arms away from their bodies in order to see and experience the world. By moving in this way, they are strengthening their back and neck muscles in preparation for more advanced gross motor development.

If you think of tummy time in this way, instead of as an activity that needs to be done on the floor or on an activity mat, tummy time can start as early as directly after birth. When babies are still in the newborn phase of development, they do not need to be placed away from their mothers in order to achieve the benefits of tummy time. Simple changes in your daily routine will allow for those “tummy time” moments from birth until they are old enough to do tummy time on their own. Laid-back breastfeeding is a good example of one of the first ways you can introduce tummy time to a baby.

How long should you do tummy time?

Now that you know when to start, you need to decide how long tummy time should be done for. WHO (World Health Organization) advises that tummy time during the first year of life should add up to at least 30 minutes per day, spread out over multiple tummy time sessions. This is, however, the minimal requirement and if your baby is willing you can easily increase this amount of time to between 40 and 60 minutes a day.

Start with small tummy time sessions, lasting between 1-2 minutes, gradually increasing the time until they can take part for 3-5 minutes per session. As they get older and are more able to explore with their hands and bodies, they might be able to take part in 10-15 minutes of tummy time per session.

What to do if your baby doesn’t like tummy time

Remember never to force a baby to do tummy time or end on a bad note. If you see that a baby is becoming tired or fussy, end the tummy time session and try again later as you do not want your baby to attach a negative connotation to tummy time and refuse to take part. (You can also download the free Shaw Academy crying elimination chart to help determine why your baby is crying or fussing.) Remember to count all those laid-back breastfeeding sessions and tummy-down cuddles on your chest as part of your daily tummy time as well!

Tummy time will always deliver the best results if you are spending that time with your baby, so be sure to get down to the floor with them and use that time for bonding, having conversations, and showing them the world around them.

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Johanlie De Bruin