Make tummy time a fun time

Column by Brenda Pardy

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By Brenda J. Pardy, Pediatric Therapy Institute in Greenwood Village
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Since 1994 pediatricians have been recommending that parents not allow their young infants to sleep on their stomachs due to a relationship between the incidence of Sudden Infant Death Syndrome (SIDS) and sleeping in that prone position. According to the American Academy of Pediatrics there has been a decrease in SIDS deaths by 40 percent since that time, so keep up the good work in having your baby sleep on her back!

As a result of all the time spent in back-lying or sitting semi-reclined in car seats, swings, etc. we therapists have been seeing an increase in children with flat spots on the back of their skulls (plagiocephaly), weak neck muscles, and delayed gross and fine motor skill development. Pediatricians are recommending that at least 30 minutes per day be spent in tummy time. As an occupational therapist working with children for over 30 years, I would say that this is the bare minimum. The more time spent on the floor, in a playpen the better. It needs to be supervised time so that if the infant falls asleep, he can be turned to his back for the nap. Rather than having your child laying on his back or seated in a reclined infant carrier, use a front pack or body wrap carrier whenever possible.

But, what if your child hates being on her tummy? When babies used to spend a lot of time sleeping in that position, they found it natural to be there. They spontaneously worked to lift their heads up and pushed up onto their elbows then even higher onto extended arms. Learning to push up against gravity helps to set life-long muscle tone and is the beginning of developing strength in the core muscles. Learning to bear weight through the shoulder girdle is essential in learning to stabilize those joints. Stability in the shoulders is necessary to learn to belly crawl and creep on all fours. Refined finger dexterity develops more effectively when the shoulders automatically hold themselves strong in a neutral position when children begin to grasp and pinch. Now babies often find it uncomfortable to lay on their stomachs since they have to work so hard to hold their heads up and they are not used to it.

Start early. Begin tummy time as soon as you bring your baby home from the hospital for a minimum of 30 minutes total time per day, broken up into small segments. Use a head support for your newborn in a carseat or infant carrier to hold his neck straight. Use carriers as little as possible. Once the baby has some head control, (about four months) try sitting him in a bumbo/boppy seat. It is a C-shaped pillow that supports a child as they are learning to sit up, but puts no pressure on the head.

Get down on the floor face to face with your baby, cooing, making faces, singing, showing her toys. Keep her company when she is on her tummy. Older siblings and pets can help with the entertainment.

Have her lie on your tummy while you are lying on your back to see each other eye.

Lay him on a firm surface such as the bed while you sit on the floor at eye level (Not shown). Be sure to hold him to keep him safe, especially after he can roll. Give his shoulders some support to keep him happy for longer periods of time until his arms are stronger.

Use commercially available toys that include positioning pillows, or roll up a hand towel to provide support under her chest as she learns to push up onto her elbows, then all the way up onto her hands.

Most parents tend to hold their baby in the same arm when laying him down, and so his head is at the same end of the crib every time. Switch directions with each bedtime so he will be facing the other way. Hold your baby in the other arm whenever feasible. This comes naturally with breastfeeding, but should be done with the bottle as well.

When using an infant seat be sure to move it around the house so that interesting things to look at are not always in the same direction to encourage head turning. It takes extra effort to move a head that has flattened on one side, so some infants avoid it and the neck muscles become shortened on one side in a condition known as torticollis. If the child's head is not symmetrical to start with, that can affect neck control as well.

After some head control has developed (at about 4 months) hold him lying on his tummy across your forearms sometimes so that he can look around from that position instead of cradling him in your arms. If you lie on your back and bring your knees to your chest, the baby can lay on your lower legs to play face to face.

If you notice that your son or daughter has a consistent head tilt, struggles to lift his or her head or that you are concerned about the shape of your baby's skull, consult your pediatrician. You might be referred to a pediatric physical or occupational therapist, who can recommend stretches, exercises, activities and positioning specific to your child's needs. If you have questions about your child's motor, speech or behavioral development call us at 303-649-9007.