From the 1980s onwards, many developed countries began to provide recommendations on infant sleep position, focused on minimising the incidence of sleep-related infant deaths. The supine, or ‘back to sleep’ position was determined the safest position for babies to be put to sleep in (1,2) While this change led to a drastic decrease in the prevalence of sleep related infant deaths, research published suggested that the change from tummy (prone) sleeping to back (supine) sleeping resulted in babies reaching their developmental milestones slower, and had an increased incidence of head shape abnormalities. To neutralise these effects, new recommendations for tummy time were introduced. (1)
What is Tummy Time?
Tummy time simply means giving your baby supervised time on their stomach while they are awake. (1) It is an important form of physical activity for infants, and as such has been included in an Australian Government-funded national guideline known as the ‘24-Hour Movement Guideline.’ The guideline provides recommendations for daily movement behaviours including physical activity, sedentary (sitting or lying down) behaviours, and sleep duration to promote healthy growth and development of young children. The current recommendation from these guidelines is a minimum of 30 minutes tummy time for all healthy babies, right from birth until they become mobile, spread over 24 hours. (3)
Tummy time not only encourages head, neck, and shoulder strength and mobility, but also has been shown to have a positive association with gross motor development. (1) Gross motor skills require coordination in the movement of larger core stabilising muscle groups such as the torso, arms, and legs that enable children to perform everyday functions such as sitting, crawling, and walking. Furthermore, a lack of tummy time is one of the most frequently reported risk factors for the development of positional plagiocephaly or brachycephaly – the development of a flat spot on their head. (4,5) Recent research has demonstrated that increased amounts of physical activity – such as tummy time -, less time spent in sedentary behaviours and sufficient sleep duration are independently linked with positive physical, psychosocial (how mental and emotional wellbeing relate to social factors) and cognitive (learning and understanding) outcomes in early childhood. Additionally, adequate time spent on each of these behaviours appears to provide optimal outcomes for children. (6)
When Should Tummy Time Start?
Tummy time is going to look different depending on the age of your baby. In the first few weeks of life, you may want to try shorter periods of 1-2 minutes, 2-3 times a day. As a newborn, you and your baby might be most comfortable with the baby on top of your tummy while you lay down. As they begin to grow stronger some other options include having your baby across your lap or placing them on top of a rolled-up towel. Once your baby develops the strength, tummy time is a perfect activity for the play-mat or a blanket on the floor or grass. The more interactive and engaging this time is, the better! Moving their favourite toy side to side in front of their face or flipping through a picture book can help to develop strength and coordination in your baby's neck and eyes. As your baby develops strength, you will be able to increase the duration your baby spends playing on their tummy.
Some babies may need a little more care and attention to begin enjoying time on their tummy. However, if you notice that during tummy time your baby has difficulty turning their head to a particular side, or favours one side more heavily, there may be an underlying musculoskeletal issue such as neck pain that is causing discomfort. (8) If this sounds like your baby and you feel that your little one may be in need of a check-up, a chiropractor or your chosen musculoskeletal health care professional trained in the musculoskeletal health of infants will be able to assess and determine if your baby may benefit from infant chiropractic care. Naomi
Erickson BHS/AppSci (chiropractic)
1. Hewitt L, Kerr E, Stanley RM, et al. Tummy Time and Infant Health Outcomes: A Systematic Review. Pediatrics. 2020;145(6):e20192168
2. De Luca F, Hinde A. Effectiveness of the ‘Back-to-Sleep’ campaigns among healthcare professionals in the past 20 years: a systematic review. BMJ Open. 2016;6(9):e011435.
3. Okely AD, Ghersi D, Hesketh KD, et al. A collaborative approach to adopting/ adapting guidelines – the Australian 24- hour movement guidelines for the early years (birth to 5 years): an integration of physical activity, sedentary behavior, and sleep. BMC Public Health. 2017; 17(suppl 5):869
4. De Bock F, Braun V, Renz-Polster H. Deformational plagiocephaly in normal infants: a systematic review of causes and hypotheses. Arch Dis Child 2017;102:535–542
5. Bialocerkowski A, Vladusic S, Wei Ng C. Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Developmental Medicine & Child Neurology. 2008; 50(8):577-586.
6. Hesketh K, Downing K, Campbell K, Crawford D, Salmon J, Hnatiuk J. Proportion of infants meeting the Australian 24-hour Movement Guidelines for the Early Years: data from the Melbourne InFANT Program. BMC Public Health. 2017;17(S5).
7. Tummy time for babies: in pictures [Internet]. Raising Children Network. 2020 [cited 31 August 2020]. Available from: https://raisingchildren.net.au/newborns/play-learning/play-ideas/tummy-time
8. Allen-Unhammer A, Wilson F, Hestbaek L. Children and adolescents presenting to chiropractors in Norway: National Health Insurance data and a detailed survey. Chiropractic & Manual Therapies. 2016;24(1).