Tummy time explained

Tummy time should not be confused with Timmy Time.

Tummy time is a colloquialism for placing infants in the prone position while awake and supervised to encourage development of the neck and trunk muscles and prevent skull deformations.^{[1] [2] [3]}

In 1992, the American Academy of Pediatrics recommended babies sleep on their backs to prevent sudden infant death syndrome (SIDS). Although the rate of SIDS has decreased by 50% since the Safe to Sleep campaign started in 1994,^[4] an unintended consequence was that babies missed out on the twelve or so hours they used to spend in the prone position while asleep, and there was a sharp increase in plagiocephaly (flat head syndrome) in infants.^[2] Along with tummy time, rotating the direction infants lie in their cribs as well as avoiding too much time in car seats, carriers, and bouncers are behaviors recommended to alleviate the associated risks of infants sleeping in a supine position.

Impact on development

Infants put to sleep in the supine position have been found to reach motor developmental milestones (e.g. crawling, rolling, and sitting) at a slower rate compared to infants who sleep in the prone position.^{[5] [6]} When babies experience tummy time in their waking hours, they are provided with opportunities to strengthen their neck^[7] and trunk muscles. Positioning the infant on their stomach while awake will not impact the amount of slow wave sleep^{[8] [9] [10] [11] [12]} since tummy time only occurs when an infant is awake.

Furthermore, tummy time provides infants with opportunities for cognitive and communicative development through interactive play with their supervisor.^{[13] [14]}

Implementation

Tummy time is recommended to be practiced from birth, first in short sessions of three to five minutes, two to three times a day. As babies grow more receptive towards the sessions, they can be extended and performed more frequently. The World Health Organization advises that infants under one year of age who are not yet mobile should experience tummy time for at least 30 minutes per day across sessions.^[15] Supervision by a parent or caregiver is important during tummy time so that the infant's position can be monitored and to encourage social interaction. Babies who are unaccustomed to frequent tummy time sessions may cry or show noncompliance when it is first introduced,^[16] however enjoyment may be increased by providing stimulating objects during sessions, such as preferred toys and videos.^[17]

Tummy time may also be used to stabilize the neck in torticollis,^[18] and to address hypertonia associated with Down syndrome.^[19]

Although sleeping in the supine position without sufficient tummy time may change the physical appearance of the head through plagiocephaly and consequently promote developmental delays, regardless of these effects, it is essential that infants are placed to sleep on their back due to the risk of SIDS.

See also

• Sudden infant death syndrome
• Safe to Sleep Campaign
• Plagiocephaly
• Torticollis

Further reading

• 10.1016/j.jpeds.2004.10.017 . Deformational brachycephaly in supine-sleeping infants . 2005 . Graham . John M. . Kreutzman . Jeannie . Earl . Dawn . Halberg . Andy . Samayoa . Carlos . Guo . Xiuqing . The Journal of Pediatrics . 146 . 2 . 253–7 . 15689919. free .
• 10.1016/j.jpeds.2006.06.043 . Asymmetric heads and failure to climb stairs . 2006 . Kemp . James S. . The Journal of Pediatrics . 149 . 5 . 594–5 . 17095324.
• News: Jane . Elliott . . Babies need 'tummy time' to develop . 1 July 2006 . 2007-06-21.
• 10.1016/S0031-398X(08)70506-X . Tummy Time Key to Prevent Delays . 2008 . Gardner . H. Garry . Sarwark . John F. . Pediatric News . 42 . 10 . 24.

Notes and References

1. Web site: Babies Need Tummy Time!. Safe to Sleep, US Department of Health and Human Services, National Institutes of Health. April 30, 2020.
2. 10.1542/peds.2011-2220 . Prevention and Management of Positional Skull Deformities in Infants . 2011 . Laughlin . J. . Luerssen . T. G. . Dias . M. S. . Pediatrics . 128 . 6 . 1236–41 . 22123884 . Committee On Practice Ambulatory Medicine. free .
3. Web site: Doctor Finds Success In Treating Infants With Flat-Head Syndrome . CBS Los Angeles . November 11, 2013 . April 30, 2013.
4. Web site: Back to Sleep Public Education Campaign . . March 23, 2010.
5. 10.1017/S0012162205000733 . Influence of supine sleep positioning on early motor milestone acquisition . 2005 . Majnemer . Annette . Barr . Ronald G . Developmental Medicine & Child Neurology . 47 . 6 . 370–6; discussion 364 . 15934485.
6. 10.1542/peds.102.5.1135 . Effects of Sleep Position on Infant Motor Development . 1998 . Davis . B. E. . Moon . R. Y. . Sachs . H. C. . Ottolini . M. C. . 18553504 . Pediatrics . 102 . 5 . 1135–40 . 9794945.
7. Web site: Geyer. Hilda. How to ensure your baby's neck muscles are strong. 2021-03-19. Parent. en-US.
8. 9646378 . 1998 . Myers . MM . Fifer . WP . Schaeffer . L . Sahni . R . Ohira-Kist . K . Stark . RI . Schulze . KF . Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants . 21 . 4 . 343–9 . Sleep.
9. 10.1203/00006450-200209000-00016 . Quality of Diet, Body Position, and Time after Feeding Influence Behavioral States in Low Birth Weight Infants . 2002 . Sahni . Rakesh . Saluja . Deepak . Schulze . Karl F . Kashyap . Sudha . Ohira-Kist . Kiyoko . Fifer . William P . Myers . Michael M . Pediatric Research . 52 . 3 . 399–404 . 12193675. free .
10. 10.1016/S0022-3476(73)80017-4 . Psychophysiologic effects in the neonate of prone versus supine placement . 1973 . Brackbill . Yvonne . Douthitt . Thomas C. . West . Helen . The Journal of Pediatrics . 82 . 82–4 . 4681872 . 1.
11. 10.1016/S0387-7604(12)80020-9 . Effects of prone and supine position on heart rate, respiratory rate and motor activity in fullterm newborn infants . 1991 . Amemiya . Fumiaki . Vos . Johan E . Prechtl . Heinz FR . 4763777 . Brain and Development . 13 . 3 . 148–54 . 1928606.
12. Kahn A, Rebuffat E, Sottiaux M, Dufour D, Cadranel S, Reiterer F . Arousals induced by proximal esophageal reflux in infants . Sleep . 14 . 1 . 39–42 . February 1991 . 1811318.
13. Dewey. C.. Fleming. P.. Golding. J.. The Alspac Study Team. 1998. Does the Supine Sleeping Position Have Any Adverse Effects on the Child? II. Development in the First 18 Months. Pediatrics. 101. 1. e5. 10.1542/peds.101.1.e5. 9417169. free.
14. Martiniuk. Alexandra L. C.. Vujovich-Dunn. Cassandra. Park. Miles. Yu. William. Lucas. Barbara R.. 2017-01-01. Plagiocephaly and Developmental Delay. Journal of Developmental & Behavioral Pediatrics. 38. 1. 67–78. 10.1097/dbp.0000000000000376. 28009719. 39477708. 0196-206X. 1959.4/unsworks_43153. free.
15. Web site: To grow up healthy, children need to sit less and play more. April 24, 2019. World Health Organization.
16. Graham. John M.. 45672124. 2006-03-01. Tummy Time is Important. Clinical Pediatrics. 45. 2. 119–121. 10.1177/000992280604500202. 16528431. 0009-9228.
17. Book: Kadey, Heather J Roane, Henry S. EFFECTS OF ACCESS TO A STIMULATING OBJECT ON INFANT BEHAVIOR DURING TUMMY TIME. 2012. The Society for the Experimental Analysis of Behavior. 810682892.
18. Kaplan. Sandra L.. Coulter. Colleen. Sargent. Barbara. 52909510. 2018-10-01. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatric Physical Therapy. 30. 4. 240–290. 10.1097/PEP.0000000000000544. 1538-005X. 30277962. 8568067 .
19. Boutot. E. Amanda. DiGangi. Samuel A.. 2018-02-23. Effects of Activation of Preferred Stimulus on Tummy Time Behavior of an Infant with Down Syndrome and Associated Hypotonia. Behavior Analysis in Practice. 11. 2. 144–147. 10.1007/s40617-018-0212-5. 1998-1929. 5959811. 29868339.