The Ultimate Guide to Tummy Time

What is Tummy Time?

Tummy time is the intentional, supervised playtime that babies spend on their tummies while awake.  According to the American Occupational Therapy Association (AOTA), tummy time strengthens an infant’s torso, back, neck, and arm muscles. Since authorities like the American Academy of Pediatrics (AAP) strongly recommends putting babies to sleep on their backs, babies can spend up to 15 hours a day facing the ceiling. For this reason, it is even more important than ever for infants to get enough tummy time while awake. Ensuring your child gets enough tummy time provides the foundation and muscle strength for crawling and other developmental milestones throughout childhood.

Why Does My Baby Need Tummy Time?

Because parents put their babies to sleep on their backs (as strongly advised), infants can spend close to half of their 24 daily hours lying on their backs. Even during waking hours, the popularity of infant seats, swings, strollers, and carriers mean that infants spend even less time on their stomachs than in the past. As a result, infants need as much practice as possible using their arms and core strength.

Tummy time is also crucial for helping babies use their necks, strengthen their backs, stabilize their trunks, and hold their heads upright. It is the first step for infants to learn how to lift themselves up on their own.  Pediatricians, physical therapists, and occupational therapists advise that tummy time is the prerequisite to rolling over, sitting up, and crawling.

What are Other Benefits of Tummy Time?

In addition to helping babies achieve early developmental milestones, tummy time is crucial for preventing conditions like flat-head syndrome (positional plagiocephaly) and twisted-neck (positional torticollis). Since infants sleep on their backs (and sleep nearly half the day), leaving infants on their backs during waking hours can increase the likelihood of flat-head syndrome. In extreme cases, the syndrome can weaken facial muscles or distort features. Experts advise that babies sleep on their backs and spend much of the rest of their time on their tummies to play.

Similarly, twisted-neck syndrome can cause the head to tilt unnaturally to one side due to neck stiffness. In extreme cases, the condition makes it difficult for children to move their heads from left to right. Tummy time helps prevent this condition by strengthening the neck muscles and encouraging babies to rotate their head to look at parents, hear sounds, and reach for toys while on their stomachs.

When Should My Baby Start Tummy Time?

Tummy time can begin as soon as an infant arrives home from the hospital. No later than 2 weeks old, a baby should have short tummy time sessions ranging from 30 seconds to one minute. After each daytime diaper changing, place the newborn across your chest or lap so that the baby can get used to the position. (Exception: For newborns, refrain from doing tummy time immediately after feedings to avoid unnecessary spit-ups.)

By 3 months old, babies should be able to handle a cumulative one-hour of tummy time each day (spread across the day with each session lasting a few minutes at a time). The simple mantra “Back to Sleep & Tummy to Play” is a helpful reminder to ensure infants get enough tummy time daily.

Tummy Time Moves

The following moves can help make tummy time a natural part of your baby’s routine:

Tummy to Tummy or Tummy to Chest

Lie down on a floor mat or bed. You may prop yourself up with pillows if desired. Place child gently on your chest or tummy so that you can communicate face to face. Always maintain a secure hold on your baby for safety.

Tummy to Lap

Lay baby face-down across lap to burp or comfort. Resting hand on the infant’s bottom can also help calm the child. Always hold the child securely for safety.

Tummy Down Carry

Position a hand under the tummy and between the legs to hold the baby tummy-down. Use the other hand to support the infants head and neck. Hold the baby comfortingly close to your body (some describe it as if you are holding a football securely) so that the child can get used to the position.

Tummy Minute

Make it a habit to place the baby on his or her stomach after every daytime diaper change. Allowing the baby to lie on the tummy for minutes at a time adds up over the course of the day.

Tummy Down and Eye-to-Eye

Place a blanket or tummy mat on the floor and lay down eye-level during your baby’s tummy time to encourage play and eye contact.

Tummy Time Milestones

Tummy time begins soon after a newborn arrives home from the hospital. Although your baby may not appear to enjoy tummy time at first, with continued practice a baby will begin to associate it with play and find the muscle strength to sustain tummy time for longer periods. Regular tummy time is crucial for helping babies reach their future developmental milestones.

2 Weeks Old

Tummy to Tummy and Tummy to Lap both work best at this age.  These positions allow newborns to bond with their parents, enable babies to cuddle, and prepare infants for the more challenging tummy time on the floor.

1 Month Old

At this age, babies can turn their heads during tummy time (and may even attempt to lift their heads for a second or two before laying down again). If it helps, place a rolled receiving blanket under the baby’s chest and armpits to make it easier for the child to lift the head.

2 Months Old

By this age, babies should be able to spend one minute in tummy time (several times a day) without becoming too agitated or upset. You should aim for five-minute sessions. Most tummy time should be done on a flat, cushioned surface (like a playmat) while on the floor. Babies also tend to tilt their heads to the side, so make sure they are alternating directions instead of slumping their head to one side only.

3 Months Old

At this critical stage, babies have gained enough head control to lift the head between 45 and 90 degrees without tilting to the side. The baby can typically put weight on arms (leaving elbows behind the shoulders at 45-degree angles). A three-month-old should spend at least one hour per day in tummy time (spread out over the course of a day). To hold the baby’s interest, try shaking a rattle in front of the infant as his or her eyes follow.

4 Months Old

By four months, babies can push up on forearms to lift their chests off the floor. Elbows position at 90-degree angles beneath the shoulders or just in front of the shoulders. Babies can also lift their heads around 90 degrees while keeping centered above the torso. They can move their necks to look toward toys, sounds, or parents during tummy time. Some babies are strong enough to attempt rolling. A tummy-time mirror is also a great way to keep babies engaged at this age.

5 Months Old

Babies begin to push up on hands with straight elbows (known as “baby push-ups”). They may also move arms forward to reach for favorite toys.

6 Months Old

At 6 months, babies tend to “direct” the content of tummy time. They are willing to reach forward and grab desired toys while on their tummies. Pivoting in a circle, rolling from tummy to back, and moving from back to stomach is also common. At this point, babies prefer to be on the tummy because it enables them to move easily and is the closest to scooting and crawling.

After 6 Months

Since babies are entering the crawling stage at this point, parents aim for around 15 minutes of tummy time. Babies who have reached the previous tummy-time milestones usually prefer to stay on their tummies longer, roll onto their tummies without prompting, and play on their tummies independently. At this point, parents and caregivers have stopped dedicated tummy time once babies have moved on to crawling. If you notice that your child has struggled to meet these tummy-time milestones, consult with a professional for an assessment and potential early childhood intervention. These services may involve physical therapy and occupational therapy to get your baby back on track.

Tips for Tummy-Time Success

• Keep it consistent. Make sure each parent and all caregivers know about tummy time. Schedule it after each diaper change or bath so that your baby can learn to expect it.
• Use tummy time as an alternative to sitting a baby in a carrier.
• Turn tummy time into a game by getting down at eye-level with your child.
• By 3 months old, use a rattle to keep your baby occupied
• By 4 months old, use a tummy-time mirror to fascinate your child.
• Try doing tummy time when your child is already happy so that he or she begins to associate it with fun.

How Does Tummy Time Help With Other Developmental Milestones?

Tummy time is the precursor to a host of early childhood developmental milestones:

• Gross Motor: Tummy time strengthens the back, core, neck, legs, and arms. It provides the trunk stability and muscular strength needed for rolling, sitting, crawling, standing, and walking later.
• Fine Motor: As babies push themselves up on their hands and arms, tummy time helps develop arches within the hands since babies are bearing most of their weight on them.
• Visual: During tummy time, babies follow object with their eyes and learn to use both eyes together. Tummy time also improves hand-eye coordination as babies constantly look down at hands to determine how they can maneuver or move.
• Sensory: Different textures like blankets or carpets naturally introduce tactile sensations. Balancing weight helps create whole-body awareness and holding different positions at different times of the day helps build the vestibular sense of balance and coordination.
• Speech and Feeding: Tummy time strengthens the neck, thereby creating the jaw support necessary for talking and eating
• Social and Emotional: Tummy-to-tummy is one of the best forms of early bonding, and later forms of tummy time (such as Tummy-Down and Eye-Contact) allow babies to interact with parents instead of remaining in their carriers.
• Cognitive: As babies move their heads and neck during tummy time, they build awareness about the sources of sounds, location of parents, and cause-and-effect of movements.

Concerned about your child meeting all of the tummy-time milestones? Contact the Warren Center for early childhood intervention information.