Tummy Time Positioning Strategies for Developing Strength and Head Shape Symmetry in Young Babies Dulcey G. Lima CO, OTR/L Orthotic Interventions Darla Walker BS, Special Education-DHH Lake County Health Department/ Community Health Center Lake County Interagency Council Coordinator Child and Family Connections #2

Why incorporate Tummy Time into your baby’s daily routine? Babies spend very little time on their tummies.  Babies are often held in infant carriers during the day.  Babies sleep on their backs at night. The lack of tummy time when babies are awake is slowing down the baby’s developmental progress.

Benefits Tummy time helps strengthen neck, shoulders, arms, and trunk muscles. Tummy time helps babies work against gravity. Frequent position changes help babies work out tight neck muscles.

How can Tummy Time help keep heads symmetrical and well proportioned? It relieves pressure on the back of the head. It helps strengthen the muscles that extend the neck. It encourages the baby to turn her head to both sides.

Tummy Time is: Any position that keeps a baby from lying flat in one position against a hard, supporting surface. Anytime you carry, position, or play with a baby while he is on his belly. Beneficial to babies of all ages. Fun, and it can be designed to be easy or challenging to your baby. PLAY SUPERMAN!

Tummy Time is: Always supervised. Never leave a baby alone on his tummy. A great time to bond with the baby. More enjoyable when you play music or give the baby interesting things to look at and play with—like the caregiver’s face.

When should you start Tummy Time with the baby? From the very first day when the baby is awake and supervised. When the baby is awake, place him tummy down on your tummy. Cuddle.

Chest support in Tummy Time Add a little towel or a Boppy cushion underneath the baby’s chest to help support the baby’s trunk. It makes lifting the head much easier. Always be sitting next to the baby for safety.

Positions for play: On the tummy over a caregiver’s thigh. Easy: Support the baby’s entire chest and shoulders with your thigh. Difficult: Scoot the baby’s shoulders and chest forward so his hands are on the floor.

Positions for play: Supported and prone over a Boppy cushion. Give support to the trunk if necessary. Arrange toys so they are in midline, or in the direction you want to increase range of motion.

Good positioning using the environment develops the baby’s cognitive skills. Mirrors are terrific tools for enhancing Tummy Time fun.

Tummy Time After Diapering: After every diaper change, place the baby on their tummy for a few minutes while you are present and supervising. This is a great way to incorporate more tummy time 6 or 8 times into your baby’s day.

Dressing and bathing: Gently massage the baby’s neck, arms, shoulders, trunk, legs and feet after every bath. This will feel very relaxing and will help stretch tight muscles.

Put the baby to work! Encourage positions that make your baby work against gravity. Hold your baby high up on your shoulder to encourage neck extension against gravity. Change shoulders often. Give the baby’s head support as needed.

Put the baby to work! Passive holding position Active holding position

Symmetrical neck turning Encourage neck turning to both sides with kisses and cheek to cheek cuddling. If the baby’s neck is tighter to one side, incorporate this kind of snuggling to that side more often during the day.

More activities to increase strength and symmetry Burp your baby over your lap. That’s tummy time too! This is also a great position for watching TV while holding your baby.

Holding Try to avoid pressing your arm against the baby’s head. Continuous pressure on the baby’s head can create flattening. Most babies with posterior flattening are flat on the right side. Alternate the side in which you cradle the baby.

Holding and Carrying Parents in other countries have some great ways to carry their kids. Many of these same designs are available in the U.S.

Restrict time in hard baby carriers. Consider these alternatives:

This is an easy way to calm and soothe baby without placing pressure on the back of her head.

Encourage siblings to play with the baby on the floor. Siblings are wonderful motivators for babies to move in the direction you want the baby to turn and reach.

Get down on the floor with the baby. Engage the services of friends and siblings to help entertain the baby while in challenging positions. Try supported tummy time first, then move to more challenging positions.

Tummy Time leads to higher level developmental skills.

When should a parent be concerned? Your baby may need a referral for further evaluation if:  Baby is more than 4 months old and she does not have head control.  Baby always positions his head to the same side.  Baby seems to be behind other babies who are the same age.  Baby has a physical problem that prevented tummy time in the early months of life.  Baby has observable neck tightness.  Baby seems to have floppy or tight muscle tone.

SIDS prevention program is now called First Candle. Information for parents and professionals may be found at  BACK TO SLEEP.  No shared bed sleeping.  No blankets, bumpers or toys in the crib.  Crib should be in the room with the parents for first 6 months. (room sharing)  No smoking in the house.  The baby’s room should be kept cool.

Which Baby Is Sleeping According to SIDS Guidelines? This baby is covered with too many blankets and is not positioned well. This baby looks great!

BACK TO SLEEP! No exceptions to this rule except as ordered by a physician for a medical reason. Do not succumb to pressure from older parents or others who did not raise their children during the Back to Sleep Era. Remember that this program has saved thousands of babies from Sudden Infant Death Syndrome.

Where can I go to get more information on developmental screening sites or information on referring my child for further developmental evaluations? ces/Pages/CFC.aspx ces/Pages/CFC.aspx Click on the web site above and then scroll down the right hand side to “Screening Sites” for a list of free, developmental screening sites