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‘Tummy time’ helps babies develop motor skills

Q : My daughter is a very responsible mother to a new baby girl. She follows all of her pediatrician’s recommendations, including “tummy time.” When I was a new mother, we were taught “Back to Sleep,” to avoid putting babies on their stomach. Is tummy time a good idea?

A : Thank you for your question. You are right, recommendations about what is best for babies do evolve over time, due to the collective experience of doctors and parents and the availability of new research.

In 1992, there was a growing awareness of a terrible condition called Sudden Infant Death Syndrome (SIDS). There seemed to be an association between sleeping prone (on the stomach) and SIDS. Small infants who cannot lift their heads, roll themselves over or effectively call for help were at risk for suffocating in their soft bedding, blankets and toys.

The American Academy of Pediatrics recommended that infants be placed supine (on their back) to sleep. This became known as the Back to Sleep campaign, which contributed to a 40% decrease in the incidence of SIDS in the U.S.

Some unexpected consequences of infants placed Back to Sleep were subsequently noted. Those babies appeared to have slower achievement of their motor milestones; an increased occurrence of abnormal head position (torticollis); and an abnormal flattening of the back of the skull (plagiocephaly).

To counteract these effects, parents were encouraged to provide their infants with supervised, short sessions of tummy time.

Tummy time is a form of physical activity recommended for newborns and infants up to 6 months of age. It is defined as “awake prone positioning on the floor that is encouraged and supervised by an adult.” Prone positioning ability is an infant’s ability to move their body when placed on their stomach.

This includes the ability to roll from front to back, lift their head, push up with their arms and the ability to move their arms and legs. After babies can hold their heads up, roll over and sit without support, tummy time is no longer necessary.

Because studies have demonstrated a positive association between tummy time and motor development, tummy time is a component of the national movement guidelines in Australia, the United Kingdom, Canada, South Africa and here in the United States.

It is included in the World Health Organization global guidelines for physical activity and sleep for children less than 5 years of age.

The early childhood years are a crucial period of physical, cognitive, social and emotional development. Research shows that getting at least 30 minutes of tummy time per day – ideally in 3- to 5-minute sessions – appears helpful to the development of motor skills.

The American Academy of Pediatrics advises parents to put awake, alert newborns and infants on their tummies to play two-to-three times a day for three-to-five minutes each time, increasing the duration as babies learn to enjoy it. Time in this prone position may help babies develop strong neck, back and arm muscles so that they can learn to sit up, crawl and eventually walk.

Furthermore, researchers have found ties between when babies develop motor skills and when they develop certain cognitive (perception, problem solving, memory, thinking, etc.) skills. In many ways, this link makes sense, because babies learn by interacting with their environment.

They move to learn, and learn through movement. Infants who are able to sit up have a more advanced understanding of the three-dimensional nature of objects. This may partly be because they can more easily inspect and explore their toys when they are able to sit up. Babies who spend more time crawling and walking, regardless of their age, also have better spatial memory skills, which is now thought to be an important factor in mathematical skills.

Keep in mind that just a minute or two, or even 30 seconds, of tummy time will add up if you do it regularly. Should the baby react badly, and appear to hate it, try placing him or her on your chest instead of on the floor. Or, try getting down on the floor also, and singing songs or playing with a toy. If the baby whimpers or cries, see if you can let him/her work through it for a minute. On the other hand, no one will judge you if you pick them up and comfort them! But then try again later. Tummy time is a good thing, but even more important for babies is to be in a variety of positions throughout the day.

Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to her at