Baby Development Information

Tummy Time, starting day 1 on a parent’s chest, is the most important “work” a baby can do!

Why should we place the baby on his Tummy? 

“Tummy Time” is the foundation of all normal development. It is especially important for babies to gain strength from the head to the feet. Pushing on the hands and forearms helps the hands open to be able to manipulate toys. Tummy play helps to build the muscles needed for rolling over and crawling, both very valuable milestones that impact preschool readiness.

If the baby is not placed on the tummy for short periods of time as soon as home from the hospital, neck strength will not develop as fast as the head grows. When the Back To Sleep policy was adopted in 1992, it was intended for SLEEPING babies. AWAKE babies truly need the tummy position. Sleep position should be on back until approximately 6 months when the baby can change positions independently.

How to do Tummy Time so the baby enjoys this playtime: 

Start by laying the baby on a parent’s chest day one. It is a comforting position for the baby. When home, place the baby on a clean blanket for 15 seconds on the tummy, then turn baby to his side for 15 seconds, then on back for 15 seconds, then on other side for 15 seconds. During each position, interact with the baby with soft talk, sweet music, or rustling paper.  It is important to have all background noise off so baby will pay attention and try to look toward the sound. Watch the baby’s eyes.  It might take a moment for the head movement to follow the eye movement.

The goal of tummy time at one to two weeks is to start the process of building neck muscles against gravity.  If parent’s wait until one month, the baby’s head will flop to the shoulder when placed in a car seat. By one month all babies should be able to turn their heads fully right and fully to left when on their backs and when lying on the tummy.

Research shows that babies who start tummy time early and have good strength to lift against gravity, will be less apt to have a flat spot on their heads and less apt to develop stiff necks turned to one side all the time.

The Baby Development Information brochure is designed for new parents. It is in a question and answer format to help parents understand the importance of varying infant play positions including time flat on the tummy, on the side, and on the back. This brochure was developed by Ms. Jennings during a research project published in 2005 with Xavier University, Cincinnati, Ohio.

Summary

Week 1 Position: Baby is inclined on the parent’s chest.

Week 2-Week 8 Position: Flat on the belly attended by the caregiver at all times. Play in all four positions: back, belly, and both sides.

Schedule in TT several time a day for 15 sec to 1 minute each: after each diaper change, before each feeding, before or after each nap

It is common sense that babies will only tolerate tummy time for very short times in the beginning. Trying to leave a baby for a 15 minute interval will cause intense crying. They feel just like any adult would feel if someone told them to get down and do 50 pushups!

Flat spots (plagiocephaly) can and should be prevented.

New parents need to know that babies who are always reclined in car seats or bouncers frequently develop misshapen skulls. Research says that almost 48% of babies develop a flat spot. This is not normal. Research now indicates that babies that get adequate Tummy Time are less likely to develop flat spots on the back of the head, or stiff necks that may require therapy or helmets. Prevention of these positioning problems is always better than trying to fix them later on.

We don’t know exactly what bad things can develop from flat spots, but I have treated enough babies and preschoolers with both gross motor and cognitive delays related to early positioning that I can strongly say: Let’s Stop the Flat Spots!

Prevent flat spots by doing routine tummy time play times as explained above. Developing good head control will provide a great foundation for the baby to zip through all the good motor milestones…and be ready for preschool activities.

Head control is the baby’s ability to turn her head either direction to orient to a noisy toy or brightly colored stimulus,  At two months both on the tummy and on the back!.  It is work at first, but becomes great fun quickly. The baby will tell you when enough is enough for that session. See below for suggestions when tummy time was not started early enough and is not fun.A note of warning: Babies are people first. Tummy time should always be done in short bursts of time as the baby can tolerate. To leave a baby on the belly and expect him to lift his head for many minutes can cause a muscle strain in the neck that will require physical therapy immediately.

Neck tightness (Torticollis) can and should be prevented.

New parents also need to know that research indicates that babies with a strong preference to one side (have their head to one side) are more apt to develop a neck problem called torticollis or wry neck. This positional preference also can develop into a flat spot on the back of the head, muscle imbalances, or even a curvature in the spine.  It is not normal and should always be treated by a pediatric occupational therapist or pediatric physical therapist.  Noting a strong preference at 6-7 weeks is the best time to correct.  Some doctors are still waiting until 4 months. By then a flat spot may be severe, wry neck may affect vision, and much more therapy will be needed to get the baby back on track.  Whether seen at 6 weeks, or 4 months, it is imperative that the restrictions be corrected.

Besides Tummy Time positioning, other optimal positioning strategies will help a baby reach milestones on time.

1. If bottle feeding, switch sides each feeding. It helps baby turn the head both directions.

2. Change the baby’s position in the bed. Lay the baby on the back so he turns head to right for naps and turns the head to left for nighttime.

3. Change direction on the diaper changing table each change.

4. Limit sit/reclining equipment to transportation only times for the first few months. This eliminates gravity pulling the chin to the shoulder. Babies are best laid flat for at least the first 2 months.

And of course, if holding a baby upright against the shoulder, always support the head.

Helping a baby tolerate tummy time if prone positioning is started later.

1.  Incline the baby over your leg or a pillow so she is comfortable before you dangle a toy for her to look at. Support her so she does not roll off by putting slight pressure on her bottom. Move her to her back as soon as she fusses. Wait a minute and then try again.
2. When on her back, slightly inclined on a pillow, dangle a toy over her face and move to one side and then the other. This is an important exercise.
3. Warning: If you do the first exercise when on the belly over the pillow, and your baby can not lift her face to look at the toy without first rotating the face to the right or left, STOP, and take the baby to a pediatric therapist.  She already has tight muscles that will need to be stretched.

Publications of Interest to New Parents – FREE

Please click the links below to download each PDF item:
– Baby Development Information Brochure
(Baby-Information-Brochure.pdf; 537KB)
– Baby Development Information Brochure – Spanish (Desarrollo del bebe)
(desarrollo-del-bebe.pdf; 537KB)

Pictorial Milestone Chart for Baby Development
(Milestone-Pictorial.pdf; 111KB)
Companion sheet for Road to Success CD

APTA Press Release on Tummy Time (TummyTime.pdf; 84kb)

Babyhood Road To Success.pdf (Babyhood-Road-To-Success.pdf; 1.5MB)
A Baby Developmental PDF demonstrating why and how a baby develops as they do normally. This is a PDF to teach parents the long term effects of early appropriate play with their baby.

Bibliography of Interesting Books

Roxanne Small, PT, “Building Babies Better, Developing a Solid Foundation for Your Child” Victoria, British Columbia, Canada, Trafford Publishing, 2005 ISBN 1-4120-6233-0