The “Back to Sleep” program, introduced by the American Academy of Pediatrics after comprehensive research from multiple continents, was one of the most successful public relations campaigns. From 1994 to 2006, the frequency of babies placed on their backs to sleep increased six-fold while at the same time the SIDS rate was reduced by 50%. However, there have been many unintended consequences. Before the back to sleep program, infants had a combined awake and asleep time on their tummies of at least 18 hours per day. We are lucky these days if infants experience even 30 minutes per day. That is a lot of time lost in a position that is imperative for proper development in many domains and body systems. Research has repeatedly shown that a lack of tummy time contributes to gross motor delays such as lifting head up/head control, rolling over, pushing up and crawling. However, tummy time is imperative not only for gross motor development, but for the foundation skills required for fine motor, oral motor, body awareness, vision, and self-soothing skills. This series will address the importance of tummy time from birth to seven months, provide benchmarks for each stage and the developmental importance of tummy time for many domains and body systems.

A parent’s anxiety about tummy time can negatively affect how their infant perceives and experiences this important position. SIDS is a scary thing, but parents feel they have a strong, effective tool to help combat the likelihood of it happening to their child: by placing their infant on their back to sleep. Unfortunately, even if a parent understands that it is during sleep time that the back position is important, it is difficult to turn off that anxiety about the tummy time position even during awake hours.  In turn, when a baby fusses or cries while on his tummy, parents swoop in to rescue them versus calmly trying to modify the situation to truly figure out why the baby is upset. Babies have great instincts and they figure it out quickly that the tummy is a position that should cause anxiety. Thus, many babies do not tolerate it well.

There is much parents can do to help babies develop happy routines on their tummies. The easiest way to start is at birth when a baby is used to being “smashed.” A full term baby’s house is very small before birth when she is most often supported in a “fetal position” by the uterine walls. After birth, the floor can also provide that kind of comfort barrier. Because it is more difficult for babies to remain in a flexed position on their back, often nurses and families choose to swaddle to contain them as if still in utero and to support them before their muscles really have had a chance to first stretch out and then learn to move efficiently and with control against gravity.  The tummy down position after birth is comforting. If it is repeated frequently and consistently everyday, trying it first whenever you place your baby down, it remains a very comfortable position and a place where your baby can happily learn to move, play and grow.

For a photo essay and general description of what to expect the tummy position to look like from newborn to seven months, see blog post, Madeline’s Tummy Time Journey: Birth to Seven Months. Future blog posts will also describe this journey in greater detail to explain why your baby’s posture and movement changes as she matures. Stay tuned!