Keeping Kids Healthy by Dr. Sally Robinson
“Back to Sleep” and “Tummy Time”, two phrases that are familiar to most child health care givers. Many parents are also very familiar with these phrases but sometimes they are confusing. The idea is simple; a baby should be supine (face up) when asleep and prone (face down) when awake and under supervision.
Expert recommendations for sleep position are very clear. Infants should be placed in a wholly supine position for sleep on a firm surface and without surrounding soft objects. This is with the infant lying on his back not even a little bit on the side. The number of deaths attributed to Sudden Infant Death Syndrome has decreased by more than 50% since the “Back to Sleep” recommendations were first made by the American Academy of Pediatrics in 1992. Sudden Infant Death Syndrome is rare but if it happens there is no going back. The evidence is clear that this sleeping position can reduce the incidence of such a tragedy.
Evidence suggests that remaining in a supine (face up) position can lead to delay in the baby developing their early motor milestones. Learning of this delay in 2003 the American Academy of Pediatrics recommended that infants spend time in the prone (face down) position when awake and being observed. Babies who have frequent tummy time tend to meet developmental milestones earlier than those that don’t and it also prevents the back of the baby’s head from becoming flat from the constant pressure on the back of the skull. Limit the amount of time the baby spends in car seats, bouncers, swings and carriers where their head is against the surface.
Tummy time should start in the hospital by holding the baby chest to chest (kangaroo care). This introduces the baby to new body positions out of the uterus. It is also good for bonding and starts the process of lifting the head and moving the arms and legs. When first at home, tummy time should be just a couple of minutes two-three times a day. Gradually the baby can work longer and more frequently as they develop upper body strength and stamina.
By 2 months of age, babies should have worked up to a total of 15-30 minutes of tummy time every day. Parents often think that if their babies cry, they don’t like tummy time. Some resistance to tummy time is normal as it takes great effort for babies to use their neck, chest and shoulder muscles to push themselves up and lift their heads off the ground.
Caregivers can make tummy time more enjoyable by engaging with their baby, getting down at eye level while talking to them about what they are seeing and doing. This will not only increase their strength but also their understanding of language. They can spread a blanket on the floor and put a toy within the baby’s reach to help the baby interact with their surroundings.
Sleep tummy up, learn tummy down (always observed).
Sally Robinson, MD Clinical Professor
UTMB Pediatrics - Children's Complex Care
Also see: Pediatric Primary Care