Tummy time tips

 C Coulter-O'Berry et al Tue 22 January 13


Tummy time is a valuable and important activity for your baby from birth onwards. The increased awareness of SIDS (sudden unexpected death in infancy or fatal sleeping accidents) has lead to safe sleeping guidelines and principles from The SIDS and Kids Safe Sleeping campaign. These promote positioning baby on the back to sleep from birth, not on the tummy or side, and that baby has head and face uncovered.

A newborn baby has a very soft and mouldable head, something which is a great benefit during the birthing process, but continually lying, turned one way, will alter the shape of the head, causing flattening on the underside. We all have some element of asymmetry in our bodies but persistence of one head position will cause a marked asymmetry and can lead to positional plagiocephaly – marked flattening of the head and may lead to alteration of the babies facial features. Plagiocephaly may occur before or during birth (eg. breech position or multiple babies) although it tends to occur more often after birth, particularly if the baby has a positional preference (baby favours placing their head to one side) and/or the baby spends long periods of time with their head in a constant resting position.

So, what things can be done to help prevent changes in babies head shape during both sleeping and awake times?

Sleep time activities:
• When your baby is asleep try to alternate the head position (left or right).
• Babies become more interested in their environment as they grow and will look at certain objects before they fall to sleep. Placing baby at alternate ends of the cot will encourage them to look in different directions.
• Changing the position of the cot in the room may also have the same effect.
• Place the objects they like in different positions, but never inside the cot with them.
• Alter the side that you approach to pick baby up from the cot as babies learn to look at the direction of someone coming to get them.
• Try to avoid prolonged seated positions in the car seat, stroller, swings or bouncers.
• Alternate the holding position when feeding baby i.e. hold in left arm for one feed and the right arm for the next feed.
• When baby is awake, avoid prolonged lying down positions, and instead keep baby upright when holding, or use a sling to carry baby.
• Never place your baby on their tummy or side to sleep, as even from a young age they can roll onto their tummy.

Tummy Time Awake Activities:
Tummy time is anytime your baby is carried, positioned or playing on their tummy. It can be fun, and can be made easy or challenging for your baby. It is a time that is ALWAYS supervised, as even the tiniest of babies will make kicking movements with their legs. It is possible for them to make some forward movement even at an early stage and this is very dangerous if not supervised.

Cuddle time
When you are standing, hold your baby against your shoulder facing you. This encourages your baby to lift their head to look at you. Make sure you do this to both sides to encourage your baby to turn both ways. When you are lying on your back in a reclined position – hold your baby on your chest facing you. Again this encourages your baby to lift their head to look at you.

Dressing time
This is a really good time for some gentle massage and play. Gently rolling a baby from back to tummy to allow for doing up buttons and straightening clothing is a lovely way to introduce some tummy time.

Play time
Place your baby on their tummy on the floor. For younger babies a small towel or blanket placed under the chest will help them to lift their head. Lie on the floor near to your baby and encourage them to look at your face, or toys to both sides, and as they get older encourage reaching out to play with them. 
Place your baby over your lap with one leg raised slightly higher than the other. This helps your baby to lift their head. Place or hang toys to either side so baby can look and reach. Change the side your baby lies on even if they prefer one side to the other.

Carry time
Alternate the side you carry your baby on your hip to encourage looking, turning and balancing. Carry your baby over your shoulder and support the head in a midline position. Vary the side you hold your baby to help then to turn to both sides. 
Hold your baby in front of you facing outwards. Keep the head in the midline position. Carry your baby with their chest supported by your forearm. Younger babies will need head and chest support.
As your baby gets older you can play 'aeroplanes' and pretend your baby is flying as you carry them. Alternate the arm you hold your baby in so they look and turn to both sides.

Adjust babies head position so they can watch you with their head in midline. Change the position of the car seat to encourage baby to look in different directions. 
Change the arm you feed baby in, so they look equally to both sides and the pressure of your arm to one side of your baby's head is limited. 
Alternate the position of your baby on the change mat and talk to your baby from different sides during a nappy change.

I hope that theses activities give you some ideas of ways you can include tummy time activities into your daily routine. If you have any concerns about your baby's head shape, or notice that they have a preference to look to one side, then consult your doctor or community child health nurse for further advice. A small number of babies have tight muscles on one side of the neck, a condition known as torticollis or wryneck, and these require further exercises to help this.

This article was put together by Zoë Atkinson from Zoë Atkinson Mobile Physiotherapy based in Kiama. Zoë has specialist experience in Paediatric Physiotherapy and provides appointments in the home and community throughout the Illawarra. Zoë is also a registered provider with the Better Start Initiative. For more information please see parents guide listing or contact her on: 0431 952 787

Resources used for article:
Tummy time tools – A developmentally based program to incorporate positioning, handling, and fun activities into the lives of young infants. Coulter-O'Berry C et al


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