The Toledo, Ohio, pediatric occupational therapist had treated kids with weak neck muscles and seen the misshapen heads of babies who lay on their backs too much. She even wrote the American Occupational Therapy Association’s Tummy Time Tip Sheet.
Then she had her own baby.
And she discovered a problem: Tummy time made her daughter cryyyyyyyy.
“When you’re writing academically, you think everything is possible,” she told me. “Sure, parents can do this or that, you think. But when you’re a parent and your child screams, you don’t want to upset her, so you don’t do it,” says Pumerantz, whose daughter is now 12 months old. “Now I understand why a lot of parents are afraid of tummy time or find it such a hassle.”
For a parenting practice that nobody heard of, much less sweated over, just a half-generation ago, it’s stirring up a lot of strong feelings—among parents and babies alike.
Maybe it’s time to reframe tummy time.
You know Tummy Time. You place your baby on his or her belly every day in order to strengthen neck and upper-body muscles and avoid the dreaded flathead look. The American Academy of Pediatrics (AAP), which coined the term back in 2003, advises starting tummy time “beginning on their first day home from the hospital” for “2 to 3 times each day” for “3 to 5 minutes.”
Some babies plop there, no problem. But plenty of others…well “hate it” isn’t an exaggeration, going by a quick scan of comment threads:
“My baby hates tummy time. Screams bloody murder every time.”
“She acted like I was torturing her!”
“My mom instincts kept telling me I’m doing something terrible … feel guilty that somehow his inability to tolerate tummy time is my fault.”
“She mostly hates it and gives me these eyes that say, ‘What the hell am I doing here? Pick me up!'”
“Parents are often confused because they hear tummy time is important but don’t hear the details,” says pediatrician Tanya Altmann, author of The Wonder Years.
“Parents talk about it like it’s a prescription,” says Erika Schillinger, a clinical associate professor of medicine specializing in family medicine at Stanford University. “They want to know, ‘Am I doing it right? Doing it often enough? Do I talk to my baby? What if my baby will only last for one minute? What if my baby hates it?'”
“It’s absolutely overrated,” she told me.
Tummy time also has become another annoying source of mom-petition:
Your baby hates it? Mine loves it!
Yours can’t lift his head or roll over or hop on one foot? You must have slacked off at tummy time!
Time out! A closer look at what’s involved in tummy time actually offers some much-needed chill about what we’re talking about here.
Rethink the WHY: Lift your baby out of the car seat, carrier, stroller, and Bumbo.
Tummy Time rolled onto new parent To-Do lists in response to another AAP campaign-with-a-catchphrase, Back to Sleep, which began in 1992. (That SIDS-fighting effort is now known as Safe to Sleep, having been expanded from putting babies on their backs to sleep to include a firm surface, no co-sleeping, and having nothing else in the crib.) Soon after came the first reports of flattened skulls and delayed motor skills.
But sleep position isn’t the only cause of those problems—maybe not even the biggest one. In 2008, two-thirds of physical and occupational therapists in a 2008 American Physical Therapy Association survey blamed an uptick in early motor skill delays on the unnatural amount of time babies spend on their backs or in carriers—during waking hours.
Now known as “container baby syndrome,” it’s all that non-crib time babies spend in portable carriers. “The good thing about car seats and carriers is the technology that makes them so easy to transport a baby. But too many leave the baby in it too long,” Altmann says. “Car seats are for cars.”
Fear is fueling their use too. Having had it drilled into us that babies should be on their backs, some parents are (mistakenly) afraid to let their babies spend time in any other position, even when they’re awake, she adds.
Another risk: baby-wearing 24/7. Babies need chances to work against gravity and hold their heads up on their own.
Not being able to move freely and look around while awake can lead to problems like torticollis, a stiff neck that’s treatable with home physical therapy, as well as plagiocephaly (flat head).
Rethink the “tummy” in tummy time.
No wonder our babies cry: It’s no fun being face-planted on the floor before they have much neck muscle strength, says Pumerantz. But here’s the thing: There’s nothing magical about being FACE FIRST ON THE FLOOR!
“Tummy time is simply any position your baby can get into to exercise her neck and back muscles and to get off the back of her head,” says Kansas City pediatrician Natasha Burgert. Especially in the first weeks, that can mean:
Holding your baby skin-to-skin, belly-to-belly. You can cuddle your baby like this from birth, when there’s still very little neck control, even when the umbilical stump is still attached. “Kangaroo time snuggling is less traumatic for everyone,” says Pumerantz.
Burping your baby. Being upright counts!
Carrying your baby around, belly down or supported upright. You don’t have to always cradle-hold your baby.
Laying your awake baby on her side, supported by a rolled-up blanket. With both arms in front of her, she can reach for things or look around in a new way.
Supporting your baby to “walk.” As they get older, most babies love to be pulled to a supported sit or stand long before they can actually master these moves on their own.
Playing “airplane.” That motion where you support your baby on your forearms and glide through the air? Yup!
Notice these are all natural things we do with our babies. All that’s required is a little intention—and getting them out of a carrier.
“Tummy time is really about playing and interacting with them,” Burgert says.
Babies also do a lot of this work while lying on their backs—all on their own, points out Canadian Feldenkrais practitioner Irene Lyon. Bit by bit, they shift and wriggle, priming the spine to discover and access the muscles needed for later moves, like turning and rolling over. “It isn’t about the firing and strengthening of muscles per se, ” she says. “It’s about functionally doing the movements that our nervous system wants to find, and then letting the muscles, and nature, just do their job.”
You don’t need to force a baby to develop. “Kids let us know when they’re ready,” Schillinger adds.
Rethinking the “time” in tummy time.
Somewhere the idea has also stuck that tummy time is a Quantified Event, like nap time or feeding time, that must be done for a certain number of minutes per day.
Those guidelines calling for “3 to 5 minutes a day”? “They can consist of 30-second intervals several times a day if that’s all your baby tolerates well,” Pumerantz says.
If your baby starts crying? Pick her up and cuddle. Don’t let her cry a full three minutes! “You don’t want to create a negative association with being on the belly,” Pumerantz says. Just try again later or in a different way. Obviously a newborn doesn’t have many awake, alert moments. She finds that babies tolerate time on their tummies much better after the first month or two, once they have some control of their head and neck.
“It’s not a test—we don’t want to add another pressure on busy moms and dads,” says Altmann, who’s also an AAP spokesperson. “Tummy time should just be a way of life, a way of interacting with your baby.”
Look for everyday moments like these:
After naptime, play games. Altmann’s older sons liked to compete for their younger sibling’s attention by making funny faces and sounds. “Whoever got the baby to turn his head to the side won,” she says.
Before your baby’s neck muscles are strong, you can try propping her body on a thin rolled towel to see better.
After a diaper change, place your baby on her tummy for a few minutes’ change of view. “The key is distracting them from knowing they’re on their tummies,” Pumerantz told me. “I’d get right down next to mine and let her see my expression—happy and encouraging.”
Babies loooooove human faces, Burgert agrees. Two other great ways to use this to engage attention, she says: Prop up an unbreakable, baby-safe mirror or a board book with baby faces.
After bathing your baby, give her a massage or apply lotion on both back and belly. Mix up your baby’s position while you do it.
But notice: No timer necessary. No special “tummy time techniques” or special equipment, either, Altmann says. “You don’t need a fancy, expensive tummy time mat,” she told me.
Opportunity = success
“What gets lost in translation,” Burgert says, “is that tummy time isn’t about checking off a box so you can say, ‘I was a good mom today.’ We forget to step back and look at the big picture: You’re just engaging your baby to help give her a good start in the basics…being able to roll over, sit up, eat on her own, and all the rest.”
With a little common sense, most babies will develop just fine. What to look for:
By 2 months, most babies can hold their heads up and begin to push up with their hands when on their bellies.
By 4 months, some begin to roll tummy to back. Back-to-tummy takes longer, up to 8 months.
By 6 months, most babies can roll both ways and begin to sit without support.
And then, look out! “Babies don’t like to stay in one position very long,” says Pumerantz.
Having written the AOTA Tummy Time guidelines before she became a mother, she says she now has a lot of empathy for what we’re all up against. A brief start in the NICU meant her daughter Gracyn never did tummy time from Day One, for example. But by going slow and persisting with giving her daughter lots of chances to be on her back and her belly, Gracyn hit her first-year milestones right on time—from holding her head up by 2 months to rolling tummy to back for the first time at 8 weeks (“pretty early”).
“I totally understand not wanting your baby to scream while you’re trying to do something all the experts tell you is so important,” Pumerantz says. “It’s nice to know there are other things you can do.”
So…yes: Flat head is real. Muscle weakness and a lack of coordination from too much “container time” are real. But if your baby is exposed to a variety of interactions and positions in everyday ways—spending time out of the car seat, playing with you, and getting to look around at and explore this wonderful world—you’ll be good to go. Really.