I love working in early intervention for many reasons, but one of the most rewarding is working alongside other passionate therapists. Today I got a call from a long time and skilled colleague, a speech language pathologist who is a feeding expert in our community. She had a question that led to a great discussion that led to this post (why not share helpful convos, right? That’s why we are here). Her question: I’m working with a 2 month old that hates her tummy. I’ll give general recommendations, but when do I need PT support? And why do babies hate being on their bellies so much? And what can we do to make this more pleasant for babies and families?
In my experience, there are several understandable reasons parents tend to avoid tummy time, rooting in real reasons that babies don’t enjoy the position, resulting in real (and incredibly frequent) consequences.
WHY DO PARENTS AVOID TUMMY TIME FOR THEIR BABY?:
FEAR: As a new parent leaving the hospital you are overwhelmed with education on the dangers of letting baby sleep on their belly. It is natural that your first instinct as a new parent is to keep them SAFE. That’s the #1 goal right? I see so many parents avoid tummy time out of fear that their precious, little, fragile baby will not be safe on their tummy. I was this parent. And I am a physical therapist and my husband is an occupational therapist and we STILL avoided it somewhat with baby #1 OUT OF FEAR. I reassurance parents daily (and wish someone had reminded me) that if you are present, awake and alert, and placing baby on a firm surface, being on their tummy from day 1 is not only safe, but beneficial. Here’s WHY.
DISCOMFORT: For many reasons (another post, another day), there are many babies that suffer from acid reflux and colic early on. This can lead to legitimate (and often under recognized pain) and a strong avoidance of a tummy down posture (interestingly some babies with these diagnoses may prefer this posture and find it soothing). If untreated and unresolved the pain from acid reflux often leads parents to avoid placing baby on his/tummy and this ultimately leads to other concerns. If you feel that a baby is genuinely in pain or distress, speak to your pediatrician about your concerns.
CONVENIENCE: Technology and innovation continues to progress as time goes on and the baby industry is not absent from advances. More and more baby “containers” are created that are incredibly efficient at soothing a baby. Often recreating the sensation of the womb, these swings, seats, bouncers, and rockers can keep baby happy and quiet for long periods of time. The result is more time for parents to get some rest and get things done (who doesn’t love and need that? Me too!) However, there is a reason babies fuss. It’s how they communicate early on. It is their way to request what their body needs – food, physical contact, movement etc. If the container does such a good job at soothing them, they often miss out on natural experiences with their caretakers and during play that are SO IMPORTANT and essential for their development. So while we all need some help and convenience from time to time, it’s important to limit time in these containers. More on avoiding the “container shuffle” here.
WHY DO BABIES DISLIKE BEING ON THEIR TUMMIES?:
PAIN: See above. A baby in pain may not like this posture. We can’t stress enough that signs of pain should not be ignored.
SENSORY CONFUSION: When we think of senses, we thing smell, taste, touch, and hearing. But body position and vestibular movement is a large sense represented in the young brain. Our brains seek out what we are used to and familiar with. Many parents tend to wait until 4-5 months when baby seems more stable with more head control to start tummy time. But by this time, this belly down posture, can seem very foreign to a baby who has only been positioning upright or on his/her back. When things seem foreign we tend to make noise. Think of yourself upside down on the occasional roller coaster. It feels weird, and scary – so you scream….same for baby who has never been placed belly down. If tummy time is started from day 1, it is my experience that frequently baby will never complain or dislike it.
POSTURAL IMBALANCES: The longer baby stays in the womb the more restricted they are to movement (no more room in the Inn). So many are born with some postural imbalances where the fascia over the muscles becomes restricted on one side vs. the other (think of your stiff neck on one side when you’ve slept in a “funny” position). In many European countries, they often treat infants with osteopathic adjustments for this very reason before they send them home from the hospital. Often times, these imbalances (if minor) will work themselves out if baby is benefitted with free movement, however if significant, imbalances occur (often presenting as torticollis) baby may be uncomfortable on his/her belly.
CONSEQUENCES OF AVOIDING TUMMY TIME:
DELAYED MILESTONES: Studies show us that babies that have more exposure to free play on the floor meet their milestones earlier. I see this every day. To be frank, this isn’t rocket science. We get better at anything we get to practice. More time on the floor or a firm surface to play allows baby to flex, extend, move in diagonal patterns, and generally get stronger and more coordinated which eventually leads to rolling, crawling, sitting, and walking! I frequently remind parents that they can’t magically roll if they are either held or strapped to some sort of seat all day.
MISSING OUT ON TYPICAL DEVELOPMENTAL EXPERIENCES: Babies are born with primitive reflexes and responses that are replaced with more mature postural reflexes as they move and develop. If these aren’t replaced or fully integrated, there can be lasting consequences. For example, there is a reflex that integrates when a baby crawls. If it does not, seated attention, posture, and hand/eye coordination can be affected. Other benefits can include improved visual coordination and strength, aided digestion, promotion of natural head shape, and development of natural muscular arches in the hand that support eventual skills such as handwriting.
IMPACT ON OVERALL DEVELOPMENT: We focus on gross motor or physical benefits of tummy time which are so important, but we can’t forget the other areas. When babies become mobile on their tummies, they engage in problem solving situations, flexing their cognitive muscles (How can I get to that thing I want across the room), fine motor skills (picking up tiny things they shouldn’t on the ground), and social skills (I WILL get to mom/dad to show them what I want) to start to advocate for themselves and engage with others at will.
STRATEGIES TO MAKE ALL THIS BETTER:
ALTERNATE POSITIONING: Tummy time means belly down – allowing lifting the body against gravity. This doesn’t have to be on the floor. It can be on a parents’ chest, a large yoga ball, over a lap, or on an incline/wedge/Boppy type pillow.
INTERESTING MATERIALS AND ENTICING SETTINGS: Kids always like the paper or the box, right? Save enticing but safe materials for supervised tummy time experiences (bubble wrap taped to the floor, tissue box, kitchen spoon/whisk) and settings (textured blanket, kitchen floor (yes I’m serious), the grass (or any place outside on a blanket), the kitchen table (with parent right next to them – great place for eye contact!).
DO IT EARLY & STOP SCHEDULING IT: My favorite tips include not to schedule it and to start on the day you come home from the hospital. If we make tummy time an “event” on the daily schedule, it’s likely to not happen or only last 10 minutes. I advise parents to always place baby on the floor or Pack-N-Play on the tummy when they set them down vs. a swing or seat. Ay the end of the day, this practice leads to MANY minutes of exposure to play on the belly, and a natural part of the daily routine leading to consistency.
A child’s development is fascinating and exciting. Learn more about what to expect and how to encourage early milestones in a format you will actually have time to read and use. 1-2-3 Just Play With Me is kind of like this post – Mom inspired and therapist created. Hope both are helpful!