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Dr. Gollup's Pediatric Housecall

Dr. Howard Gollup is a board-certified pediatrician with Aurora Advanced Healthcare in Germantown. He cares for children from birth through adolescence. Though he cannot respond to individual medical questions, he welcomes your feedback and suggestions for future topics.

The Right Way to do "Tummy Time"

tummy time, prone, sleep, back to sleep, supine, SIDS

One of the most tragic mysteries in all of pediatrics is Sudden Infant Death Syndrome, or SIDS. In the mid-1990’s, the American Academy of Pediatrics recommended that babies sleep supine—on the back—as it appeared that foreign countries that followed this practice had a lower incidence of SIDS. Whether doing that in this country would result in declines in SIDS cases was an article of faith—we still have only theories of what causes it—but back-sleeping has seemed to be associated with a decreased numbers of SIDS cases.

One of the unintended repercussions of the American Academy of Pediatrics “Back to Sleep” program of the past 15+ years is that babies do not spend nearly as much time on the tummy. Babies simply don’t consistently develop prone (tummy) skills as they used to a couple decades ago—skills like pushing up, getting up on hands and knees, and crawling. Pediatricians have had to learn to be able to assess childhood development without relying on these traditional “milestones”: Although years ago a child not crawling by 8-9 might have been raised concern, these days it more commonly signals a developmental variation than a deviation from normal.

Every baby should have daily “tummy time”, starting within a few weeks after birth. This involves placing your baby on his or her tummy to practice prone skills like lifting his head or pushing up on his arms. Often this will occur on a blanket on the floor, with the parent down at eye level, face-to-face with the baby. The surface he is on should be firm so his face doesn’t sink down into it. There's no right or wrong frequency or duration. Recommendations are not that specific.

However, many parents tell me their baby doesn’t like being on the tummy. I think that isn’t so often dislike as it is a learned behavior. Here is how this works: Parents who are aware of the recommendation for “tummy time” will put their baby down prone. Then, they will wait for the baby to begin fussing. The parent will then figure the baby has had just about enough of that position, and will quickly pick him or her up. The baby rapidly learns that if they fuss when on the tummy she will get picked up—one of a baby’s prime goals. As a result, the baby fusses sooner and sooner, not because they dislike being on their tummy, but to be picked up. It just looks like they don’t like it.

Instead, I recommend starting with your baby on her tummy for just, literally, a few moments. While she is still happy, pick her up, give her some big smiles, and express your glowing approval. Put her down again, this time for a slightly longer time. Pick her up again while she is still happy, and show her how pleased you are. Repeat this over and over, leaving her down for gradually increasing lenghts of time.

True, you don’t know how long she would have been happy on her tummy had you waited, but that’s not the point.

By giving your baby positive reinforcement, essentially, for remaining happy and spending increasing time on her tummy, she will build her tolerance and spend longer and longer time that way.

Although I have never seen this suggestion published elsewhere in discussions of “tummy time”, I suspect there are other pediatricians who might have figured this out as well. In the next entry, I’ll discuss a couple other unintended consequences of the “back-to-sleep” program—potential effects on head shape and neck mobility—and how to prevent them.

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