Tummy Time: Why It Matters and How to Start

Babies should always sleep on their backs. But when they are awake, spending some time on their tummies helps them grow strong. This simple practice is called tummy time. Many babies fuss about it at first, and many parents wonder if they are doing it right. Here is why it matters, when to start, how much to aim for, and how to make it easier on both of you.

Why tummy time matters

Back sleeping, a core part of the AAP's safe sleep guidance, has greatly lowered the risk of sudden infant death. The tradeoff is that babies now spend much of their day lying on their backs, in car seats, or in carriers. Tummy time balances that out. When your baby lies on their stomach while awake and watched, they:

• Build neck, shoulder, arm and back muscles. Lifting the head against gravity is hard work, and it is the base for rolling, sitting, crawling and pulling up.
• Help keep the head a nice shape. A baby's skull is soft. Lying in one position for long periods can cause a flat spot. Time off the back of the head helps prevent this.
• Loosen tight neck muscles. Turning the head to look around on the tummy stretches both sides of the neck.
• See the world from a new angle. Being on the tummy gives babies a chance to reach, push and explore with their hands.

When to start and how much

You can start the day you bring your baby home, even before the umbilical cord stump falls off. The American Academy of Pediatrics suggests starting with about 3 to 5 minutes at a time, two or three times a day. As your baby gets stronger and more comfortable, slowly build up. A common goal is a total of 15 to 30 minutes a day by around 7 weeks, spread over several short sessions. Older babies can do more.

Good times to try are after a diaper change or when your baby wakes from a nap. Right after a big feed may lead to spit-up, so you may want to wait a little while after eating. Tummy time is only for when your baby is awake and an adult is watching. If your baby falls asleep on their tummy, turn them onto their back and move them to their crib or bassinet.

The AAP's "Back to Sleep, Tummy to Play" page has more ideas for each stage.

Easy ways to do tummy time

Tummy time does not have to happen on the floor. Any position where your baby is on their front and working to lift their head counts.

• Chest to chest. Lie back on a couch or bed at a slight recline and place your baby on your chest. Your face is a great reason for them to lift their head. Stay awake and keep a hand on your baby.
• Across your lap. Lay your baby face down across your thighs while you sit, with a hand on their back to keep them steady and calm.
• On the floor. Use a clean blanket on a firm surface. Get down at eye level so your baby can see you.
• The tummy-down carry. Hold your baby face down along your forearm, with your hand supporting the chest and your other hand on their back.
• A rolled towel. A small rolled towel under the chest and armpits can make floor time a little easier for young babies. Stay right there and remove it when you are done.

If your baby hates tummy time

Lots of babies protest at first. It is hard work, and they are not used to it. Fussing does not mean you should give up. Try these ideas:

• Keep sessions very short. Even one or two minutes counts. End before your baby is truly upset, so it stays a good experience.
• Do it more often instead of longer. Several mini sessions through the day add up.
• Give them something to look at. Your face, a safe baby mirror, a high-contrast card or a soft toy just in front of them works well.
• Join in. Lie on the floor facing your baby, talk, sing and make faces. Older siblings can help too, with an adult nearby.
• Change the scenery. Move to a different room or a different blanket.
• Try a slight incline first. Chest-to-chest time is often easier for babies who dislike the floor.

Most babies come to enjoy tummy time as their muscles get stronger and they can hold their heads up to look around.

Helping prevent flat spots

Along with tummy time, a few daily habits help keep your baby's head round:

• Limit time in car seats, swings, bouncers and carriers when your baby is not traveling or needs a safe place for a moment.
• Hold your baby upright often during awake time.
• Switch which end of the crib you place your baby's head each night, so they turn to look at the room from different sides. Always keep them on their back.
• Switch which arm you hold your baby in for feedings.

What progress looks like

Every baby moves at their own pace, but over the first few months you will likely see your baby lift their head for longer, then push up on their forearms, and later push up on straight arms and start to roll. Your pediatrician checks head shape, neck movement and motor skills at each well visit. Bring up any questions then.

When to call us

Call your A thru Z Pediatrics office if:

• Your baby always turns their head to the same side, or their head seems to tilt one way.
• You notice a flat spot on the back or side of the head, or one ear or side of the face looks pushed forward.
• Your baby cannot lift their head at all during tummy time by around 3 months, or seems very floppy or very stiff.
• Your baby has lost a skill they used to have.
• Your baby cries during tummy time in a way that seems like pain, not just protest.

Call 911 if your baby has trouble breathing, turns blue, or becomes limp or unresponsive. If you would like to go over your baby's development, request a visit.