You’ve heard your pediatrician say that you need to be implementing tummy time at home, but have you ever wondered why it’s so important? You probably know that it’s crucial for strengthening muscle groups on the backside of the body, but there is SO much more to it than that when it comes to neurodevelopmental benefits. It’s absolutely foundational, which means it’s important that we talk about ways to make it easier. Because let’s face it, some babies struggle with tummy time, and there is usually a reason for that. Getting to the source of that reason is vital, because the belly should be a happy place for a baby to be! This post will outline just a few of the countless processes that are taking place during tummy time for brain and neural development. In another post, we’ll dive more into ways to make tummy time enjoyable and feasible, even for babies who aren’t the biggest fans of being belly-down.
Starting Early
Early movement is vital for later outcomes in a child’s life. And it starts immediately after birth. It’s been proven that being able to practice reflexive movement patterns and form new neural pathways from doing this has an effect not only on motor outcomes, but also overall brain development. Motor development does not happen in isolation, but rather is an intricate dance between all these other facets of brain activity which affect outcomes in domains including speech and language acquisition, feeding, bonding and attachment, cognition, sensory integration, visceral processes (gastrointestinal function, circulatory regulation, etc.), and more. So what are these reflexive movement patterns and what does that even mean?
Reflex Integration
Babies are born with about 20 primitive reflexes. Most of these are for feeding, and all are to help aid in survival. Did you know that if you place a newborn baby straight on mom’s chest after delivery (assuming it was an uncomplicated delivery) and leave them skin to skin, a healthy infant is expected to be able to perform the “breast crawl” and can find its way to the breast and latch itself to initiate the first feeding. This is possible through this cascade of primitive reflexes serving their intended purpose. Over time, reflexes are integrated (or kind of work themselves away so that more voluntary control of those muscle groups can take over) as a baby ages and as they have opportunities to practice those reflex patterns over and over again. In a sense, that frequency is fatiguing the reflex, and eventually this allows for more volitional control to be exercised instead of those automatic patterns.
Many of these reflexes are evident in the prone (belly-down) position, so making sure that babies get time on their tummies is just one way that tummy time is essential, as it helps to make these reflexes go away over time so voluntary control can happen. Something I see with many children with delays is these retained reflexes causing them mobility restrictions significantly past the expected age. So for example, an 18 month old with the absence of any medical diagnosis that is unable to roll off of their belly still because their arm gets stuck is something I commonly see. That is the ATNR (Asymmetric Tonic Neck Reflex) kicking in, as for some reason it never integrated and is inhibiting their ability to voluntarily move their arm out of extension (try rolling off of your belly with your arm stuck straight out to the side—it’s quite a challenge!). All of this to say, so many of these reflexes come into play when a baby is on their belly, so it’s important to get them into the belly down position to give them opportunities to exercise these reflexes and eventually integrate them.
Note on swaddling
Though swaddling is beneficial for several reasons (i.e.: deep pressure input for regulation), like most things it serves us best when exercised in moderation. Swaddling does inhibit many of these reflex pathways and can even mask hunger cues, but it is a great tool for an inconsolable baby at times. What’s highly important with swaddling is to make sure you are not swaddling a baby during feedings—bottle or breast—as this “holds back” so many opportunities for practicing reflexive movements. Remember, this repetition is important for eventually allowing those reflexes to integrate. Many might tell you to move the baby’s hands out of the way when feeding, but try letting them use their hands and see what happens! You might be surprised to find that a wildly flailing baby hand might eventually grasp the bottle or breast to bring it to its mouth! And that’s exactly what that reflex was designed to do. I do recognize that you can’t just hold your baby all day every day, but an alternative to swaddling that could be beneficial when a baby is struggling to calm is placing them skin to skin on your chest (a strategy often forgotten after the first few weeks of life). This is still perhaps the best regulatory strategy for an infant all the way through the first year of life. You are not “spoiling” them or creating a habit that will be hard to break later—you are helping their nervous system develop! This context of safety and security is the crucial foundation upon which every other aspect of neurodevelopment occurs.
Nervous System Regulation
A vital element and benefit of tummy time is autonomic regulation. There are all sorts of deep pressure receptors on the front side of the body that provide important input to autonomic nervous system (fight or flight). Getting this input through the belly is beneficial for the “rest and digest” portion of this nervous system, which allows the smooth muscle activity of the gastrointestinal, circulatory, and other bodily systems to relax and function as they should.
A baby is held in the fetal position or physiological flexion for the first nine or so months of its life, and coming into the world and having to grapple with gravity trying to pull them into extension is a huge adjustment. Being on the belly provides this ability to be flexed, a position more familiar and calming to infants. Think of the difference in a baby placed flat on their back compared to snuggled up asleep on mom’s chest. Mom’s chest is intended to be the new environment for the baby right as they transition from the womb, as they are able to feed off of each other’s hormones (cortisol, oxytocin) for co-regulation, baby is provided warmth, safety, and even food. For this reason, tummy time for those first weeks of life should be done on a caregiver’s chest and not necessarily flat on the floor. Here on the mom is where they will learn to begin flirting with gravity, as the inclined position obviously reduces the gravitational pull compared to just being flat on the floor. Learning this bit of head control (lifting the head and turning to rest either cheek back down on the parent, extending the neck and stabilizing the head in order to latch onto the breast, etc.) is a beautiful transition within the context of the most comforting environment imaginable for the baby.
Because believe it or not, tummy time should not be full of screaming!
I am not a fan of placing a baby on their tummy, setting a timer, and then letting them wail on their tummy until that magic amount of time is up. As a baby gets a bit older and is doing tummy time on the floor, we should ideally be easing onto the belly (try rolling there from the back or placing on an incline and progressively lowering incline), and easing out again as a baby is showing signs of distress. Creating an association in their brain and nervous system that this is a positive, bonding experience is key, and it’s kind of like a dance. And of course, this is much easier when tummy time begins right after delivery and not later in their life (though not at all impossible!). Making this time a social, bonding experience (just as it was in those first weeks of life) is a crucial part of the tummy time experience, especially for little ones that may be having a bit more trouble with it.
Social development
Motor development is social and does not occur in a vacuum—it is an intricate, dynamic dance between all these other centers in the brain and the neural pathways between them that affect the outcomes we see in every developmental domain. Just as with other positions that you find yourself holding your baby as you play and interact, the belly should be no different. Get in the floor at eye level (or put them on the couch with you in the floor at eye level) and talk and play as you normally do. Make funny sounds and use a gentle voice, and roll them gently back out of this position as they show signs of distress. Don’t force it by any means, but for the sake of keeping it a happy time, just get little tidbits of tummy time here and there throughout the day as you are able. Make it about the quality of time and not simply the quantity of time. If a little one learns to like being on the belly and knows that it is a special point of connection and play with a loved one, then tummy time will most often take care of itself as this association is made.
When It’s Just Not Working
There are a host of reasons that tummy time may be more difficult for some babies. Whether it’s medical challenges, tension in the neck and oral anatomy (a very common occurrence) such as tongue/lip/cheek ties or torticollis, low muscle tone, etc., it’s important to get to the source of the difficulty and to make modifications accordingly. Or if you notice head flattening (plagiocephaly), there’s likely some other kind of restriction that may need to be addressed. In these cases, it is highly beneficial to seek out the help of a qualified health professional (physical therapist, occupational therapist, speech therapist) to give more specially-tailored help with tummy time.
Early infancy comes with such crucial windows of development that set the stage for later outcomes in life. If you have concerns, act early and get the support you and your little one need!
