Placing infants on their stomachs helps them to strengthen their young muscles and develop better mobility

Jane McNamara, PT

Why is it so important for babies to spend time on their tummies? Why should babies who don't like the position be encouraged to tolerate it? Although most babies are comfortable in this position, some babies do not tolerate being on their stomachs. The following is intended to help parents and caregivers toward a better understanding of the benefits of "tummy time." (This discussion excludes babies for whom tummy-lying is contraindicated due to medical concerns.)

Strengthening Muscles

When a young baby is placed on his stomach, he automatically lifts his head to an upright position. Gradually, this leads to propping on forearms and later, to pushing up onto the hands with the elbows extended. These positions help to strengthen the extensor muscles (muscles of the neck, back and buttocks). They also help to lengthen the flexor muscles (abdominals and hip flexors) that have been in a shortened position prior to birth. Taking weight on the hands and arms strengthens the muscles of the shoulders and arms. Learning to stay balanced in this position provides a base from which better control of the arms and hands develops.

Promoting Motor Development

Weight shifting occurs when the baby leans over to one side, freeing the other side to reach or to crawl. In addition to building strength and stability, weight shifting causes basic balance reactions through the trunk, upon which more mature balance reactions are later built.

The ability to control weight shift gives a baby confidence when learning to move from one position to another, such as from sitting to lying down. Feeling the weight shift across the hand, such as when a baby creeps on hands and knees, also has benefits. The changing pressure as the baby's weight moves over the hand provides sensory information to the hands, helping to develop a more refined sense of touch. It also helps to develop the smaller muscles of the hands and fingers that will be necessary for good fine motor coordination.

Visual stimulation is another benefit of the tummy, or "prone" position. A baby lying on his back sees the ceiling and objects to either side. A baby placed on his tummy will lift his head and push up onto his arms to view his environment at eye-level. He is made aware of objects and challenges that are approachable and is more easily motivated to explore his surroundings.

Bothered Babies

Some babies become upset when placed on their tummies. What causes a baby to fuss when placed on the stomach? There can be many reasons. Most babies, however, when gradually encouraged, will learn to tolerate tummy-lying in a surprisingly short time.

Babies with atypical muscle tone (very loose or very tight muscles or joints) often find it difficult to push up from their stomachs onto forearms or hands. They have to work harder than their peers, but with encouragement from parents and guidance from a therapist, they can learn to enjoy being on their tummies.

A baby who is very observant and content may not be very motivated to move. This baby prefers to lie on her back or sit well-supported and watch everyone else. Having to work to see things from her tummy may make this baby fuss at first, but as she becomes stronger, her fussing at tummy-lying will decrease.

Some babies may not process information about position changes very well at first, and being placed in positions out-of-upright may seem confusing. It is important to teach these babies gradually to tolerate being on their tummies. Accomplishing skills in this position leads to other skills such as crawling and helps to build independence and self-confidence.

A baby who does not learn to tolerate being on her tummy misses a great opportunity for learning. She is at risk for delays in development, as she may have difficulty learning to move independently or may learn to do so in atypical ways.

When this child eventually learns to walk, her gait may not be as smooth as it would have been had she learned weight shifting and rotation through the typical developmental stages.

Introducing Babies to Tummy Time

The earlier a baby is introduced to being on his tummy, the sooner he will enjoy the benefits of this position. Consult a doctor or therapist about activities or techniques to help babies learn to enjoy being on their tummies.

The activities that follow are given as examples and should be used under the guidance of a medical professional.

1. Sit in a semi-reclined position on a chair or couch. Place the baby on his tummy, on your chest and abdomen. Encourage him to lift his head and push up on his arms to see your face. The higher you sit up, the easier it will be for the baby to push up, so experiment with your position so that the baby has to work against gravity, being careful not to frustrate him too much.

2. When you place the baby on his stomach, it might be easier for him if he is on an incline with his head higher than his feet. Gravity will be less of an influence than when he is lying flat.

3. Sit on the floor with your legs out straight in front of you. Place the baby across your legs so that her arms and hands are over your legs and her hands touch the floor. Place a favorite toy or game where she can't reach it. You can help to steady or anchor her by putting a little downward pressure on her hips with your hand.

4. A baby just learning to push up onto forearms may benefit from a rolled up blanket or towel placed under his chest. Be sure his arms are over and in front of the roll. You can help give him a stable base to work from by pushing downward on his hips, as in tip 3.

5. A baby will be more likely to tolerate tummy-lying if a parent gets down on the floor also, preferably facing the baby. A favorite toy can be placed in between the two.

6. Play airplane games in any way you can think of, such as holding the baby in front of you, across your arms. Support her well under the hips and abdomen as you gently swing her forward and back. You can also experiment with carrying her in a horizontal position.

7. Try having the baby push with his arms on another surface, to promote weight bearing. Fun things to push might include a cushion, a large ball or another person. (This is especially fun if the person pretends to fall down.) Try pushing from various positions such as supported sitting, supported kneeling and even lying on the back.

Use your imagination and see what other tricks you can come up with to encourage tummy-lying and weight bearing on the arms and hands.

Very often, it's the parents or therapists who have the most creative ideas.

Jean McNamara is a practicing physical therapist at Chesapeake Center, Springfield, VA. The OT/PT staff at Project Interact Inc., a birth to 3 program based in Watertown, CT, also contributed to this article.