“It’s so important that your baby does tummy time.”
Yes, it absolutely is. But, is there another option??

As we’ve discussed in our previous TT post, Tummy Time is one of the hardest, but most beneficial activities for your newborn to do. But why the fuss? The answer: The Safe-to-Sleep Campaign.

If you are a Millennial (or Gen X), you were placed in any random position for sleep. If you didn’t like sleeping on your back, who cares? Sleep on your belly. It’s fine.

Then in 1994, the American Academy of Pediatrics (AAP) started the Back-to-Sleep initiative to reduce the risk of SIDS. Despite its success in saving many newborns from this silent killer, the trade off was a delay in baby development.

Prior to the campaign, if a baby slept on their tummy, they would push themselves up once they woke, gaining the strength in the neck, shoulders, and arms to lift their head and upper body. So, while they waited for mom or dad to retrieve them, they would spend a good amount of time in this prone position EVERY MORNING.

Fast forward to now, the new (and improved) initiative of “Back to Sleep, Tummy to Play”, encourages tummy time to start as soon as possible with supervised 2–5-minute intervals.

Back to Play

Some babies HATE tummy time. Why? Because it’s hard fighting gravity with a body you barely understand.  No parent likes seeing their little one struggle and they will try everything to make them feel better, including finding alternatives. Enter RIE (pronounced as “rye”).

Founded in 1978 by Magda Gerber, RIE stands for Resources for Infant Educarers. Their philosophy is that babies are capable little humans understanding their world around them and they will flourish if given a safe space and autonomy from adult influence. In other words, let them develop naturally in their own time and in their own way.

RIE frowns upon Tummy Time because it places babies in a position that they can’t get into or out of independently. They prefer that babies remain on their backs for sleep and play since it is the provides the most support for their bodies. With this feeling of safety and security from the ground, they will eventually roll onto their bellies when they’re good and ready to.

Their stance is the following:

• Although a baby can develop flat-head syndrome (plagiocephaly) by lying on the back for extended periods of time, they contend that babies will naturally turn their head to the sights and sounds around them, creating a smooth round head shape. However, if they have difficulties turning their head to one side, they may need the assistance from a PT or OT to help.

• Being on their back is just as beneficial to building baby’s neck and core strength as being on their belly, as seen by reaching for their feet or when they look at a toy they’re playing with.
  
• It’s assumed that babies, while on their back and with time, will figure out how to roll onto their bellies as they learn to kick their legs and reach for objects that are near them, crossing their midline. While doing so, they’ll achieve transitional positions, like side-lying, which require subtle weight shifts needed for balance and body awareness.

It’s important to note that RIE also believe that babies should not be confined in containers, propped up, or placed in any baby equipment. They also feel that milestones should not be forced.

If this is your style of parenting, go for it. If it’s not, it’s best that you don’t cherry-pick on this one. Here’s why:

• Newborns fresh out of the womb are used to being tightly curled in a fetal position. This means that their flexor muscles in their trunk are tight, while their extensor muscles in their back are lengthened. Baby seats, positioners, and other forms of equipment promote a flexed position. Combine that with sleeping on their back and babies don’t get as much time to stretch out their trunk/hip flexors and activate their extensor muscles, let alone time to move their head around freely. In this case, TUMMY TIME IS KEY.

Wearing Baby Out

Tummy Time is, if anything, a North American construct. If that’s the case, what are other countries doing? Baby wearing is the popular alternative. Being carried throughout the day provides:

• Opportunities to build head and neck control when observing their environment
• Active engagement of baby’s core, back, and arm muscles while they maintain an upright and steady position
• Activation of their vestibular (movement) system due to caregiver’s dynamic movements
• Proprioceptive (body/spatial awareness) and tactile (touch) input, ensuring safety and comfort 
• Limited flat-head syndrome

Multiple studies on baby wearing in Africa have found that babies worn throughout the day showed advanced gross motor development, age-appropriate milestones, and no cases of hip dysplasia (when the ball portion of the thighbone doesn’t appropriately fit into the hip socket).

Baby wearing is a more natural and pleasurable approach to Tummy Time. How long should you wear your baby? As long as you want to. There are no strict guidelines on it. However, if your child begins showing signs of discomfort and wants out, do so.

Just Side-Lying

Side-lying gets overlooked because it serves more of a transitional position than one of importance, but being placed in this position has its advantages, like:

• Promoting rib cage development, necessary for taking deep breaths and promoting lung expansion
• Fostering balance through the co-contraction of both their flexor and extensor muscles
• Building a foundation for rolling as they may accidentally flop on either their back or belly, also activating various sensory systems to develop a sense of self in relation to their surroundings
• Preventing flat-head syndrome by taking the pressure off various parts of baby’s skull by changing sides
• Orienting baby to their midline by encouraging them to acknowledge and use both hands during play
• Encouraging self-soothing and oral motor exploration as baby becomes aware of their hands at midline and brings them to their mouth

Side-lying is versatile and can be integrated into Tummy Time, especially if your baby is struggling with being on their belly.

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Tummy Time is important and has its place and purpose in child development. However, it is not your ONLY option. All the techniques mentioned are useful in their own way. So, if your child is struggling with Tummy Time, try these alternatives out.

Keep in mind that when your baby becomes stronger and grows more curious of their surroundings, they will have less and less of an issue being on their belly. So while Tummy Time aversion may be a concern early on, give it a couple weeks/months for them become more comfortable with the position.

In the end, all babies will reach their developmental milestones in their own time, but they will need your guidance to do that in one way, shape, or form.

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