Latest Research: Is tummy time really important? Or just a fad?

What's the latest research on tummy time? Dr Ainslee, chiropractor and parent educator, talks to us about the ins and outs, and whether it’s a fad or here to stay.

Is tummy time really needed? To answer this question we must delve into a most peculiar series of events which exhibit the impact that science, combined with cultural shifts, can take on a child’s development. 

It’s the early 1990s: the Back to Sleep campaign is rolled out as a revolutionary idea to decrease infant death due to SIDS. It’s a brilliant idea.

2004: the Back to Sleep campaign has decreased SIDS morality rates in NZ by 63% compared to 1994. The safe sleep guidelines have slowly but surely integrated into our culture and with incredible statistics, are a huge success and are thankfully here to stay.

Along with the new millennium comes a marketing push for baby containers (bouncinettes, jolly jumpers, baby walkers, baby swings etc). Toy companies see a gap in the market and they take it, there is money to be made. Parents want the best for their children and toy companies know this; they advertise with images of happy babies sitting in baby walkers and baby swings, and the baby container market booms. As the industry continues to grow, babies spend less time on the floor exploring their bodies with free play movement and more time being 'contained'. Toy companies have no standards to meet and their toys and baby containers start to interrupt babies' natural development; in some cases causing delays in development and harm to babies' structure. Due to babies not having the skills, reflexes or cognitive ability to use baby walkers safely, Canada bans the sale of them (even used ones). Sellers face consequences not worth selling them over. NZ is none the wiser, the baby container market continues to boom.

It's 2008: a survey done in the United States across physical therapists show two thirds of the therapists surveyed have seen an escalation in early motor delays in babies. What did all those babies have in common? A lack of time spent in positions other than on their back. Tummy time is pushed more, groups who look after babies tell parents to do tummy time, but with no further education given. No one really knows what tummy time actually is. There is confusion.

It's 2019: I am sitting in a mothers' group. I am there as a mother. Someone asks another if they are doing much tummy time and the response was:

“My great aunty said she didn’t do tummy time with her boy and he turned out to be a professional sports player.”

The conversation flowed and comments flew around the group along the lines of:

“My baby cries in tummy time, that means he doesn’t like it, so we don’t do it.”

“I read an article saying tummy time is not needed.”

“We only do back play time, baby will learn to be on its tummy when it's ready.”

“It feels awkward putting my baby on their stomach, I’m not sure how to do it.”

I observed the conversation, kept my mouth shut (because if anyone doesn't appreciate unsolicited advice, it's a newborn mother) and nodded in empathy because these mothers were putting their best foot forward with their babies. Society was failing them and their babies. Education on tummy time needed to be readily available, and I knew I could help to provide this. An idea was born to create The Tummy Time Project.

It's 2020: a systemic review shows that only 30% of parents adhered to the tummy time recommendations. Studies done with babies show that following suggested guidelines for adequate handling and tummy time of a baby decreases plagiocephaly (an uneven head shape) by 50% by three months old. Having minimal tummy time (or any positions other than on their back), and extra container time is not only delaying our babies' natural development rate, it’s changing the physical appearance and structure of their bodies, specifically their head shapes. 

No one could have forecasted that a campaign for sleeping babies on their backs would get over interpreted from “Don’t put your babies on their stomach to sleep” to “Don’t put your babies on their stomach ever”. This, timed with a push in baby container marketing, created an enormous shift in the day-to-day handling of our babies.

Pointing the finger and playing the blame game is pointless, the fact is we can’t deny that how we handle and interact with our babies has changed over the last 30-40 years, and not for the better with regard to development and structure. 

So, what exactly is tummy time? Tummy time is a term used to indicate that parents are facilitating 'interactive head control'. Here is the thing, interactive head control can be done in many different positions, you could be doing enough throughout your day purely in how you are handling, interacting, holding and playing with your baby. This is where the education is lacking and we have a misinterpretation.

As a chiropractor, I don’t care so much about how you get the interactive head control done with your baby as long as you are doing it in some way. Interactive head control has been shown to improve a child’s total development. The question isn't, “Is tummy time needed?” The question is, “Are you facilitating interactive head control in a way that suits your family?”.

So, how do we bridge the gap for the sake of the next generation? How do we get around miscommunication and myths about tummy time? How do we ensure parents are handling their baby in a way that optimises development, rather than hinders it? How do we create a shift, and correct the course for the next generation? In my opinion, it is through education.

HOW IT SHOULD LOOK

Ideally we want to be facilitating interactive head control in a way that:

+  Matches the age and stage of the  baby

+  In a way that support their natural development

+  In a way that protects their hips and spine

+  In a respectful and supported way

Facilitating interactive head control shouldn’t be just another thing to do – with the right education it will be effortless and will naturally occur throughout the day.

AGES AND STAGES

Tummy time looks different at different ages, a newborn doing tummy time looks significantly different to a six-month-old doing it. By six months old a baby should be able to push up onto their hands with straight arms, lift their chest off the floor, hold their head up high and look around confidently. As a newborn your baby won’t be able to lift their head much at all.

WHEN SHOULD YOU START?

Tummy time (interactive head control) should be started from birth, but at this age we want to support a newborn's body by supporting their spinal shape and allowing their hips to stay bent and curled up, keeping them safe and nurturing them. One great tummy time position for a newborn is chest-to-chest with a caregiver, and skin-to-skin with chest-to-chest is even better.

HOW TO MAKE TUMMY TIME FUN

Keeping tummy time interactive is key, dumping a baby on their tummy and walking away wouldn’t be fun for you and it won’t be fun for you baby either! Interact with them, chat, sing, make it fun for both of you!

THERE ARE MANY DIFFERENT POSITIONS FOR TUMMY TIME

Many people think that tummy time is just about putting a baby on their stomach, but it is so much more than that. We want positions for tummy time to match a baby’s age and stage, we need tummy time to support their structure and help facilitate interactive head control, not set them up in a position and expect movement that is impossible for them to achieve. There are many different positions that can facilitate a baby getting interactive head control. A great example throughout the day is burping a baby over your shoulder.

AGE BASED GUIDELINES

The timings and durations of tummy time are broad, vague and generalised (much like the lack of tummy time education). Many of the recommendations suggest that children under the age of one year should get a minimum of 30 minutes of tummy time per day. This is unattainable for newborns, so graded duration guidelines need to be given to respect and honour the child’s age and development stage. 

The Tummy Time Project is a huge passion of mine, designed to help our babies and the next generation. Help put me out of a job and join the other parents who have made tummy time, or shall I say, interactive head control, effortless and part of their everyday handling with their little ones.

Dr Ainslee is a chiropractor and a human neurodevelopment educator. Ainslee lives in the Manawatu with her two-year-old son, her husband and dog. Find out more about The Tummy Time Project and her other passions at brainunderconstruction.co.nz.