Is tummy time a good form of sensory motor nourishment?

How did the advice to put babies on their tummies for thirty minutes each day come about?

The Back to Sleep campaign, which teaches parents to place their babies on their backs to sleep, started in the US in 1992. As a direct result, many tiny lives have been saved.

But researchers and health professionals soon realised that babies now had less opportunity to interact with gravity on their tummies, resulting in slower motor development. So for the past couple of decades, health professionals in the West have also advised parents to make sure their baby has tummy time. Usual recommendations state that tummy time should be

• Always supervised

• Two or three times daily from birth, for three to five minutes

• Increasing to a total of 30 minutes daily

• Ceased when baby is mobile.

Since the Back to Sleep campaign commenced, there has also been a dramatic rise in the number of babies who develop flat spots on the back of their heads (known as positional plagiocephaly). As a result, tummy time is now also advised as prevention for positional plagiocephaly.

But is tummy time actually good for babies, and why do most parents stop doing it?

Unfortunately, there are five problems with tummy time advice.

1. Less than a third of parents follow the advice to put baby in tummy time for 30 minutes a day. And this is not because parents don't care about their babies' development!

2. Babies often don't like being put down, and they don't like being put down on their tummy. Some babies learn very quickly to fuss or cry the minute they think you’re going to put them on their tummy. If this happens, it's best to stop using that position for tummy time, at least for a few weeks. Your baby's nervous system doesn't learn well when he is dialled up, anyway.

3. It's true that babies who spend just a few minutes a day on the tummy show earlier onset of rolling and crawling, and increased ability to move against gravity when prone. But there's no evidence to suggest that these changes improve your baby's motor development long-term. Onset of rolling and crawling is highly variable across cultures, without effecting motor or other skills in later childhood or adulthood. The rather rigid sequence of motor milestones which is widely applied in the West doesn't apply to the global majority.

4. Research shows that tummy time doesn't prevent flat spots (or positional plagiocephaly) on the back of babies' heads. Recommendations you might hear about how often or for how long you should be using tummy time to prevent flat spots aren't science-based.

5. Tummy time doesn't help newborns develop the movements required to tuck their chin in or turn their heads when they are lying on their back, which may explain why tummy time doesn't prevent flat spots. Tummy time also doesn't help babies develop the other anti-gravity movements they need when lying on their backs.

For these reasons, NDC or the Possums programs use an whole-of-ecosystem approach to your baby's motor development, which doesn't focus on just one single strategy like tummy time. It's really about enjoying a highly physical and interactive relationship with your little person, and encouraging others who care about your baby to do the same. It's also about making life with your baby as easy and pleasurable as possible.

How does tummy time fit into an holistic approach to motor development?

If your baby is placed to sleep on her tummy she will have an increased chance of Sudden Unexpected Infant Death, a catastrophe from which families often never fully recover. Please always place your baby to sleep on her back according to international guidelines, for this reason. You can find out about safest possible positioning for baby sleep here.

It's true that your baby needs opportunities, working against gravity, to symmetrically bend her neck forward or backwards, to rotate her head so that she looks at both sides, to bring her hands into her midline, and to bend her trunk forwards. It's true that this has become more important now that we know we need to sleep babies on their backs. Tummy time can be one way of giving your baby opportunity to practice these skills. But your baby's anti-gravity movements are practiced without you having to try in multiple ways.

A Canadian study has confirmed that babies gradually tolerate more and more tummy time as they grow, until they are mobile. Tummy time is just one way of changing your baby's position in space relative to gravity. You don't have to think of tummy time as another set of tasks to fit into the day. You don't have to feel you have to watch the clock for tummy time or notice how often you're doing it! You also don't need to put your baby down on a surface, for him to experience moving on his tummy in response to gravity.

Instead, you could think of tummy time as just one small part of the NDC or Possums holistic approach to your baby's motor development, discussed here. Your baby quickly and easily builds up an abundance of tummy time by

• Breastfeeding in a laid back or semi-reclined position using the gestalt method (which gives your baby many hours a day of fabulous tummy time opportunity, at no extra effort), changing baby from one side to the other regularly

• Carrying baby over your forearm (babies love this)

• Lying baby on your chest when you're reclined or semi-reclined (babies love this too)

• Placing baby tummy down on your lap (over your thighs) for a moment.

If you did want to experiment with more formal tummy time exercises, you could

• Put your newborn or young baby on her tummy for a brief moment when you take off her nappy to change it sometimes, nestling her up and coming down to her level to eye contact and interact with her. If you keep this very short, she's more likely to tolerate it and you're more likely to do it!

• Pick baby up and get on with your day when she communicates that she is not enjoying tummy time. (Persisting often backfires, so that babies develop a conditioned dialling up with tummy time.)

• Lie on your back on the floor. Then flex your hips, bend your knees, hold your baby so that his tummy is in against your shins and secured by you holding his arms, and begin lifting your shins up and down, so that your baby has a lovely 'ride' on your legs, rich in sensory motor nourishment (and tummy time).

Really, tummy time happens without you trying as you build a life with your baby that is as enjoyable as possible, full of interaction and physical contact together, and rich in sensory motor nourishment outside the home.

Recommended resources

What your baby needs for best possible motor development

The NDC evolutionary perspective on positional plagiocephaly, motor development and sleep

About positional plagiocephaly and motor development

The holistic NDC or Possums 8-step approach to supporting baby's motor development

Selected references

Adolph KE, Franchak JM. The development of motor behavior. Wiley Interdisciplinary Reviews: Cognitive Science. 2017;8(1,2):doi:10.1002/wes.1430.

Hewitt L, Kerr E, Stanley RM, Okely AD. Tummy time and infant health outcomes: a systematic review. Pediatrics. 2020;145(6);e20192168.

Hillyar CR, Bishop N, Hibber A, Bell-Davies FJ, Ong J. Assessing the evidence for nonobstetric risk factors for deformational plagiocephaly: systematic review and meta-analysis. Interactive Journal of Medical Research. 2024;13:e55695 doi: 55610.52196/55695.

Oudgenoeg-Paz O, Atun-Elny O, Van Schalk DM. Two cultural models on infant motor development: middle class parents in Israel and the Netherlands. Frontiers in Psychology. 2020;11(119).

Priyadarshi M, Balachander B, Sankar MJ. Effect of sleep position in term healthy newborns on sudden infant death syndrome and other infant outcomes: a systematic review. Journal of Global Health. 2022;12:12001.

Williams E, Galea M. Another look at 'tummy time' for primary plagiocephaly prevention and motor development. Infant Behavior and Development. 2023;71:101839.

Zhang Z, Predy M, Hesketh KD. Characteristics of tummy time and dose-response relationships with development in infants. European Journal of Pediatrics. 2023;182:113-121.