elevating child care

The Case Against Tummy Time: Guest Post by Irene Gutteridge

Does your baby like tummy time? Most don’t, for good reason. Until infants are able to roll into the tummy position on their own, most of them find it uncomfortable, immobilizing, and no doubt highly discouraging. 
But rather than listen to our babies, we are asked to put our faith in recent studies about plagiocephaly (flat-headedness), studies that don’t take into account the fact that infants are now spending more time than ever in restrictive devices (like car seats, bouncy seats and carriers) that inhibit babies from doing what they are naturally inclined to do: round out the back of their heads by turning them from side to side. 
Instead, the back position and rousingly successful “Back to Sleep” campaign (which has cut the SIDS rate in the US in half since it began in 1992) have been named as the culprits.  So, rather than understand these studies as a reflection of the need for more free movement and floor time during the baby’s waking hours, many experts have concluded that imposing tummy time is the answer.
In this insightful guest post, Irene Gutteridge, a Feldenkrais and Somatic Experiencing Practitioner (and producer/director of the world renowned “Baby Liv” video), sheds light on the valuable developmental processes hindered when tummy time is imposed early, and helps us see tummy time from our baby’s point of view. Irene writes: 

Have you ever had a local anesthetic for dental surgery?

Your gums, facial muscles, facial affect, smiling, talking, eating – it all just goes funny and you simply can’t use your mouth area until the anesthesia wears off. You feel kind of silly and imbecile-like, yes?

Now imagine this.

You are on your stomach, lying on the ground. You want to lift your head up.  But someone just injected your back extensor muscles (the ones that allow you to lift up off the ground and lift your head) with that same local anesthetic that dentists use. The very muscles that work to lift up your head and chest are simply deadened. It’s even hard to engage your shoulders and arms to lift yourself up because, unfortunately, they too interact with your back extensors. You might say: “Darn it, this head feels so heavy. It’s a struggle. I feel completely helpless!”

This last scenario is exactly what happens when infants are put on their stomachs for “tummy time.” The only difference is that the infant can’t speak yet to say: “Hey, what’s going on, this sucks. I’m uncomfortable. HELP!”

Putting infants on their tummies without having them go through the process of getting to their tummy on their own is analogous to injecting their back extensor muscles with that local anesthetic. They are paralyzed and basically unable to access their back extensor muscles, mainly because the actual act of getting to their tummy from their back (something that takes months!) is what forms their spinal curves – the lumbar, thoracic and cervical – and in turn gives them strength in their back muscles.

Have you had a chance to watch “Baby Liv”?

Before you read on, give yourself the 3-minute pleasure of watching Baby Liv. Watch the video piece straight through.  See the process of Baby Liv going from her back, to side, to tummy (and all the in-between’s).

Then, I’d like to give you a recap of what she’s doing from a functional and structural point of view. In essence: What is giving her the juice to get to her tummy and decide when she is ready for her own “Tummy Time”.

This footage was taken over a series of months.

@ 20 seconds: She’s pretty still, but if you look at the eye movement, to the right and left, that is priming her spine for rotating. For now, she’s doing tiny pieces of rotation. (Try this yourself, only move your eyes left and right. If you are attentive enough, you’ll sense you neck and head wanting to move in the direction your eyes travel.)

She then looks at her fingertips. This gaze upwards is forming the curves in the upper part of her spine (the cervical area) – and in actuality, it is transmitting throughout her entire body. The support she finds from the ground under her – from foot to head – provides “juice” for this movement (and all movements, really).

@ 41 seconds: You can just see the increase in fluidity throughout her entire self and a greater availability for movement.

@ 1 min: She’s moving her legs a lot, and this is putting a nice wave up her spine…think…snake like movement!

@1.15: She starts to do a roll. This seemingly innocent movement carries a lot of punch in the development world. That little push through her foot and the tiny rotation it brings is just the beginning of finding a teensy bit of spinal extension and use of her back muscles. Lifting both of her legs up tilts her pelvis and flattens her lower back into the ground. This flattening of her lower back is forming the opposite of her lumbar curve. It is lengthening her back muscles. This lengthening gives her ‘energy’ in her back muscles so that she has more ability to actually engage them.

@2.09: If you can catch it – it’s quick – when she is going for giraffe Sophie, you see her little head pick up off the ground. BINGO! This little lift is happening because the rest of her body, below, has found the support surfaces and functionally to un-weight her head.  All the pieces are falling into place.

@ 2.18: She’s a pretty happy kid.  She’s got there HERSELF (think: self-reliance), and her head held high with absolute support coming from her pelvis, hands and legs. She’s anchoring into the ground in numerous places and learning how to use her environment for movement. You see, in this moment of her lifting her body up, there is no impingement on her neck area, and clean spinal curves are being developed.

It isn’t about the firing and strengthening of “muscles” per se, it’s about functionally doing the movements that our nervous system wants to find, and then letting the muscles, and nature, just do their job.

@2.44-2.46: Now she is really showing off her ability to finely control her rotation and movement. She’s got it dialed. It feels good. She’s having fun!

Irene Gutteridge (now Irene Lyon) blogs at her virtual office, irenelyon.com. Her education is in the health sciences and she is a certified Feldenkrais and Somatic Experiencing Practitioner practicing in Whistler & Vancouver, British Columbia. You can reach her through her website, www.irenelyon.com, via Facebook: www.facebook.com/irenelyonbc, Twitter: @Irene_Lyon, or good old email: irene@irenelyon.com. She loves meeting new people!

 

For more on the tummy time issue, please read No Tummy Time Necessary, a terrific article by Early Childhood Educator and RIE Associate Lisa Sunbury.

Photo by devinf on Flickr.

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141 Responses to “The Case Against Tummy Time: Guest Post by Irene Gutteridge”

  1. avatar Barbara says:

    I never saw the point of “tummy time” on the floor for my babies in the early months. They seemed to get plenty enough of it when lying chest to chest on their dad or I. Later, when they could roll by themselves, they got it of their own volition. The whole idea of “tummy time” seems very contrived to me. What’s the need if you spend plenty of time holding and lying with your baby?

    • avatar Becca says:

      I agree our daughter uses her muscles a lot when she is on our chest. She has been rolling onto her side now on the floor so its a matter of time before she can roll all the way over. She is held a lot but is very very strong and holds her head up very well. I think babies’ bodies know when they need to reach their milestones.

    • avatar Julia says:

      The Case against Tummy Time seems not very well researched. Tummy time does include lying on Mum or Dad’s chest, across lap, winding etc. The claim that “Most” babies do not like it seems unfounded. Left for long periods yes of course babies will get uncomfortable. Its only supposed to be for as long as the baby can tolerate. An increase in motor delays due the lack of “tummy time,” is the number one contributor to the escalation in cases.http://pathways.org/awareness/parents/tummy-time/tummy-time-research#.UgWzdtI3CcQ.

  2. avatar KC says:

    Just wondering what your thoughts are of propped up tummy time ? I was encouraged to prop my baby up with her arms over the top of a small towel roll. From memory I think she had just started making the effort to roll but wasn’t actually doing it at that point.

    • avatar janet says:

      KC – thank you for asking… I think it’s totally unnecessary to prop or position babies. When we do this we “freeze” them in a position that we think they should be in, rather than trusting and allowing them to choose the positions they are ready for.

  3. Thank you! I always felt a little weird about it but EVERYONE was saying how important tummy time was. Good thing I was kind of a slacker about it.

  4. avatar Amy Appel says:

    I’m expecting my first baby in a few months and I totally agree with the RIE philosophy on just about everything, including tummy time. However, I just googled “positional plagiocephaly” and found a bunch of mainstream articles that basically said my baby will have a flat head if allowed to be on his/her back for extended periods of time. What is your experience with this? Do you know any RIE babies who got positional plagiocephaly? Is this just fear and hype? Maybe I shouldn’t have looked it up b/c it sounds scary!

    • avatar Hannah says:

      As far as I am aware from my own readying and research no babies at the PIKLER institute(Have a google) ever got a flat head and were never ever placed into any position they couldn’t get into/out of themselves.

      Babies on there backs naturally move their head from side to side when listening and looking at things, this is only prevented if they are frequently ‘contained’ in bouncers, carseats etc.

  5. avatar Julie says:

    I understand it in theory but it doesn’t quite explain the fact that my first son preferred being on his tummy from birth. It was years before the Back to Sleep campaign so I let him sleep on his tummy all the time.

    I agree that SOME babies probably feel very uncomfortable but to say that ALL babies feel this way is just ignorant.

    • avatar janet says:

      Julie, it seems you’ve misread the article, which states that most, but not all young infants are uncomfortable in the tummy position because they are immobilized. This immobility is the reason some babies sleep more soundly on their tummies and also why it is associated with SIDS.

  6. avatar Mich says:

    “the actual act of getting to their tummy from their back (something that takes months!) is what forms their spinal curves – the lumbar, thoracic and cervical – and in turn gives them strength in their back muscles.”

    Ok no, that’s not how the curves are formed. First of all, when you are born your back is concave (aka, you already have your thoracic, and sacral curves.) when the baby first starts lifting its head, that’s when the cervical curve forms and when the baby starts standing upright is when the lumbar curve forms.

    While I can understand not wanting to make your baby uncomfortable, they are not paralyzed. The whole purpose is to strength the muscles and get neural coordination to start movement control. Hence, by making them try to use their muscles, they should be able to control their movements faster. And it would not be necessary to leave the baby on their stomach for long periods of time to do this.
    so I’m sorry, I don’t really understand what you are trying to get at here because so far most of what you say just sounds ridiculous to me. Most scientists don’t tell you to do it to prevent a flat head, they say it to help develop muscle and coordination.
    Will a child’s motor skills be fine if they don’t do tummy time? For sure. But don’t go saying that its a bad thing to try and help the development of it. I feel like a bigger concern should be when to submerge your baby underwater when swimming. In that situation, I feel a baby truly is helpless. But a couple minutes on it’s stomach won’t hurt it.

    • avatar orna says:

      “Hence, by making them try to use their muscles, they should be able to control their movements faster.”

      I think you found the RIE point right here: Though I’m not at all an RIE expert, I think that “making” babies do things rather than trusting them to move at the right for them pace is what’s being questioned. Babies will learn to lift their heads without anyone coaxing it out of them; why rush and deny them the freedom to explore movement at their own pace? It seems to me that childhood is a process and we’re trying to skip it for immediate “results”. People spend fortunes learning how to “be in the moment” yet we encourage babies to hurry up the process of becoming. We are born with a thirst for knowledge, we needn’t be “made” to learn (and frequently the making kills the process of learning).

  7. I mostly agree… except that plagiocephaly is the real deal in preemies, who tend to roll on their own anyway. With our preemie daughter, we did do enforced tummy time (sometimes right on us or on a roll) under the guidance of a PT because she was getting a flat spot and her back muscles had actually started to tighten (as can happen with preemies). So in cases where there’s a medical necessity, enforced tummy time has its place.

    • avatar Momofamiracle says:

      I agree with Christa here. My daughter was also a preemie and tummy time was incredibly important to her development. She was on her back most of her 6 month NICU stay. While she would turn her head back and forth and was repositioned often by nurses, she still had severe plagiocephaly.

  8. avatar Donna says:

    Hi Janet

    Thank you so much for sharing this. I am an ECE teacher and I often had parents telling me about tummy time and my staff thought it was a good idea too! I am totally against babies having tummy time and also being placed in positions that they are not ready for. My now near 4 year was brought up on the philosophy of Magda Gerber and Emmi Pikler. She never had tummy time and was aloud to develop in her own natural time. I believe this had led her to become a confident child and in complete control of her body. I am a huge advocate for free movement and am trying one person at a time to change the way people think about child development. Thank you again for your posts, they are inspiring and educational

  9. avatar Lisa says:

    This is so silly, babies that are put to sleep on their tummy like to be on their tummy and babies put to sleep on their back like to be on their back. Not particularly surprising since they spend so much time sleeping when they are newborn. I’m also not sure where you are coming up with the idea that babies can’t lift their heads or their muscles aren’t capable of working. Healthy newborns are capable of turning their head, even when they are brand new. Give the babies a little credit! Try putting a brand new baby on their tummy, they move their heads, push with their legs and feet and change the position of their hands. Sure, the muscles are weak at first and they may not be able to keep their head up for very long, but they get strong pretty quickly. This is totally a cultural phenomenon and totally a product of the back to sleep campaign. I’m all for keeping babies safe from SIDS, but putting babies on their back is no more natural or right then putting babies on their tummy. Soon enough the baby will be able to roll over and show you their preferred position, which will probably change over time anyway.

  10. avatar claire says:

    My second baby was always put to sleep on his back & as soon as he learned to roll over at 4 months insisted on sleeping on his stomach. When I was a baby in the 70s my mother tried to get me to sleep on my stomach as was recommended then and I did not like that from the start. I think babies do have a preference that goes beyond just the position that has been chosen for them. Interesting thoughts on tummy time. My first hated tummy time and I didn’t do it very much with him because it was so upsetting for him. Glad I listened to him.

  11. avatar Sarah says:

    I understand the idea of listening to babies, but we’re not listening to babies by forcing them to sleep on their backs (until they are able to roll on their own). Plagiocephaly and certain physical delays increased pretty much the same time that the “Back to sleep” campaign took off. Without Tummy Time, many more babies would be significantly delayed.

    In other words, I don’t think you can use the “natural” argument of listening to babies cues when you are creating an unnatural situation that is causing problems.

    For those who are interested in Tummy Time but don’t want to cause great discomfort to their baby, my baby’s physical therapist taught me the following:

    She specifically said NOT to do tummy time by just plopping my baby on his stomach. Firstly, since they can’t lift themselves up much, they’re not getting much of a work out. Secondly, when they cry and get upset on their stomachs, they tense up and work the wrong muscles. She showed me how to prop him on his elbows and support his upper arms and shoulders while distracting him with toys. (I understand the idea of respecting children by not trying to distracting them, but I think we all appreciate distraction when we are a little uncomfortable or doing something we don’t enjoy). She also emphasized the importance of doing this multiples times a day for short periods of time and stopping when he gets upset, as opposed to doing one longer tummy time session in which he would get distressed. In this way, the baby’s sense of comfort is respected and the physical gains are greater.

    As an aside Janet, I recently discovered your website and I’m enjoying very much. My baby is already almost a year, but I’m glad I can put some of the RIE principles into practice for his upcoming delicious toddler year!

  12. avatar PoppyWassle says:

    Wow this is great. Both my son and daughter hate tummy time and I’ve been told to force them into it despite their distress, and of course my own. Good news!

  13. avatar Ina says:

    I have been following this blog on and off for a while now, and although I typically agree with most of the articles, I disagree on this one. As an occupational therapist, I continue to highly encourage tummy time. Developmentally, a child should be able to hold his head up in prone (on his tummy) before being able to roll over, so the premise that they are not ready for tummy time if they aren’t able to roll over is incorrect. The comparison of tummy time to being injected with a local anaesthetic is also a little over the top.
    I agree that we need to listen to the child’s cues, and not force them into tummy time if they are uncomfortable. But there are many ways to do tummy time while continuing to respect the child’s cues, such as on mom or dad’s chest, supported with a roll or towel, and only as tolerated, as I have seen previously mentioned in some of the comments.
    Although most kids will be able to develop typically without specific “tummy time” being implemented, there are many kids with developmental delays that continue to benefit from it.

  14. avatar Andrea says:

    I think of tummy time as parents leaving their children alone, or out of touch, on the floor for a length of time that usually lasts 20 minutes, 1-2 times a day. I realize that tummy time counts if your child is laying on your tummy playing with you, etc, but most people I know do not practice it this way or sadly even hold their babies that much. I know that sounds ilke an extreme statement but I’m just speaking of the people I know personally- babies are almost always in car seats, swings, bouncy seats, etc out of physical contact with their parents- even during bottle feeding.

    Anyway, the point I’m getting at is that it seems to me tummy time is a “medicine” to cover up some “symptom”. Not something that is good, natural, and needed in an of itself. For example- people need to do it because their babies are laying on their backs too much and develop a flat spot. The problem isn’t that the baby hasn’t gotten enough TT, the problem is some type of care going on is unnatural and causing the flat spot. Are these babies breastfed and cosleeping? Where babies will naturally switch sides often during the night and lay on their sides? Or are these babies put in a crib, on their back, for long periods of time that isn’t natural for most babies? Are people not holding and interacting with their babies enough, which causes their babies head to be flat?

    It seems when children are cared for in a natural way, the need for TT goes out the window. TT fixes the symptoms of a larger problem altogether.

    This isn’t to say that sometimes there are extenuating circumstances (like premies) that don’t make TT neccessary- there are. But premature birth isn’t the “norm” so again TT isn’t something that children are born innately to need.

  15. avatar Ann Marie says:

    Being a grandmother, and having raised my infants in the “dark ages” when ALL babies were to be put on their TUMMIES to sleep, I can tell you, I observed all of my infants in their bassinet. Each one was able to lift and set her head down, first on one cheek, then the other. This helped develop the crossed- extensor reflex, with baby turning the head toward a bent arm, and the opposite leg extending, and vice-versa when the head was turned the opposite direction. Thus, they were developing crawling muscles in a normal pattern, and they were able to roll over by 6-7 weeks, and to creep forward. Other than the hazard of SIDS, which at that time was not believed to be related to babies sleeping on their bellies, I saw no harm or problem with my babies or their development from belly position time, from the moment they came home from the hospital. All babies struggle to command their muscles and body parts as they grow. The head is, well, large, in proportion to the rest of the body, and yes, heavy. My babies could lift their heads from side to side right from the start. We let babies back then have a few minutes of “back” time daily, such as during diaper changes, until they got old enough to roll over on their own. Ironic, how the world turns…

  16. avatar Jennilee says:

    You know where babies belong the majority of the time? In their parents arms or being worn. I never needed to do tummy time, my kids gained head control and strength while on my chest or in the sling.

    • avatar Kim says:

      Actually babies do need to not be in your arms ALL the time. They do need to learn to turnover, lift their heads and such. If you are holding them ALL THE TIME, they won’t learn how to do this.But yes, they do need to be held. Holding them too much will also create other problems when they get older.

  17. avatar Tahnee says:

    In the end we all do what we think is best for our babies. I found that most of the RIE principles fell right in line with how I already thought/felt about caring for and nurturing my babies.

    I never believed in forced tummy time and hated that our pediatrician was pushing it. To me, 2 minutes or 5 minutes of tummy time on the floor several times a day was not going to counteract the amount of time spent in a car seat or other contraption. It just wasn’t logical. (I will admit that as a working mother of 6 month old twins I do rely on my swing and bouncer a little more that I would like)

    It is important to let babies do things in the own time in their own way. I am amazed watching my boys during their floor time. Their development is as different as it is the same. My older twin was the first to roll over (weeks ahead of his brother) and he rolled one direction back to tummy to back to tummy. When the younger twin was ready he was able to roll both directions but hasn’t figured out how to go from tummy to back with any consistency. One is more vocal, the other has better hand to mouth coordination. We have never done tummy time and guess what – they still can roll and lift their heads up and push their bodies up with their arms. They are like little yogis! One was ahead of and one slightly behind “schedule”. We made the decision that was right for our family and our boys are thriving.

  18. avatar Anna says:

    This feels like rebelling against the norm just for the sake of it.
    FWIW…
    My baby enjoyed many different positions – tummy, back, propped, cuddled, but mostly on her back on the living room floor.
    She hated the car seat and the sling until about 3 months.
    She rolled by herself at 4 months for about a week and enjoyed some tummy time, but used to get frustrated that she couldn’t roll back onto her back, and she has never rolled since! (she is now almost 6 months)
    She has a flat head because she was born like that.
    How is it that it comes across that its not OK to ‘contain’ a baby in a carrier etc yet its OK to ‘wear’ a baby in a sling?
    My baby truly hated any kind of confinement such as the sling or pram for the first 3 months, so we were housebound, which was very difficult at times.
    She is better now that she is older.
    In conclusion I don’t think you can generalise, you just need to listen to your baby and offer them lots of options and see what they like. If I had a £ for every time someone told me to put my baby in the car because she would nap!
    Personally I think tummy time is important for strengthening baby’s wrists and arms, and makes up part of their early experiences. Variety is the spice of life!

  19. avatar Kate says:

    Hey everyone,

    This is an interesting read as are the comments. I didn’t do tummy time with my eldest and we haven’t done it so far with our 10 week old but she is starting to get a flat head and I’m freaking out a bit. I think she initially developed the flat bit on one side when sleeping in our room and getting fixated on a throw on our bed and being in the same position. Once I realised that’s what it was I changed the position of her moses basket so she’d face the other way to even things out. While the one-sided flatness is not so noticeable now she is still looking a bit flat across the back.

    I breastfeed so she changes position then but she does spend a lot of time on her back – she is an awesome sleeper and does not need to be held heaps to get to sleep. I have been alternating how she sleeps – lying one side, on the back and then the other side but this requires propping her in bed and I’m not completely comfortable with that either as I don’t think it would be that comfy for her.

    Essentially, I don’t want to do tummy time but I don’t know what to about her flat head. Maybe she’ll start to move her head around more soon as she becomes more interested in whats going on around her and it’ll fix itself. Any thoughts?

    Thanks in advance!

    Kate :)

  20. avatar Nick says:

    This article is dramatic and absurd. The kind of over the top opinion based poopery that is about as informative as Us Weekly. A local anesthetic? Oh okay, exempt baby has fully functional muskets back there. May as we’ll let them potty train themselves, why encourage them to anything they don’t feel inclined to do at all?

    • avatar janet says:

      Sorry you don’t agree with natural motor development, Nick. And, BTW, I do advise allowing children to self-direct toilet learning, and could share with you hundreds of letters from parents facing all kinds of difficulties because they tried to make toilet learning happen. Trust your kids.

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