Secret Guide To Tummy Time

Transcript of this week's interview with Rachel Coley, M.S., OT/L of CanDo Kiddo. Our discussion focuses on the rationale behind "tummy time,"  some extremely useful tips to help your infant tolerate longer periods, and useful information to help you as parent/caregiver feel successful!

Ayelet: So, today I would like to introduce a very special guest to you. Her name is Rachel Coley, she’s a pediatric occupational therapist, and creator of CanDo Kiddo, a really wonderful online resource for parents, caregivers of, and professionals working with infants and toddlers. She’s also the author of several books, including my personal favorite, “Begin With A Blanket.” Welcome, Rachel, thanks so much for being here on Strength In Words!

Rachel: Thank you, Ayelet! I love the podcast – I’ve been enjoying it with my little one during nap times for her brother lately.

Ayelet: Perfect! So, you are an occupational therapist. Why don’t you give us a little background about what your focus has been in your field.

 Rachel: Sure! Well, I’ve always been interested in children, working with kids, even before I was an OT. And then, the last about 4-5 years of my career was spent exclusively in Early Intervention, which is birth to three. And my real passion is babies – so that first year of life, I love working with families, I love working with babies, and as you know, that’s just such an important, crucial time where you can make such a lifelong impact on development.

Ayelet: Absolutely. And I know that one of the topics that is near and dear to you is the subject of tummy time. So, most of us know that we’re supposed to give our infants time on their tummies. I’m hoping that you can give our listeners just a very brief history of why this is an important thing to do.

Rachel: Sure! Yes, it is one of my favorites. I love tummy time. So in the early 90’s, most people are aware of the “Back to Sleep” campaign, now called the “Safe to Sleep” campaign. And it’s done wonderful work for dramatically reducing the rates of Sudden Infant Death Syndrome, also known as “Cot Death” in different countries. But as a side effect of that, we’re having babies sleeping on their backs most of the time. And research is showing us that having babies sleep almost exclusively on their backs is leading to some slower attainment of milestones. So not true “textbook” delays, but just slower attainment of milestones. And so that makes it even more important for us to do things while they’re awake to combat those effects and keep them on track.

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The other piece of it, a secondary effect, is that it’s led to parents being a little bit more nervous about putting baby on their back, even when awake. And so we want to combat that, too, and just help spread awareness that tummy time is safe, tummy time is fun.

And then, the other thing to note is at the same time that the Back To Sleep campaign came on the scene, we’ve seen a dramatic rise in the amount of baby gear during that time, so seats and swings, and car seat carriers… and so that makes tummy time even more important, too, because all that time contained needs to be balanced – it needs to be modified and reduced – but it also needs to be balanced by freedom of movement and playtime.

Ayelet: So, essentially, number one: the Back To Sleep campaign did such a good job that it sort of over-zealously created a need for a step back in a way and a modification of the approach.

Rachel: Correct. And in cultures where babies naturally spend a lot of time being worn or being put on the floor, it’s not as essential to have that discreet, intentional tummy time because it sort of naturally happens. So we just have a culture that’s a little different that makes it so that we need to be a little more mindful.

Ayelet: Now, you mentioned that carriers and carrying a baby on your body is considered to be a different type of gear than other types of gear that you related to. Can you tell us about why that is?

Rachel: Sure! So when you wear baby upright, it’s a very different position – like what you were saying, in a carrier on your chest – than that “bucket seat” where a baby is semi-reclined, and most of the other pieces of baby gear… while they’re different pieces of equipment, they’re all basically that same bucket position. And so, when you have your baby upright, you’re giving them a chance to turn their head, you’re giving them a break from all that pressure on the back of their head, you’re giving them really nice sensory input, and that connection to the wearer – the caregiver or the parent.

Ayelet: Great, thank you. Are there schools of thought or people in general who view tummy time as an unnatural type of position, or that discourage parents from doing it?

Rachel: Absolutely! I hear from those folks on a regular basis on the blog – and I welcome that! I welcome an open dialogue about that. But, basically, that tends to stem from a paradigm or a viewpoint on development that is typically among educators. And so, for healthcare professionals or developmental specialists, we view development through a neuro-developmental paradigm and/or a bio-mechanical paradigm. And so, it’s just a different way of viewing development and understanding how babies develop. I think a lot of the criticism stems from this view that tummy time is an adult-imposed position, or that it’s unnatural. And I just have to chuckle because every position of an infant is adult-imposed… even holding an infant is adult-imposed! So when I look at the reflexes that a newborn has and the skills that they’re born with, I see that tummy time is natural. And the best way to see that is to go on YouTube and look up a “breast crawl.” What that means is when you put a baby belly down - in literally the moment after they’re born – on Mommy’s belly, they have the reflexes to crawl to the breast and nurse. And I – I literally get choked up thinking about it because it’s so amazing and beautiful and probably one of the most natural things in the world. And so I really see that as evidence as something that baby is born to do, it’s something that’s natural, and that they have the reflexes to cope with that position.

Ayelet: And we see… I mean, it’s interesting because I think in general, people think of tummy time as ‘you need to put the baby on the floor…’ but actually, one of the positions, as I understand it, that you can use for tummy time as a parent, is reclined, and as the baby is on their tummy, on the parent. That is included in tummy time!

Rachel: Absolutely! There are a ton of ways to do tummy time! Over your lap is a great way, as well. And I think that’s naturally how generations before us that didn’t have the word ‘tummy time,’ that’s how they were doing it a lot of the time. They thought of it as, “well that’s just how I hold my baby… while I’m kneading bread, I have the baby on my lap.” So, yeah, I think that’s an important distinction.

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Ayelet: Right. We love giving terms these days, don’t we? For things that are thousands of years old, actually.

Rachel: Yeah! And I like to also equate it to that mentality about exercise where, you could hold yourself accountable to go to the gym at discrete increments every week, or you could adopt that active mindset where you park a little further away from the grocery or you take the stairs instead of the elevator. So, instead of thinking of tummy time as this really discrete assignment or task that you have to do, if you just incorporate into, “well, this is how I hold my baby sometimes, and this is how I put my baby down sometimes when I have to brush my teeth.” I think it becomes a little less scary, and a little more doable.

Ayelet: So when should parents actually start with tummy time? And, also, on the other end, what age does the baby sort of outgrow the need for it?

Rachel: As long as your baby was healthy and full-term, you really want to start right away in that first week of life. I actually have videos that I post sometimes on social media of my baby literally at 24 hours old in the hospital totally rocking tummy time – better than she did a week or two later, because she had those stronger reflexes! Yeah, as early as possible is the best, both for development and for tolerance, that helps baby get used to it. And yeah, when to stop? I think it’s more about when to stop worrying – baby will stop doing tummy time when they’re pretty much ready. They’ll start to move out of it and crawl or roll, it will become a very transitional, brief position. But the one exception would be if you have a really early roller from belly to back. That happens accidentally a lot with newborns, but every now and then you’ll have a baby that say, at 6 or 8 weeks truly learns how to roll from belly to back – and that’s a baby that you may want to continue to encourage to do a little more tummy time, because they’re still going to be several months away from crawling and being mobile.

Ayelet:  Now, you have some great recommendations and goal-setting ideas for tummy time on CanDo Kiddo… how in the world are parents, caregivers, educators… how are we expected to reach these amazing goals? You suggest that 30 minutes per day by the end of month one, 60 minutes by the end of month two, and 90 minutes by the end of month three are the goals that we should shoot for?

Rachel: Right. I like how you phrased that – the goals to shoot for – because not every baby can or will reach those, and not every family’s lifestyle will allow you to reach those, but I set them high for two reasons. One, is because it’s in alignment with some of the very limited research that we actually have on how much tummy time to do, and that’s focused on 4-month olds, where an hour and 20 minutes, or 80-minutes a day by 4 months of age, seemed to be this magic number. And so we want to make sure that we’re building up to that, right? And so that is where my goals come from is building up to that 80 minute mark by 4 months.

So some of my secrets, or my tips, for meeting those pretty high goals, are to carry your baby in tummy time – that’s a huge one! So you can lay your baby belly down on your forearm and walk around the house or walk out to the car, or be brushing your teeth with the other hand. So that one is huge. I would say that my baby, my second born, who didn’t love tummy time as much as my first… she probably spent 40% of her daily tummy time in those early months being held in tummy time. And then, like you said, on your chest or on your lap. And the other one is just to break it up in to really little bits – especially in those first couple of months. I mean, I think I was hitting that 30-minute mark, probably took me 20 sessions in a day! And it was just so short – it was like, ‘alright, I’m going to have to put her down, see if she’ll tolerate a minute, and then roll her off.’ And so it’s not this big stressful feeling that “I have to do 5 minutes of tummy time!” It’s just how I put her down every time I put her down, and that added up.

Ayelet: That does really take the pressure off, I think, for us as parents, because for some of us, I think, we have the basic vulnerability of being new parents when we have a new infant, and then we have all these other things that we’re reading about – milestones, and “your baby should be doing this by this age, and your baby must be tolerating this much tummy time every day!” But breaking it up and, especially because newborns don’t like being put down, oftentimes! Allowing your baby to experience a different position while helping to develop those muscles is such a great way to think about it, as well.

Rachel: Yeah, and to think of it also as the goal to shoot for but not beat yourself up – it took us longer with my second than it did with my first, and some of that was personality, and some of it was lifestyle – I didn’t have as much bandwidth to be thinking about tummy time because I had a toddler to care for. So just honoring that and just, in the same way that we set goals in different areas of our lives that we aim for and that we don’t always meet them. It’s more of an intention. And that’s what I hope for parents – to extend grace to themselves, but to set the intention so that it’s not one more thing you forget to do.

Ayelet: Well said. So, why is it that some babies really just don’t tolerate tummy time?

Rachel: Yeah, well there’s a couple reasons, and sometimes we just don’t really know. I mean, some of it is really a temperament thing. Definitely babies who are colicky or babies who have reflux tend to be fussier. And, at times, with some children I’ve worked with, I’m not sure if that’s a true discomfort or if it’s truly just “I just want to be held.” You know, and we have to honor that. I think that sometimes it’s a red flag for some sensory processing issues – and we won’t know that until many, many months or even years down the line when we meet that child in a clinic and we go back to the developmental intake and we say, “how was tummy time?” and the parent says, “oh, it was awful.” And that’s when we say, “oh well maybe it was awful because that child has some sensory defensiveness.” I think children who, or in my experience, children who do not experience tummy time until months into their life have a harder time coping with it. And part of it is just that the reflexes that I’ve touched on earlier have integrated more – so if you put a 2 or 3-month old baby down for the first time in tummy time, it is harder for them. And they also have better vision, so they want to see more, further away, and suddenly you put them in this position that they’re not strong enough to lift the head and see. And also they just have a little bit of autonomy by then – they have a little bit more understanding that they should be able to control their body and their environment more. I just think that starting early is key for people – and then, if you did start late, not to beat yourself up about that, but to adjust those goals and intentions for tummy time, accordingly, and realize that your baby may not be hitting those same numbers.

Ayelet: And that’s ok!

Rachel: That’s right. You know more now than you did yesterday as a parent. That’s a good thing! I tell people that all the time. Don’t beat yourself up for yesterday – start today, make some changes, and move on.

Ayelet: So, let’s hear it: your top three ideas or suggestions for tummy time.

Rachel: I think my biggest one would be to have either a blanket or a Pak-n-Play* in the hot spots of your house where you need to put baby down. If tummy time can actually be a thing that helps you out, then you’re going to be a lot more likely to do it. So, we have a Pak-n-Play* in our kitchen, and we put baby (even in those first weeks) belly down for a few minutes in her Pak-N-Play, and then roll her over and let her play under her activity gym*. We had blankets stacked up in the bathroom so that I could get ready in the morning, and baby was doing a little bit of tummy time. Another big one is to use all of baby’s senses, and I know you’re going to be nodding your head at this one, Ayelet, but don’t just think about putting something for baby to see, think about something for baby to hear or something to touch – even just with the cheek, what surface is baby putting the cheek on? How could we change the sensation there? And I think it’s important to add here, too – don’t expect that all of tummy time is going to be lifting the head, heavy work for your baby – sometimes, it’s just lounging with their head to the side, and that’s ok! That’s actually wonderfully helpful for baby. And then, like I said earlier, the third one would be just to start early and start often, just little bits, a minute here, a minute there, lots and lots and lots of times throughout the day.

Ayelet: Oh, you’ve just enveloped us with wonderful information. Thank you, Rachel, this is great! Thanks so much for being here with us today!

Rachel: Thank you for having me!

* Affiliate link, provided at no cost to you.

Rachel Coley, MS, OTR/L, is a pediatric Occupational Therapist, a mommy and a self-proclaimed child development nerd. Professionally, Rachel specializes in infant and toddler development and has advanced training in the areas of infant neurodevelopment, sensory processing, head shape and neck tightness issues of infancy (Plagiocephaly & Torticollis) and feeding. Personally, she specializes in skillful navigation of a double stroller in tight spaces, hiding her ice cream addiction from her toddler and surviving on very little sleep. Rachel blogs and shares her books at CanDo Kiddo.com.

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Ayelet Marinovich, M.A. CCC-SLP

Ayelet Marinovich, M.A. CCC-SLP, is a pediatric speech-language pathologist specializing in work with pre-verbal infants, toddlers, non-verbal children, and their families. The Strength In Words podcast and blog were created as an additional resource for families of young children with infants & toddlers of all developmental levels. It is not intended to be a substitute for speech and language therapy.