Tummy time is supervised time when an infant is placed on their belly while awake. This practice gained emphasis following the “Back to Sleep” campaign, which reduced Sudden Infant Death Syndrome (SIDS). Since infants now spend most sleep time on their backs, they have fewer opportunities to naturally develop the strength needed for upright movement. Many babies protest loudly when placed in the prone position, causing parents to minimize or skip the activity entirely.
The Risk of Positional Flattening and Neck Stiffness
A direct consequence of constant supine positioning is the increased risk of positional plagiocephaly, commonly known as flat head syndrome. An infant’s skull is composed of soft, unfused bony plates susceptible to external pressure. Too much time lying on their back causes continuous pressure on one area, leading to a noticeable flattening of the skull, typically on the back or one side.
The lack of prone time also contributes to torticollis, a muscular imbalance where tightened neck muscles cause the infant to consistently hold their head tilted or turned to one side. This preference exacerbates positional plagiocephaly, as the baby always rests on the same spot of their skull. Tummy time counteracts this by encouraging the baby to lift and turn their head against gravity, strengthening neck muscles and promoting symmetrical development.
The prone position provides counter-pressure to the skull, allowing flattened areas to round out since the head is not resting on a surface. Furthermore, the activity forces the activation of deep neck extensors and upper back muscles. This early strengthening is needed for the infant to maintain a symmetrical head posture and prevent strain leading to a persistent head tilt.
How Lack of Prone Time Impacts Milestone Development
Insufficient time in the prone position can lead to delays in achieving important gross motor milestones, beyond skeletal and muscular imbalances in the neck. Tummy time is effectively a baby’s first structured workout, engaging the muscle groups required for all subsequent movement. It specifically strengthens the core, back extensors, and the muscles of the shoulders and arms.
These strengthened muscles serve as the foundation for movement; the ability to push up on the forearms is a prerequisite for numerous later skills. Without this foundational strength, infants may experience significant delays in learning to roll from back to front, which requires substantial upper body power. They may also struggle with pivoting on their bellies and achieving the balance needed to maintain a stable sitting posture.
The lack of upper body strength also affects the complex sequence of movements leading to crawling. The ability to bear weight through the arms and transition onto the hands and knees is directly linked to time spent in the prone position. While infants will eventually achieve all these milestones, those with limited prone time may demonstrate a noticeable lag in motor skill acquisition compared to peers.
Strategies to Achieve Developmental Goals Without Traditional Tummy Time
For babies who strongly resist being placed on the floor, parents can use alternative supervised prone positions to achieve the same developmental benefits. One effective method is “tummy-to-tummy,” where the parent reclines slightly and places the baby face-down on their chest. This position is often more tolerable because the baby is comforted by the parent’s closeness and can make eye contact.
Another option is to position the baby “tummy across the lap,” with the infant lying prone across the parent’s legs. Gently swaying the legs or patting the baby’s back provides stimulation and distraction, while still encouraging the baby to lift their head against gravity. Any position requiring the baby to lift their head and engage their neck and upper body muscles qualifies as beneficial prone time.
Parents can also incorporate supervised prone positioning into daily routines, such as carrying the baby in a “football hold,” where the infant is draped belly-down over the parent’s forearm. Even very short bursts of prone time, like a minute or two during a diaper change, contribute to the cumulative goal of muscle strengthening. The objective is to provide supervised time on the stomach in any comfortable setting, not just on a floor mat.