Back to Sleep, Tummy to Play

The back-to-sleep, tummy-to-play are engagement patterns for babies that help prevent Sudden Infant Death Syndrome (SIDS). Parents are therefore medically advised to lie their babies to sleep on their back and lie babies on their stomach while awake for intermittent tummy exercises. ⁽¹⁾

The back-to-sleep, tummy-to-play concept is a major concern for 21st-century parents. In fact, reading about the possibilities of flat heads when adopting this method would have heightened your fear.

We understand your concerns. This article will explain why back-to-sleep and tummy-to-play are best for your baby and how to prevent flat heads in babies.

What is Back to Sleep, Tummy to Play?

Back to Sleep, Tummy to Play” is a simple reminder that while babies should always sleep on their backs to reduce the risk of SIDS (Sudden Infant Death Syndrome), they also need supervised tummy time while awake to support healthy development and help prevent flat head syndrome (plagiocephaly). Balancing both is key to keeping your baby safe and supporting their growth.

The American Academy of Pediatrics affirms that placing children on their backs to sleep is an effective SIDS prevention tip ⁽⁴⁾. It is essential to state that while ensuring your baby sleeps on their back significantly reduces the risk of SIDS, tummy time exercises are not a direct prevention of SIDS; tummy time exercises, however, help in the growth and development of your baby. ⁽³⁾

According to Matthew Badgett, MD, a pediatrician at Lakewood Family Health Unit, Tummy time is as simple as putting a baby or an infant on their tummy for short periods every day to help train them ⁽²⁾. Tummy to play time helps babies' motor skill growth, which aids muscle control when they start to sit up, crawl, and even walk. ⁽³⁾

The Importance of Infant Sleep Safety

According to research published by the AAP in 2022 ⁽¹⁰⁾, about 3500 babies died of sleep-related infant deaths. The high rate of infant deaths during sleep has prompted the AAP to recommend the use of a safe sleep environment to reduce the rate of all sleep-related deaths.

As you ensure that your baby has adequate sleep, you must also ensure the safety of their sleep environment to reduce the chances of SIDS. The knowledge of the ways to ensure your infant’s sleep safety will help protect your baby. ⁽¹¹⁾

• Practice supine positioning when putting your baby to sleep. This means you should always lie them on their back to sleep. Putting them on their back prevents them from choking when they sleep.

• Use a firm, flat, and non-inclined mattress in a well-secured crib for your baby’s sleep.

• Avoid using and putting fluffy beddings, pillows, comforters, loose beddings, toys, teddies, etc., in your baby’s sleeping area.

• Avoid using and putting fluffy beddings, pillows, comforters, loose beddings, toys, teddies, etc., in your baby’s sleeping area.

• If you have to sleep in the same place to monitor your baby, sleep in the same room but not on the same bed.

• While you can decorate your baby’s room, ensure their sleep area or crib is free.

• Avoid placing your baby on an adult chair or couch, or other soft area, to avoid suffocation.

• Avoid smoking around your baby and do not expose them to nicotine, alcohol, opioids, etc.

Does Tummy Time Help Prevent Flat Head Syndrome?

Tummy time is one of the most effective ways to help prevent flat head syndrome (also known as plagiocephaly) in babies. This condition often develops when infants spend extended periods lying on their backs, causing the soft skull to flatten in one area, typically at the back of the head, or leading to a bulge in the forehead.

Interestingly, research involving 565 children at 36 months old (including 224 with deformational plagiocephaly and 231 without) suggests that DP may be linked to a higher risk of developmental delays. This highlights how simple habits like tummy time might not only help protect your baby’s head shape but also give their overall development a healthy start. ⁽¹³⁾

Even though Tummy time activities may help prevent flat heads, it is crucial to know that tummy time alone will not suffice. There are other tips you can practice to reduce the risk of your baby's flat head.

• FaceTime is an effective muscle practice that strengthens babies' shoulder and neck control and also prevents the development of flathead in babies.

• Constantly alternate your baby’s resting area while they are awake. Moving them while they are sleeping might disturb their sleep. However, when they are awake, you can alternate moving them from their slope chair to a flat surface or a sling. ⁽¹⁴⁾

• Regularly switch the position of their toys. This will encourage them to turn their heads.

• Incorporate a front carrier to reduce the time they spend on a flat surface, especially when their skull is still tender.

When is The Best Time to Start Tummy Time With Your Baby

The American Academy of Pediatrics recommends that parents start tummy time exercises with their babies as soon as they are back from the hospital ⁽¹⁵⁾. To get the best from tummy time for your baby, it is important to engage your baby in tummy time exercises at least once a week. ⁽²⁾

Starting tummy time for newborns doesn't mean they can immediately raise their heads up after birth; however, tummy time will help them learn faster and better.

When introducing tummy time to your newborn, it’s important to be gentle, watchful, and always supervise to ensure they’re safe and comfortable. Start with short sessions once a day, and gradually increase to two or three times daily as your baby grows stronger. With consistency, your baby will adjust over time and begin to enjoy spending more time on their tummy.

According to a publication by Dr. Cindy Gellner, babies should have a minimum of one hour of tummy time daily by 3 months. The tummy time exercises can be divided, but must be consistent ⁽¹⁶⁾. Some babies dislike tummy time and often make a fuss when lying on their bellies. So, it’s important to pay attention to your baby’s cues, notice whether they enjoy tummy time, and if they’re ready for longer or more frequent sessions.

If your baby dislikes tummy time, you can make it engaging with toys. If your baby still fusses after several sessions, you should visit your doctor to ensure that your baby’s fussiness is not due to an underlying medical illness.

Benefits of Tummy Time

Research shows that tummy time plays an important role in a baby's development ⁽¹⁷⁾. Compliance with the AAP back-to-sleep recommendation implies that babies spend more time on their backs since they spend more time sleeping.

It is, however, important to incorporate tummy time to play exercise to help infants' overall development. Adequate tummy time is beneficial for your baby’s physical and motor skill development.

• Tummy time strengthens your baby’s back, arm, and neck muscles. It strengthens their core and hip reflexes. ⁽¹⁶⁾

• Tummy time develops your baby’s gross motor skills and aids their gradual body movement. ⁽⁴⁾

• Regular tummy time is an effective way of preventing flat head.

• Tummy time is a good way to prevent torticollis or plagiocephaly in babies, which happens when a baby’s neck is stuck to one side.

• Tummy time also helps in your baby’s sensory development as it helps them interact with their environment more than they would if they were constantly on their back. ⁽²⁾

• Supervised tummy time is a good opportunity to bond with your baby, especially when you engage them by singing or talking with them during tummy time.

Top 6 Engaging Tummy Time Tips for Your Baby

Introducing tummy time to your baby can be initially strange. However, with time, they get used to it. Ensuring that your baby’s tummy time is engaging helps build your baby’s interest in their tummy time session. It is not compulsory to explore all of the engagement styles, you can stick to the ones your baby enjoys the most. ⁽¹⁹⁾

• You can bop your baby’s arms with a small and non-harsh towel to help during their tummy time activity.

• Lie on a flat surface and place your baby on your belly; it is called belly to belly.

• Lie your baby flat on their belly across your lap to soothe them or burp them. This would count as a tummy time session.

• Lie on the floor to be at eye level with them and speak or sing to them to draw their attention. They will follow your voice with their head. ⁽²⁰⁾

• Cradling your baby on your arm with their tummy down.

• Place a mirror in front of them during tummy time. This will keep their attention and result in them spending more tummy time per session because babies are curious by nature. They would be curious about their reflection.

Tummy Time Challenges and Solutions

Babies respond to tummy time differently. While some babies would enjoy tummy time, your baby might be fussy and restless during tummy time. The age of the baby and the engagement sometimes influence how babies respond to tummy time.

For instance, babies aged 4 to 5 months might show some signs of frustration because moving on their belly is not easy for them ⁽²¹⁾. It is, therefore, important to understand some of the challenges you might encounter while having tummy time with your baby and the best way to address these challenges.

The Struggle Against Gravity

Your baby might dislike tummy time because of the struggle against gravity. Everyone, including babies, loves their comfort zone. So they might be fussy or teary in the first few days of tummy time exercises. In this instance, it is advised that you make the tummy time engaging, short, and frequent to ensure they are distracted from the struggle against gravity and that they adapt quickly⁽²¹⁾. You can explore some of our tips on engaging tummy time, some of which include singing or talking to them on a face level during tummy time.

The Inability to Roll From Their Belly to Their Back

Often, younger babies around the ages of 3-5 months cannot roll from their belly to their back, and this is another reason why your baby might dislike tummy time. Babies within this age bracket would likely cry and make a fuss during their tummy time. Babies aged 3 months and above are expected to have a minimum of one hour daily tummy time, and your baby might make a fuss if they were not introduced to it early enough. ⁽¹⁶⁾

In this instance, you should consider breaking the daily tummy time into smaller sessions. Doing this will help them ease into having daily tummy time. You could also modify their tummy time positions to make them more comfortable, such as placing them on your lap, placing them on your chest, or placing a towel under their chest

The Problem of Reflux

Reflux occurs when babies still struggle with digesting food. Thus, they bring the food back by spitting or vomiting. While tummy time does not cause reflux, babies with reflux might struggle with tummy time. It is important to state that tummy time actually helps babies' digestion, but babies with reflux initially struggle during tummy time.

If your baby vomits or spits out their food, it is recommended that you wait for about 30 minutes after their feeding before placing them on their belly ⁽²⁰⁾. It is advised that you gradually place them on their belly after positioning them on their back and side for a few minutes.

Difficulty in Breathing

There might be other medical conditions that might affect your baby’s tummy time session. Once you notice that your baby is struggling to breathe or that they are changing color, stop the tummy time and contact your doctor immediately ⁽²²⁾. (Procrastinating in visiting a doctor or trying to watch a baby who has difficulty breathing is very risky.